International Journal of

Toxicological and Pharmacological Research

e-ISSN: 0975 5160

p-ISSN: 2820-2651

Peer Review Journal

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1. A Study of Immunization Status of Children Under Five Years in a Defined Rural and Urban Population: A Temporal Trend
Anjali Singh Kanwar, Ravishankar Uikey
Abstract
Background: Individuals who encounter obstacles in obtaining immunization services are at a heightened risk of developing morbidities associated with vaccine-preventable illnesses. The spectrum of variables that may hinder immunization programmes and their health benefits includes affordability, accessibility, lack of knowledge, and other constraining elements. Aims and Objectives: The present study aimed to study the immunization status of children aged one month to sixty months in a defined urban and rural population and to evaluate the impact of National Immunization Schedule and assess the progress made in the areas studied. Materials and Methods: The study was conducted as an OPD based cross sectional survey on children aged one month to sixty months in defined urban and rural areas from 01 March 2021 to 31 August 2022 where 608 children were randomly taken from the study areas which was the Department of Pediatrics Tertiary health care center, a community health centre and Primary Health Centre belonging to central India. Our data were collected from the parents of the children coming to the study area. The immunization status of these children was analyzed and the cause for partial immunization was studied. Data was analyzed by using statistical software SPSS version 21. The chi-square test was used to compare various determinants. A p-value <0.05 was considered significant. Results: Highest percentage of study participants in both urban as well as rural areas belonged to the 1-12 months of age group (35.7% and 61.7%) respectively. There was no statistically significant difference found between gender and place of residence for study participants (p = 0.07). The association between socioeconomic status of the family, mother’s as well as father’s education and occupation and the place of residence was found to be statistically significant (p < 0.0001). It was observed that 256 (84.5%) in the urban areas were fully immunized while 255 (83.6%) in the rural areas were fully immunized (p=0.08). A total of 47 (48.5%), of participants gave the reason for delay as domestic work followed by non-availability of health staff at centre which was the reason given by 16.5% of the participants. This difference was found to be statistically significant between urban and rural population (p <0.0001). Conclusion: The importance of parental education in improving child health and the socioeconomic status of the family were found to be significant determinants of incomplete immunization. Coverage of optional vaccines was found to be very low in comparison with routine vaccines. From this study, policymakers and social workers can target young pregnant women to increase female education. These findings emphasize the need for regular monitoring and evaluation of immunization coverage to achieve the benefits of vaccination in all strata of society.

2. Short-Term Outcomes of Mechanochemical Ablation Versus Trendelenburg Procedure for Varicose Veins: A Randomised Control Trial
Swathi Vellaichamy, Narenkumar A, Sarathganesh S, Gokul D Yatheendranathan
Abstract
Introduction: Varicose veins is a common disease of the lower limbs, affecting predominantly the great saphenous system. Various methods are in place for effective management of varicose veins. Trendelenburg operation with stripping of the vein has long been considered as the gold standard of treatment. However, in the era of minimal access surgery, it is necessary to study the wide application of various endovenous procedures and its effectiveness against the standard of care. In our study we have compared the effectiveness of mechanochemical endovenous ablation (MOCA), using FlebogrifTM, a newer non thermal endovenous therapy with conventional surgery. Methods: Randomised control trial was conducted among 71 patients undergoing mechanochemical endovenous ablation using FlebogrifTM and conventional surgery for the treatment of great saphenous varicose veins. Factors such as blood loss, pain scores, return to mobility, duration of hospital stay, incidence of surgical site infection, recanalization rates, and cost were compared between the groups. Results: Age, Gender, and Diagnosis weren’t significantly different between the groups. Patients undergoing mechanochemical endovenous ablation had lower blood loss, lesser pain scores in early post-operative period and earlier return to mobility. They also had significantly decreased length of hospital stay as compared to the conventional surgery group. However, cost of the surgery was found to be more in the endovenous group. Further, on follow up the recanalization rates in the endovenous group was found to be significantly higher than the conventional surgery group. However, patients with recanalization presented back with only minimal or no symptoms. Ulcer healing, complications, and Pain scores at one month and six months were not significantly different between the groups. Conclusion: Mechanochemical endovenous ablation is preferred over conventional surgery for the treatment of great saphenous varicose veins. It can be performed under local anaesthesia and ensures better early post-operative outcomes as compared to the Trendelenburg operation with stripping of the veins.

3. Comparative Study of Tissue Glue vs Traditional Suturing in Skin Approximation in Surgical Wound Closure: A Randomised Control Trial
Adhiyaman Manimaran, Narenkumar A, Swathi Vellaichamy, Gokul D Yatheendranathan
Abstract
Introduction: Tissue approximation is one of the fundamental requirements for skin closure. An ideal surgeon’s practise would result in a satisfactory tissue reunion and a scar that is cosmetically acceptable. If advanced suturing techniques are effective, the patient might experience less anxiety, better cosmesis, less postoperative pain, fewer wound infections, and shorter stays in the hospital as a result of these benefits. Objective: To compare between tissue glue and traditional suturing and its adequacy in skin approximation, and to evaluate the pain score of the patient between the two techniques. Method: Randomized controlled trial was conducted among fifty Patients who came to ER, OPD as well as IP of General Surgery Shri Sathya Sai Medical College and Research Institute, a Tertiary Care Hospital, Ammapettai, Chengalpet District, South India. This was done to study the efficacy, patient satisfaction levels, cosmetic outcome and cost effectiveness between skin adhesive and suture material in skin approximation during surgical wound closure. Results and Discussion: The mean of the study group and control group was found to be 44.09±6.3 and 45.63±8.4 years respectively. Most of the patients were males. Postoperative pain score is better in Tissue glue group compared to traditional suturing group. Association is statistically significant (P<0.05). Duration of procedure is less in Tissue glue group compared to Traditional suturing group. Wound infection is more in traditional suturing compared to Tissue glue. Association is statistically significant (P<0.05). Conclusion: Our study proved that tissue glue is better than traditional suturing. The two groups are comparable with respect to age, sex, mean haemoglobin and diabetes status. Mean duration of procedure is less in tissue glue group. Postoperative pain score and wound infection  is better in tissue glue group.

4. A Prospective Observational Study on Diabetic Foot Ulcer and Prevalence of Drug Resistant Organisms
Lavanya Gopinath, D. Harindranath. H.R., Vishnupriya G
Abstract
Introduction: Diabetes mellitus is a chronic disease with chronic micro vascular and macro vascular complications. The major concern at present is the increasing incidence of multi-drug resistant organisms. The problem of multi-drug resistant organisms was poorly studied because of lack of uniform definitions and specific criteria to name an organism as multi-drug resistant. Hence this study was done to analyses the prevalence, risk factors and impact of multi-drug resistant organisms in diabetic foot ulcers at a tertiary care hospital. Methodology: 150 diabetic patients with foot ulcer were prospectively studied. Detailed clinical history and clinical examination of the ulcer were done for all patients. The microbiological profile was analysed in detail for each patient. Using internationally accepted criteria, the multidrug resistant organisms were identified. Each patient was followed for a period of ten weeks to assess the status of wound healing. Results: Multi drug resistant organisms were isolated from 99 patients of 150 (66%). 54.8% (153 out of 279) of isolated organisms were multidrug resistant organisms. The commonest organism isolated in our study was Escherichia coli followed by Staphylococcus aureus and Pseudomonas aeruginosa. Poor glycemic control, previous hospitalization, previous history of amputation, previous antibiotic usage, size of ulcer, higher grade of ulcer, and polymicrobial culture, were associated with multidrug resistant infected foot ulcers. Conclusion: The prevalence of multi drug resistant organisms is alarmingly high in infected diabetic foot ulcers. Recurrent ulcers and higher grade of ulcers are more prone to acquire multi drug resistance. They are associated with longer duration of hospital stay and higher rates of amputations. The study also directs us to manage the diabetic foot ulcers with appropriate antibiotics adhering to the institutional antibiotic policy along with effective glycemic control to decrease the incidence of multi-drug resistant organisms.

5. A Comparative Study on Health Problems among the Rural and Urban Post-Menopausal Women of Telangana
M Sheeba Apoorva, Y Sai Krishna, Vimala Thomas
Abstract
Background: Hormonal changes after the menopause and the process of ageing cause marked health issues among the post-menopausal women, which varies between urban and rural women. The objective of the study was to assess the health problems among rural and urban postmenopausal women. Methods: A cross sectional comparative study was conducted among 300 rural and 300 urban post-menopausal women in the field practice area of Gandhi Medical College, Hyderabad from August 2015 to September 2017. The information from respondents was collected using pre designed semi structured questionnaire administered in their local language after taking informed consent. Results: The mean age at menopause of rural women was found to be 46.21 ± 3.33 and that of urban women was 47.40 ± 3.45. Vasomotor symptoms such as Hot flushes, night sweats, increased sweating are found to be more among urban population. Among the non-communicable diseases, Majority (37.6%) were hypertensive .Obesity was among 18.5% of the women and diabetes mellitus among 16.3%. Conclusions: Of the physical symptoms, most commonly reported was muscle and joint ache and among non-communicable diseases, more than one third were diagnosed with hypertension followed in a descending order by cataract, obesity, diabetes, coronary artery disease, malignancies and stroke.

6. Arthroscopic Staple Fixation of Displaced Anterior Cruciate Ligament Avulsion Fractures: Study of 60 Cases
Manthan Soni, Haresh Fatesinh Chaudhary
Abstract
Background and Aim: Arthroscopic Anterior Cruciate Ligament (ACL) avulsion fracture fixation has acquired popularity in recent years, but there is no consensus regarding the most effective method of fixation. Our study’s objective was to evaluate the clinical and radiographic outcomes of arthroscopic staple fixation for the treatment of ACL avulsion fractures. Material and Methods: This two-year prospective study includes 60 patients who underwent arthroscopic fixation of displaced ACL avulsion fractures at a tertiary care institute in India. All patients were clinically evaluated by calculating their Lysholm and International Knee Documentation Committee (IKDC) scores, and their radiological union was evaluated using follow-up radiographs. Results: At the conclusion of the follow-up period, 58 patients’ knees had regained their full range of motion. Two patients had a 5° fixed flexion deformity and a 15° terminal flexion restriction. The average IKDC score was 90,9, while the average Lysholm score was 95,1. In our study, 19 patients with large avulsed fragments underwent double staple fixation, while 41 patients with minor fragments underwent single staple fixation. At the ultimate follow-up, there was no difference in the functional outcome of the patients based on the number of staples. Conclusion: Using arthroscopic technique enables the surgeon to minimise soft-tissue injury and evaluate other potential knee injuries. According to our study, arthroscopic fixation is preferable to open fixation for the treatment of displaced ACL avulsion fractures in terms of earlier mobilisation, averting knee stiffness, and residual instability.

7. Medico legal Aspects and Pattern of Head and Neck Injury Cases in a Tertiary Care Centre: A Retrospective Study
Showket Rashid, Mohammad Zahoor Hamdani, Arshad Bashir
Abstract
Background and Aim: The goal should be to eliminate head and neck injuries, which can be accomplished by improving socioeconomic conditions, raising educational standards, implementing more security measures in this evolving and changing lifestyle, and extending corroboration to judicial authorities through the best submission of evidences as an expert to avoid failure of justice. We attempted to identify factors influencing allegations and verdicts in cases involving head and neck practices in this study. Material and Methods: The current study was conducted for one and a half years in the Department of Forensic Medicine and Toxicology of a Tertiary Care Medical Teaching Institute. A total of 100 Medicolegal head and neck reports were reviewed. Age, gender, diagnosis, treatment information, surgical note, plaintiff allegations, and date of verdict were all extracted. Cases were divided into medical or surgical treatment groups, and the distribution of cases by year was examined. Plaintiff demographics, defendant speciality, procedure performed, plaintiff symptoms, cause of claim, distribution of files by years, treatment centre, and jury final report data were gathered. Cases were also categorised based on the nature of allegation. Results: The most common reasons for claims were dyspnea (n=24) and dysphonia (n=22) after thyroidectomy. These were followed by the requirement for additional procedures (n=19), mortality (n=11), needless procedures (n=13), unsuccessful procedures (n=8), and delayed diagnosis (n=3). Conclusion: Malpractice claims in head and neck practises cover a broad spectrum. According to studies, the majority of head injury victims admitted to a tertiary care hospital were involved in traffic accidents, and males are more likely to sustain a brain injury. Aside from otolaryngologists, other physicians who practise in the head and neck region, such as general surgeons, radiologists, and anaesthesiologists, should be wary of malpractice lawsuits.

8. A Prospective Comparative Study between Dural Puncture Epidural and Lumbar Epidural in Knee and Hip Arthroplasty
Das Arunima, Shaikh Rahaman Mijanur, Sarkar Manabendra
Abstract
General Objective: To compare the effectiveness of Dural puncture epidural with Lumbar epidural techniques regarding onset, duration and regression of analgesia in knee and hip arthroplasty. Specific Objective: (1) To compare onset of sensory (T8 level) and motor block between Dural puncture epidural and Lumbar epidural group in knee and hip arthroplasty. (2) To compare duration of analgesia between dural puncture epidural and lumbar epidural group in knee and hip arthroplasty. (3) To find out hemodynamic variables (arrhythmia, hypotension, palpitation) and nausea and vomiting. (4) To see any adverse effects. Background: Disease of knee and hip is very common in older patients. Previously these surgeries were done under general anaesthesia. But due to postoperative complications after general anaesthesia, scope of neuraxial anaesthesia has been increased. Dural Puncture Epidural (DPE) is Modified Epidural which has faster onset of analgesia and long duration of analgesia and anaesthesia. So, in this study we will be able to differentiate between Dural Puncture Epidural and Lumbar Epidural regarding onset, duration and regression of anaesthesia. Materials and Methods: The Sample Consists of a total of Eighty (80) ASA Grade I AND II patients of either sex and age group of 50-65 years, scheduled for Knee and Hip Arthroplasty in Orthopaedic Operation Theatre was observed. Patient undergone Dural Puncture Epidural was included in Group A and patient undergone Lumbar Epidural was included in Group B. After obtaining informed consent the data collection was done intra operatively through a pre-designed pre tested questionnare. The data was by statistical methods, P VALUE<0.5 was considered significant. Results: Dural Puncture Epidural technique produced faster onset of sensory block than in group Lumbar Epidural without affecting patient’s outcome. Conclusion: Both techniques were effective in producing adequate sensory block however, the use of Dural Puncture Epidural technique produced faster onset of sensory block than in group Lumbar Epidural when continuous epidural infusion was used in both groups without affecting patient’s outcome.

9. Age and Incidence of Pharyngeal Candidiasis in Patients Undergoing Bronchoscopy
Tauseef Neem Rashid Akhtar, Pankaj Bhat, Yatin Wagh
Abstract
Candidiasis is a type of fungal infection that often spreads to the skin, mouth, throat, oesophagus, and vagina. It is caused by the build-up of yeast called Candida. Multiple types of Candida can be infective agents, with C. albicans being the most prevalent. When it spreads to the mouth and throat, it is called thrush otherwise known as Oropharyngeal Candidiasis. In this retrospective study, the frequency of candidiasis in the “throat” (pharyngeal), was examined exclusively in 1255 patients who underwent bronchoscopy. Most of the findings of pharyngeal candidiasis were incidental.
The objective of this retrospective study was to investigate whether or not age was a factor in the occurrence of pharyngeal candidiasis in patients undergoing bronchoscopy. The age of the sample ranged from 18-95 years. It was found that the lowest incidence of pharyngeal candidiasis was at age ≤ 25 (0.2%). Moreover, at ages 26 to 50 years there was a moderate chance of having the condition (9.3%). As well between ages 76-100 years, there was slightly more incidence (16.1%). The highest incidence of presenting pharyngeal candidiasis was between ages 51-75 years (39.2%). Furthermore, additional study is required before confirming a link between age and pharyngeal candidiasis.

10. A Prospective Randomized Study of Etomidate and Propofol Induction on Hemodynamic Response in Patients Undergoing Short Surgical Procedures with Laryngeal Mask Airway
Deepa Yadav, Santushti Vijay, Jyoti Kanwat, Brijesh Kumari
Abstract
Objective: This study was done to compare Etomidate and Propofol as inducing agent in general anaesthesia for laryngeal mask airway with following objectives. To evaluate and compare haemodynamic parameters between the two groups and compare the ease of insertion of laryngeal mask airway. Methods: Prospective randomized single blind controlled study was conducted in 90 patients of either sex in the age group of 20-60 years of ASA grade I or II scheduled for short surgical procedures with LMA insertion under general anaesthesia. Patients were randomly divided into two groups of 45 patients each. Group P Propofol (P) (n=45) Group E: Etomidate (E) (n=45). Total sample size-90. Pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), oxygen saturation and end tidal carbon dioxide (ETCO2;) baseline and then every minute after the induction until ten minutes. Duration and number of attempts for LMA insertion, side effects such as pain on injection, myoclonus and postoperative nausea & vomiting if any were recorded. Results: Demographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) as compared to propofol (p > 0.05) from baseline value. Pain on injection was more in propofol group while myoclonus activity was higher in etomidate group. Conclusion: This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection.

10. Therapeutic Outcome and Safety of Intralesional Vitamin D3 in the Treatment of Cutaneous Warts
Neelima Goyal, Maulik Kotadia, Sarita Beniwal
Abstract
Introduction: Cutaneous warts are a common but vexing condition with high recurrence rate and tendency to spread in spite of various therapeutic options. Intralesional immunotherapy is an attractive modality as it has an additional role of clearing both treated and distant warts by stimulating cell-mediated immunity against human papilloma virus. Aims and Objectives: To evaluate efficacy and safety profile of intralesional Vitamin D3 formulation in the treatment of cutaneous warts. Materials and Methods: Patients with multiple cutaneous warts were injected intralesionally with Vitamin D3 (0.2 ml, 15 mg/ml) at an interval of 2 weeks for maximum of 4 sessions, and patients were followed up for 6 months. Results: Of the 106 patients included, complete clearance was seen in 26 (76.4 %) patients of verruca vulgaris, 20 (66.6 %) of palmoplantar warts, 18 (100 %) of plane warts, 6 (50 %) of genital and filiform warts each. Moderate response was seen in 14 (13.2%) patients while mild response was seen in 6 (5.7 %) patients. No response was seen in 10 (9.4 %) patients. No serious adverse effects were reported. Conclusion: Intralesional Vitamin D3 is effective, safe, cheap and long lasting modality with a short downtime for the treatment of multiple cutaneous warts.

12. Spectrum of Renal Calculi Composition in Southern Rajasthan Using Infrared Spectroscopy
Manish Bhatt, Patel Ujaskumar Ashvinbhai, Ali Abbas Shakir Hussain Sabunwala, Rishabh Saini
Abstract
Introduction: The aim of this study was to evaluate the chemical composition of urinary stones and pattern of changes according to the patient’s age in Southern Rajasthan using infrared spectroscopy (IRS). Materials and Methods: A prospective study of 500 urolithiasis patients was carried out in a tertiary care center from August 2021 to August 2023. Chemical composition of urinary stones was analyzed using IR spectroscopy, and a subgroup study based on the patient’s age was done (8–12 years – Group A, 13–18 years – Group B, and >18 years – Group C). Results: Out of 500 patients, 29 were in Group A, 52 in Group B, and 419 in Group C. Male predominance was found in all age groups. Mixed composition stones were much more common than pure one (74.83% vs. 25.17%). Overall, combination of calcium oxalate monohydrate with dehydrate was the most common composition (58.0%). Calcium oxalate was the predominant chemical composition in 91.54% of stones, followed by uric acid in 4.28%, struvite in 2.29%, calcium phosphate in 1.49%, and cystine in 0.4%. The proportion of calcium oxalate stone was increasing while that of struvite, uric acid, and cystine stone was decreasing with age. Most of the vesical calculi in pediatric age group (Group A; 8–12 years) patients were made up of combination of struvite, calcium phosphate, and uric acid. A total of 85.11% of staghorn calculi were of oxalates. Conclusion: In Southern Rajasthan, calcium oxalate is the most common composition of urinary stones in all age groups. Mixed stones are more common than pure ones. The incidence of calcium oxalate stone increases while that of struvite, uric acid, and cystine stone decreases with age.

13. Non-Antibiotic Therapy for Infectious Diseases in the Era of Antibiotics: A Foresee into the Future
Ganesh Perumal P, Gnanadeepan, Sreeram Astic Deshpande, Preethi Thiruvengadam
Abstract
Antibiotic misuse or unregulated use has contributed to the rise and spread of resistant microorganisms. Owing to increase rates of resistance and stagnating rates of the discovery of novel antibiotics, the efficacy of conventional antibiotics in the treatment of bacterial infections has been put under growing strain. As a result, it is widespread to meet bacterial strains that are pan-drug resistant. Fears have been expressed about a “post-antibiotic era” where many bacterial illnesses might not be curable. It is essential to investigate alternative non-antibiotic therapy methods to guarantee that practitioners have access to a wide range of potent treatments. In an era of multidrug-resistant (MDR) bacterial infections, the new therapeutic techniques for bacterial infections (beyond antibiotics) may offer a solution to shorten the utility of present antibiotics. This review focuses on major alternatives to antibiotics on which include: phages, bacteriocins, antibacterial activities of non-antibiotic drugs, quorum sensing inhibitors, probiotics, nanobiotics, faecal microbiota transplant, stem cell derived antimicrobial peptides, immunotherapeutics, and hemofiltration devices.

14. Study of Effect of Alcohol Intake on Blood Indices
Ketan R. Ganvit
Abstract
Alcoholic beverages have been associated with human civilisation since time immemorial, and today, alcohol is ubiquitous, with constantly changing patterns of alcohol intake around the world. This study was undertaken to assess and compare the blood parameters in form of Blood Indices among these two groups, which would help when detected earlier in preventing serious complications due to alcoholics. 30 adult patients who are alcoholics and 30 adult’s patients who are non-alcoholics are included in this study. Haemoglobin Estimation, RBC counts and MCV, MCH, MCHC was done in all alcoholics and non-alcoholics subjects. Hemoglobin, Red blood cell counts, MCH, MCHC was less in alcoholic subjects as compared to non-alcoholic subjects and this difference was highly significant. MCV was more in alcoholic subjects as compared to non-alcoholic subjects and this difference was highly significant. This shows alcoholic subjects had megaloblastic anemia.

14. ‘Deb’s Active Surveillance & Assisted Reporting System: A District Based Innovative Approach to Adverse Drug Reaction Monitoring
Tirthankar Deb, Saurav Misra, Nitika Sindhu, Ritu Beniwal
Abstract
Pharmacovigilance aims to alert healthcare professionals and the general public about risks from medications by gathering data, analysing it, and drawing findings that may be used to recommend sensible regulatory actions aimed at patient safety. The product, the indication, the target audience, and the problem at hand should decide the approach of pharmacovigilance to be taken in a given circumstance. Adverse drug reaction (ADR) monitoring in India mostly follows passive surveillance where voluntary and individual case reports of suspected adverse reactions are examined. Getting reports facilitates the creation of an alert. In contrast to passive monitoring, active surveillance employs a continuous, pre-planned strategy to thoroughly collect the desired information. Using an active surveillance system in pharmacovigilance is expected to make it more possible to gather comprehensive information on each adverse event report, including those missed out in passive monitoring. With this background, this innovative ‘Deb’s active surveillance & assisted reporting system has been designed for ADR monitoring of special situations of mass administration of medications or vaccines in a short span of time or extensive use of specific disease-related pharmacotherapy in a defined population of a particular geographical area, for example, mass administration of albendazole to children, vaccination drives in response to epidemics like COVID, at the level of a district. This strategy offers to increase the involvement of pharmacovigilance specialists, health care professionals, other service providers like school teachers and beneficiaries in adverse drug reaction monitoring, making it possible to find all potential, unreported suspected ADRs by proactive methods. A well-defined and novel six-step wise approach (TTWVAA) comprising team formation, train the trainers, work distribution, visits, active extraction and assisted reporting makes this technique highly promising and implementable. Among other aspects, assisted reporting of individual information through direct assistance provided by experts to end level service provider in completing every report makes this monitoring system very end user friendly. In this review, the steps of this new approach have also been further elaborated with respect to a particular situation and two cases have been described where this novel approach has been used in a district.

16. Comparison of Basal Heart Rate Variability in Patients of Primary Open Angle Glaucoma and Healthy Controls
Singh H, Singh I, Khurana I, Dhull CS
Abstract
Introduction: Primary Open Angle Glaucoma (POAG) is diagnosed by characteristic pattern of visual field defects, morphological changes in optic disc and raised intraocular >21mm Hg. Autonomic dysfunction is contributory factor in pathophysiology POAG. Heart rate variability (HRV) refers beat to beat variation of heart rate and reflects the modulating effect of autonomic nervous system on intrinsic firing rate of cardiac pacemaker. Analysis of HRV was done by time and frequency domain variables. Material and Methods: Study comprised of 30 POAG cases (group I) and 30 controls (group II). Basal HRV was recorded in Physiology department. Data was statistically analysed using student t-test. Observations: Insignificant low values of time domain parameters of basal HRV were observed in group I. On comparison of frequency domain analysis of basal HRV, significant high values of LF(nu) in group I was observed. LF/HF ratio was insignificantly higher in group I. Discussion: HRV reflects fluctuations of impulses as the heart rate reflects. Low values of time domain variables observed in the present study document reduced parasympathetic tone in patients of POAG. Higher LF/HF ratio of basal HRV among group I suggests higher degree of sympathetic tone and relatively less parasympathetic tone. Conclusion: The cardiac sympathetic markers of HRV change parallel to autonomic challenges. High vagal tone is cardioprotective while high sympathetic activity increases the vulnerability of the heart for cardiovascular risks.

17. Audit of Antibiotic Prescription with Emphasising Adherence to Antibiotic Policy: A Prospective Observational Study from South India
Kanagasanthosh K, Prabhusaran N, Saravanan KS, Poorani S
Abstract
Introduction: Antimicrobial resistance being a public health challenge, Ministry of Health and Family Welfare Department of Government of India recognized this as a high priority area. In collaboration with ICMR, lots of efforts are taken to implement antimicrobial stewardship program. Our objective was to peruse the antibiotics prescribed for inpatients and day care surgical cases with emphasizing the importance of adherence to antibiotics. Appraise and to find out the deviation of antibiotic prescriptions from the department policy before and after training with antibiotic policy and highlighting the areas for improvement in the prescription. Materials and Methods: It is a Prospective, observational and Cross-sectional study for the patients who are admitted to General Surgical wards and day care surgical patients in the two months period between august and September 2022. Consecutive cases receiving the antibiotic prescription were screened using a structured proforma in order to elicit various data for analysis. Results: Males predominated and male to female ratio was 2:1 among the cases included in Phase 1 (50 cases) and Phase 2 (54 cases). Nearly, 90% of the patients had one or other evidence of overt infections. In this category (Phase 1) the surgeon did not deescalate the antibiotics prescribed. After training, among the 54 cases, (90.74%) received empirical antibiotic therapy and escalation and de- escalation were noticed in 17 (31.4%) and 15 (27.77%) cases respectively. The pattern of antibiotic prescription invariably reflected a combination of antibiotics, and these were administered parenterally in 74% of cases. Conclusion:The audit of antibiotic prescription revealed that many surgeons prescribed high end antibiotics invariably. The indications stated by the surgeons were co morbid conditions and a fear of cross infection. Deviation of antibiotic prescription was noticed even after training in 66.6% of cases. Though training has helped to alter the approach of surgeons towards antibiotic prescription.

18. Histopathological Evaluation of Lower Gastrointestinal Biopsies
Anil Kumar Gupta
Abstract
Aim: The endoscopy evaluation and biopsy is common and frequently used in the diagnosis and treatment of gastrointestinal tract (GIT) mucosal pathology. Lower GIT is relatively common to navigate and thus gives easy accessibility for endoscopic evaluation, and plays an important role for direct visualization as well biopsy for histopathological evaluation of various pathology. In our study, we retrospectively evaluated the histopathological results of the lower gastrointestinal endoscopic biopsies. Materials and Methods: A total of 130 (n=130) patients were endoscopically examined and biopsied from lower GIT between Jan 2015 to Dec 2015. Results: out of 130 patients, 96 (73.8%) were male and remaining 34 (26.2%) patients were female. The average age of patients was 39.2 years (Male 41.73 years and female 38.77 years), their age range varies from 5 years to 84 years. Histopathological diagnosis inferred in descending order of frequency as inflammatory bowel disease in 49 patients (37.69%), nonspecific colitis in 42(32.2%), acute infectious colitis in 13 (10%), Solitory rectal ulcer syndrome in 7(5.38%), carcinoma in 6(4.60%), chronic colitis in 4(3.04%), granulomatous and amoebic colitis – 3 each (each 2.30%) and polyp in 2(1.53%) patients. Conclusion: Endoscopy is an important tool for direct evaluation of GIT and histopathological diagnosis for variety of pathological lesions.

19. Hematologic Evaluation of Beta Thalassemia Major Patients
Vipul Kavar, Garasiya Harshalkumari Bharatbhai, Dhaval. P. Chadasaniya
Abstract
Background and Aim: Thalassemia is a common inherited illness, with Beta-thalassemia major being the most severe kind. The current study has the following goals: To investigate several RBC parameters and their relationships in patients with multi-transfused beta thalassemia major.  To evaluate changes in serum ferritin levels following blood transfusions, the efficacy of chelation therapy, and the prevalence of seropositivity among beta thalassemia major patients. Material and Methods: The study included 100 individuals with significant beta thalassemia from a pediatric/medicine department of an Indian tertiary care centre. A thorough history was taken, as well as a physical examination and laboratory measures such as full blood counts. Over a year, all patients were evaluated for serum ferritin levels, chelation therapy, and screening for transfusion-transmitted illnesses. All of the data was collated, and statistical analysis was performed. Results: The younger age group patients required less chelating agent at a lower transfusion frequency compared to the older age group patients who required a larger dose of chelating agents. Out of the 100 cases, 19 had the A+ blood group (19%), 12 had the AB+ blood group (12%), 29 had the B+ blood group (29%), and 38 had the O+ blood group (38%). There were 28 HCV+ patients (28%), 4 HIV+ cases (4%), and 66 nonreactive cases (66%). With p values of 0.005, serum ferritin levels were shown to be substantially linked with transfusion frequency. Serum ferritin levels were usually higher in patients who received two or more transfusions per month. Serum ferritin levels were shown to be substantially linked with medication and chelating agent dose, with p values 0.001. Conclusion: Haematological metrics such as haematocrit, RBC mass, haemoglobin, and mean corpuscular volume have high covariances, whereas mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration have relatively narrow covariances.

20. An Epidemiological Study Detecting Mycobacterium Tuberculosis Using Sputum Evaluator Methods: An Observational Study
Rizwan Ahmad, Sanjay Nag
Abstract
Aim: The aim of the present study was to evaluate the detection of mycobacterium tuberculosis using sputum evaluator methods. Methods: The Study was conducted as a prospective epidemiological study in Department of Microbiology for one year. Total of 100 sputum samples obtained from both in-patients and out-patients of Hospital from various departments like Medicine, Surgery, TB and RD and Orthopedics were subjected to decontamination by both HS-SH method and NALC-NAOH methods. Results: Out of 100 microbiological sputum samples, 70 were found to be positive for acid fast bacilli by both Modified petroff’s method and Hypertonic Saline Sodium Hydroxide method (HS-SH) of concentration and decontamination and 30 samples were negative by both these methods. Sensitivity, Specificity, Positive predictive value and Negative predictive value of the HS- SH method was found to be 100%. Conclusion: In conclusion, the HSSH sputum decontamination method is equally sensitive, specific, cost-effective, feasible and less time consuming procedure compared to the gold standard NALC-NaOH method for decontamination of Mycobacterium tuberculosis from sputum samples and can be routinely used in all peripheral health centres because of the low cost, especially in developing countries.

21. Assessing Recurrence Rate in Patients with Epilepsy During and After Discontinuation of Antiepileptic Drug (AED) Treatment: An Observational Study
Satya Prakash Singh, Asha Kumari, Kanchan Kumari
Abstract
Aim: The aim of the present study was to assess the recurrence rate in patients with epilepsy during and after discontinuation of antiepileptic drug (AED) treatment who had been seizures free for either 2 or 4 years and to identify the risk factors for recurrence of seizures. Methods: The present study was conducted at Department of Pharmacology and One hundred patients with epilepsy were prospectively studied for the period of 1 year. The epilepsy diagnosis was established by obtaining detailed history and descriptions from an eyewitness. All patients had Electroencephalography (EEG) and CT brain scan. Results: There was no statistically significant difference between the groups regarding the demographic and clinical characteristics. There was significant correlation between the risk of seizure recurrence, duration of active seizure and number of seizures prior to seizure control. No significant correlation was found with the number of AEDs, the duration of seizure free period before drug withdrawal and family history of epilepsy. Conclusion: The risk of recurrence during drug tapering after discontinuation of AEDs was related to the duration of active disease and number of seizures prior to control.

22. A Prospective Randomized Study of Etomidate and Propofol Induction on Hemodynamic Response in Patients Undergoing Short Surgical Procedures with Laryngeal Mask Airway
Deepa Yadav, Santushti Vijay, Jyoti Kanwat, Brijesh Kumari
Abstract
Objective: This study was done to compare Etomidate and Propofol as inducing agent in general anaesthesia for laryngeal mask airway with following objectives. To evaluate and compare haemodynamic parameters between the two groups and compare the ease of insertion of laryngeal mask airway. Methods: Prospective randomized single blind controlled study was conducted in 90 patients of either sex in the age group of 20-60 years of ASA grade I or II scheduled for short surgical procedures with LMA insertion under general anaesthesia. Patients were randomly divided into two groups of 45 patients each. Group P Propofol (P) (n=45) Group E: Etomidate (E) (n=45).Total sample size-90. Pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), oxygen saturation and end-tidal carbon dioxide (ETCO2;) baseline and then every minute after the induction until ten minutes. Duration and number of attempts for LMA insertion, side effects such as pain on injection, myoclonus and postoperative nausea & vomiting if any were recorded. Results: Demographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) as compared to propofol (p > 0.05) from baseline value. Pain on injection was more in propofol group while myoclonus activity was higher in etomidate group. Conclusion: This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection.

23. Study on Sociodemographic and Clinical Profile of Opioid Dependence Patients in a Tertiary Health Care Center in Central India
Vijay Savita, Megha Maholi, Vijay Niranjan, Varchasvi Mudgal, Priyash Jain
Abstract
Background: Abuse of opiates is a widespread issue that affects people of many nationalities worldwide. Opi-oid use and dependence have recently increased both internationally and in India. It severely affects social, psy-chological, physical, and environmental aspects of existence and complicates the law. Therefore, among other substance addiction, the rise in opioid dependence is one of the major problems. Methods: It was an observational study, which enrolled 100 patients from DTC OPD through purposive sam-pling for one year duration after fulfilling inclusion and exclusion criteria patient included in the study, with the help of pretested semi structured questionnaire. Results: Majority of the opioid abusers were males (97%) and within the age group of 26 to 35 years (40%). Most commonly used method of opioid consumption is by chasing method Mean age of initiation of substance 23years. Conclusions: Opioid is illicit drug of abuse in India showing raising concern as these associated with more serious and fatal outcome as well as has medicolegal implications. While many of the respondents began using drugs as early as age of 15 or younger. Our results show that India needs management and prevention methods for substance abuse at central and state level to protect future generations. Policymakers must act right away to deal with this hidden epidemic.

24. A Study of Prescription Pattern in Musculoskeletal Disorders Causing Low Back Pain in a Tertiary Care Teaching Hospital in Northern India
Abdul Waseem Khan, Quazi Shahir Ahmed, Kauser Sayedda, Abdul Shaheer Umar, Nazia Siddiqui
Abstract
Background: Prescription pattern analysis studies are a tool to provide feedback to the prescriber and also create awareness regarding rational use of medicines. Objective: To explore the pattern of prescriptions in the treatment of acute LBP and to ascertain the level of adherence of health care providers to prescribing patterns according to WHO/INRUD core drug use indicators. Material & Methods: Total 100 patients >18 years of age having confirmed diagnosis of acute LBP attending the OPD of Orthopedics were enrolled in this study. Prescribing patterns of drugs for LBP were elucidated based on differences in age, gender, etiology, socioeconomic profile & severity of pain. The study was a descriptive observational type. Results: Ratio between males & females was 1:1.7 (P<0.05). Maximum patients (37%) belonged to the upper lower class. 27% were from Upper Middle class. 25 % belonged to Lower middle class, 9% from lower class & only 2% were from upper class. (P0.05) Drugs prescribed in LBP patients were NSAIDs, proton pump inhibitors, H2 blockers, opioids, Muscle relaxants, steroids, Ca++, cholecalciferol and multivitamins. All patients invariably received NSAIDs & Proton pump inhibitors (PPIs)/H2 blockers. 4 patients received opioids. 80 patients received muscle relaxants, 11 patients received steroids. 94supplementary drugs in the form of Ca++, Vit D3 & multivitamins were prescribed. Each category of patients (age wise, gender wise, socioeconomic wise, etiology wise, severity wise) received same drugs. (P>0.05) Total 236 systemic NSAIDs were prescribed. Non-selective NSAIDs were used more than selective (79.23% vs 20.76%). Etoricoxib was the only selective NSAID used. According to WHO/INRUD drugs use core indicators by health care providers in the Institute, average number of medicines prescribed per patient encounter was 5.25. Medicines prescribed by generic name were 10. No antibiotics & injections were given. 100% drugs were from Essential Medicine List. Conclusion: A very common practice of poly pharmacy was seen in many prescriptions. Health care providers are not adhered to WHO/INRUD drug use Indicators Thus, we can conclude that irrational prescribing exists all around. To minimize this, regular CMEs, workshops, lectures, OPD/ward visits on rational prescribing should be held by competent authorities without hurting anyone’s ego.

25. Histomorphological Study of Salivary Gland Lesions: A Study at Tertiary Care Centre
Jaymala Solanki, Manjula Babariya, Hiren Mundiya, Jitendra Kumar Parmar
Abstract
Introduction: Salivary gland tumors are uncommon. They account for about 3 % of all head and neck tumors. Two third of the tumors are benign and one third are malignant. The parotid gland is most frequently involved, while minor salivary glands and submandibular glands are less commonly affected. Since benign tumors are common, the malignant tumor is important to diagnose for proper treatment and clinical management of patient. Objective: The objectives of this study are 1) to diagnose & classify various salivary gland tumors into non-neoplastic lesions & neoplastic lesions based on their histomorphology & 2) to find out which salivary gland affected more & which lesions (non-neoplastic lesions & neoplastic) are common. Materials and Method: Present study was done at tertiary care hospital and medical college, NAMO Medical Education & Research Institute and Shree Vinoba Bhave Civil Hospital, Silvassa. The period of study is for 3 years. (2020-2022). Total 40 cases were studied with salivary gland lesions. The specimens were properly fixed with 10% of formalin and sections were stained with hematoxylin and eosin & then Histopathological examination done to classify salivary gland lesions. Results: In the present study out of 40 studied cases 28 cases are neoplastic and 12 cases are non-neoplastic. Out of 28 neoplastic cases 20 cases are benign and 8 cases are malignant. The most common benign tumor is pleomorphic adenoma. The most common malignant tumor is mucoepidermoid carcinoma. The most commonly involved salivary gland is parotid gland. The most common non-neoplastic lesion is chronic sialadenitis. Conclusion: Histopathological examination is mainstay for proper diagnosis of salivary gland lesions and to differentiate into neoplastic and non-neoplastic lesions for better clinical management and treatment of the patients.

26. Radiographic Evaluation of Crestal Bone Loss Following Endosseous Implant Placement
Y. Surya Kiran, Sambit Subhas, G.N.V. Alekhya
Abstract
Background and objectives: The purpose of this clinical and radiological prospective study was to assess “crestal bone loss” surrounding two-piece polished collar implants after a submerged surgical procedure. Crestal bone loss was measured in relation to age, gender, location, implant type and length, soft tissue thickness, and probing pocket depth. Other general characteristics included mobility, pain, bone loss pattern, and the presence or lack of peri-implant radiolucency. Methods and materials: The trial sample included 30 individuals who received 40 implants. A detailed medical and dental history, current general and oral health status, and inclusion and exclusion criteria were all done as part of the pre-treatment clinical examination and patient selection. The implants were evaluated in the current study based on clinical and digital radiography examination utilising the long cone paralleling technique. The radiograph was taken using the conventional procedure and a stabilising device. The exposure period, distance from the implant to the sensor, and distance from the sensor to the anode are all standardised. Clinical and radiographic evaluations were performed during the first week, three months, six months, and twelve months after surgery. Results: The mesial and distal sides revealed nearly identical findings (1.9mm and 2.0mm, respectively), with the highest bone loss happening after implant loading. The probing pocket depth scores were statistically significant and linked with radiographic bone loss. Except for one factor, the thickness of the soft tissue prior to implant placement, which had a substantial effect on crestal bone loss, all of the parameters studied were age, gender, site, type, and length of implant. Overall, the success rate was 92%. Conclusion: Based on the findings of this study, it was determined that there was significant bone loss between 3 and 6 months, which might be attributed to remodelling activities following 2nd stage surgery. The radiographic examination aids in the surgical procedure’s prosthetic planning phase as well as the early detection of osseous alterations following loading. A accurate diagnosis of the pathologic aetiology is critical in the management of implant therapy problems.

27. A Prospective Comparative Study on Patients Quality of Life After Laparoscopic Cholecystectomy Vs Open Cholecystectomy in J.A. Group of Hospitals Gwalior (MP)
Shivam Upadhyay, Shashikant Arya, Sandeep Thakre, Sunil Agarwal
Abstract
Objectives: Comparing overall GIQLI (Gastrointestinal quality of life index) along with its 5 components (psychological, social, physical, disease specific, core GI symptoms) in patients who underwent laparoscopic and open cholecystectomy for cholelithiasis. Material and Methods: The study involved a total of 150 patients which were blindly randomized into 2 equal groups of 75 patients each which underwent open and laparoscopic cholecystectomy respectively. Quality of life (QOL) was evaluated by using Gastrointestinal Life Quality Index (GIQLI), specifically designed to assess the quality of life of patients with gastrointestinal disorder. Mean values of GIQLI and its each domain were calculated for each group and then compared for significance. Results: The mean age of patients was 38 years and 42.89 years in laparoscopic cholecystectomy and open cholecystectomy group respectively. Among the 75 patients undergoing laparoscopic cholecystectomy, 17 patients (22.67%) were male and remaining 58 patients (77.33%) were female. The mean preoperative GLQI score was 80.82 and 78.14 in the LC and OC groups respectively. The main factors affecting the quality of life were as follows: Core GI Symptoms including epigastric fullness, abdominal pain, anorexia, disturbed physical functions including reduced physical strength, fatigue, Pyschological & social problems including sadness and nervousness. In addition, most of the patients had some limitation in work ability. The data were all recorded and analyzed using simple statistical tests. Significance was measured using student t test, to compare the results. Conclusion: Laparoscopic cholecystectomy is a better surgical treatment modality which improves patient’s psychological well-being, social status, disease specific symptoms, Core GI symptom & physical functioning as compared to open cholecystectomy.

28. The Relationship between Tumor Size and Immunochemistry Status with Lung Metastasis in Breast Carcinoma
Prakash Kumar Mansangbhai Chaudhary, Jignesh Kumar D. Damor, Gaurav Gattani, Deval Kumar Manharbhai Patel
Abstract
Background and Aim: Tumour size and lymph node metastases are critical factors in the progression of breast cancer. Currently, therapy options for bone metastasis include pain relief, reduction of pathological fractures, and prevention of cord compression in spinal metastasis. Radiotherapy and chemotherapy are used to accomplish this. The study’s goal was to investigate the relationship between tumour size and lung metastasis, as well as the relationship between ER, PR status, and lung metastasis. Materials and Methods: This study included 100 patients with breast cancer who visited the general surgery and oncology department at a tertiary care institute in India. Case specifics and a complete history were acquired. Blood tests were performed on a routine basis. Clinical examination and imaging are used to determine the size of a tumour. Core needle biopsy is performed on all patients to confirm the diagnosis and receptor status. The pathologist determines the IHC status of the tumour. CECT chest was used to confirm the presence of lung metastases. Results: The prevalence of lung metastasis in patients with carcinoma breast was 10% in this study. In this study, patients are divided into three groups based on their age: those under 40, those between 41 and 60, and those over 60. In our study, the prevalence of breast cancer is 19% (19 cases) in the age group under 40 years, 55% (55 cases) in the age group, and 26% (26 cases) in the age group over 60 years. In this investigation, 55 of 100 cases were determined to be ER positive, representing a 55% prevalence rate. Conclusion: The prevalence of lung metastasis in cancer of the breast is 10%. There appears to be no link between ER, PR, and HER-2 neu status and lung metastases. There is also no link between clinically T2 and T3 tumours and lung metastasis, whereas clinically T4 tumours appear to have a higher frequency of lung metastasis.

29. A Study to Evaluate the Morphological Pattern of Anemia by RBC Indices and Peripheral Smear at a Tertiary Care Center in Rajasthan
Poonam Burdak, Ajeet Gadwal, Pradeep Kumar
Abstract
Background: Anemia is a common problem worldwide. Morphological typing of anemia provides a lot of information about the underlaying cause and guides the treatment. Red cell indices which is a quick and easy to determine, can be used to determine the morphological type of anemia. Methods: This is a prospective study for one year. All the peripheral blood smears received by the department during study period were studied and the smears with pathological diagnosis of anemia were included in the study. A complete hemogram was done for all samples to get the RBC indices and PBF examination was done and both the findings were compared and analysed. Results: We received a total of 479 samples for PBF examination. 354 (74%) smears were reported as having anaemia and were included in the study. There was a female predominance in our study with M: F ratio of 1: 1.94. The age of patients ranged from 12 years to 59 years with the median age of 41 years. On complete blood count based on haemoglobin concentration, 162 (45.76%) cases showed mild anaemia, 144 (40.68%) showed moderate and 48 (13.56%) showed severe anaemia. According to age, the most common affected age group was 6th decade in our study with 39.55% cases followed by third decade with 22.60% cases. Mild anaemia was most prevalent in all the age groups as compared to moderate and severe anemia and the difference between the number of cases with mild, moderate and severe anaemia were not statistically significant (p-value = 0.3002). On basis of red cells indices, the anaemia was grouped in Microcytic hypochromic anemia with raised RDW with 125 cases which was the most common finding in our study. There were 59 cases of Microcytic hypochromic anemia with normal RDW, 67 cases of Normocytic normochromic anemia with normal RDW, 49 cases of Normocytic normochromic anemia with raised RDW and 54 cases of Macrocytic anemia. Conclusions: Our present study demonstrates that red cell indices are a good initial screening for typing the anemia with good sensitivity and specificity. However, the role of peripheral blood smear by an experienced pathologist cannot be died in identifying the morphology of red cells in anemia. We feel that in cases with mismatch in CBC and clinical data of patients and in confusing cases, smear examination should be carried out.

30. A Retrospective Clinico Etiological Study of Adult Epistaxis in a Tertiary Centre in Guwahati
Anandita Das, Ellora Das
Abstract
Background: Epistaxis (nosebleed) is one of the most common ear, nose, and throat (ENT) emergencies that present to the emergency room or primary care. The true prevalence of epistaxis is not known, because most episodes are self-limited and thus most of the time is not reported. When medical attention is needed, it is usually because of either recurrent or severe bleeding. Treatment depends on the clinical picture, the experience of the treating physician, and the availability of ancillary services. Materials And Methods: This retrospective observational study (based on hospital records) consists of 500 cases of epistaxis, due to various etiological factors studied between JAN.-2020 to DEC.-2022 in patients who attended emergency and OPD of ENT department of Gauhati Medical College and Hospital. A total of 501 cases were studied during this period and they constituted the subjects in this study. Conclusion: Most of the patients had acute onset of bleeding. Anterior epistaxis was found to be more common than posterior bleeds. Most cases could be successfully managed with conservative treatment alone, while some required packing and local cauterization.

31. A Prospective Study of Diagnostic Laparoscopy in Chronic Abdominal Pain at Tertiary Care Hospital
Vazralatha Gatham, Atluri Ajitha, D. Ravi Kumar
Abstract
Chronic abdominal pain is a common complaint which is difficult to manage by both physician and surgeon. It is the 4th frequent chronic pain syndrome in general population. This condition affects the patient both physically and psychologically. More than 40% of the cases the specific etiology for chronic abdominal pain remains undiagnosed by our routine physical, laboratory and imaging. With the introduction of the diagnostic laparoscopy new tools has been added to our knowledge. Laparoscopy can identify abnormal findings and improve outcome in majority of the patients with chronic abdominal pain. This study is mainly designed to highlight the significance of laparoscopy in diagnosing the etiology of chronic abdominal pain and impact on the treatment and post-operative pain relief. Appendicular pathology is the leading cause for chronic abdominal pain of unrevealed etiology and it is about 33%, followed by adhesion is about 23%. Positive outcome is 80% in the follow up of 1 month and 90% of the patients got complete pain relief in the follow up of 3 months. Conclude that Diagnostic laparoscopy is a safe and effective tool to establish the etiology of chronic abdominal pain and allows for appropriate interventions.

32. Analysis of Methods of Screening of Cervical Cancer -Liquid Base Cytology Versus Conventional Pap Smear
Shanti Snehlata, Sadhana Kumari, Reena Sinha, Usha Kumari
Abstract
Background: Cervical cancer continues to be the most common genital cancer among females in India. The universal application of PAP smears in western countries has led to drastic decline in invasive cervical cancer. In developing countries like India its incidence is still high due to lack of effective screening Programs. In this study the efficacy of LBC was compared with CPS for screening of cervical cancer. Aims & Objectives: The aims and objectives of our study is to evaluate the sensitivity and specificity of conventional Pap smear versus LBC for Screening of Cervical cancer and find out a better option. Material and Method: The study was done in the Department of Obstetrics and Gynecology, Nalanda medical college and Hospital Patna from May 2022 to April 2023 (one year). Total 200 women were included in the study. Samples collected were divided into two parts by split sample technique. Cervical biopsy was done with abnormal cells in either conventional Pap smear or LBC samples and results were compared and analyzed. Result: Liquid Base Cytology was found to be more sensitive than CPS (79% Vs 66.5% ) with similar specificity (98.25% Vs 97.5%). Samples were satisfactory in 94% in LBC Versus 92% in CPS. Conclusion: Liquid base cytology has higher sensitivity with similar specificity in comparison to CPS in the screening of cervical cancer. LBC can be used as a better option in the screening of cervical cancer.

33. Study of Thyroid Dysfunction in Type 2 Diabetes Mellitus: A Comparative Cross-Sectional Study
Sunil H. Tetambe, Kamalakar B. Mane, Shinde Vitthal
Abstract
Background: Type 2 diabetes mellitus (T2DM) is most predominant and thyroid dysfunction is second most predominant endocrine disorder in India. Thyroid dysfunction may increase the risk of cardiovascular events as well as alters insulin requirements in T2DM patients. Materials and Methods: Aim of the present study was to find the prevalence of thyroid dysfunction in type 2 diabetes mellitus as compared to non-diabetic subjects. In this study, we included 100 type 2 diabetic subjects and 100 non-diabetic healthy subjects who attended OPD and admitted in medical wards of Dr. VMGMC, Solapur from October 2020 to October 2021. All these subjects were investigated for serum fasting and 2-hour postprandial sugar, total triiodothyronine(T3), total thyroxine (T4) and Thyroid stimulating hormone (TSH). Results: Difference of values obtained for all three parameters (T3, T4 and TSH) between type 2 diabetics and non-diabetics was compared by using student unpaired t-test using mean and standard deviation (SD) and for all the three parameters p value was <0.001. This means difference observed between type 2 diabetics and non-diabetics for all these three parameters was highly significant. Prevalence of thyroid dysfunction in type 2 diabetics was 56% (54% hypothyroidism, 2% hyperthyroidism) and that in non-diabetics was 30% (29% hypothyroidism, 1% hyperthyroidism). Conclusion: Prevalence of thyroid dysfunction was significantly higher in type 2 diabetics (56%) than non-diabetic subjects with hypothyroidism being most predominant type of thyroid dysfunction.

34. Ratio of Patient’s Height to Sternomental Distance in Assessing Difficult Laryngoscopy among Adults Scheduled for Elective Surgery
Niranjana P.S., Nanna R. Chandran, Sanjith Thomas
Abstract
Background: Failure to assess and predict difficulty in airway management can contribute to poor outcomes in anesthesiology practice. The existing parameters are far from perfect. Ratio of height to sternomental distance as a tool to predict difficult laryngoscopy requires further validation. Methods: This was a hospital based prospective observational study conducted among 300 adult patients undergoing general anaesthesia for elective surgery. Modified Mallampati test (MMT), Upper lip bite test (ULBT), sternomental distance (SMD) and ratio of height to sternomental distance (RHSMD) were assessed preoperatively. Difficulty in laryngoscopy was assessed using Cormack -Lehane grading. The sensitivity, specificity, predictive values and accuracy of each test for predicting difficult laryngoscopy (i.e., CL grade III and IV) were compared. The best cut off of RHSMD was determined by receiver operating characteristic curve (ROC) analysis.  This was done in the Department of Anaesthesiology, Government T.D. Medical College, Alappuzha from January 2019 to June 2021 after obtaining Institutional Ethics Committee approval. Results: The incidence of difficult laryngoscopy was 8.7%. There were no difficult intubations. RHSMD was independent of age and gender. The area under the ROC curve for RHSMD was 0.89 (95% confidence interval 0.83-0.96). The best cut-off was 11.9. RHSMD>11.9 (OR=19.5), ULBT class 3 (OR=15.5) and MMT class above 2 (OR=9.2) were independently associated with difficult laryngoscopy. The sensitivity and the specificity of predicting difficult laryngoscopy were 65.4% & 86.9% for MMT, 15.4% & 99.6% for ULBT, 42.3% & 93.8% for SMD at cut off of 12.5cm, 73.08% & 92.3% for RHSMD at cut off of 11.9 and 92.3% & 81.39% for combination of MMT, ULBT and RHSMD. Conclusion: RHSMD is an accurate tool for predicting difficult laryngoscopy.  It is a better screening test for difficult laryngoscopy compared to ULBT, MMT and SMD. However, a combination of multiple tests is recommended to improve the accuracy of the prediction of difficult laryngoscopy.

35. Difficult, Different, Unusual Fixation of Comminuted Fracture Inferior Pole Patella with Pinless Tension Band Technique – Will it Work?
Parithooran S. K., Karthik. V, Sandeep V.P., Amar M, Ashraf Jamal, Ahilan S, Roy Arokiam Daniel, Karthik Anandh
Abstract
Patellar fractures accounts for about 1% of all the fractures and inferior pole account to 9-22 % of surgically treated cases Preservation of Distal pole of patella using Osteosynthesis would have better results compared to Excision and tendon repair with the main fragment. Here in this case, Infero lateral portion of patella is comminuted with a fracture at lower 2/3 and 1/3 junction of patella. This fracture pattern is not suitable for traditional Tension band wiring or plating techniques. Here we did a Pinless Tension Banding, Cerclage with CCS for fixation of this fracture pattern which is unusual mode of fixation.

36. Comparison of Single Dose versus Multiple Doses of Antibiotic Prophylaxis in Elective and Emergency Caesarean Section
Shipika
Abstract
Background: Infectious complications after caesarean delivery (CD) are a substantial cause of maternal morbidity, increase in hospital stay and treatment cost. The spectrum of these complications’ spreads from fever, wound infection, endometritis, urinary tract infection, and some serious complications like pelvic abscess, septic shock and septic pelvic vein thrombophlebitis. To prevent these prophylactic antibiotics have been used however the use of antibiotics should be judicious. Aim was to compare the efficacy of single dose versus multiple doses of antibiotics in elective caesarean section. Methods: This study was conducted in a tertiary care hospital from December 2019 to May 2020. It was a prospective case control study. Sample size was 162; patients were randomly allocated in two groups A and B by card method. Subjects in arm A received ceftriaxone 1 g and metronidazole 500 mg intravenously within 60 min before incision. A repeat dose was planned to be given if blood loss exceeded 1500 ml because this factor has been shown to increase infectious morbidity during surgery. Subjects in arm B received the same preoperative prophylaxis as arm A. They then received metronidazole 500 mg intravenously every 8 h for 48 h, followed by cefuroxime 500 mg twice a day for 5 days and metronidazole 400 mg three times a day for 5 days. The participants were examined for indicators of infection beginning 24 h post-caesarean section, then every 12 h for 72 h until discharge. Following discharge, they were monitored and followed up via phone calls SMS and enquiries made on presence of any symptoms of infectious morbidity by the researchers for 2 weeks. Result: There was no statistical difference in the incidence of wound infection (6.6% versus 7.4%; p = .882) and febrile morbidity (11.8% versus 11.1%, p = .807). However, clinical endometritis (0.0% versus 6.1%, p = .028) was statistically significant with none reported in the single-dose arm. Conclusions: Single dose antibiotic prophylaxis was found to be comparable to multi-dose antibiotics in our study. Hence it is advocated that single dose antibiotic can be given in elective caesarean section as it is cost effective and as efficient as multi-dose regimen, ensures complete compliance and minimizes side effects and cut-down nursing workload. Keywords: Cefuroxime, Caesarean delivery, Fever, Multi-dose, Prophylactic antibiotics, Single dose, Urine culture and sensitivity, Urine routine microscopy.

37. Ulipristal Acetate versus Placebo for Fibroid Treatment
Shipika
Abstract
Background: The efficacy and safety of oral ulipristal acetate for the treatment of symptomatic uterine fibroids before surgery are uncertain. Methods: We randomly assigned women with symptomatic fibroids, excessive uterine bleeding (a score of >100 on the pictorial blood-loss assessment chart [PBAC, an objective assessment of blood loss, in which monthly scores range from 0 to >500, with higher numbers indicating more bleeding]) and anemia (hemoglobin level of ≤10.2 g per deciliter) to receive treatment for up to 13 weeks with oral ulipristal acetate at a dose of 5 mg per day (96 women) or 10 mg per day (98 women) or to receive placebo (48 women). All patients received iron supplementation. The coprimary efficacy end points were control of uterine bleeding (PBAC score of <75) and reduction of fibroid volume at week 13, after which patients could undergo surgery. Results: At 13 weeks, uterine bleeding was controlled in 91% of the women receiving 5 mg of ulipristal acetate, and 19% of those receiving placebo (P<0.001 for the comparison of each dose of ulipristal acetate with placebo). The rates of amenorrhea were 73%, and 6%, respectively, with amenorrhea occurring within 10 days in the majority of patients receiving ulipristal acetate. The median changes in total fibroid volume were −21%,, and +3% (P = 0.002 for the comparison of 5 mg of ulipristal acetate with placebo. Serious adverse events occurred in one patient during treatment with 5 mg of ulipristal acetate (uterine hemorrhage) and in one patient during receipt of placebo (fibroid protruding through the cervix). Headache and breast tenderness were the most common adverse events associated with ulipristal acetate but did not occur significantly more frequently than with placebo. Conclusions: Treatment with ulipristal acetate for 13 weeks effectively controlled excessive bleeding due to uterine fibroids and reduced the size of the fibroids.

38. A Comparative Analysis on Conservative versus Surgical Treatment in Haemorrhoidal Disease Patients: Retrospective Study
Sunil Kumar Saxena, Anju Jha, Shalini Hajela, Smriti Pandey, Jitendra Singh Dangi
Abstract
Introduction: Hemorrhoidal disease is a common condition that affects a large number of people worldwide. Conservative and surgical treatments are the two main treatment options available for hemorrhoidal disease. However, there is a lack of consensus on which treatment option is more effective. The aim of this study was to compare the outcomes of conservative treatment versus surgical treatment in patients with hemorrhoidal disease. Objective: To analyze the outcomes of conservative treatment versus surgical treatment in patients with hemorrhoidal disease. Methods: This was a retrospective observational study conducted at Bundelkhand Medical College, Sagar, from October 2019 to December 2022. The study sample consisted of patients who underwent either conservative or surgical treatment for hemorrhoidal disease during the study period. The data was collected from the medical records of eligible patients, and the outcomes of conservative treatment versus surgical treatment were analyzed. The statistical analysis was performed using appropriate statistical software. Results: A total of 100 patients were included in the study, with 33 patients in the surgical management group and 67 patients in the conservative management group. The surgical group having a mean age of 48.9 years (SD = 8.2) and the conservative group having a mean age of 46.5 years (SD = 7.9). The satisfaction level among the surgical group was 73%, while it was 96% in the conservative management group. The difference between the two groups was statistically significant (p 0.05). Conclusion: This study suggests that conservative treatment is more satisfying than surgical treatment in patients with hemorrhoidal disease. This study highlights that a few procedures, such as the Kegels exercise and sitz bath, along with the pharmacological agent Micronized Purified Flavonoid Fraction (MPFF), are of great importance in the treatment. This study recommended that aggressive surgical treatment should be reserved for thrombosed and resistant cases of hemorrhoids.

39. Prospective review of Vancomycin Resistance among Enterococcus faecalis in a tertiary care teaching hospital
Soniya T, Shama Taj K R, R Raghunath, Pradha V
Abstract
Introduction: Vancomycin stays remains the drug of choice for resistant gram-positive diseases brought about by Enterococcus spp. Increased use of vancomycin has led to frank resistance and increase in MIC (MIC creep). Vancomycin-resistant Enterococci (VRE) are important emerging nosocomial pathogens resulting in treatment failures. Aim: This study was undertaken in view to detect resistance to vancomycin among clinical isolates of Enterococcus faecalis by phenotypic and genotypic methods. Materials and Methods: A cross sectional study was conducted in a teaching hospital from January 2020 to July 2021. In this study we have included only non-repetitive, consecutive clinically significant Enterococcus faecalis (124). They were identified up to species level by conventional methods. Susceptibility to various antibiotics was tested by disc diffusion method. MIC of vancomycin was determined by agar dilution method. All 124 isolates were subjected to polymerase chain reaction (PCR) to detect van A and van B genes in this study. Results: Out of 124 Among Enterococcus faecalis, twenty-one (16.9%) and seven isolates (5.6%) exhibited resistance to vancomycin and teicoplanin by disc diffusion respectively. All isolates were susceptible to linezolid. Van A was detected in three, van B in eight and two had both van A and van B. Conclusion: PCR remains the gold standard for determination of vancomycin resistance. Thirteen isolates (10.4%) of Enterococci were vancomycin-resistant.

40. Oxidative Stress Part in Liver Disorders
Mohd Rafi Reshi, Shanib Ali, Nusrat Nabi
Abstract
Background: Redox state is a significant contributor to the backdrop of many liver illnesses. Inflammatory, metabolic, and proliferative liver diseases all involve the redox state. The cytochrome P450 enzymes are largely responsible for the production of reactive oxygen species (ROS) in the mitochondria and endoplasmic reticulum of hepatocytes. Main Body of the Abstract: An imbalance between oxidant and antioxidant agents causes oxidative stress. The main cellular structures that are impacted by ROS and reactive nitrogen species include hepatocytic proteins, lipids, and DNA. Oxidative stress has been recognised as a co-occurring pathogenic process that initiates and advances liver injury. Numerous risk factors, such as alcohol, drugs, environmental toxins, and radiation, can cause the liver to experience oxidative stress, which can lead to serious liver illnesses such alcoholic liver disease and non-alcoholic steatohepatitis. Short Conclusion: Natural antioxidants found in edible or therapeutic plants frequently have potent anti-inflammatory, free radical scavenging, and antioxidant properties. These properties are thought to form the foundation for additional bioactivities and health benefits.

41. A Hospital Based Observational Assessment of Etiological Profile of Febrile Thrombocytopenia in Children
Kumar Arpit, Rizwan Akhtar, Alka Singh
Abstract
Aim: The aim of the present study was to assess the etiological profile of febrile thrombocytopenia in children aged between 1 month to 12 years admitted to the pediatric department. Methods: A hospital based observational study done at Department of Pediatrics  for the period of one year by collecting and analyzing details of 200 patients between 1 month-12 years of age who presented with fever and thrombocytopenia at admission. Patients on drugs causing thrombocytopenia were excluded from the study. Results: Majority of the cases (52%) belonged to the age group 1-6 years, and (45.5%) belong to the age group of 7-12 years. Among these cases females (55%) are more common than males (45%). The most common etiology of fever with thrombocytopenia was dengue fever (61%), followed by malaria (12%), enteric fever (10%), other undifferentiated viral fevers (10%) and MIS-C (multisystem inflammatory syndrome in children) (5%), immune thrombocytopenic purpura (2%), leukaemia (0.5%) and hepatitis A (0.5%). The common symptoms associated with patients having febrile thrombocytopenia were headache in 70%, followed by body ache in 51%, retro-orbital pain 42%, pain abdomen 30% and bleeding manifestations 22% cases. 104 patients had mild thrombocytopenia, 36 patients had moderate thrombocytopenia and 60 patients had severe thrombocytopenia. Among the total dengue cases (n=122), severe thrombocytopenia was seen in 71 children. Duration of hospital stay in majority of cases (65%) was prolonged to due to bleeding manifestations and associated complications. Conclusion: Febrile thrombocytopenia is a common clinical presentation in children. Majority of the dengue cases responded well to treatment given as per WHO guidelines. In most of the other infections, thrombocytopenia was transient and asymptomatic with lesser severity and resolved with the treatment of underlying condition.

42. Effectiveness of Prophylactic Antibiotic Administration using Cefoxitin at the Time of Elective Caesarean Section: A Randomized Controlled Clinical Assessment
Rani Dipa, K. Manju
Abstract
Aim: The aim of the present study was to determine whether prophylactic antibiotic administration using cefoxitin at the time of elective caesarean section significantly reduces infectious morbidity. Methods: The present study was conducted in the Department of Obstetrics and Gynecology for two years .Two hundred women undergoing elective caesarean section had cefoxitin or placebo administration after umbilical cord clamping. Postpartum complications including febrile morbidity, wound infection, endometritis, urinary tract infection, pneumonia and transient postpartum fever were recorded, as were the duration of hospital stay and the need for therapeutic antibiotics. Results: The two groups were similar with respect to age, parity, gestational age, weight and pre- operative haemoglobin values. Ten women (10%) in the placebo group and 12 women (12%) in the cefoxitin group were antibody positive for the human immunodeficiency virus (HIV). Women who had two or more previous caesarean sections constituted just over half the women in each group and the second most common indication of one previous caesarean section accounted for about a third of the cases. The operator status, type of anaesthetic, type of skin incision, length of surgery, the presence of adhesions, and the type of skin closure were not significantly different between the groups. Over 90% of women in both groups were operated on by a registrar, had spinal anaesthesia and their duration of surgery was less than an hour. There were fewer women in the placebo group who had skin wound drains compared with the cefoxitin group. Conclusion: Antibiotic prophylaxis with cefoxitin in elective caesarean section did not reduce post-operative infectious morbidity in this double-blind randomised placebo controlled trial. We suggest that prophylactic antibiotics in elective caesarean section be restricted to women who have a high body mass index and where the baseline infectious morbidity is > 15%.

43. Assessing Efficacy of Endoscopic Versus Microscopic Excision of Pituitary Adenoma: A Hospital Based Analytical Study
Sachin Kumar Singh, Gaurav Batra, Girish K. M.
Abstract
Aim: The aim of the present study was to compare the efficacy of endoscopic versus microscopic excision of pituitary adenoma. Methods: The present study was conducted at department of neurosurgery  and our study included 50 cases of pituitary adenoma. 30 cases underwent endonasal endoscopic transsphenoidal surgery whereas remaining 20 cases were operated using the microscopic transsphenoidal surgery. Results: The mean duration of symptoms in endoscopic group was 28.22±19.31 months (ranged from 15 days to 8 years), and in microscopic group, it was 22.6±18.02 months (ranged from 1 month to 5 years). Complete tumor excision was achieved in 20 (66.66%) patients in endoscopic group and in 11 (55%) patients in microscopic group (Chi‑square test, P = 0.890, statistically not significant). In endoscopic group, mean operative time was 1.88±0.32 hours (ranged 80–135 min). In microscopic group mean operative time was 2.28±0.12 hours (ranged 120–145 min) (unpaired t‑test, P = 0.001, statistically significant). In endoscopic group, mean blood loss was 125.45±38.62 ml (ranged 60–190 ml), and in microscopic group, it was 178.22±40.024 ml (ranged 100–220 ml) (unpaired test, P = 0.001, statistically significant). Postoperative complication was present in both endoscopic and microscopic groups. Slightly higher percentage of complication such as diabetes insipidus, cerebrospinal fluid (CSF) leak and reoperation and sinusitis was observed in microscopic group as compared to endoscopic group. Reoperation was performed one for postoperative hematoma and one for CSF leak in both groups. All the patients after surgery had improvement in a headache and vision in both groups. There was no deterioration of endocrinal function in both groups. In endoscopic group, mean hospital stay was 9.12=8±2.621 (ranged 5–12 days), and in microscopic group, it was 10.05±2.154 (ranged 6–14 days) (unpaired t‑test, P = 0.52, statistically not significant). Conclusion: In pituitary surgery, endoscopic surgery had started new fields not only by direct endonasal approach but also by providing a panoramic view inside the sphenoid cavity and sella turcica. Endonasal endoscopic transsphenoidal pituitary adenoma surgery is a safe and effective procedure.

44. A Retrospective Observational Assessment Study of Clinical Profile of Patients with Acute Pancreatitis
Kundan Kumar, Rahul Singh, Manish
Abstract
Aim: The aim of the present study was to assess the clinical profile of acute pancreatitis, the etiology and complications of acute pancreatitis received treatment in the Department of Surgery, Material & Methods: It was a retrospective observational type study with study sample size of 100 cases. The study was conducted with objective of age, sex distribution, etiology, clinical presentation& complications of Acute Pancreatitis. All patients presenting to Department of Surgery, within the duration of 10 months meeting inclusion criteria for acute pancreatitis. Results: Regarding gender distribution, we observed that out of total 100 subjects, 85 were male and remaining 15 were females (85% vs. 15%). We noted a male predominance in our study. Regarding age incidence, we observed that median age group in our study was 37.5 years among all 100 subjects. Underlying cause of the clinical condition was noted as alcoholic in nature by majority (80%) of the study subjects. In 15 patients (15%) reason for the pancreatitis could not be ascertained despite extensive evaluation. Abdominal pain (100%) and vomiting (88%) were the most consistent symptoms in our study. Among the 100 patients studied 85 had mild pancreatitis, 4 had severe pancreatitis and 11 patients had acute on chronic pancreatitis. One patient of acute necrotizing pancreatitis required intensive Care Unit (ICU) admission and developed organ failure indicating adverse outcome. Common complications of the clinical condition were noted as pleural effusion (n=21, 21%), followed by ascites (n=16, 16%) and acute fluid collection (n=7, 7%). Morality was seen among two patients (3%). Conclusion: Acute pancreatitis is one of the leading causes of increase in morbidity and mortality to society. Alcohol and gallstones were the most common etiological factors of acute pancreatitis. Clinical assessment along with radiological findings correlated well with the morbidity and mortality. Our study identifies alcoholism as one of the most important etiological factors.

45. A Study to Assess the Clinical and Functional Outcomes of Cemented Bipolar Prosthesis in Unstable Intertrochanteric Fractures in the Elderly
Rohan Parwani, Rajdeepsinh Chauhan, Poorv Patel, Divyesh Jetpariya
Abstract
Aim: The aim of the present study was to evaluate the clinical and functional outcomes of cemented bipolar prosthesis in unstable intertrochanteric fractures in the elderly. Methods: We conducted a prospective study in which we included 30 patients who presented to Orthopedics Outpatient Department and Emergency with inter-trochanteric femoral fractures. Results: Mean age of the patients was 77 years (range: 65–85 years). Out of 30 patients, 24 (80%) were female and 6 (20%). Left-side (66.66%) involvement was more than right-side involvement (33.34%). Most cases required 1 U of postoperative blood transfusion, and four cases required 2 U. Mean duration of surgery was 84 min, ranging from 55 to 105 min. The mean blood loss was 272 ml and ranged between 200 and 400 ml. The dislocation rate in our study was zero. The mean Harris hip score improved progressively with time of follow-up. The mean score was 46.34 on the third day, which increased to 57.63 at 2 weeks, whereas at 3 and 6 months the scores were 76.14 and 79.81, respectively. The final average Harris hip score at last follow-up was 82.92.  30% excellent, 33.34% good, 26.66% fair results obtained in our study according to Harris Hip Score. Conclusion: Intertrochanteric fractures of femur are very common among old age patients, females being more commonly affected. According to our results, we believe that Cemented Bipolar Hemiarthroplasty is of choice in freely mobile elderly patients above sixty years of age with an intertrochanteric femoral fracture. In elderly patients with intertrochanteric fractures of the femur treated with hemiarthroplasty gave early mobilization, early return to pre injury level, superior the quality of life and gave a long term solution. Postoperative early full weight bearing after Hemiarthroplasty avoids long-term immobilization, rehabilitation, deformities and need for revision surgeries.

46. A Hospital-Based Study to Evaluate Relationship between Serum 25 (OH) Vitamin D and Insulin Resistance in Prediabetes
Vijay Gadhia, Darshankumar Parmar, Sanket G. Makwana
Abstract
Aim: The aim of the present study was to evaluate relationship between serum 25 (OH) vitamin D and insulin resistance in prediabetes. Methods: The present study was conducted in the Department of General Medicine and the sample selected was 60 diabetics, 50 pre-diabetes and 40 healthy control individuals. Inclusion criteria used was subjects in age ranged 40-75 years of either gender with persistent IFG or IGT over 2 OGTTs. Results: Maximum pre-diabetes subjects (16) had serum 25 (OH) D >30 ng/ml, diabetes (20) between 21-30 ng/ml and control (15) >30 ng/ml. In diabetes, pre-diabetes and control subjects had BMI of 24.6 kg/m2, 25.5 kg/m2 and 23.7 kg/m2, waist circumference of 91.7 cm, 88.2 cm and 86.4 cm, waist- height ratio of 0.84, 0.52 and 0.50, waist- hip ratio of 0.94, 0.90 and 0.86, LDL- C of 97.3 mg/dl, 106.4 mg/dl and 98.6 mg/dl, HDL- C of 46.2 mg/dl, 48.4 mg/dl and 49.6 mg/dl, TG of 148.4 mg/dl, 146.4 mg/dl and 117.4 mg/dl respectively. HbA1C found to be 7.3%, 6.5% and 5.6%, HOMA2-IR was 2.52, 1.52 and 0.82, HOMA2-β was 63.7, 82.6 and 86.4 and 25 (OH) D level was 25.5 ng/ml, 24.2 ng/ml and 22.8 ng/ml. A significant difference was observed (P< 0.05). 1 hour PG blood glucose had statistically significant positive correlation with FBS and 2 hours PG blood glucose (P< 0.05). Conclusion: It is important to understand association of vitamin D and diabetes. Vitamin-D deficiency led to worsening of insulin resistance in individuals with prediabetes.

47. A Hospital Based Observational Study Assessing Road Traffic Accidents with Respect to Road Users Type, Offending Vehicles and Type of Injuries Sustained Including Fatal Injuries
Ambedkar Ranjan
Abstract
Aim: The aim of the present study was to assess the road traffic accidents with respect to road users ‘ type, offending vehicles and type of injuries sustained including fatal injuries. Methods: The present study was conducted at Maa Vindhyawasini Autonomous State Medical College, Mirzapur, Uttar Pradesh, India. The study material comprised of victims of RTA who died in spot or died in Maa Vindhyawasini Autonomous State Medical College, Mirzapur, Uttar Pradesh, India during the 1-year period. During the present study a total of 500 medico legal autopsies were conducted out of which 100 cases were of RTA with skeletal injury. Results: Deaths due to RTAs accounted for (26%) of the total medicolegal autopsies conducted. Out of 100 cases of fatal RTA, maximum 46 cases (46%) were motorcycle riders, followed by pedestrians 20 cases (20%) minimum were front seat passengers of four wheelers 5 cases (5%).  Heavy motor vehicle topped the list of offending vehicles 38 cases (38%) followed by MMV 27 cases (27%), LMV 13 cases (11%), Motor cycle 9 cases (9%), Others 10 cases (10%), Unknown (Hit and Run) 5 cases (5%). In our study out of 100 cases of RTA, Spot death were observed in 34 cases (34%), 36 cases (36%) died on the way to hospital and in 30 cases (30%) died in the hospital. In our study, 36 victims (36%) died within 1 day (24 Hours) after the accident. The maximum number of deaths was observed between 1 day to 3 days (60 cases, 60%). 3 victims (3%) survived beyond 4 days but died within 1 week. Only 1 (1%) victim survived beyond 1 week but died within 2 weeks. 37 cases had cranial cause alone. Conclusion: Increased motorization, rampant encroachment of roads, nasty tendency of violating traffic rules and anarchic traffic systems have greatly contributed to rapid increase in RTAs. Population explosion is a catalysing factor for a number of accidents. Good conditioned roads, following traffic rules and awareness about RTA in the people will definitely bring down the incidence of RTA.

48. A Hospital Based Comparative Study to Evaluate the Role of Computed Tomographic (CT) Scores and Pulmonary Function Tests to Detect Changes in Lung Disease in Children and Adults Diagnosed with Cystic Fibrosis (CF)
Arunika Prakash, Shruti, Kaushalendra Kumar Singh, Bhupendra Narain
Abstract
Aim: The aim of the present study was to compare the ability of computed tomographic (CT) scores and pulmonary function tests to detect changes in lung disease in children and adults with cystic fibrosis (CF). Methods: The present study was conducted in the Upgraded Department of pediatrics for one year. CT scans were available for 100 patients with CF (50 children and 50 adults). Patients were diagnosed as having CF when they had a positive sweat chloride test and/or two known CF mutations. The cohort was divided into subjects aged (less than years at first scan (children) and those aged above 18 years. Results: In the present study, male was higher in both the groups. In children, 6 had pancreatic status as sufficient and 12 had sufficient pancreatic status as sufficient in adults. Interestingly, FEV1 worsened by 0.07 Z score in the children (p=0.03) and FEV1/FVC worsened by almost 0.1 Z score per year in both children (p=0.002) and adults (p=0.02). MEF25 and MEF50 also worsened in children (p=0.005 and 0.006, respectively) and adults (p=0.007 and 0.005, respectively), and RV worsened in adults (p=0.01). All other PFTs remained unchanged (p.0.07). Composite CT scores and all component CT scores except the mosaic perfusion score in children and adults and peripheral mucus plugging score in adults deteriorated significantly over time in children (p,0.004) and adults (p,0.03). There was no significant difference in the slopes for any of the parameters between children and adults (p.0.09), but the composite CT score and RV tended to deteriorate faster in adults than in children. Conclusion: In conclusion, this study showed that routine CT scans deteriorated while PFTs remained unchanged or deteriorated at a slower rate in both adults and children with CF. The deterioration on the CT scan was best reflected in the peripheral bronchiectasis CT score in children and in both the composite CT score and peripheral bronchiectasis CT score in adults.

49. A Comparative Assessment of the Effect of an Endurance Activity on Cardiac and Metabolic Markers in Persons with and Without Spinal Cord Injury: An Analytical Study
Ratnesh Kumar, Arun Kumar, Nitin Joshi
Abstract
Aim: The aim of the present study was to check effects of an endurance activity on cardiac and metabolic markers in persons with and without spinal cord injury. Methods: The present study was conducted at Department of Physical medicine and Rehabilitation. Individuals were considered eligible if they met the following criteria: (a) diagnosed with a traumatic SCI at the lower cervical, thoracic, and upper lumbar level (C5-L2); (b) classified as A, B, C, D (motor and sensory complete or incomplete) on the American Spinal Injury Association (ASIA) Impairment Scale (AIS); and (c) >3 years post injury. Individuals with cardiovascular disease, renal disease, or orthopedic problems were considered ineligible. The study was approved by the Institutional Review Board at a large university medical center. Results: There were no significant differences between groups on any baseline measures. With the exception of a significant time effect for QUICKI, there were no other significant differences between groups on body composition and cardiometabolic markers. However, there was a significant Group x Time interaction for arm fat percent. There was a significant time effect for chest press and lateral pulldown. Conclusion: No differences between two groups were observed. Both conditions led to improvements in insulin sensitivity, aerobic capacity, muscle strength, and blood lipids in individuals with SCI. Future larger cohort studies are needed.

50. Evaluating the Conversion Rate and Factors Responsible for Conversion of Laparoscopic to Open Cholecystectomy: An Observational Study
Santosh Kumar, Balkeshwar Kumar Suman, Shri Krishna Ranjan
Abstract
Aim: This study was conducted in an effort to determine the conversion rate and also identify the factors responsible for conversion of laparoscopic to open cholecystectomy. Methods: This was a prospective clinical study consisting of 200 patients undergoing laparoscopic cholecystectomy at department of General Surgery for one year. Results: In 200 cases, 60 were males and 140 were females. The mean age in this study was 42.4 years. The age group of the patients ranged from 18 years to 76 years. The maximum incidence was seen in the age group of 41-50 years followed by 31-40 years of age. Out of 200 patients, 144 patients (72%) had a chief complaint of pain in the right hypochondrium, 44 patients (22%) presented with epigastric pain and the remaining 18 patients (6%) were asymptomatic (incidental cholelithiasis). 60 patients presented with nausea along with pain abdomen and 20 patients presented with vomiting, whereas 32 patients presented with both. 12% of patients suffered from Diabetes mellitus whereas 15% of patients were Hypertensive. On ultrasound, single calculi were noted in 140 patients whereas remaining 60 patients presented with multiple calculi. Difficult anatomy at Calot’s triangle accounted for near one half of conversions (46.66%); we observed that individual anatomy was obscured primarily by dense adhesions (40%) and aberrant anatomy (6.66%) was also noted. Conclusion: It can be reliably concluded that LC is the preferred method even in the difficult cases. Our study emphasizes that although the rate of conversion to open surgery and complication rate are low (7.5%) in experienced hands the surgeon should keep a low threshold for conversion to open surgery and it should be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon.

51. A Hospital Based Observational Study Assessing Associated Factors on Timely Initiation of Breastfeeding among Mothers of Children Age Less Than 12 Months
Prashant Kumar, Brajesh Kumar, Gopal Shankar Sahni
Abstract
Aim: The aim of the present study was to assess timely initiation of breastfeeding and associated factors among mothers of children less than 12 months old. Methods: The present study was conducted in the Department of Pediatrics and mothers who have a child less than 12 months of age were included in the study. Total 500 mothers were included in the study. Results: In this study, 500 mothers had infants less than 12 months participated in this study making the response rate 98%. The mean age of mothers that participated in this study was 24.96 with the standard deviation of (±0.970). About 350 (70) of respondents were Hindus in their religious affiliation. About 200 (40%) of mothers completed primary school and 375 (75%) of them were housewives. Around 260 (52%), and 240 (48%) of them were females and males respectively.. About 450 (90%) of the study participants had exposure to mass media and the majority of respondents. The highest majority, 475 (95) of respondents had received antenatal care (ANC). About 400 (88.88%) of participants started their antenatal care before fifth month of gestation. Majority, 260 (57.77%) had four antennal visits. 293 (65.12%) of the study participants had gotten counseling on breast feeding. 250 (55.55%) were receiving counseling on timely initiation of breastfeeding. 400 (80%) respondents delivered at health institutions and 440 (88%) of them were assisted by health professionals. 430 (86%) of the mothers had spontaneous vaginal delivery. About 225 (45%) of infants were first in their birth order. From 383 mothers who participated, 400 (80%) initiated feeding within one hour of delivery. About 425 (85%) of respondents heard about early initiation of breast feeding, 415 (83) thought that giving breast milk within 1 hour of birth is important. 425 (85%) were giving breast milk based on the demand of the child. Conclusion: Prevalence of timely initiation of breast feeding experienced by mothers was 80%. Being male infant, living with nuclear family, spontaneous vaginal delivery and counseling on timely initiation of breast feeding during ANC were factors associated with early initiation of breastfeeding.

52. Clinical Study of Pleural & Lung Diseases by using Radiodiagnosis and Sonography: A Retrospective Study
Daya Prakash
Abstract
Sonography is the best modality for very ill patients and it causes minimum discomfort and can be used at bed side. Based on these literature findings the present study was planned to assess the diagnosis of the pleural and lung diseases by using sonography in comparison with the sonography.
The 50 Patients referred to Department of Radiology  were enrolled in the present study. The patients considered in this study are of all ages. All patients were undergone radiologically as well as sonography evaluation. All the patients were informed consent. The aim and the objective of the study are conveyed to all patients.
The data generated from the present study and the reported literature suggests that the Ultrasonic examination is simple method. This can be performed at bed side of the patient. The outcomes of inspection are known instantly to the doctor and they are easy to interpret. Also as like radiology, the ultrasonic examination is a non-invasive technique, more comfortable for a sick patient. It is generally accepted that the ultrasonic intensity used for diagnostic purpose is entirely harmless to the patient.

53. Assessment of the Prophylactic Use of Antibiotic Coated Intramedullary Nail in Treatment of Open Tibia Fractures in Adults
Manishi Anant, Neeraj Kumar
Abstract
Aim: To assess the outcome of prophylactic use of antibiotic coated intramedullary nail in treatment of open tibia fractures. Materials and Methods: 50 patients were selected with open fracture of shaft tibia, treated operatively with antibiotic coated intramedullary interlocking nail and were followed up for a minimum of four months duration. Radiological Union was assessed using RUST Score and clinical assessment results were graded as excellent, good, fair and poor. Result: In this study all 50 patients (35 males and 15 females) were followed up for a minimum of four months duration. The mean age of the study population was 35.5 years. Males were 70% against females 30% .The most common cause of injury was found to be due to road traffic accidents and accounted for 78% of cases. Fibula fracture was associated with 92% of patients. Time taken in wound healing in majority of patients was less than 4 weeks 27 (54%), 4-6 weeks 32% , 6-8 weeks 8% and those were not healed 6% .Majority of patents (56%) had RUST score 10 at four months of duration, Large numbers of patients had fair outcome- 56%. Average time of wound healing in our study was 4.1 weeks. Conclusion: The use of the antibiotic coated nail has good clinical and radiological outcome at six months and preliminary results support the use of antibiotic coated implants as a new potential treatment option for prevention of infection in open tibia fractures.

54. Assessment of Left Atrial Function by Tissue Doppler Strain Imaging in Mitral Stenosis before and after Balloon Mitral Valvotomy
Mani Shankar Pandey
Abstract
Aim: The aim of the present study was to assess the LA function with tissue doppler velocities, strain imaging and variation of left atrial lateral wall, interatrial septum and global longitudinal la stain in severe mitral stenosis. Methods: A prospective case study performed over 18 months in the Department of Cardiology, Patients were recruited from outpatient department and those admitted with severe Mitral Stenosis. Twenty five patients with severe Mitral Stenosis in sinus rhythm and 25 ages matched Controls were enrolled in the study. Results: Left ventricular systolic and diastolic dimensions and Left Ventricular Ejection Fraction were comparable in both the groups and there was no significant difference seen in M mode parameter of LV in both groups. LA ejection fraction as calculated by modified Simpson’s method was lower in Mitral Stenosis patients when compared to controls. Tissue Doppler Imaging parameter of Left Atrial function like E’ and A’ Diastolic velocities showed significant lower value in Mitral Stenosis when compared to controls. Severe Mitral stenosis showed a lower ventricular end Systolic Strain as measured at Atrial Septum and Left Atrial Lateral Wall Global LA Strain. Post BMV LA volumes (maximum and minimum) and M mode LA dimensions reduced significantly as compared to pre BMV. All patients of Mitral Stenosis included in the study underwent successful BMV with post BMV 2D mean Mitral Valve area of 1.94 ± 0.25 cm2 by palnimetry which was more than 50% of initial MVA. Post BMV Tissue Doppler velocity remained unchanged as measured at interatrial septum however E’ velocity at lateral wall improved significantly. A significant inverse correlation was found between Left atrial Systolic Strain as measured at atrial septum (p<0.001) and left atrial maximum volume. Conclusion: Left Atrial function as assessed by Tissue Doppler velocities and Tissue Doppler derived Strain is lower in patients with severe Mitral Stenosis. Left atrial reservoir function assessed by Strain imaging improves within 24 hours after Balloon Mitral Volvotomy.

55. An Observational Study Evaluating the Pattern of Skull Fractures in Cases of Two Wheelers without Wearing Helmet in Fatal Road Traffic Accidents
Abuzar Rizwi
Abstract
Aim: The aim of the present study was to assess the pattern of skull fractures in cases of two wheelers without wearing helmet in fatal road traffic accidents. Material & Methods: The present record based retrospective study was conducted in the Department of FMT. 100 cases of road traffic accidents involving fatal head injuries which underwent autopsy over the period of 2 years were included in the study. Out of these cases patients involved in two wheeler accidents were further evaluated. Informed consent was obtained from the parent or legal guardian of each enrolled patient. Results: It was observed that out of total 100 cases of RTA with two wheelers 91% had not used helmet while only 9% were wearing helmet. It was observed that majority of the cases (36%) not using helmet were 20-29 years of age. Among helmet non users 93.40% cases were male. The most common associated injury was head injury and rib fracture. Abrasions and Lacerations were the most common injuries to face and head. Diffuse Extravasation of Blood from Scalp was observed most commonly followed by combined Extravasation from Frontal, Parietal and Temporal region among the non-helmet users. Among the helmet non users ACF with MCF and PCF was seen as most common base of skull fracture. The most common type of fracture in vault was linear fracture followed by Comminuted fracture. Parital bones, Frontal bones and temporal bone were the most commonly fractured bone. Conclusion:  Head injury due to road traffic accidents often leads to fatal outcomes. Wearing helmets by two wheeler riders, strict implementation of traffic rules and prompt emergency services especially neurosurgery facilities can help in reducing the incidence of road traffic accident fatalities.

56. A Hospital Based Evaluation of the Safety and Feasibility of Transrectal Ultrasound (TRUS) Guided Free‑Hand Transperineal Prostate Biopsy under Local Anesthesia (LA) for Suspected Prostate Cancer
Shivanand Prakash, Nitesh Kumar, Karthik Maripeddi, Sunil Palve, Sanath T
Abstract
Aim: We assessed the safety and feasibility of transrectal ultrasound (TRUS) guided free‑hand transperineal prostate biopsy under local anesthesia (LA) for suspected prostate cancer. Methods: The present study was conducted at department of Urology for a period of 18 months. Total 50 patients were included in the study. Informed consent and patient information sheet were explained in detail to the study subjects prior to their enrolment. Results: The mean age of the patients was 69.4 ± 8.72 years, median PSA 14.56 ng/mL (4.17–672) and prostate size 44cc (16–520). Of 50 patients, PIRADS 3, 4, and 5 lesions in mpMRI were found in 15 (30%), 15 (30%) and 20 (40%) patients, respectively. Conclusion: Freehand TRUS‑guided transperineal prostate biopsy by coaxial needle technique under LA is a safe, feasible procedure with good tolerability, high CDR, and minimal complications, particularly no urosepsis. In developing countries like India, this approach has a potential to avoid economic burden due to general anesthesia and management of post biopsy urosepsis. It shows excellent patient tolerability while minimizing complications.

57. An Observational Study to Estimate the Prevalence of NAFLD in Individuals with Hypothyroidism
Deepak Kumar
Abstract
Aim: The aim of the present study was to estimate the prevalence of NAFLD in individuals with hypothyroidism. Material & Methods: This cross‑sectional comparative study was conducted on Department of General Medicine.100 patients who qualified for the eligibility criteria. Proper history, examination, anthropometric measurements, and biochemical parameters were estimated. The collected data were entered in Excel and analyzed using the Statistical Package for Social Science 25 version developed by IBM (International Business Machine), IBM is a USA based company and the Student’s t‑test and the Chi‑square test were applied. Results: Out of 100 subjects, 55% were males and 45% were females. The age distribution among the study patients showed that majority of the patients are in a late age group with 58% patients belonged to >50 years of age. In this study smoking, diabetes and hypertension was present in 9%, 40% and 51% patients respectively among the subjects having thyroid dysfunction. 45% were in grade 1 followed by grade 2 and grade 3 according to grades of fatty liver. With the increasing grades of fatty liver more percentage of patients had high serum TSH and with increasing grades of fatty liver more percentage of patients had low free T4 levels and this relationship was statistically significant. In patients having grade 1 fatty liver on ultrasonography, out of 45 patients, 44 had a normal thyroid function, whereas only 1 patient was having overt hypothyroidism. In patients having grade 2 fatty liver on ultrasonography, out of 40 patients, 32 had a normal thyroid function. Conclusion:  Free T3 levels had no significant relationship with grades of fatty liver. Free T4 showed an inverse relationship with the increasing grades of fatty liver. Serum TSH showed a positive correlation with increasing grades of fatty liver.

58. A Retrospective Study of Uric Acid as Predictor of Severity in COVID 19 in Indian Population
Priyanshu Mala
Abstract
Aim: The aim of the present study was to evaluate the association between the serum uric acid and the severity of COVID-19. Methods: A retrospective observational study on patients admitted to with diagnosis of SARS-CoV-2 between March 2020 and March 2021. The data from a total of 1220 patients admitted between March 2020 and March 2021 with COVID-19 were initially screened. The electronic medical records were reviewed and COVID-19 patients who underwent uric acid analysis at the time of admission were included. Results: Out of 1220 patients, 550 (45.08%) women were included, and the median age was 63 (18-98) years. Of the patients, 40.98% had hypertension, 23.77% had diabetes mellitus, and 20.49% had chronic kidney disease. Pneumonia was detected in 86.06% of the patients at admission. Median UA level was 5.1 mg/dl. The uric acid levels were measured after the progression of COVID-19. The most severe  period  of  COVID-19  was  considered when maximum oxygen support  was  required and predictors associated with poor prognosis, namely CRP, procalcitonin, ferritin, and D-dimer were at the highest values. The mean uric acid levels were found to be significantly decreased in patients with a negative prognosis. Conclusion: The study concluded that UA, a purine base metabolite, can be used as a prognostic indicator in severe patients with COVID-19. High serum UA level affects mortality in COVID-19 patients.  Risk assessment for the prognosis of patients can be made according to the UA levels at admission.

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