Condence Intervals Research Articles

PROFILE OF ANTENATAL CARE AMONG PREGNANT WOMEN ATTENDING OUTPATIENT CLINICS IN A RURAL BASED MEDICAL COLLEGE

Introduction: Antenatal care (ANC) provides monitoring and regular follow-up of maternal and fetal health during pregnancy. Women with appropriate ANC tend to have uneventful delivery and birth outcomes. This study describes the patterns of ANC care provided in a tertiary care rural teaching hospital. Methods: Baseline cross-sectional data from pregnant women who attended the ANC clinic at GITAM Institute of Medical Sciences and Research, Rushikonda, Visakhapatnam between May 2017 and January 2019 was analyzed. All the participants enrolled in the study completed a self-administered questionnaire in the regional language. The data collected were socio-demographic and pregnancy-related information. Regression models assessed the relationship between socio-demographic and pregnancy-related variables and “appropriate” (≤ 4 months' gestation) vs. “late” ANC initiation (>4 months' gestation). Results:At enrolment, 841 participants reported that it was their rst ANC visit and half (50.2%) of the women attending were late i.e. > 4 months gestation in registering for their ANC. Mothers who were more educated, had previous infertility treatment or previous miscarriages were all more likely to achieve appropriate ANC initiation [adjusted odds ratio (aOR): 1.66, 95% condence interval (CI): 1.05–2.62; aOR: 3.68, 95% CI: 1.50–9.04; aOR: 1.80, 95% CI: 1.16–2.79, respectively]. Women with anxieties about childbirth were less likely to achieve appropriate ANC initiation (aOR: 0.54, 95% CI: 0.34–0.85). Conclusion: Half of the pregnant women in this study did not achieve the global consensus guidelines on appropriate ANC initiation. Better counselling for the less educated women and those with previous pregnancy complications and childbirth anxieties are recommended to ensure appropriate ANC initiation and better outcomes.

TO ASSESS SUBCLINICAL UREMIC ENCEPHALOPATHY IN NEWLY DIAGNOSED CHRONIC KIDNEY DISEASE PATIENTS BY USING COGNITIVE PARAMETERS IN TERTIARY CARE CENTRE

Background: Chronic kidney disease(CKD) is one of the leading cause of death in the world because of its late or end stage presentation. In our study we assessed patients of CKD for cognitive dysfunction with Addenbrooke scale and other biochemical parameters. Methods: This crosssectional study was conducted on 60 newly diagnosed CKD patients at MGM Medical College and MY Hospital Indore, MP, India, from 2019 to 2021. Baseline parameters like serum urea, creatinine, bilirubin and sodium were done and patients were subjected to Addenbrooke scale to assess subclinical uremic encephalopathy and data were analysed using SPSS statistics version 22.0 and p value <0.05 and condence interval more than 95% were considered signicant. Results: In my study of 60 patients, we have different mean of Addenbrooke scale according to stages. In stage 1 of CKD the mean value of scale is 94.33%. In CKD stage 2 the mean scale is 96.833% . In stage 3 CKD mean value is 94.5%. In CKD stage 4 the mean value is 91.2%. In CKD stage 5 the mean value is 86.88%. Conclusions: This study supports the fact that as CKD stages progresses, there is propensity of Addenbrooke score to decrease which helps in early detection of subclinical uremic encephalopathy and therefore the risk of uremic seizures

CLINICAL EVALUATION OF INTRAOCULAR PRESSURE MEASUREMENTS USING DIFFERENT TONOMETERS IN PATIENTS OF VARIOUS REFRACTIVE ERRORS

Background: Intraocular pressure (IOP)is an important rst indicator of probability and suspicion of Glaucoma. The virtual IOP status is grossly inuenced by multiple factors including Refractive errors, corneal biomechanics ,central corneal thickness(CCT) and Scleral rigidity. Aim: To compare relative IOP measurements and its variability in Emmetropes, myopic and hypermetropic patients using Schiotz, Goldmann Applanation(GAT)and I-Care Rebound tonometer to establish an equation between virtual and real time IOP. Materials and Methods: This observational prospective study comprised of 100 subjects above the age of 18 years inclusive37 Emmetropes , 31 Hypermetropes and remaining 32 belonged to myopia . Statistical Analysis : Descriptive statistics were performed using SPSS for Windows version 17.0 to calculate the demographic characteristics of the study cohort. The data were expressed as mean values including the standard deviation (SD) and the 95% condence interval (CI). Mean IOP measurements between Schiotz, I-Care and GAT were compared by One way ANOVA along with Individual pair wise comparison by applying Post Hoc Tukey Test for comparison of IOP measurements using a particular method of Tonometry in individuals of myopia, hypermetropia and emmetropia. Results: The highest mean value of CCT 536.667 mum was in Hypermetropes whereas the lowest CCT value of 507.031mum was in myopic eyes with statistically signicant (P<0.05). The mean value for IOP in Emmetropes was16.665 mm Hg for Schiotz , 15.027 Hg for GAT and 15.081 mm Hg for I –Care .Whereas Hypermetropes revealed mean value of 15.055 mm Hg for Schiotz , 14.323 mm Hg for GAT and 14.065 mm Hg for I –Care . The mean value for IOP in Myopic eyes was 16.875 mm Hg for Schiotz , 14.375 mm Hg for GAT and 14.688 mm Hg for I –Care . Conclusion : The study had revealed higher mean value of IOP in Myopic eyes as compare to Emetropic and Hypermetropic subjects. IOP measurements by the Schiotz tonometer were signicantly higher as compare to GAT and I-Care tonometer. Whereas recordings by GAT and I Care tonometers were almost in agreement .Denitive correlation could not be established between pachymetry readings and adjusted IOP following GAT and I –Care tonometry .

METHYLPREDNISOLONE - THE SAVIOR IN CHILDREN WITH MULTISYSTEM INFLAMMATORY SYNDROME (MIS-C)

Background: Multisystem inammatory syndrome in children (MIS-C), also known as pediatric inammatory multisystem syndrome is a new entity and is fatal disease that is temporally associated with SARS-COV 2 (PIMS-TS) [1]. We aimed at studying varied clinical presentation, management and outcome in children with MIS-C associated with covid-19 treated with IvIg and methylprednisolone at tertiary care centre, Davangere. This is a retrospective observational Methods: study conducted at two tertiary care hospitals at Davangere from October 2020 to August 2021 (11 months.). All cases who fullled WHO criteria for MIS-C were included in the study. Institutional ethics committee approval was taken. Data was obtained from hospital records .Parameters studied were demographics, symptomatology, laboratory markers, medications and immediate outcome. All children were then grouped into 2. Group 1- those who presented with shock and group 2- those who presented without shock . Data were entered and analyzed using SPSS software version 22.0. For interpretation of results signicance was adopted at p-value less than 0.005 and at 95% condence interval. A total of 182 patients w Results: ith MIS-C were treated during the study period. The median age of presentation was 6.8±4.5 years. We had 14 cases of infants. M:F ratio 1.35:1 showing no sex predilection. Children who presented with shock had signicant symptoms of pain abdomen, tachypnoea, Lower GCS and lower saturation levels and had signicantly higher CRP, LDH, ferritin, D-dimer levels and had lower albumin levels which is statistically signicant . Also requirement of IVIg was signicantly more in children with shock (TABLE 2). Out of 182 children with MIS-C, only 21 received IVIg and rest all received only steroids - methylprednisolone ( due to nancial constraints ). However the outcome did not vary much with IVIg or steroids. IV methylprednisolone pulse therapy was associated with favorable immediate outcome which is comparable with IVIg in our study. Mortality in our series was 6.04% which is comparable to international studies [11,12]. In our Conclusion study most of our children with MIS-C recovered with timely use of pulse methylprednisolone therapy alone with favourable short term outcomes. Thus in resource limited settings methylprednisolone pulse therapy can help in saving lot of young children with MISC.

RELEVANCE OF COMMON CAROTID INTIMA-MEDIA THICKNESS AND CAROTID PLAQUE AS RISK FACTOR FOR ISCHEMIC AND HAEMORRHAGIC STROKE IN PATIENTS ATTENDING MEDICAL COLLEGE AND HOSPITAL, KOLKATA

Introduction: A stroke or cerebrovascular accident is dened as an abrupt onset of a neurologic decit that is attributable to a focal vascular cause due to cerebral ischemia or intracranial haemorrhage. Atherosclerosis and carotid artery stenosis are the major causes of stroke. Carotid Intimamedial thickness is a marker of subclinical atherosclerosis. So the measurement of CIMT is of major concern in high risk individuals. To measure the carotid wall thickness Aim: (CIMT) using B-mode ultrasound of both right and left carotid artery and to establish association between CIMT and stroke. A Hospit Methodology: al based prospective, cross-sectional study concluded 100 diagnosed cases of stroke of which 50 ischemic stroke and 50 hemorrhagic stroke. All these patients underwent clinical evaluation CT Scan and MRI Scan of Brain, CIMT and blood investigation including complete hemogram , lipid prole , fasting blood glucose. Results: Mean age for presentation of stroke was 68.68 with maximum number of patients belonging to 61-80 years of age group with lowest age taken was 39 and the highest was 92. 49 (98%) patients with hemorrhagic stroke and 30 (60%) patients with ischemic stroke had hypertension. The CIMT was measured using B-mode USG probe correlated with the type of Stroke. The minimum value of Right CIMT in Hemorrhagic Stroke was 0.6 with maximum value 1.1; the mean was 0.788 + 0.1305 (mean + SD). The minimum value of Right CIMT in Ischemic stroke was 0.6 with maximum value 1.2; the mean was 0.93 + 0.1258 (mean + SD). Independent T-Test was performed, and 95% condence interval was between: 0.0931 to 0.1909 and p-value was <0.0001. There was positive correlation between the CIMT and t Conclusion: ype of stroke. Between Right CIMT and type of stroke, the p-value was <0.0001 which is highly signicant. Between Left CIMT and type of stroke, the p-value was also <0.0001 which is highly signicant

MANUAL TRACING QUANTIFICATION OF HIPPOCAMPI TO PREDICT THE LATERALIZATION OF THE SEIZURE FOCUS IN TEMPORAL LOBE EPILEPSY PATIENTS

This study was aimed to determine the ability of manual tracing quantication of hippocampi to predict the lateralization of the seizure focus in TLE patients and establish a normative data for Indian population. The study was Materials And Method: conducted in the Department of Radiology, Chettinad Hospital and Research Institute. It was a hospital based prospective double blinded study. It was approved by the human ethical committee of our institution and was performed after getting informed, written consent from all the patients referred from Neurology department of Chettinad Hospital and Research Institute, Kelambakkam. The data collection for the study was done for an 18 months' period between February 2019 and August 2020. 35 patients with clinical and EEG proven tempora Results: l lobe epilepsy patients underwent MRI brain. In 32 (91%) patients, HA was detected on quantitative volumetry as opposed to visual inspection which could detect only 26 (74%) cases out of 35. The difference was statistically signicant (p-value<0.1). The mean HV was calculated to be 2.64709 cm3 (SD - 0.0879). The mean RHV was 2.659 cm3 and the mean LHV was 2.634 cm3. Using 95% condence intervals (2SD), the upper and lower limits for HV were calculated to be 2.822 cm3 and 2.471 cm3, respectively. Mean RHV of 2.683 in males and 2.627 in females was obtained. The difference was statistically signicant (P < 0.1). The most common ndings documented in evaluation of TLE with MRI in the current Conclusion: study were hippocampal sclerosis and hippocampal atrophy

STUDY OF EFFECT OF ANTENATAL STEROIDS ON MECHANICALLY VENTILATED LOW BIRTH WEIGHT NEONATES WITH RESPIRATORY DISTRESS ADMITTED TO NEONATAL INTENSIVE CARE UNIT(NICU)

Background: Low birth weight (LBW) is dened as a birth weight of less than 2.5kg as per World Health Organization (WHO)1. Low birth weight (LBW) is a major public health problem in developing countries including India. In India, 30-35% of babies are LBW and more than half of them are full term babies2. Reduction of low birth weight forms an important contribution to the Millennium Development Goal (MDG) for reducing child mortality3. Corticosteroids administration before anticipated preterm births is one of the most important antenatal therapies available to improve neonatal outcomes. Corticosteroids alter the structural and biochemical physiology of neonates, like surfactant production and lung maturation and thus reduces the requirement and duration of mechanical ventilation. Aims And Objectives: 1.To know the effect of antenatal steroids in minimizing the duration of ventilation in LBW neonates 2.To know the effect of antenatal steroids on assisting in early extubation of LBW neonates. All Low birth weight neonates <2.5 kg who were intubated and on vent Inclusion Criteria: Exclusion Criteria: ilator support. 1.Major congenital anomalies 2.Extubated as a part of withdrawal of care. This Materials And Methods: study was a Prospective Observational Study and was conducted in Rajarajeswari Medical College and Hospital, Bangalore for a duration of 18 months between January 2021 and June 2022.SAMPLE SIZE: n=54, Sample size calculated using considering 95% condence interval and 10% precision. All the parameters Results: i.e., birth weight, gestational age, gender, presence of maternal comorbidities, surfactant and antenatal steroids showed signicant association with number of days of mechanical ventilation in the study. This study was conducted Conclusion: to study the effect of antenatal steroids on mechanical ventilation in low-birth-weight neonates admitted to neonatal intensive care unit and it was found that antenatal steroids had signicant effect on duration of mechanical ventilation; this study has also recognized the factors involved in prolonging the days of mechanical ventilation such as prematurity, doses of antenatal steroids received, low birth weight, lower gestational ag . Recognising such factors can help in preventing complications among the newborns thereby reducing the number of days of mechanical ventilation

DAILY DENGUE SEVERITY SCORE – IMPLICATIONS, BENEFITS AND LIMITATIONS IN OUR SETTING

Introduction- Dengue is associated with high morbidity & at times develops potentially fatal complication. Predicting the outcome on the basis of clinical presentation alone is less reliable and complicated owing to variable symptomatology. there is a need for developing and testing a scoring system, for the detection of complicated and severe dengue fever early in the course of infection, to identify those children who may progress to DSS/DHF and succumb to disease subsequently & to triage sick patients for early referral from primary and community health centers to higher center for intensive care management. This Material & methodsProspective observational study was conducted in Department of Pediatrics, SMS Medical College, Jaipur during January 2020 to September 2021. Sample size is calculated at 95 % condence interval expecting sensitivity of 86% using dengue severity score of more than equal to 12 in the assessment of outcome of dengue severity among the dengue fever patients. An absolute allowable error of 15% and at prevalence of 17.4% of severe dengue patients, the required sample size was 125 cases with dengue fever. Statistical analyses were done using computer software (SPSS Trial version 23 and primer). if we use the critical cut off of DDS Results- S >10.5 on day 1 of hospital admission; it was a strong predictor of mortality with p <0.001 and area under curve was 0.906 which is near 1. The sensitivity of score at this cutoff was 100% and specicity was 71.7%. The cutoff was chosen as 10.5 because at this cut off both sensitivity and specicity were reasonably high and below this score although sensitivity remains 100% but specicity decreases i.e., false positive cases would increase and if cutoff is increased then specicity increases but sensitivity decreases i.e., false negative increases. If cutoff was chosen at 16.5 sensitivity of score decreases to 83.3% but specicity increases to 85%. On cutoff of 22 sensitivity decreases to 50% and specicity increases to 90.3%. Conclusions- If critical cutoff more than 10.5 is used, dengue shock syndrome can be predicted with specicity of 82.5% and sensitivity of 94.6%. If critical cutoff of more than 8.5 is used, prolonged length of hospital stay can be predicted with sensitivity and specicity of 51.9% and 53.1% respectively. If critical cutoff of more than 11.5 is used then organ dysfunction in dengue patients can be predicted with sensitivity of 78.9% and specicity of 89.7% respectively. If critical cutoff of more than 10.5 is used then mortality in dengue patients can be predicted with sensitivity100% of and specicity of 71.7%

STUDY OF LOW BACK PAIN AMONG NURSES WORKING IN A TERTIARY CARE HOSPITAL

Background: Possibility of healthcare personnel to encounter occupational risks varies according to their profession, job and the department in which they work. Nursing is accepted as a stressful profession with work overload due to several negative factors (overwork, overtime and long working hours, role conict and ambiguity, problems with shift work etc.) arising from work circumstances. Healthcare workers are at a higher risk of developing low back pain due to a variety of factors. This problem is associated with major consequences in terms of disability and frequent absence. LBP might lead to activity limitation and sick leaves for more than 50 % of the nurses. This study aims to assess the prevalence and risk factors of LBP among nurses in a tertiary care center. 1. To determine the fre Objectives: quency of low back pain and associated factors among nurses working in a tertiary care hospital 2. To assess the level of functional disability due to low back pain. A cross-sectional study Methodology: was conducted on 125 nurses, aged between 25 and 60 years, who had been working for at least 1 year at CPR Hospital Kolhapur (Maharashtra). Both male and female staff nurses were included in the study. Those who were pregnant and who were not willing to participate were excluded from the study. A self-administered Oswestry Low Back Pain Disability questionnaire which was applied to obtain data from the respondents. Both descriptive and inferential statistics was used. The baseline characteristics were presented as mean with standard deviation or frequencies and percentages whichever appropriate. The determinants of low back pain and knowledge on body mechanics were found using Chi-square. P value <0.05 is considered signicant at 95% condence interval. In the present study, out Results: of 125 participants, 56% were aged 31 to 40 years. Mean age was 32.68±7.32 years. There was female preponderance with 82.4. 71.2% had LBP. Based on Oswestry LBP Disability (OLBPD) Score, 28.8% were found to be free from any disability, 50.4% had minimal, 18.4%) had moderate and only 3 nurses had severe disability. Association was signicant between higher age groups, history of caesarian (44.9%), no history of exercise (53.9%), designation of staff nurse (91.0%), physical exertion during work (92.1%), > 10 years of work experience (43.8%), attending >50 patients per day (22.5%), standing time > 5 hours in duty hours (82.0%) were found to be signicantly associated with LBP (all p values <0.05).

FETAL SONOGRAPHIC PARAMETERS BETWEEN GESTATIONAL DIABETIC AND NORMAL PREGNANT WOMEN.

Background– Gestational diabetes mellitus (GDM) is dened as intolerance of glucose seen during pregnancy and is associated with fetal and maternal morbidity. The aim of our study was to measure various fetal sonographic parameters such as fetal biometry, fetal liver length (FLL), amniotic uid deepest pocket (AFDP), placental thickness, inter ventricular (IV) septum thickness, Wharton's jelly area and fetal abdominal fat thickness (FAFT) during 21-24 weeks of gestation and comparison of these parameters between Gestational diabetic and normal pregnant women. Tot Methods: al patients selected in our study were 100 in number, of which 50 had GDM and 50 were normal pregnant women. Fetal standard biometry with additional parameters were measured on transabdominal scan from 21-24 weeks. Fetal sonographic measurements and patients characteristics were measured and compared between two groups. P-value was evaluated along with mean, standard deviation, mean difference and condence interval Patient characteristics and standard fetal Results: biometric parameters were comparable except for femur length (FL), mean femur length was signicantly greater in GDM women compared to normal pregnant women (39.20 ± 0.70 vs. 38.36 ± 1.20, p = 0.001). Mean values in GDM vs. normal pregnent women were, fetal placental thickness in mm ( 42.28 ± 2.09 vs. 33.24 ± 1.70, p = 0.001), amniotic uid maximum vertical pocket in mm (54.96 ± 1.24 vs. 44.46 ± 1.06, p = 0.001), fetal abdomen fat layer thickness in mm (3.59 ± 0.17 vs. 3.46 ± 0.15, p = 0.001), inter ventricular septum thickness in mm (3.71 ± 0.13 vs. 3.63 ± 0.16, p = 0.001), fetal liver length in mm (36.48± 1.15 vs. 31.86 ± 0.90, p = 0.001), Wharton jelly area in mm2 (115.26 ± 1.96 vs. 109.34 ± 4.81, p = 0.001), Fetal sonographic Conclusion: parameters are signicantly increased in GDM women compared to normal pregnant women even before 24 weeks. Measurements of these parameters in routine practice could be used to monitor fetal growth and hence can prevent fatal complications.

ASSOCIATION OF ADULT OBESITY AND SERUM B12 DEFICIENCY - A CASECONTROL STUDY FROM INDIA

Introduction: Vitamin B12, also known as cobalamin; has been implicated as an important factor in regulating various metabolic processes, thus playing a role in the etiology of obesity. To assess whether obese adults a Objectives: re at an increased risk for vitamin B12 deciency. This study aimed to assess the serum vitamin B12 status of obese Indians to see if there were any associations between body mass index (BMI) and serum B12 concentration. Medicine outpatient at a medical college university hospita Settings: Methods: l. We included 224 adult participants aged ≥19 years. Overweight and obesity were dened as BMI ≥ 25-29.9 kg/m2 and ≥ 30 kg/m2 respectively. The study subjects were divided into 2 groups as normal BMI (< 25 kg/m2) group, and the obese BMI (≥ 25 kg/m2) group. BMI was calculated as weight in kilograms divided by height in meters square. Fasting venous blood samples were taken from the subjects for the estimation of serum B12 concentrations which were measured using the fully automated electrochemiluminescence immunoassay. Low serum B12 was dened concentration < 197 pg/mL, and B12 deciency was dened as concentration below 150 pg/mL. The adjusted odds ratio (OR) and 95% condence interval (CI) were obtained by the binary logistic regression method. The correlation between serum B12 and BMI was calculated using Pearson's correlation coefcient (r) across various BMI categories. Serum B12 level was signicantly lower among obese adults compa Results: red with non-obese adults. There were signicant negative associations between BMI and serum B12 (p =0.004). Pearson correlation coefcient was strongly negatively associated for BMI with serum B12 level (r= -0.703, p<0.00001). Obesity in otherwise healthy adults was associated with Conclusions: an increased risk of serum B12 deciency. A negative association was found between serum B12 concentrations in obese adult subjects. This association was more pronounced with higher grades of obesity; further research at a large scale is needed to understand the underlying mechanisms and its prevalence in the obese population. We recommend that the possibility of vitamin B12 deciency should always be considered in obese adults.

PROGNOSTICATION BY RATIO OF TRICUSPID ANNULAR PLANE SYSTOLIC EXCURSION TO PULMONARY ARTERIAL SYSTOLIC PRESSURE BY ECHOCARDIOGRAPHY IN ACUTE PULMONARY EMBOLISM

Depending upon hemodynamic status and right ventricular dysfunction, In-hospital mortality of acute pulmonary embolism ranging from 0 to 50%. By assessing right ventricular function, we can predict the outcomes in patients with acute pulmonary embolism. In patients with acute pulmonary embolism (PE), right ventricular (RV) failure causes death due to a mismatch between RV systolic function and increased RV afterload. The aim of our study was to know whether the ratio of tricuspid annular plane systolic excursion (TAPSE)to pulmonary arterial systolic pressure (PASP) would predict adverse outcomes. This study was a retrospective analysis of a single Centre Pulmonary embolism register. After the conrmation of PE, patients taken a formal transthoracic echocardiography within 48 hours were included in this study. A 7- day composite outcome of death or hemodynamic deterioration was the primary end point of this study. The secondary endpoints of this study were 7- and 30- day all-cause mortality. A total of 67 patients were included; 14 met the primary composite outcome. In univariate analysis, the TAPSE/PASP was associated with our primary outcome [odds ratio = 0.027, 95% condence interval (CI) 0.010–0.087; P < 0.0001], which was signicantly better than either TAPSE or PASP alone (P = 0.018 and P < 0.0001, respectively). For predicting adverse outcome in PE, a TAPSE/PASP cut-off value of 0.4 was identied as the optimal value. Echocardiographic ratio of tricuspid annular plane systolic excursion to pulmonary arterial systolic pressure is superior in prediction of adverse outcome in acute PE. And also, it may improve risk stratication and identication of the patients that will suffer short-term deterioration after acute PE.

TIME TO ADD PROCALCITONIN AS AN ADJUNCT BIOMARKER IN DIAGNOSING BURN SEPSIS: A TERTIARY LEVEL CARE EXPERIENCE

The most common cause for mortality in burns worldwide is sepsis. American Burn association guidelines 2007 are followed till date. But the conrmation of the sepsis requires tissue/blood culture which takes a minimum of 48-72 hours. Adding Procalcitonin as an adjunct biomarker to the sepsis criteria enhances the predictability of sepsis. This prospective study has been carried rst time with the help of Procalcitonin. The prospective study was performed between October 2019 to October 2021 in the department of burns and plastic surgery wherein we evaluated serum procalcitonin of 52 patients with (30 %to 60%) Total Body Surface Area burns within 24 hour of admission and at the time of burn sepsis suspicion as per American burn Association2007 guidelines .The Positive blood/tissue culture was taken as the conrmatory evidence of sepsis. Patients were divided in two groups, sepsis (Group A) and non sepsis (Group B). All the parameters for sepsis as per ABA guidelines were serially noted . The Sensitivity and specicity of the test was 89.29 % and 58.33 % respectively. 2.1 ng/ml was taken as the cut off value for diagnosing sepsis in burn patient with an area under the curve of 0.78 at 95% condence interval. Elevated Procalcitonin concentrations correspond to the documented sepsis in 30 -60 % of burns which enhances the Predictability of diagnosing burn sepsis .Hence we recommend to add procalcitonin as an adjunct biomarker to diagnose sepsis in burn patients.

THE RELATION BETWEEN ORAL, MASOCHIST AND RIGID CHARACTERS TRACES WITH OVERWEIGHT AND THE IMPACT ON THE WEIGHT LOSS PROCESS

Efcient interventionist proposals for overweight and obesity depend on how the person feels, thinks, and acts. This is possible through the body analysis, a technique that, based on the structural forms of the body, allows the determination of individually percentages of characters traces (schizoid, oral, psychopathic, masochist and rigid). The objective of this study was to verify the relation between overweight or obesity and characters traces. This is an observational, transverse, retrospective study, described with secondary data obtained from the records of a training school in body analysis between 2018 and 2022. A total of 838 people participated in this study, being excluded those participants who did not lled out their height and weight. The Map of Characters instrument was used to identify the prole of the body identication; the sociodemographic prole and habits were evaluated by an original questionnaire, and the quality-of-life contents, using the WHOQOL-BREF. Individual BMI was calculated and three groups were determined: eutrophic ((18,5 ≥ IMC < 25); overweight (25 ≥ BMI < 30) and obese (BMI ≥ 30.0). With 95% condence intervals, the variables were described from frequency distributions, media, and standard deviation in the univariate analysis. In the bivariate analysis, the Chi-square and the Kruskall-Wallis test were used. The variables that, at this stage, presented a descriptive level (p-value) up to 0.20 were selected for the multiple analysis, which used the Multinomial Logistic Regression model and estimated the adjusted odds ratios (OR) with respective (OR). The Deviance test and Pseudo-R 2 of Nagelkerke's evaluated the quality of the setting. The IBM SPSS software version 23.0 was used in all analyses. It was noticed an isolated and combined increase in the percentage of Oral and Masochist traces in relation to the overweight and obese groups, while the Schizoid, Psychopathic and Rigid traces had their percentages decreased. The chances of overweight and obesity were signicantly higher in individuals with below average quality of life and a higher percentage of emotional dependence.

TO ASSESS SUBCLINICAL UREMIC ENCEPHALOPATHY IN NEWLY DIAGNOSED CHRONIC KIDNEY DISEASE PATIENTS BY USING ELECTROENCEPHALOGRAPHY IN TERTIARY CARE CENTRE

Background: Chronic kidney disease(CKD) is one of the leading cause of death in the world because of its late or end stage presentation. In our study we assessed patients of CKD for cognitive dysfunction with EEG (electroencephalography) and other biochemical parameters. This cross-sectionalstudy was conducted on 60Methods: newly diagnosed CKDpatients at MGM Medical College and MY Hospital Indore, MP, India, from 2019 to 2021. Baseline parameters like serum urea, creatinine, bilirubin and sodium were done and patients were subjected to electroencephalography to assess subclinical uremic encephalopathy and data were analysed using SPSS statistics version 22.0 and p value <0.05 and condence interval more than 95% were considered signicant. In this study, beta wavesResults: were found to be maximum in stage1 (83.3%) whereas delta waves were found to be more in stage 5 (68%). In CKD stage 1, 16.7% patients had alpha waves and delta waves were absent. In CKD stage 5, 12% & 20% patients were having beta and alpha waves respectively. Epileptiform discharges were absent in patients of CKD stage 1 with stage 5 CKD having 80% patients with epileptiform discharges (P value =0.001). All patients in CKD stage1 have symmetrical EEG waves, with 80% asymmetrical waves were present in CKD stage 5 (P value=0.021). This study supports the fact that as CKDConclusions: stages progresses, there is propensity of delta waves, asymmetrical waves and epileptiform discharges which helps in early detection of subclinical uremic encephalopathy and therefore the risk of uremic seizures.

INSECTICIDE TREATED BED NET OWNERSHIP AND UTILIZATION IN HOUSEHOLDS OF UNDER-FIVE CHILDREN IN MALARIA ENDEMIC AREAS IN NUH, HARYANA

Context: Vector control is an effective way to prevent and reduce malaria transmission. If coverage of Insecticide Treated Bed Net within a specic area is high enough (>80%), then a measure of protection will be conferred across the community. To describe the ownership and utilization of Insecticide Treated Bed Net inAims: households of under- ve children in rural areas. The study was community based cross sectional study.Settings And Design: Methods and Material: The nal analysis was done on 440 households of under-ve children. The mothers were interviewed with pre-designed, pre tested, semi-structured schedule. The data were analyzed using Epi-Info.Statistical Analysis Used: Descriptive statistics were used to summarize variables. Bivariate analysis and comparisons of proportions between groups were analyzed using chi square (χ2) at 95% condence interval (CI). Out of 440 households, 305 household (69.3%)Results: owned at least one LLIN, 173 household (39.3%) in which under-ve children slept under LLIN. Following explanatory variables were statistically associated with under-ve children slept under LLIN in the previous night: household belonging to nuclear family (OR = 1.92; CI [1.20-3.07]); Mothers received malaria prevention and control message in past month (OR = 1.65; CI [1.11- 2.45]); Mothers knew benets of bed net in the prevention of malaria (OR =2.56; CI [1.33-4.89]). CommunicationConclusions: programme with special focus on mothers for utilization of bed net should be well planned and implemented to achieve elimination of malaria from India by 2030.

PREDICTION OF OUTCOMES IN ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) WITH DECAF SCORE AND BAP 65 SCORE

Background: Prognostic research in exacerbations of chronic obstructive pulmonary disease (COPD) requiring hospitalization has been limited and there appears to be little common ground between predictors of mortality in stable disease and during COPD. Furthermore, none of the prognostic tools developed in stable disease have been tested on hospitalised patients so this study was planned. To test dyspnoea, eosinopenia, consolidation, acidaemia, and at Objectives: rial brillation (DECAF) and biological assessment prole (BAP) 65 scores on patients in a tertiary care set up and validate the same. Hospital based prospective observational Methods: study was carried out in 80 patients with COPD who were admitted in Government Hospital for Chest and Communicable Diseases. DECAF and BAP-65 Scores were calculated. Data was analysed using SPSS 22 version software. In our study both DECAF score and BAP-65 score Results: performed equally well for prediction of need for Mechanical Ventilation. The AUC for need for Mechanical Ventilation was 0.75 (95% CI=0.67–0.84) for DECAF score and 0.77 (95% CI=0.67–0.85) for BAP-65 score. The AUC for prediction of mortality for DECAF score was 0.81 (95% condence interval [CI]=0.71–0.88) and for BAP-65 score was 0.79 (95% CI=0.67–0.89). Conclusions: DECAF and BAP-65 are good and also equal in predicting mortality as well as need for mechanical ventilation.

Factores asociados a la ansiedad en internos de medicina de una universidad privada en el contexto de la pandemia Covid-19

Objective:To determine the factors associated with anxiety in medical interns at a private university in the context of the COVID-19 pandemic. Methods: The study design is quantitative, observational, analytical, retrospective, cross-sectional. The sample was composed of 343 human medicine interns, who were selected by a non-probabilistic snowball type sampling. The Coronavirus Anxiety Scale instrument was used for the diagnosis of anxiety. A Poisson regression model with robust bivariate and multiple variances was used to calculate the prevalence ratio and their respective 95% condence intervals. Results: The prevalence of anxiety and severe depressive symptoms of 22,74% and 6,71% respectively was found. Depressive symptoms aPR 3.27 (95% CI 1,06 - 10,09), having children aPR 2,61 (95% CI 1,26 - 5,38), and the diagnosis of COVID-19 in the last 12 months aPR 2,20 (95% CI 1,25 - 3,87) were associated with the presence of anxiety in the multiple regression model. Conclusions: The presence of severe depressive symptoms, having children, the diagnosis of COVID-19 in the last 12 months are associated with the diagnosis of anxiety in medical interns at a private university in Lima, 2021

Factores asociados al no uso de métodos anticonceptivos en mujeres adolescentes del Perú. ENDES 2018-2020

Introduction: In Peru, adolescents tend to use contraceptive methods (CM) less frequently, constituting a subgroup at risk of unwanted pregnancies and sexually transmitted diseases. Methods: Quantitative, observational, analytical-cross-sectional study corresponding to a secondary analysis of data from women aged 15 to 19 from the ENDES 2018-2020. To quantify the association, Poisson regression was used for robust variances, calculating the Prevalence Ratio (PR) in its crude (PRc) and adjusted (PRa) forms, with a 95% con􀃶dence interval. Results: 28.4% did not use MC, there was a signi􀃶cant association for the variables without a partner (Rpa: 2.49 CI: 1.99-3.11) and zero children (Rpa: 2.73 CI: 2.22-3 .35). Conclusions: The factors associated with the lack of CM in female adolescents were without a partner and zero children, with a higher prevalence of the lack of CM.

DYSPHAGIA FOLLOWING ANTERIOR CERVICAL SPINE SURGERY: A TWO YEAR PROSPECTIVE STUDY

Introduction: Incidence of dysphagia following anterior cervical spine surgery is not uncommon, in studies it has ranged from 2% to 60%. Most studies in have been done in a retrospective manner which have doubtful conclusions. We have followed up 212 case of anterior cervical spine surgery for two years and documented the risk factors in patients developing dysphagia in the follow-up period. Aims & objectives: To nd the incidence and risk factor for dysphagia in anterior cervical spine surgery. Materials & method: st It's a prospective study where patients under went operation in our institute in the year from 1 january2018 st st to 31 December 2019. We have completed our follow up in 31 December 2021. Results: Proportion analysis (chi-square or a Fisher Exact Test), prevalence ratios, and 95% condence intervals were used for data analysis. Female gender(p <0.03), revision surgeries (p <0.01) and more than 3 level surgeries( p<0.03) seems to be some important risk factors. Conclusion: study concluded that female gender, revision surgeries and surgery done in ≥ 3 cervical levels are at risk for dysphagia.