Proceedings: National multidisciplinary conference on recent advances in medical specialities

Oral Presentation: O2401: Geriatric Depression and Its Associated Factors in an Urban Area of District Gautam Buddha Nagar: A Cross-Sectional Study

Sachin K. Nagar, Amit S. Pawaiya, Neha Tyagi, Shalini Srivastava, Harsh Mahajan

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: India’s elderly population is growing, leading to increased concerns about depression, which is not a normal part of ageing. While many older adults report life satisfaction despite health issues, those with a history of depression may be more susceptible in later life. Objectives: (i) To estimate the prevalence of depression in the geriatric population. (ii) To assess the risk factors associated with depression in the geriatric population. Methodology: The study was conducted in the urban area of Bhangel, District Gautam Buddha Nagar, the field practice area of the Department of Community Medicine, SMS and R. A total of 255 participants who fulfilled the inclusion criteria and gave informed consent were selected by purposive sampling. Data were collected through house-to-house visits using a semistructured questionnaire, and one elderly person was interviewed in each house. The questionnaire consisted of the following domains: (i) Sociodemographic profile and (ii) Geriatric depression scale. Results: The prevalence of depression among study participants was 54%. Depression was found to be significantly associated with alcohol use (P ≤ 0.05), lower socioeconomic status (P ≤ 0.05), and the presence of comorbidities (P = 0.02). Conclusion: The present study revealed that the prevalence of depression in the elderly was high. Lower socioeconomic status, alcohol use, and the presence of comorbidities are major contributing factors to depression in the elderly.

Keywords: Depression, geriatric, urban population

O2402: Anatomical Insights and Radiological Innovations in Breast Cancer Detection and Staging

Anamika Tiwari, Aditi Bhatnagar, R. P. Gupta

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Breast cancer is a leading cause of cancer-related mortality among women worldwide. Early detection and accurate staging are crucial for improving patient outcomes. Anatomical understanding and advancements in radiological techniques have significantly enhanced these processes. Breast cancer can present in various forms. Understanding the role of lymphatic and vascular involvement in metastasis has provided deeper insights into the spread and prognosis of the disease. Aim: This study explores the role of advanced radiological imaging techniques, as digital breast tomosynthesis (DBT), contrast-enhanced mammography (CEM), ultrasound, magnetic resonance imaging (MRI), positron emission tomography (PET), and radiomics, in improving breast cancer detection, staging, and treatment decision-making. Materials and Methods: This review synthesizes studies on imaging modalities for breast cancer. It examines the efficacy of mammography, ultrasound, MRI, DBT, CEM, PET/CT, and radiomics in detecting and staging breast cancer. Results: Advanced imaging techniques such as DBT, CEM, and MRI enhance breast cancer detection, particularly in dense breasts where mammography is less effective. PET/CT aids in staging and identifying metastasis. The integration of radiomics and molecular imaging offers improved prognostic accuracy, predicting tumor behavior and treatment response, thus enabling more personalized therapeutic strategies. Conclusion: The integration of advanced imaging modalities with anatomical and molecular insights improves breast cancer detection and staging. These innovations offer a more comprehensive approach to diagnosis and treatment, with potential for more tailored, effective therapies and better patient outcomes.

Keywords: Breast cancer, anatomical insights, digital breast tomo-synthesis, molecular imaging, radiological innovations

O2403: Studies on Lipid Peroxides/Antioxidant Status in PIH, Pre-Eclampsia, and Eclampsia

Renu Chane, Manoj K. Nandkeoliar, S. B. Sharma

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Pre-eclampsia and PIH (pregnancy-induced hypertension) is a pregnancy-specific condition defined by early onset of hypertension (greater than 140 mm Hg systolic or 90 mm Hg diastolic) that occurs after 20 weeks of gestation or postpartum, accompanied by either proteinuria (greater than 300 mg/24 hours by 24-hour urine or a random urine protein/urine creatinine ratio of 0.3 or greater) or other maternal organ dysfunction. Pre-eclampsia can progress to the obstetric emergency of eclampsia, which refers to the onset of seizures in patients with pre-eclampsia. This disorder is a leading cause of maternal and fetal morbidity and mortality. It is seen that placental oxidative stress is involved in the etiopathogenesis of pre-eclampsia. Material and Methods: The study was conducted on 90 women in the age group of 18–44 years. Thirty nonpregnant healthy women comprised the control group. There were two study groups of 30 each; one had pre-eclampsia/eclampsia/PIH, and the other study group comprised normotensive pregnant women. Results: Statistical analysis showed that levels of MDA were significantly higher in PIH patients as compared to those in normotensive pregnancy and nonpregnant healthy women. On the other hand, antioxidants like catalase, SOD, and glutathione were found to be decreased in both study groups compared to the normal women. Conclusions: Lipid peroxidation increases throughout in normal pregnancy, but the increase is more marked in patients with hypertensive disorders of pregnancy. Increased lipid peroxidation enhances the requirement of antioxidants (glutathione, catalase, SOD, ascorbic acid), resulting in their deficiency. This deficiency is more in PIH patients as compared to the normotensive pregnancy and control groups.

Keywords: Antioxidants, eclampsia, oxidative stress, PIH, pre-eclampsia

O2404: Evaluation of Clinical and Histopathological Concordance and Discordance of Skin Diseases at a Tertiary Care Center

Aashima Singla, Kangana Sengar, Anshu G. Devra

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Biopsy plays a major role in diagnosis of skin diseases. Numerous variables can affect clinicopathological consistency, such as information provided in histopathology requisition forms, representative lesion biopsied, age of the lesion, choice of biopsy technique, fixation and processing of the tissue, and use of ancillary tools such as special stains and immunofluorescence wherever deemed necessary. So, in this study, we attempt to evaluate the clinicopathological concordance and discordance rates in a variety of dermatological conditions. Aim and Objectives: The aim of the present study is to evaluate the clinicopathological concordance and discordance rates and to evaluate the spectrum of skin diseases in Delhi-NCR region. Material and Methods: The study is a cross-sectional analytical study conducted in the Department of Pathology, SMS and R, Greater Noida. The skin biopsies received from April 2024 to September 2024 were analyzed. Results: The study involved a total of 40 patients, with 23 (57.5%) males and 17 (42.5%) females. The mean age of 39 non-neoplastic cases was 34 years, and one neoplastic case was 42 years. Overall, 16 (40%) cases had noninfectious papulosquamous, while 7 (17.5%) cases had eczema, 5 (12.5%) cases were inflammatory, and 12 (30%) cases had infections which included leprosy followed by lupus vulgaris. Only one case (0.25%) was found neoplastic. Out of 40 cases, 37 were found as concordant and 3 as discordant. Conclusion: From dermatitis to malignant neoplasms, there were a wide range of skin disorders. The significance of particular histomorphological characteristics lies in differentiating distinct skin lesions.

Keywords: Concordance, discordance, histopathology, skin biopsy

O2405: Evaluating the Interplay of Inflammation, Stress, and Cardiovascular Risk in Obesity

Pooja Sharma, Manoj K. Nandkeoliar, S. B. Sharma

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Obesity is a multifactorial condition closely linked to chronic inflammation and elevated cardiovascular disease (CVD) risk. A key pathway in obesity-related CVD involves atherosclerosis, marked by lipid build-up and immune cell infiltration in arterial walls. While traditional lipid measures help in risk stratification, composite markers like the total cholesterol to HDL cholesterol (TC/HDL-C) ratio or atherogenic index offer greater predictive value by reflecting lipid metabolism imbalances that exacerbate CVD risk. Interleukin-4 (IL-4) is emerging as a critical modulator in lipid metabolism, where it contributes to obesity management by reducing adipogenesis, enhancing lipolysis, and improving insulin sensitivity. However, data on the correlation between IL-4 levels and the atherogenic index remain spars. Additionally, cortisol, known for glucose regulation, presents a complex relationship with metabolic health in obesity, though its specific impact on cardiovascular markers, particularly in morbid obesity, is not fully understood. Aim: To investigate the interplay of cortisol (stress), IL-4, and the atherogenic index across obese and nonobese subjects. Methods: This cross-sectional study included 100 healthy young adults aged 18–24. Serum IL-4 and cortisol levels were measured using ELISA, atherogenic indices (TC, HDLC, and LDLC) were assessed through spectrophotometry, and body mass index (BMI) was calculated using a body fat analyzer. Results: Higher IL-4 and cortisol levels were significantly correlated with increased BMI and atherogenic index. Conclusion: The study indicates a significant association between elevated IL-4, cortisol levels, and cardiovascular risk factors in obese individuals, suggesting that IL-4 and cortisol may serve as valuable biomarkers for early cardiovascular disease risk assessment in the context of obesity.

Keywords: Cardiovascular risk, cortisol, inflammation, interleukin-4, obesity

O2406: Comprehensive Study of Arrangement of Renal Hilar Structures: An Anatomical Study

Niketa Ranjan, Aditi Bhatnagar, R. P. Gupta

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: The hilum is a deep vertical fissure present anteromedially in the kidney and contains the renal vein, renal artery, and renal pelvis from anterior to posterior. However, variations in the hilar structures are frequently encountered. Aim: This study seeks to raise awareness of potential anatomical variation in the renal hilum, which is crucial for invasive renal procedures. Material and Methods: The present study was conducted in the department of anatomy, School of Medical Sciences and Research, Sharda University. A detailed dissection of 50 embalmed cadaveric kidneys was performed. The renal hilum was dissected, and the sequence of structures from anterior to posterior direction and their relationships was noted. Results: The kidneys were classified in five patterns, with the classical pattern (renal vein, renal artery, and renal pelvis from anterior to posterior) observed in 38% cases only. The remaining 62% cases exhibited variations, of which pattern 2 (V-A1-P-A2) was seen in maximum cases (24%). Conclusion: The present study will help to understand the better knowledge of the disposition of hilar structures for urological surgeons, radiologists, and anatomists, thereby reducing the risk of vascular complication during surgical intervention.

Keywords: Kidney, renal artery, renal hilum, renal pelvis, renal vein

O2407: Cytological Profile of Granulomatous Mastitis: A Rare Entity and Its Diagnostic Challenges

Sambhavi, Devyani Pendharkar, Anshu G. Devra

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Granulomatous mastitis (GM) is a benign rare inflammatory disease of the breast, with painful lump as the most frequent presentation. Young females are generally affected and usually give a past history of antibiotic intake without any permanent relief. Since the clinical presentation and imaging studies closely mimic malignancy, GM should be considered in all cases of chronic mastitis. Aim: To study the cytomorphological profile of GM and its important clinical characteristics and to differentiate it from mimickers like carcinoma breast to prevent needless mastectomies. Method: The present study was a 5-year retrospective observational study done in SMSR, Sharda University. Aspirates were stained with Giemsa stain. Special stains like Zeihl Nelson and PAS were done to rule out mycobacterium or fungal etiology. Results: Our study comprised 15 cases of GM. The mean age was 29.2 years with left breast involvement in 53% of females. Inflammatory features present in 60% cases. Noncaseating granulomas along with abundant polymorphs in the background were suggestive of GM. Other ancillary tests further aided in confirmation of diagnosis. Conclusion: Diagnosis and treatment of a patient of GM are challenging as not only it is a rare disease but also other cases of mastitis and malignancy have to be ruled out, which helps us to prevent unnecessary mastectomies.

Keywords: Granulomatous mastitis, Non Caseating granuloma, Zeihl Nelson stain

O2408: Malnutrition – A National Priority

S. Dhivya, Usha Bindal, Abhishek Dubey, S. B. Sharma, Manoj K. Nandkeoliar

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Malnutrition causes increased risk of morbidity and mortality in children because of various infections. Serum albumin, C-reactive protein (CRP), immunoglobulins, and others can evaluate the nutritional status and its impact. The CRP/albumin ratio is a novel marker for poor prognosis or mortality among patients. Aim and objectives: To assess the nutritional deficiency and its impact in the pediatric population (0–18 years), the objectives were set as to estimate serum albumin, CRP, and immunoglobulins (IgA, IgM, and IgG) levels in the pediatric population. Material and methods: This cross-sectional, retrospective study was conducted in the Department of Biochemistry, Postgraduate Institute of Child Health, Noida, from the data obtained from 1022 cases in the Biochemistry Lab. Albumin (BCG method), CRP, and immunoglobulins (immunoturbidimetric method) were estimated from serum in Beckman Coulter. Results: 44% of 359 study subjects showed depleted levels of albumin (<3.5 g/dL), and 5% of those are severely deficient (<2.1 g/dL). The average serum albumin levels are 3.66 g/dL (normal range: 4–5.5 g/dL). The average serum CRP levels in 822 study subjects are 36.14 mg/L (normal range: 0–6 mg/L). The average serum CRP/albumin ratio in 215 study subjects is 14.63 (normal range: 0.02–1.2). The average immunoglobulin levels of the study subjects were found to be normal. There was a weak negative correlation between albumin and CRP levels (n = 215). Conclusion: This study stresses the screening of the pediatric population in the hospital for albumin, CRP, and immunoglobulins and to take necessary action on an urgent basis in high-risk groups to avoid morbidity and mortality

Keywords: Albumin, C-reactive protein, malnutrition, mortality

O2409: Morbidity Patterns among Primary School Children in Urban and Rural Areas of District Gautam Buddha Nagar – A Comparative Study

Rahul Chaudhary, Neha Tyagi, Amit S. Pawaiya, Anshu Singh, Harsh Mahajan, Shalini Srivastava

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: School age is a crucial period of transformation for children, both physically and mentally, as they develop into promising adults. During this phase, they are susceptible to diseases and various infections. School settings provide a unique stage to address various health issues of school-going children, improving their health and self-reliance. Objectives: 1. To estimate the prevalence of morbidities among primary school-going children in urban and rural areas of District Gautam Buddha Nagar. 2. To compare the morbidity patterns among primary school-going children in urban and rural areas of District Gautam Buddha Nagar. Methodology: The study was conducted in the urban and rural areas of District Gautam Buddha Nagar, the field practice area of the Department of Community Medicine, SMS and R. A total of 303 students of Ist to Vth Standard who were present and gave consent were included in the study. Data were collected through School Health Camps using a semistructured questionnaire. Results: Among school-going children in rural areas, the highest prevalence was eye problems (55.5%), followed by ENT problems (31.9%) and dental caries (14.3%). In contrast, ENT problems were found to be higher in urban areas (43.5%), followed by dental caries (36.4%) and micronutrient deficiencies (10.9%). Conclusion: Overall, morbidities were found to be higher in urban school-going children. Dental caries and ENT-related issues were more common in urban school-going children, whereas eye problems were found more common among rural school-going children.

Keywords: Children, morbidity pattern, urban and rural areas

O2410: Median Nerve Conduction Velocity in Uncontrolled Diabetics without and with Complications

Roopali Mittal, Rinku Garg

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Diabetes mellitus (DM) is a metabolic disorder which has widespread effects on all body systems. The most common complications of uncontrolled diabetes overtime are microvascular disorders including retinopathy, nephropathy, and cardiovascular diseases as well as neuropathy (peripheral/central or both). Peripheral neuropathy is the most common manifestation of neural involvement and is related with type of diabetes, its duration, and instability in blood sugar regulation. NCV is a noninvasive investigation to test the peripheral neuropathy. The probability of abnormal NCV is greater in uncontrolled diabetics more so having complications too. Aim: To study and compare the NCV parameters in: Uncontrolled diabetics without and with complications. Uncontrolled diabetic neuropathy and diabetic retinopathy. Material and Methods: Ninety uncontrolled type 2 diabetics including 25 having no complications, 50 with symptoms of peripheral neuropathy, and 15 with retinopathy were subjected to bilateral median nerve NCV test after taking written consent and explaining the purpose and procedure to them. MNCV was recorded on Neurostim NS-4. Results: It was found that patients with retinopathy and neuropathy were having significant reduction in mean (of both hands) MNCV (P < 0.05) compared to the uncontrolled diabetics without any complication. Moreover, the strength of the stimulus required was more in the complicated cases (P < 0.05). Conclusion: Though the poor glycemic control is a known cause of peripheral neuropathy, the magnitude is greater in uncontrolled diabetics having the associated complications. NCV, thus, may be an important diagnostic tool to assess the prognosis of DM.

Keywords: Conduction velocity, peripheral neuropathy, median nerve

O2411: Spectrum of Infections Detected on Pap Smears in a Tertiary Care Hospital

Mohit Saxena, Ayush Saxena, Devyani Pendharkar, Atul Verma, Anshu G. Devra

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Cervical infections are frequently observed in women of reproductive age. The Pap smear, primarily used as a screening tool for cervical cancer, is a simple and quick test that can also diagnose cervico-vaginal infections. This study was conducted to evaluate the effectiveness of Pap smears in diagnosing cervico-vaginal infections. Aim and Objective: This study aimed to determine the prevalence of infective lesions in cervical smears categorized as NILM at a tertiary care medical center and to identify the most common organisms involved. Material and Methods: A retrospective analysis was conducted on 1066 cervical smears received over a 1-year period (July 23–June 24). The smears were evaluated and reported according to Bethesda terminology. Those falling in the category of NILM were further observed for specific infective etiologies present and noted. Results: Out of 1066 smears evaluated, 94.8% were categorized NILM. In 27%, no inflammatory changes were observed; in the remaining, 73% inflammatory changes were seen. Smears revealed specific infective etiologies in 12.8% of cases; the rest were nonspecific. The spectrum of specific infective etiology further highlighted that the most common infective agent was candida accounting for 84.6%, followed by Trichomonas vaginitis 14.6% and Actinomyces 0.7%. Conclusion: Infective lesions are common in cervical smears categorized as NILM, with Candida spp. and Trichomonas vaginalis being the most frequently detected organisms. These findings underscore the importance of thorough examination of NILM smears to ensure appropriate management of underlying infections

Keywords: Actinomyces, candida spp. NILM, trichomonas vaginalis

O2412: Evaluation of Phaeohyphomycosis among Positive Fungal Cultures from 2021 to 2024: A Retrospective Study in a Tertiary Care Hospital in Greater Noida

H. Vanlalhruaii, Supriya Mahajan, Dalip K. Kakru

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Phaeohyphomycosis is caused by darkly pigmented fungi with melanin in their cell walls that gained importance during COVID-19 pandemic, but there is paucity of information related to their prevalence, treatment, and prognosis from India. Aim: To evaluate major etiological agents and treatment response of Phaeohyphomycosis among positive fungal cultures from 2021 to 2024. Materials and Methods: This retrospective study was conducted from February 2021 to October 2024 on specimens received from patients with varied clinical manifestations which were subjected to KOH mount and fungal culture on Sabouraud’s dextrose agar (SDA). SDA showing dark-brown or black wooly colonies were subjected to lactophenol cotton blue (LPCB) mount to identify the fungus. Clinical details were obtained from the hospital information system. Results: A total of 431 specimens were fungal culture-positive, of which 37 (8.5%) specimens showed growth of phaeohyphomycetes on culture. KOH was positive in 3/37(8%) cases. Spectra of the isolated fungi included Bipolaris spp (51%), Alternaria spp (32.5%), Curvularia spp (16%), Exophiala spp (3%), and Fonsecaea pedrosoi (3%). The clinical spectrum of diseases showing phaeohyphomycosis included sinusitis (30%), onychomycosis (21.5%), cutaneous infections (19%), pneumonia (13.5%), meningitis (5.5%), and others (10.5%). 73% sinusitis cases were associated with mucormycosis. 28.5% cutaneous infections were associated with psoriasis. 38% cases were subjected to antifungal treatment, and 16% cases underwent surgical debridement. Recovery was seen in 16% patients, 84% were lost to follow-up, and no mortality was observed. Conclusion: High index of suspicion is necessary to diagnose phaeohyphomycosis due to varied clinical manifestations with timely antifungal treatment.

Keywords: Alternaria, bipolaris, curvularia, exophilia, fonsecaea pedrosoi, fungal cultures, KOH mount, LPCB, mucormycosis, onychomycosis, phaeohyphomycosis, SDA

O2413: Study on Interleukin-4 Levels and Body Fat Percentage in Essential Hypertensive Patients – An Observational Study

Thuraya Abdullsalam A. A. AL-Azazi, S. B. Sharma, Manoj K. Nandkeoliar

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Genetic, environmental, and immunological factors influence the multifaceted condition of essential hypertension. Essential hypertension is one of the major risk factors of kidney disease and stroke. IL-4 may control blood pressure by affecting endothelial cells and vascular smooth muscle. Body fat percentage was significantly associated with CVD-related lipid biomarkers in adults, positively with TC, TG, and LDL-C and negatively with HDL-C. It could be used as a noninvasive screener and monitor of high CVD risk population. Therefore, studying the risk factors that contribute to the pathogenesis of essential hypertension is the key to preventing and controlling the complications associated with it. Material and Methods: The study involved 135 individuals with hypertension and 135 control subjects who were attending the outpatient department (OPD). The study was carried out in the Department of Biochemistry and Department of Medicine, Sharda Hospital, School of Medical Science and Research, Sharda University. IL-4 levels were measured using an enzyme-linked immunosorbent test kit. Body fat percentage was measured by using Bioelectrical Impedance Analysis. Results: The data were statistically analyzed through an unpaired Student’s t-test. IL-4 levels in hypertensive patients were found to be significantly higher than control (P-value ≤ 0.001). Pearson correlation indicates that there is nonsignificant positive correlation between body fat percentage and IL-4 (P-value = 0.37). Conclusion: It is concluded that IL-4 is significantly higher in essential hypertensive patients than in control; body fat percentage was nonsignificantly correlated to IL-4 levels. Therefore, studies with a higher sample size are required to explore the role of IL-4 and other cytokines in the pathophysiology of hypertension, which may open the doors to more clinical treatment interventions.

Keywords: CVD, ELISA, essential hypertension, interleukin-4

O2414: Incidence and Role of Hematological Parameters and Liver Enzymes in Diagnosis of Dengue Infection: Study in a Tertiary Care Center

Zarine Khan, Lipika Gaur, Tarana Sarwat, Neeraj Pal Singh, Riti Srivastava, Dalip K. Kakru

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Dengue is a viral disease transmitted by Aedes mosquitos and is a growing global health threat. Early detection of dengue infection during the fever stage is critical for determining optimal treatment. Aim: To find the predictive markers from clinical and laboratory results in dengue infection. Material and Methods: A hospital-based cross-sectional study was conducted at Sharda Hospital in Greater Noida for two seasons (June 2022–September 2022 and June 2023–September 2023). All samples received in the lab were tested for the NS1 antigen using an enzyme-linked immunosorbent assay. The samples for hematological and liver function testing were processed using an automated analyzer, SYSMX.KX-21n and Vitros 5600, respectively. Statistical analysis was performed using the t-test. P-values < 0.05 were considered significant. Results: The overall dengue incidence rate was 16.2% (n = 1426/8772). The confirmed NS1 cases had varied clinical presentations, which included fever (100%, n = 1426/1426), arthralgia (95.5%, n = 1326/1426), headache (85.8%, n = 1224/1426), retro-orbital pain (78.6%, n = 1121/1426), myalgia (76.5%, n = 1091/1426), vomiting (48.8%, n = 696/1426), stomachache (55.6%, n = 793/1426), and rash. Positive patients showed considerably increased levels of ALT, AST, and hematocrit, as well as thrombocytopenia. Conclusion: Effective and prompt diagnosis is required for the treatment of the disease. The severity of dengue can be predicted by closely monitoring the laboratory parameters of the patients.

Keywords: ALT, AST, clinical features, dengue, hematocrit, laboratory parameters, NS1 Ag, thrombocytopenia

O2415: Perception and Impact of Cadaveric Dissection as a Learning Tool for Undergraduate Medical Students

Sarah Khan, Aditi Bhatnagar, Nirupma Gupta

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India.

Background: For centuries, dissection of the human body has been perceived as an indispensable mode of learning anatomy for medical students. It has survived cultural barriers, scientific progress, and change in curriculum. Technological advancements in the past decades, however, have raised the question whether the practice can be replaced with newer, more innovative and clinically relevant methods of learning human anatomy. The present study has been taken to evaluate the relevance of cadaveric dissection in the present CBME curriculum. Aim and Objectives: To understand the importance of cadaver dissection as a learning tool. To evaluate the perception and impact of cadaveric dissection as a learning tool for MBBS Students. Materials and Methods: The study was conducted on all 150 First Year MBBS students studying anatomy in accordance with the current CBME Curriculum. After completion of a specific topic using didactic lectures and small group discussions, the students were tested using MCQ tests both before and after dissection of the part covered previously. Test scores were recorded and analyzed. Students’ perceptions regarding dissection were also recorded. Results: Comparison of student responses showed enhanced scores post dissection sessions. It was found that most of the students sought the practice to deepen their understanding of human anatomy. Conclusions: The ancient method of learning anatomy – cadaveric dissection – is not only relevant to the students’ education but also irreplaceable despite advancements in learning methods.

Keywords: Anatomy, cadaveric dissection, impact, perception

O2416: Effect of Acute Exercise on Cardiorespiratory Parameters in Sedentary Adults

Shyam S. Sharma

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Exercise is widely recognized for its profound impact on cardiorespiratory health, metabolic function, and mental wellbeing. This study aims to investigate the acute effects of isotonic and isometric exercises on cardiorespiratory parameters in sedentary adults. We have also shown correlation between isotonic exercises, which involve dynamic movements with muscle contraction and joint movement, and isometric exercises, characterized by muscle contraction without joint movement, represent two distinct forms of resistance training with potentially different physiological impacts. Materials and Methods: A total of 40 sedentary adults (male) participated in a longitudinal study involving two exercise conditions: isotonic and isometric. Each individual underwent a single session of isotonic exercise (dynamic muscle contractions) and isometric exercise (static muscle contractions) on separate days. Cardiorespiratory parameters (heart rate, blood pressure, heart rate recovery, VO2, and VCO2) were evaluated before and after each exercise session. Results: Acute isotonic exercise significantly improved cardiorespiratory parameters, evidenced by increased VO2 max. Isometric exercise also showed a notable improvement in cardiorespiratory metrics, though to a lesser extent. Conclusion: Isotonic and isometric exercises both positively influence cardiorespiratory health in sedentary adults. Isotonic exercises provide greater improvements in cardiovascular and metabolic parameters. These findings suggest that incorporating isotonic exercise and isometric exercises may be particularly beneficial for sedentary individuals seeking to improve their cardiorespiratory fitness and metabolic health. Further research is needed to explore long-term effects and optimal exercise prescriptions for different populations.

Keywords: Cardiorespiratory parameters, isometric exercise, isotonic exercise, sedentary adults

O2417. Anatomical Approach of Learning Anatomy – Perspective of Medical Students on Traditional vs Virtual Methods

Archisha Bansal, Ankur Sharma, Nirupma Gupta, Gaurav Bansal, Shweta Bansal

School of Medical sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Anatomy is fundamental to medical education, with cadaveric dissection long regarded as the gold standard for learning. It not only enhances anatomical knowledge but also fosters teamwork, professional skills, and clinical acumen. Recently, technological advancements have introduced virtual tools like virtual dissection tables, VR, AR, and 3D modeling as supplementary methods, improving accessibility and reducing psychological strain. Aims and Objectives: The study aims to explore the perceptions and preferences of medical students regarding anatomy education through cadaveric dissection and virtual learning tools. Materials and Methods: A cross-sectional study surveyed 273 undergraduate medical students from SMSR and eight medical colleges in Delhi NCR. A structured, anonymous questionnaire collected data on students’ experiences, preferences, and confidence levels with cadaveric and virtual methods. Likert scale questions, along with multiple-choice and open-ended questions, evaluated educational preferences and confidence in learning anatomy. Results: Cadaveric dissection was deemed essential by 57.5% of students, while 31.5% favored a hybrid approach combining traditional and virtual methods. Cadaveric dissection was preferred for building clinical skills and confidence, whereas virtual tools were valued for review and accessibility. Only 10.9% favored prosection alone. Conclusion: Cadaveric dissection remains critical for skill development and clinical competence. However, a hybrid approach integrating both traditional and virtual methods offers a comprehensive anatomy education model. Institutions should adopt this approach to optimize learning outcomes and clinical preparedness for medical students.

Keywords: Anatomy education, cadaveric dissection, confidence level, face-to-face learning, skill, virtual dissection

O2418: Peeping Bugs from the Lens of a Pathologist: A Case Series

Kanak Atri, Kiranjot Kaur, Salony Mittal, Anshu G. Devra

School of Medical sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Histopathology plays a crucial role in diagnosing infectious organisms. Often, detection of the exact etiological agent causing an infective lesion is difficult or missed by direct microscopy, especially by amateur pathologists. Infective etiological agents have specific features which can act as pointers in leading to definitive diagnosis of the pathogen. Hence, this case series highlights the morphologic clues that can raise a suspicion of infection and recalls the specific telltale signs of pathogens. Aim and Objectives: To emphasize the clinical and histomorphological clues to infective etiologies by analyzing cases from the data of 6 months at a tertiary care hospital. Material and Methods: Histopathological evaluation of cases from July 2023 to December 2023 was conducted, including clinical presentation, age of the patient, site of biopsy, history of immunocompromised status, and microscopic clues. Cases were compiled, reviewed, and analyzed. Result: The spectrum of lesions encountered ranged from bacterial to fungal, viral, and parasitic infestations. Specific cases included amoebic proctitis, rhinosporidiosis, mucormycosis, HSV infection, actinomycosis, hydatid cyst, Helicobacter pylori gastritis, aspergillosis, enterobius vermicularis, and fungal mycetoma. Conclusion: Thorough knowledge of microorganism morphology, telltale signs, and the utility of histochemical stains are essential for histopathologists. Correlation with clinical details is key to identifying the actual etiological agent.

Keywords: Fungal infections, infections, mycoses, parasites, worms

O2419: Comparison of Effects of Intravenous Nalbuphine and Dexmedetomidine as Premedication on Emergence Agitation in Adult Patients Undergoing Abdominal Surgery

Varalika Sharma, Shivika Nath, Nupur Aggarwal

School of Medical sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Emergence agitation (EA) includes agitation, confusion, disorientation, or violent behavior that develops in the early phase of recovery from general anesthesia. EA can cause serious complications, which include self-injury, self-extubation, increased pain, hemorrhage, and removal of catheters, and may even necessitate physical or chemical restraint. Objectives: To compare the effect of intravenous nalbuphine and intravenous dexmedetomidine as premedication on incidence and severity of postop emergence agitation. Methodology: The present study was conducted in the Department of Anaesthesiology, SMSR Medical College and Hospital, Greater Noida, after approval by Ethical Committee, with informed and written consent from patients. The study was carried out for 18 months in a randomized prospective and comparative manner. Patients were divided into two groups by using computer-generated random tables. GROUP N (n = 40): received intravenous nalbuphine 0.1 mg/Kg as premedication 15 minutes before induction. GROUP D (N = 40): received intravenous dexmedetomidine 0.4 µ/Kg as premedication 15 minutes before induction. Result: The EA incidence was 17.5% in the Dexmed group and 40% in the Nalbuphine group. Dexmed significantly decreased postoperative pain and analgesic requirement. The sedation was higher in group D than in group N. 30% patients in group D had sedation, and only 5% patients in group N were sedated with an RASS score of 3. Conclusion: Based on our study, we concluded that Dexmed is better in decreasing emergence agitation incidence, severity, postop pain, and postop analgesic requirement than nalbuphine but causes more sedation than nalbuphine.

Keywords: Agitation, dexmedetomidine, Intravenous Nalbuphine

O2420: Comparison of Effects of Intravenous Nalbuphine and Dexmedetomidine as Premedication on Emergence Agitation in Adult Patients Undergoing Abdominal Surgery

Varalika Sharma, Shivika Nath, Nupur Aggarwal

School of Medical sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Emergence agitation (EA) includes agitation, confusion, disorientation, or violent behavior that develops in the early phase of recovery from general anesthesia. EA can cause serious complications, which include self-injury, self-extubation, increased pain, hemorrhage, and removal of catheters and may even necessitate physical or chemical restraint. Objectives: To compare the effects of intravenous nalbuphine and intravenous dexmedetomidine as premedication on incidence and severity of postop emergence agitation. Methodology: The present study was conducted in the Department of Anaesthesiology, SMSR Medical College and Hospital, Greater Noida, after approval by Ethical Committee, with informed and written consent from patients. The study was carried out for 18 months in a randomized prospective and comparative manner. Patients were divided into two groups by using computer-generated random tables. GROUP N (n = 40): received intravenous nalbuphine 0.1 mg/Kg as premedication 15 minutes before induction. GROUP D (N = 40): received intravenous dexmedetomidine 0.4 µ/Kg as premedication 15 minutes before induction. Result: The EA incidence was 17.5% in the Dexmed group and 40% in the Nalbuphine group. Dexmed significantly decreased postoperative pain and analgesic requirement. The sedation was higher in group D than in group N. 30% patients in group D had sedation, and only 5% patients in group N were sedated with an RASS score of 3. Conclusion: Based on our study, we concluded that Dexmed is better in decreasing emergence agitation incidence, severity, postop pain, and postop analgesic requirement than nalbuphine but causes more sedation than nalbuphine.

Keywords: Dexmedetomidine, nalbuphine, postop emergence

O2421: Effect of Port Site Infiltration of Dexamethasone as an Adjuvant to Ropivacaine on Postoperative Analgesia in Laparoscopic Cholecytectomy

Kanishka Jaisinghani

School of Medical sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Poorly managed postoperative pain may cause adverse physical and psychological effects. Various methods for managing postoperative pain include the use of narcotics, NSAIDs, nerve blocks, and wound infiltration. Objective: This study aims to assess the effect of port site infiltration of dexamethasone as an adjuvant to ropivacaine on postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Methodology: A prospective, randomized, double-blinded controlled study was conducted with 40 ASA class I and II patients, aged 18–60 years, undergoing elective laparoscopic cholecystectomy. Patients were randomly assigned to two groups: Group RS (ropivacaine 0.5% with saline) and Group RD (ropivacaine 0.5% with dexamethasone 8 mg). Port site infiltration was performed with the prepared drugs before wound closure. Postoperative pain was assessed using the Numerical Rating Scale at 1, 3, 6, 9, 12, and 24 hours. The duration of analgesia, sedation scores, and the need for rescue analgesia were also recorded. Results: Group RD (ropivacaine + dexamethasone) experienced significantly lower pain scores and prolonged analgesia compared to Group RS (ropivacaine + saline) at all postoperative intervals up to 12 hours (P < 0.05). The mean duration of analgesia was 476.25 ± 116.76 minutes in Group RD, compared to 360 ± 88.79 minutes in Group RS (P = 0.002). Sedation scores remained low in both groups, with no sedation observed in the dexamethasone group. Conclusion: The addition of dexamethasone to ropivacaine for port site infiltration significantly prolongs postoperative analgesia in laparoscopic cholecystectomy patients.

Keywords: Laproscopic cholecystectomy, nerve block, ropivacaine

O2422: Comparative Analysis of Dexmedetomidine and Tramadol Adjuvants to Bupivacaine in Femoral Nerve Blocks for Paediatric Lower Limb Surgeries

Madhav Aghi, Nupur Aggarwal, Poonam Singh, Shaista Jamil

School of Medical sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: In pediatric anesthesia, there is a growing emphasis on enhancing postoperative pain management strategies. Femoral nerve blocks are commonly used for targeted analgesia in pediatric surgical pain management. Objectives: Comparative analysis of dexmedetomidine and tramadol as adjuvants to bupivacaine in pediatric femoral nerve blocks. Methodology: Sixty children aged 1–12 years undergoing lower limb surgeries were randomly allocated in two groups. Group BT (n = 30) received 0.25% Bupivacaine 1 mL/kg + Tramadol 2 mg/kg, and Group BD (n = 30) received 0.25% Bupivacaine 1 mL/kg + Dexmedetomidine 2 mcg/kg in femoral nerve blocks for perioperative pain management. Postoperatively, patients were observed for 24 hours, assessing pain with the r-FLACC score and providing rescue analgesia as needed. Sedation, hemodynamic parameters, and adverse effects were recorded. Results: Group BD demonstrated a significant advantage with lower r-FLACC scores at 6 hours (P = 0.013*) and a reduced need for rescue analgesia at 12–24 hours (P = 0.047*) compared to Group BT. Hemodynamically, Group BD trended toward better parameters compared to Group BT with a statistically nonsignificant difference (P > 0.05). Group BD demonstrated similar adverse effects compared to Group BT, indicating comparable safety profiles (P > 0.05). Conclusion: Dexmedetomidine as an adjuvant with bupivacaine in pediatric femoral nerve block prolongs analgesic duration and significantly reduces postoperative pain scores compared to the tramadol combination.

Keywords: Femoral nerve, Bupivacaine, pain management

O2423: Comparison of Hemodynamic Response to Induction with Propofol versus Etomidate in Patients Scheduled for Elective Surgery

Gaurav Shankar, Ram M. Sharma

School of Medical sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background and Objectives: Sudden hemodynamic changes after induction of anesthesia have threatening complications, specially in high-risk cases. This study evaluates the effect of propofol and etomidate on hemodynamic parameters for safer induction. Methodology: After the ethical committee’s approval and written informed consent, 28 patients of ASA 1 and two of either gender, aged between 18 and 60 years and undergoing elective surgery, were randomly divided into two groups. Group P received injection Propofol (2.5 mg/kg), and Group E received injection Etomidate (0.3 mg/kg). The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and SPO2 (oxygen saturation) were recorded before induction, immediately after induction, and at 1, 3, 5, 10, 15, and 20 minutes. Result: Demographic variables and baseline hemodynamic parameters were comparable in both the groups. There was significant fall of HR, SBP, DBP, and MAP in group P in comparison to group E (P < 0.05). There were no statistically significant changes in oxygen saturation (SPO₂). Conclusion: Etomidate is a better induction agent when compared to propofol as it gives better hemodynamic stability and thus can be used in high-risk cases where stable hemodynamics are required.

Keywords: Etomidate, hemodynamic changes, propofol

O2424: Exploring the Etiology of Referred Otalgia: A Comprehensive study

Kshitij Saraswat, Sanjeev Awasthi, Hitender, Somya Gupta

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Ear pain, known as otalgia, has diverse origins, spanning from benign to severe conditions. Accurate diagnosis and treatment require an understanding of its etiology. Otalgia can be categorized as primary (ear-related) or referred (originating elsewhere). Referred otalgia poses unique challenges as pain is perceived in the ear despite nonear origins. Objectives: The aim of present study is to investigate the potential causes of referred otalgia involving cranial and cervical nerves and to explore the interplay between ear and distant body structures. Methodology: A prospective study conducted in an ENT OPD of Sharda Hospital, Greater Noida, involved 360 patients. Evaluations encompassed dental, nasal, and head and neck assessments. Data included age, gender, side affected, and underlying cause. Statistical analysis was conducted using SPSS version. Results: Out of 360 patients, 16.1% had referred otalgia. Most were female (67.2%), and right-sided involvement was predominant (47%). Toothache (31.6%) and pharyngitis (29.1%) were the most common leading causes. Other causes included gastroesophageal reflux disease, sinusitis, temporomandibular joint disease, cervical spine arthritis, and Bell’s palsy. Two cases (0.5%) were associated with supraglottic and base of tongue malignancies. Conclusion: This study provides insights into referred otalgia’s diverse origins, stressing the importance of comprehensive clinical evaluation for accurate diagnosis and tailored treatment. Collaboration among medical specialists is vital. Further research and clinical cooperation are needed to enhance our understanding of this complex condition.

Keywords: Referred otalgia, pharyngitis, temporomandibular joint disease

O2425: Assessing Intraoperative and Postoperative Complications Associated with Tonsillectomy in Children: Institutional Study

Pasupuleti Shivasai, Rohit Saxena, Abhinav Srivastava, Vishwani Khanna

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Tonsillectomy, a common procedure in children aged 2–18, aims to improve their wellbeing and minimize tonsil-related complications. Comprehensive risk assessment before and post surgery is crucial. This study analyzed numerous pediatric tonsillectomy cases to enhance our understanding of its safety and identify associated risk factors. Methodology: A 24-month retrospective cohort study focused on 100 children (aged 2–18) who underwent unilateral or bilateral tonsillectomy at Sharda Hospital’s ENT Department. Factors like age, gender, and complications during and up to 7 days post surgery were analyzed. Results: Gender and age were assessed for their correlation with complications in tonsillectomy patients. No significant correlation was found between gender and intraoperative or postoperative complications (P-values: 0.679584 and 0.822866). The low phi coefficient (1.501E-22) supports this, aligning with the infrequent occurrence of intraoperative complications. Age also showed no significant association with complications (P = 0.77216). Postoperatively, 49.11% experienced no issues within 7 days, while common problems included pain/discomfort (31.25%), nausea/vomiting (9.82%), and secondary hemorrhage (5.36%). Conclusions: This 24-month study on 100 pediatric tonsillectomy cases revealed no significant correlation between gender/age and complications. Postoperatively, the most prevalent issues included pain/discomfort, nausea/vomiting, and secondary hemorrhage, affecting nearly half of the patients.

Keywords: Discomfort, secondary hemorrhage, tonsillectomy

O2426: Hearing Impairment Impact on Mental Health in the Outpatient Department of ENT

Priyanka Barman, Stuti Shukla, Vivek Pathak, Rohit Saxena, Abhinav Srivastava

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Objectives: To assess the impact of hearing loss on the mental health of patients, highlighting the importance of a national hearing preservation program and its potential benefits. Methodology: The data for this study were sourced from patients attending the outpatient department of Otolaryngology at Sharda Hospital, SMS and R, Greater Noida. This hospital serves a diverse population, providing a broad demographic base for the study. This study was designed as a cross-sectional observational study. The objective was to observe and record data at a single point in time to determine the prevalence and impact of hearing loss on mental health among the patient population. The sample size for this study was calculated based on the formula for estimating population proportions in cross-sectional studies. Results: The incidence and associated risk of various mental health issues among 200 patients with hearing disabilities are documented. It reveals a notable prevalence of depression in 45% of these patients, with an odds ratio (OR) of 2.8, indicating they are nearly three times as likely to suffer from depression compared to those without hearing disabilities. Sleep disturbances and stress were reported in 37.5% and 32.5% of the patients, respectively, with both conditions showing statistically significant odds ratios suggesting increased risks relative to non-hearing-impaired populations. Conclusion: In conclusion, the findings from this study illuminate the profound interconnections between auditory health and mental wellbeing. They call for a paradigm shift in the management of hearing loss, advocating for an integrated approach that addresses the spectrum of physiological and psychological needs of those with hearing impairments. Ensuring that mental health consideration is integral to the treatment of hearing loss will significantly enhance the quality of life and wellbeing of affected individuals, fulfilling both medical and social models of health care.

O2427: A Clinical Study of Skin Changes in Pregnancy

Radha R. Rathi

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Pregnancy induces significant immunologic, metabolic, endocrine, and vascular changes, impacting the skin and related structures. Most dermatoses observed during pregnancy are benign and resolve postpartum, but certain skin conditions pose risks to fetal life and require monitoring. Aims: This study aimed to assess the frequency and types of skin changes in pregnant women, distinguishing between physiological alterations and specific dermatoses of pregnancy. Materials and Methods: This cross-sectional observational study was conducted at Sharda University Hospital’s Dermatology and Obstetrics departments. A total of 400 pregnant women, with or without skin complaints, were included after providing informed consent. Data were collected through physical examinations, medical histories, and relevant investigations such as CBC and LFT, with statistical analysis performed using SPSS v21. Results: In this study of 400 pregnant women, common skin changes included pigmentary alterations such as areola and nipple hyperpigmentation (83%) and linea nigra (37.5%). Vascular changes were noted in 13%, primarily peripheral edema (10.25%) and palmar erythema (1.5%). Connective tissue changes, especially striae gravidarum, were observed in 60.5% of participants. Specific dermatoses of pregnancy, such as atopic eruption (4.25%) and intrahepatic cholestasis (3.5%), affected 8.75% of women, while infections, predominantly fungal, were present in 13.5%. These results emphasize the range of physiological and pathological skin changes that occur during pregnancy. Conclusion: Skin changes during pregnancy are prevalent, typically benign, and resolve postpartum. However, specific dermatoses require thorough assessment to ensure appropriate management. Early identification can aid in providing supportive care, thus improving maternal and fetal outcomes.

Keywords: Atopic eruption of pregnancy, cross-sectional study, intrahepatic cholestasis, physiological alterations, pigmentary changes, pregnancy dermatology, pregnancy-related skin changes, specific dermatoses of pregnancy, striae gravidarum, vascular changes

O2428: Clinico-Dermoscopic-Histopathological Correlation of Partial Unilateral Lentigenosis – A Case Series

Alok indal, Kritika Bansal

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Partial unilateral lentiginosis (PUL) is an unusual pigmentary disorder characterized by multiple lentigines that are grouped within an area of normal-appearing skin. Lesions are often in a segmental pattern with a sharp demarcation at the midline. Aim: Correlation between clinical-dermoscopic-histopathological features of partial unilateral lentiginosis. Case Series: This present study aims to evaluate the clinico-dermoscopic-histopathological characteristics of PUL. The case series included eight cases of partial unilateral lentiginosis. A detailed clinical evaluation and local examination have been carried out. Dermoscopic examination was performed to assist the diagnosis. Histopathological examination to confirm the clinical diagnosis was carried out in addition to other tests. Then patient was enrolled for Nd-Yad laser. Methods: Hospital-based observational study. Patients presenting to Dermatology OPD in the past 1 year with the complaints of hyperpigmented macules on the body. Dermoscopy and histopath biopsy were done after confirming the diagnosis of partial unilateral lentiginosis; eight patients were included in the study. Results: Out of eight cases, seven cases were present in females and one was male. The common presentation includes lesions present at birth, but also some adult cases have been reported so far. Three out of eight patients had been diagnosed with adult-onset disease. Dermoscopy was done in all cases; out of eight cases, seven showed the features of simple lentigo and one showed the feature of ink-spot lentigo. Histopathology was done in all the patients, and findings were consistent with the diagnosis of lentigens. Conclusion: Hence, this study highlights the demographic profile of partial unilateral lentiginosis and correlation between clinical-dermoscopic-histopathological features of partial unilateral lentiginosis.

Keywords: Café au lait spots, dermoscopy, freckles, histopathology, lentigines, lentiginosis, partial unilateral lentiginosis

O2429: Evaluation of Hemoglobin, Serum Ferritin, and Thyroid Profiles in Female Noncicatricial Alopecia: A Case-Control Study

Anmol Rathore, Shitij Goel

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Alopecia can be broadly categorized into scarring and nonscarring types, with the latter including common conditions such as telogen effluvium and androgenetic alopecia. Several studies highlight the role of micronutrient deficiencies, such as low serum ferritin and thyroid dysfunction, in contributing to nonscarring alopecia in women. Objective: To assess hemoglobin, serum ferritin, and thyroid profiles in female patients with noncicatricial alopecia and correlate the findings with a control group to determine their significance in hair loss. Material and Methods: This case-control study was conducted at a tertiary care hospital in North India, involving 60 female patients with non-cicatricial alopecia and 60 healthy age-matched controls. Both groups were assessed for key lab parameters, including hemoglobin, serum ferritin, and thyroid profiles, to identify potential correlations. Results: Cases and controls had comparable distribution of age. Compared to controls, cases showed a similar distribution of hemoglobin (P = 0.091) and serum ferritin (P = 0.896). Significant differences were observed in serum T3 (P = 0.019) and T4 (P = 0.003) levels, with lower proportions of cases falling within the normal ranges. However, no significant difference was found in TSH levels (P = 0.063). Conclusion: The study showed that while hemoglobin and serum ferritin levels between cases and controls were comparable, significant differences were observed in serum T3 and T4 levels. These findings suggest that thyroid function may play a more pivotal role than iron status in non-cicatricial alopecia.

Keywords: Female non-cicatricial alopecia, iron deficiency, thyroid abnormality, and hair loss

O2430: Organophosphorus Poisoning in Pregnancy – A Case Report and Review of Literature

Mayuri Ahuja, Shelly Agarwal, Samta Gupta, Kajal Gupta

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Aim: This case report describes the management of a poisoning case due to organophosphate exposure in a third trimester pregnant woman. Case report: A referred case of 26-year-old intubated primi gravida at 34 weeks gestation presented in emergency. There was history of domestic fight, followed by some pesticide intake 24 hours back. The patient was intubated at some local hospital due to respiratory depression and was referred for further management. There was history of multiple episodes of vomiting, excessive salivation, and sweating, followed by unconsciousness. The patient was given intravenous atropine to reverse the cholinergic side effects. Her plasma pseudocholinesterase levels were also very low (150 IU), which further confirmed the diagnosis. Conclusion: Her atropinization as intravenous infusion continued with a tapering dose for a duration of 5 days till full recovery. The patient was discharged in stable conditions and delivered vaginally at 37 weeks of gestation. There were no neurological defects in fetus as well as mother. Discussion: Organophosphorus poisoning is a significant public problem, specially in developing countries where domestic abuse, poverty, and gender inequity are a matter of great concern. Organophosphorus, which is present in pesticides, is easily accessible for homicidal as well as suicidal cases. This case report represents the fact that the pregnancy was well.

Keywords: Atropinisation, Organophosphorus poisoning, pregnancy

Abbreviations

OP: organophosphorus poisoning

O2431: Beyond the Organogenesis and That the Baby Could be Delivered if Needed at any Stage During the Treatment

Priyanka Choudhary

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Challenge for obstetricians – Cesarean Scar Ectopic Pregnancy

Background: Cesarean scar is defined as when a blastocyst implants on a previous cesarean scar. The incidence of cesarean scar ectopic has increased due to an increase in number of cesarean deliveries. Early diagnosis of this can be done by using sonography. Incidence: 1 case in 2000 normal pregnancies and has increased along with cesarean delivery rates. It is very important because a delay can lead to increased maternal morbidity and mortality. Aim: To study the efficacy of various treatment modalities. Material and Methods: Case series of patients managed with different approaches. Conclusions: Cesarean scar ectopic pregnancies can have very fatal and poor outcomes; thus, it is important that early and accurate diagnosis of cesarean scar pregnancy is obtained in order to avoid complications and preserve fertility.

Keywords: Cesarean scar ectopic, cesarean section, fertility, methotrexate, uterine rupture

O2432: Comparing the Safety and Efficacy of Cyclosporine 0.05% versus 0.09% in Dry Eye Disease: Does Strength Make a Difference?

Rishabh S. Kushawaha

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: This is a multicenter, randomized, interventional study aimed to compare safety and efficacy of cyclosporine (0.05% versus 0.09%) in dry eye disease. Objectives: To compare the efficacy of cyclosporine 0.05% versus 0.09% in dry eye disease Methodology: Random allocation of patients (n = 450) was done in two groups by parallel assignment. Group 1(n = 225) received CAs 0.05% drops twice daily, and group 2 (n = 225) received CAs 0.09% drops twice daily for 3 months. The primary outcomes were changes from baseline in Lis amine green staining score, Nelson grade on conjunctiva impression cytology, and tear film osmolality. The secondary outcomes were changes in dry eye symptoms, Schemer’s test, changes in corneal fluorescein staining, and changes in TBUT. Results: Within the groups, there was a significant improvement (P < 0.05) in tear film osmolality, Lis amine green staining score, DESS, corneal fluorescein staining, and Schemer test scores over 3 months. Between the groups, there was a significantly better improvement in tear film osmolarity (P < 0.001), Lis amine green staining score (P = 0.002), corneal fluorescein staining (P = 0.011), dry eye symptoms (P = 0.040), and Schirmer test (P = 0.001) with CAs 0.09%. The overall patient’s comfort was significantly better over time in patients on CAs 0.05%. Conclusions: Increasing strength of CAs better improves corneal staining, tear production, and tear film osmolarity but not conjunctival morphology and tear film stability.

Keywords: DESS, dry eye, Schirmer, TBUT

O2433: Clinical Correlation between Polycystic Ovary Syndrome and Dry Eye Disease

Sanchita Gupta

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Hyperandrogenism and insulin resistance are seen in polycystic ovary syndrome (PCOS), which are also known risk factors for dry eyes. Dry eye is a potential comorbidity present in patients with PCOS. Objectives: To find correlation between dry eye disease (DED) and PCOS. Methodology: A total of 50 women with PCOS and 50 healthy controls were included in the study. They were then subjected to a complete ophthalmic evaluation which included tear film break-up time, Schirmer’s test, and Ocular Surface Disease Index (OSDI) questionnaire scoring. Results: Correlation between DED and PCOS was found to be statistically significant in both TBUT and OSDI score, while Schirmer’s test was found to be statistically insignificant. Conclusion: PCOS has a positive correlation with DED, and hence, regular eye check-ups are advisable for patients with PCOS.

O2434: Clinical Correlation between Diabetes and Dry Eye Disease

Anjali Tyagi

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Diabetes mellitus (DM) is one of the most common health-related diseases that the world has ever seen. There is increased prevalence of diabetic eye syndrome due to poor glycemic control, affecting the anterior and posterior segments of the eye. Objectives: To determine the prevalence of dry eyes in individuals with diabetes mellitus and to establish a relationship between the stages of diabetic retinopathy and dry eye conditions. Methodology: A total of 150 diabetic patients were subjected to comprehensive ophthalmic evaluation including visual acuity assessment, slit lamp examination, fundoscopy, and test for dry eyes, which included tear film break-up time, Schirmer’s test, tear meniscus height, fluorescein staining of cornea, meibomian gland status, and questionnaires. Chi-square and Fisher exact test were used to compare mean values, find P values, and ensure sugar statistical significance. Results: Correlation between dry eye disease, glycemic control, and diabetic retinopathy was found to be statistically significant, while gender, duration of diabetes, and random blood were statistically insignificant. Conclusion: Dry eyes and diabetes seem to go hand in hand. Patients with diabetes were shown to have a higher prevalence of asymptomatic tear film instability. As a result, testing for dry eyes needs to be a crucial component of diagnosing diabetic ocular illness.

Keywords: Diabetic retinopathy, dry eye disease, glycemic control

O2435: Determination of the Prevalence of Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus Seropositivity among Patients Posted for Cataract Surgery at a Tertiary Care Center

Bhumika

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Human Immunodeficiency Virus I, II (HIV-I, II), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV) are major public health and worldwide health issues. By applying universal infection control strategies, knowledge of seroprevalence would assist and limit the horizontal spread of infection and facilitate early patient diagnosis and treatment. Objectives: To assess the seroprevalence of HIV I, II, HBV, and HCV infections in patients having eye surgery. Methodology: Study design: Retrospective study. Duration of study: 1 year. Study location: Ophthalmology Department, Sharda Hospital, Sharda University Greater Noida. The total number of patients screened prior to cataract surgery was 1203, including 603 (51.1%) males and 600 (49.9%) females. Results: Out of the 1203 cataract patients booked for surgery, 130 (10.8%) turned out to be positive for HBV, HCV, and HIV. The total prevalence of HBV and HCV was found to be 81/1203 (6.7%) and 49/1203 (4.1%), respectively. Only one patient was found with a coinfection with both HBV and HCV, while only one patient (0.83%) was HIV-positive. Conclusion: The high prevalence of 10.8% of HBV and HCV among cataract surgery patients suggests that preoperative viral screening for all patients should be mandatory prerequisite for conduct of surgery. This prevalence among cataract surgery patients is alarming, not only for the general population but also for the general health care personnel. A solid policy outlining preventive practices is badly needed to control this phenomenon and prevent its adverse consequences.

Keywords: Cataract screening, HBV, HCV, viral screening

O2436: Evaluation of Visual Outcomes Following Neodymium Yttrium Aluminum Garnet (Nd-YAG) Laser Therapy for Posterior Capsular Opacity

Lakkshya B. Sharma

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Posterior capsular opacification (PCO) is a common late complication after cataract surgery, reducing visual acuity. Nd laser capsulotomy is an effective, noninvasive treatment, widely preferred for its safety and efficiency. Objectives: This study aimed to assess visual outcomes and complications following Nd capsulotomy in PCO patients. Methodology: A prospective study at a tertiary care center in India included 100 patients (over 40 years) with PCO-induced visual decline post-cataract surgery. Comprehensive eye exams were conducted, covering visual acuity, refraction, slit-lamp, intraocular pressure, and fundus exams. Results: Of the 100 patients (58 females, 42 males), 92% showed improved visual acuity (6/18 to 6/6) postcapsulotomy. Complications, occurring in 6% of patients, included raised intraocular pressure and iritis, both managed with medication. Conclusion: Nd capsulotomy is a safe, effective outpatient procedure that improves visual acuity in PCO patients. Risks are low but require careful patient selection, skilled techniques, and follow-up to prevent complications like glaucoma and retinal detachment.

Keywords: Fundus, IOP, Nd-YAG, PCO

O2437: Study of the Effect of Children Diagnosed with Autism Spectrum Disorder on Lives of Parents and Problems and Challenges Faced by Them

Vinayak Upadhyay, Pradeep Kumar, Praneta Swarup

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Autism spectrum disorder (ASD) poses significant challenges not only to affected children but also to their families, particularly parents. The impact of ASD on parents’ psychological, emotional, and social wellbeing can lead to increased stress and reduced quality of life. Aim: To study lives of parents and problems, challenges faced by them, of the children diagnosed with ASD. Objectives: To understand the specific issues that parents encounter, healthcare providers and policymakers can better address the needs of these families and develop effective interventions to improve their quality of life. Materials and Methods: This hospital-based observational cross-sectional study was conducted over 6 months (January to June 2024) at the Department of Pediatrics, School of Medical Sciences and Research. It is a questionnaire-based study. Ethical clearance was obtained, and informed consent was acquired from parents of children diagnosed with ASD visiting the Pediatrics Outpatient Department. Result: Among the participants, a majority were female (56.0%), with most parents aged 31–40 years (65.5%). Many parents reported inadequate support, with 31.5% feeling they received and “little support”. Satisfaction rates varied: 45.5% were satisfied with sleep, and 46.0% with daily living activities. Notably, 32.5% of respondents experienced negative feelings and “very often”. Conclusion: Parents of children with ASD face diverse challenges, including inadequate support and emotional distress. The findings underscore the need for targeted interventions and support programs to enhance their quality of life.

Keywords: Autism spectrum disorder, parental stress, quality of life, stress

O2438: A Case Series of Traumatic Brain Injury patients

Sonakshi, Rajeev K. Thapar, Bindu T. Nair, Amit Vij, Praneta Swarup

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Traumatic brain injury (TBI) in children leads to frequent visits to the emergency department (ED) and poses a risk for long-term negative consequences, making it a major public health issue. Road traffic accidents account for a major proportion of head injuries, but in the pediatric age group, fall from height is equally responsible. Aims: 1. The aim is to highlight the clinical presentation and management of TBI patients in pediatric age groups. 2. Role of Neuroprotective agents in TBI. Materials and Methods: Seven patients admitted to a tertiary care PICU with history of TBI were studied. Severity of brain injury of each patient was assessed according to clinical presentation, GCS, and NCCT findings. Pharmacological measures which were common to all patients included antiepileptics, osmotherapy, and antibiotics. Neuroprotectives were also added in one of the patients. Results: Out of the seven pediatrics, four were males and three were females, with age less than 5 years in all; the most common cause of TBI was fall from height, followed by road traffic accidents. The imaging studies (NCCT brain) revealed varying degrees of TBIs, including contusions, epidural hematomas, subdural hematomas intraventricular hemorrhage, and fractures, managed by osmotherapy, antiepileptics, and nutritional neuroprotectives. Conclusion: TBI in pediatric patients presents a significant clinical challenge. The addition of neuroprotective agents, particularly in severe TBI cases, may aid in accelerating recovery and improving clinical outcomes.

Keywords: Contusion, EDH, neuroprotective agents, SDH, traumatic brain injury

O2439: Adherence to Correct BCG Immunization Technique: A Clinical Audit

Kuldeepsinh Chavda, Ranjit Ghuliani, Meenakshi Bothra, Praneta Swarup

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Bacillus Calmette-Guerin (BCG) vaccination plays a pivotal role in preventing tuberculosis and mycobacterial infections. This clinical audit explores the historical significance, diverse protective mechanisms, and the critical role of accurate administration techniques for optimizing BCG’s global health benefits. Aims and Objectives: To evaluate and enhance adherence to the correct technique of BCG vaccination in neonates born at the hospital. Material and Methods: Conducted at Sharda Hospital, the audit aimed to evaluate and enhance adherence to the correct BCG vaccination technique in neonates. Pretraining audits revealed inconsistency, prompting a 1-day training program emphasizing intradermal administration. Post-training audits demonstrated a significant increase in adherence from 27.7% to 87.0%. Ethical considerations were strictly adhered to, with informed consent obtained for documentation. Results: Before training, wheal formation occurred in only 27.7% of cases. Post training, the rate rose to 87%, reflecting improved adherence. Newborn demographics showed term and preterm distribution, with timely vaccinations improved in post-training assessment. Conclusion: This clinical audit highlights the success of educational interventions in improving adherence to correct BCG vaccination techniques, emphasizing the need for periodic staff training and sustained monitoring. As tuberculosis cases rise, maintaining the correct vaccination practices is imperative for better healthcare outcomes.

Keywords: BCG, clinical audit, tuberculosis, vaccination

O2440: Spectrum of Dissociative Experiences in Generalized Anxiety Disorder: A Case Control Study

Pankaj Shah, Kunal Kumar, Abhinit Kumar, Nikhil Nayar, Purvi Vats, Shubhika Aggarwal, Abhinav Dhankar, Sourabh Ojha

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Dissociative experiences have been reported in the patients of generalized anxiety disorder (GAD) that are often unacknowledged but frequently encountered, and they contribute to the burden of illness. There are very limited studies in India on the topic of dissociative experiences in patients of GAD. Objectives: To evaluate the clinical spectrum of dissociative experiences in GAD patients. Methodology: It was a case control study conducted in the department of psychiatry at Sharda University, Uttar Pradesh. Patients above 18 years of age screening positive on HAMA scale were enrolled as cases, while the rest were enrolled as controls. DES-2 scale was applied to evaluate the cases and controls for dissociative experiences. Results: We enrolled 50 patients of GAD against 50 patients who did not have GAD. The patients of GAD were of the mean age 29.54 (SD = 7.58) years, mostly females (56%), Hindu (80%), married (74%), and living in a joint family (57.9%). Dissociative experiences were significantly more in GAD patients (DES-2 score:33.81 ± 12.45) as compared to controls (DES2 score: 16.88 ± 11.85) (P = 0.003). Dissociative experiences significantly increased with the severity of GAD (P = 0.029). Conclusion: Dissociative experiences are prevalent among GAD patients, with a significant association between GAD severity and dissociation. Clinicians should routinely assess dissociative experiences in GAD, especially those with higher GAD severity, to provide appropriate interventions.

Keywords: Dissociative experience, generalized anxiety disorder, hindu, married

O2441: Incidence of Childhood Trauma in Adult Patients with Dissociative Disorder

Ekta, Kunal Kumar, Abhinit Kumar, Nikhil Nayar, Shubhika aggarwal, Purvi Vats, Siddharth Bhargava, Parika Kochhar

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Dissociative disorders are characterized by disruptions in memory, identity, consciousness, or perception, often arising from childhood trauma complicating diagnosis and treatment. This study explores the incidence of childhood trauma in patients with dissociative disorders. Objectives: To study the incidence of childhood trauma in adult patients with dissociative disorder. Methodology: This cross-sectional study included 40 participants recruited from outpatient and inpatient departments of Sharda Hospital, Greater Noida. Participants aged 18 years and above, diagnosed with dissociative disorder according to ICD-11 criteria, were enrolled. Data were collected using the Adverse Childhood Experiences (ACE) questionnaire and Dissociative Experiences Scale-II (DES-II). Statistical analyses included Pearson’s correlation, t-test, and Chi-square test, with P ≤ 0.05 considered statistically significant. Results: Emotional neglect (52.5%) and emotional abuse (45.0%) were the most prevalent childhood traumas. A significant correlation was found between childhood trauma and dissociative symptoms. Higher ACE scores were associated with elevated DES indicating greater dissociative symptoms severity. Conclusion: Childhood trauma significantly influences the severity of dissociative symptoms in patients with dissociative disorders. Trauma-focused interventions may improve outcomes by addressing these interconnected symptoms.

Keywords: ACE, childhood trauma, DES II, dissociation, dissociative disorders, emotional abuse, ICD-11

O2442: Impulsivity and Alcohol Dependence: Analyzing Behavioral Patterns in Addiction

Deeksha, Kunal Kumar, Abhinit Kumar, Nikhil Nayar, Shubhika Aggarwal, Purvi Vats, Siddharth Bhargava, Parika Kochhar

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Impulsivity is a significant trait associated with a range of psychiatric and behavioral disorders, and it plays a critical role in the development and maintenance of alcohol dependence. Impulsivity can be understood as the tendency to act on urges and make hasty decisions without adequate forethought, often leading to risky behaviors. In individuals with alcohol dependence, impulsivity is often heightened, contributing to the initiation of drinking, escalation in the amount consumed, and difficulty in abstaining from alcohol. Objectives: This paper explores the relationship between impulsivity and alcohol dependence, aiming to understand their impact on addiction progression and recovery. Methodology: This cross-sectional study was conducted at the Department of Psychiatry, Sharda Hospital, involving 40 participants diagnosed with alcohol dependence per ICD-11 criteria. Data collection tools included the Severity of Alcohol Dependence Questionnaire (SADQ) and Barratt Impulsiveness Scale (BIS-11). Statistical analyses examined correlations among variables. Result: Participants averaged 39.2 years, with 80% male and 60% married. SADQ scores indicated 37.5% moderate and 37.5% severe dependence. 87.5% exhibited moderate-to-high impulsivity. Males, those with lower education, and lower-income participants showed higher SADQ scores (P = 0.01). Significant associations were found between alcohol dependence and impulsivity. Conclusion: Findings emphasize the strong association between alcohol dependence and impulsivity highlighting the need for integrated screening and intervention strategies.

Keywords: Alcohol dependence, Barratt impulsiveness scale, impulsivity, severity of alcohol dependence questionnaire

O2443: Association between Internalized Stigma and Self-Esteem in Depression Patients

Annu Yadav, Kunal Kumar, Abhinit Kumar, Nikhil Nayar, Shubhika Aggarwal, Purvi Vats, Sidharth Bhargava, Parika Kochhar

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Depression is a common mental health disorder marked by persistent sadness, impaired functioning, and reduced quality of life. Internalized stigma—self-stigma—occurs when individuals with depression accept negative societal beliefs about their condition, leading to shame, poor treatment adherence, and worsened clinical outcomes. Objectives: This study explores the extent of internalized stigma in individuals with depression and its association with clinical outcomes and sociodemographic factors. Methodology: A cross-sectional study was conducted with 30 patients diagnosed with depression at Sharda Hospital. Participants were assessed using the Hamilton Depression Rating Scale (HAM-D), Brown Assessment of Beliefs Scale (BABS), and Internalized Stigma of Mental Illness Scale (ISMI-9). Descriptive statistics summarized the data, and correlations between ISMI-9 scores and clinical variables were analyzed using Pearson’s coefficient. A P-value < 0.05 was considered statistically significant. Results: The mean ISMI-9 score was 2.3 ± 0.3. Females, urban residents, and Muslim participants exhibited slightly higher ISMI-9 scores, though these differences were not statistically significant. A moderate positive correlation (r = 0.387, P = 0.035) was observed between ISMI-9 and HAM-D scores, indicating that higher depression severity correlated with greater internalized stigma. Conclusion: Internalized stigma is prevalent among individuals with depression, with higher depression severity associated with increased stigma. Interventions targeting self-stigma may improve treatment outcomes.

Keywords: Clinical outcomes, depression, HAM-D, internalized stigma, mental health, self-stigma, sociodemographic factors

O2444: Early Results of Comparing the Clinical Response of Ormeloxifene, Evening Primrose Oil, and Topical Diclofenac for Treatment of Mastalgia in Benign Breast Disorders

Trehan Ashish, Kar Subhajit, Moudgil Ashish, Kale Ravi

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Mastalgia, or breast pain, is a common condition affecting up to 75% of women during their lifetime and accounts for 50% of referrals to breast clinics. It can be cyclical or noncyclical and is associated with significant discomfort as well as anxiety due to concerns about breast cancer. Standard management strategies include reassurance, supportive garments, evening primrose oil (EPO), diclofenac gel, and anti-estrogenic drugs. Objectives: This study aimed to compare the efficacy of oral ormeloxifene, oral EPO, and topical diclofenac in treating mastalgia associated with benign breast disorders. Methodology: Conducted as a randomized comparative study over 12 months at Sharda Hospital, Greater Noida, the trial included follow-ups at 4, 8, and 12 weeks. Results: Ormeloxifene had the greatest reduction in mastalgia, with a mean VAS decrease from 5.76 to 0.17, compared to 5.87 to 1.28 for EPO and 5.86 to 0.98 for diclofenac. Ormeloxifene also demonstrated the highest efficacy in resolving fibroadenomas, with 50% of patients achieving complete resolution and 50% partial resolution. It also achieved reduction in breast nodularity for all patients. EPO showed some efficacy, while diclofenac showed no effectiveness in these areas. Conclusion: Ormeloxifene emerged as the superior treatment option, offering significant pain relief, regression of fibroadenomas and nodularity, with minimal adverse effects, and low cost, making it patient-friendly for managing mastalgia.

Keywords: Diclofenac, mastalgia, ormeloxifene, primrose oil,

O2445: A Prospective Observational Study to Assess 1-hour Compliance of Sepsis Patients According to the Surviving Sepsis Campaign (ssc) Bundle: 2018 Update

Pranav Jain, Ashish Moudgil, Ravi Kale

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Objective: The present study aims to estimate the 1-hour bundle compliance of adult sepsis patients presenting to Emergency Department based on the updated SSC Guidelines 2018. Methodology: An e-sepsis registry was established in a 1300-bedded tertiary-care hospital based on SSC guidelines. Prospective observational design was followed. ED nurses and physicians identified qualifying sepsis patients. A clinician reconciled data in real time and recorded focus of infection, 1-hour sepsis bundle adherence on updated SSC 2018 guidelines, and outcomes. Results: Of 100 patients recruited into registry, 42% were 60–79 years old and 65% were males. 93% had sepsis and 7% had septic shock. Mortality was 13%. Severity of sepsis was significantly associated with mortality (P < 0.001). The mortality rates were 57% and 9% among septic shock and sepsis categories, respectively. The average admission SOFA score was 5.1 ± 2.1 with significantly high scores for expired patients (7.38 ± 3.6) relative to survivors (4.72 ± 2.5) (P = 0.023). Major foci of infections were UTI (17%), bacteremia (10%), and pneumonia (9%). The patients who satisfied 1-hour bundle compliance criteria were relatively low at 9%. 68% of patients who complied with 1-hour bundle expired. The ASOFA values of the patients who had 1-hour bundle compliance (8 ± 3.4) were significantly higher than those without 1-hour compliance (9 ± 3.4). Conclusion: Our present data suggest the low prevalence of 1-hour bundle compliance. Further interventions to improve 1-hour compliance should target early identification of sepsis and administration of empirical antibiotics.

O2446: Outcome of Early versus Late Laparoscopic Cholecystectomy in Post-Endoscopic Retrograde Cholangiopancreatography Patients for Choledocholithiasis

Riddhi Samar, Roy Sharma, Shashank Rai, Kuldeep Raj, Jagdish Mutreja

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Cholelithiasis is a common condition with a low mortality rate but has significant potential for complications, including choledocholithiasis, where gallstones migrate to the common bile duct. This occurs in 10–18% of cholelithiasis cases, with secondary choledocholithiasis being more common. Treatment typically involves endoscopic retrograde cholangiopancreatography (ERCP) for stone removal followed by laparoscopic cholecystectomy. While ERCP is effective, it can lead to complications such as inflammation and adhesions, increasing the conversion rate to open surgery, especially when cholecystectomy is delayed. This study compares the safety and efficacy of early versus delayed cholecystectomy in patients with choledocholithiasis to guide optimal treatment timing. Objectives: To evaluate the outcome of early versus late laparoscopic cholecystectomy in post-ERCP patients for choledocholithiasis. Methodology: It is a prospective comparative study done at Sharda hospital over a period of 18 months (May 2023 to November 2024). A total of 52 patients were included in the study, and they were divided equally in 2 groups, 26 patients in each arm, group A, early lap cholecystectomy within 3 days of ERCP (72 hours), and Group B, late lap cholecystectomy – 6 weeks. Outcomes were compared on the basis of operating time, conversion to open cholecystectomy, Intra op findings, and postoperative complications (hemorrhage, surgical site infection, pancreatitis, CBD injury, bowel injury). Results: Group A exhibited a significantly higher rate of safe laparoscopic cholecystectomy post ERCP as compared to Group B. Conversion rates and operating time in Group A patients were statistically low with less postoperative complications and a lesser hospital stay. Conclusion: The study concluded that an early laparoscopic cholecystectomy post ERCP for the management of choledocholithiasis was found to be a safe, effective, and timesaving technique with a low rate of postoperative complications.

Keywords: Cholangiopancreatography, choledocholithiasis, hemorrhage, surgical site infection

O2447: Mesenteric Variant of Meckel’s Diverticulum with Perforation by Ascaris: A Rare Case report and Literature Review

Yadav Ruchi, Moudgil Ashish, Kale Ravi, Kar Subhajit, Trehan Ashish, Jain Pranav

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Meckel’s diverticulum, a congenital malformation due to incomplete vitelline duct regression, can lead to significant gastrointestinal complications, including obstruction, hemorrhage, and, rarely, perforation. Perforation by Ascaris lumbricoides, though extremely uncommon, represents a unique diagnostic and therapeutic challenge, particularly in regions with high parasite prevalence. Objectives: To present a rare case of a mesenteric variant of Meckel’s diverticulum with perforation by Ascaris. Methodology: A 14-year-old male presented with acute abdominal pain, vomiting, and fever. Imaging studies revealed bowel obstruction, with ultrasound and CECT findings suggestive of partial malrotation and distended bowel loops. Emergency exploratory laparotomy identified a perforated Meckel’s diverticulum on the mesenteric side of the ileum with an Ascaris worm in the peritoneal cavity. The segment of bowel containing the diverticulum was resected, followed by an ileoileal anastomosis. Results: Postoperative recovery was uneventful, with histopathology confirming inflammatory changes and necrosis in the diverticulum. A review of literature indicated fewer than 0.5% of Meckel’s (symptomatic) cases present with perforation, and perforation due to ascariasis is even rarer. Conclusion: This case highlights the need to consider Meckel’s diverticulum in pediatric patients with acute abdomen, especially in endemic areas for Ascaris. A preoperative diagnosis remains challenging, underscoring the importance of surgical exploration in atypical presentations. Literature review emphasizes the rarity of such cases and the role of prompt surgical intervention in favorable outcomes.

Keywords: Ascaris, mesenteric variant, meckel’s diverticulum

O2448: Curious Case of Retroperitoneal Hydrated Cyst

Sparsh Sharma, Ashok Bhatnagar, Vijay Anand

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Hydatid disease (HD) is a common parasitic disease which is caused by larva stage of Echinococcus granulosus with worldwide distribution and has various modes of presentation, and it can involve any part of the human body. It commonly involves liver and lungs and rarely involves the brain, heart, and other organs. It primarily affects the liver and demonstrates characteristic imaging findings on ultrasonography (US); computed tomography (CT) and magnetic resonance imaging (MRI) are highly accurate in detecting hepatic hydatid cyst. It can be treated by surgery and conservative management with albendazole and percutaneous aspiration. In our patients who presented with lump in the right iliac region, on further evaluation, the patient was diagnosed with retroperitoneal hydatid cyst based on clinical presentation, radiological correlation, and serology confirmation. The patient was given albendazole pre- and postoperatively. The patient underwent surgery with deroofing of the cyst and evacuation of the entire hydatid fluid, laminated membrane, and multiple daughter cyst. Follow-up was done for 6 months, and it showed no evidence of recurrence.

Keywords: Echinococcus granulosus, hydatid cyst, retroperitoneal

O2449: Evaluation of Hemoglobin, Serum Ferritin, and Thyroid Profile in Female Noncicatricial Alopecia: A Case-Control Study

Anmol Rathore, Shitij Goel

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Alopecia can be broadly categorized into scarring and nonscarring types, with the latter including common conditions such as telogen effluvium and androgenetic alopecia. Several studies highlight the role of micronutrient deficiencies, such as low serum ferritin and thyroid dysfunction, in contributing to nonscarring alopecia in women. Objective: To assess hemoglobin, serum ferritin, and thyroid profiles in female patients with noncicatricial alopecia and correlate the findings with a control group to determine their significance in hair loss. Material and Methods: This case-control study was conducted at a tertiary care hospital in North India, involving 60 female patients with noncicatricial alopecia and 60 healthy age-matched controls. Both groups were assessed for key lab parameters, including hemoglobin, serum ferritin, and thyroid profiles, to identify potential correlations. Results: Cases and controls had comparable distribution of age. Compared to controls, cases showed a similar distribution of hemoglobin (P = 0.091) and serum ferritin (P = 0.896). Significant differences were observed in serum T3 (P = 0.019) and T4 (P = 0.003) levels, with lower proportions of cases falling within the normal ranges. However, no significant difference was found in TSH levels (P = 0.063). Conclusion: The study showed that while hemoglobin and serum ferritin levels between cases and controls were comparable, significant differences were observed in serum T3 and T4 levels. These findings suggest that thyroid function may play a more pivotal role than iron status in noncicatricial alopecia.

Keywords: Female noncicatricial alopecia, iron deficiency, thyroid abnormality, and hair loss

O2450: A Clinical Study of Skin Changes in Pregnancy

Radha R. Rathi, Shitij Goel

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Pregnancy induces significant immunologic, metabolic, endocrine, and vascular changes, impacting the skin and related structures. Most dermatoses observed during pregnancy are benign and resolve postpartum, but certain skin conditions pose risks to fetal life and require monitoring. Aims: This study aimed to assess the frequency and types of skin changes in pregnant women, distinguishing between physiological alterations and specific dermatoses of pregnancy. Materials and Methods: This cross-sectional observational study was conducted at Sharda University Hospital’s Dermatology and Obstetrics departments. A total of 400 pregnant women, with or without skin complaints, were included after providing informed consent. Data were collected through physical examinations, medical histories, and relevant investigations such as CBC and LFT, with statistical analysis performed using SPSS v21. Results: In this study of 400 pregnant women, common skin changes included pigmentary alterations such as areola and nipple hyperpigmentation (83%) and linea nigra (37.5%). Vascular changes were noted in 13%, primarily peripheral edema (10.25%), and palmar erythema (1.5%). Connective tissue changes, especially striae gravidarum, were observed in 60.5% of participants. Specific dermatoses of pregnancy, such as atopic eruption (4.25%) and intrahepatic cholestasis (3.5%), affected 8.75% of women, while infections, predominantly fungal, were present in 13.5%. These results emphasize the range of physiological and pathological skin changes that occur during pregnancy. Conclusion: Skin changes during pregnancy are prevalent, typically benign, and resolve postpartum. However, specific dermatoses require thorough assessment to ensure appropriate management. Early identification can aid in providing supportive care, thus improving maternal and fetal outcomes.

Keywords: Physiological alterations, pigmentary changes, pregnancy-related skin changes, specific dermatoses of pregnancy, vascular changes

O2451: Study on the Association between Microalbuminuria and Hospital Outcome in Patients of Sepsis Admitted in the Critical Care Unit of a Tertiary Care Hospital

Jaishree Sharma, Anurag prasad

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: In sepsis, there is potent activation of the inflammatory cascade that leads to endothelial dysfunction. In the kidney, there is a loss of barrier integrity and a capillary leak in the glomerulus results in increased excretion of albumin in the urine. Aims and Objectives: This study was done to evaluate the degree of microalbuminuria (urine ACR) in sepsis in correlation with APACHE II score and to test whether the degree of microalbuminuria could predict mortality in critically ill sepsis patients. Material and methods: The present study was conducted on 50 patients admitted to Medical ICU in SMS and R, Sharda Hospital Greater Noida; spot urine samples were collected within 24 hours of admission. Urine albumin creatinine ratio was calculated. APACHE II scoring was done at 24 hours of admission. Samples were tested for urine microalbumin by using the immunoturbidometric method and for urine creatinine by Jaffe method. Urine albumin: creatinine ratio was calculated (Urine ACR). Patients were followed up during the hospital stay, and the outcome of the patient is recorded. Results: The present study included 50 patients, among which 36 were males and 14 were females. The mean age was 42.02 years. Among nonsurvivors, it was 17.06. Urine ACR was 103.38 ± 29.45 µgm/mg among survivors and 177.17 ± 16.06 µgm/mg among nonsurvivors. Urine ACR was statistically significant with a P-value of 0.0001 for predicting mortality. Conclusion: Our study concluded that significant microalbuminuria is predictive of mortality, which is equivalent to the APACHE II score. Early measurements may help in the clinical assessment of critically ill patients at risk of worse prognosis.

Keywords: APACHE II, Sepsis, UACR

O2452: Effectiveness of Noninvasive Ventilation in Acute Respiratory Failure

Rudra D. Kaushik, A. K. Gadpayle

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Noninvasive ventilation (NIV) has become an alternative to invasive mechanical ventilation in managing acute respiratory failure (ARF). This study aims to evaluate the effectiveness of NIV in improving clinical outcomes in ARF patients. Aims and Objectives: To evaluate the effectiveness of NIV in ARF and compare its outcomes with invasive mechanical ventilation. Materials and Methods: This prospective study enrolled 30 adult patients with ARF due to various causes. Participants were randomly assigned to receive either NIV or invasive mechanical ventilation. Outcomes measured included intubation rates, ICU stay, oxygenation improvement, and mortality. Statistical significance was set at P < 0.05. Results: NIV led to a significant improvement in oxygenation (P < 0.05), reduced intubation rates, and shortened ICU stays compared to invasive ventilation. The NIV group also showed fewer ventilator-associated complications, though mortality differences were not statistically significant (P = 0.07). Conclusion: NIV is a safe and effective alternative to invasive ventilation in ARF, reducing intubation need, improving oxygenation, and shortening ICU stay. NIV should be considered a first-line therapy in appropriate ARF cases.

Keywords: Mechanical ventilation, noninvasive ventilation, respiratory failure

O2453: To Study the Correlation of Severity of Bronchial Asthma with Vitamin D Levels

Aman Ansari, Suresh B. Gupta

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Bronchial asthma affects approximately 300 million people worldwide or 810% of the global population. Both asthma and vitamin D deficiency share common risk factors, including industrialization, poor diet, obesity, dark skin pigmentation, winter season, and high latitude. Litonjua and Weiss hypothesized that vitamin D deficiency could be a key factor in the rising asthma epidemic. Growing evidence suggests that vitamin D plays a crucial role in asthma pathogenesis by regulating immune cells and modulating both innate and adaptive immune responses. Vitamin D is also known for its anti-inflammatory properties, reducing proinflammatory cytokines while enhancing anti-inflammatory cytokines, which may impact asthma severity and control. Aim and Objectives: To evaluate Vitamin D levels in bronchial asthma and to correlate levels of Vitamin D with severity of bronchial asthma. Materials and Methods: This cross-sectional study included 90 patients diagnosed with bronchial asthma, aged 15–70 years or older, who were recruited from outpatient and inpatient patients and were enrolled as cases. There were age-matched 50 healthy controls. Participants were assessed for asthma severity using the GINA guidelines based on clinical symptoms, frequency of exacerbations, and pulmonary function tests (FEV1, peak flow). Serum vitamin D levels were measured using [method, e.g., enzyme-linked immunosorbent assay (ELISA)] and categorized as deficient, insufficient, or sufficient. The relationship between asthma severity and vitamin D levels was analyzed using Pearson correlation with a significance level set at P < 0.05. Results: A total of 90 adults with bronchial asthma were evaluated. Among patients with intermittent asthma, 53.8% had sufficient vitamin D levels, while 38.5% had insufficient and 7.7% were deficient. In mild asthma cases, 65.2% had insufficient levels, 17.4% had sufficient, and 17.4% were deficient. For moderate asthma, 73.3% were vitamin D deficient, 20% had insufficient levels, and 6.7% had sufficient levels. In severe asthma, 72.7% were deficient, 18.2% had insufficient levels, and 9.1% had sufficient levels. These findings indicate a higher prevalence of vitamin D deficiency in patients with more severe asthma. Conclusion: This study demonstrates a significant association between the severity of bronchial asthma and vitamin D levels. Lower vitamin D levels were observed in patients with more severe asthma, particularly those with moderate to severe forms of the disease. These findings support the potential role of vitamin D deficiency in asthma pathogenesis and suggest that vitamin D supplementation may be considered as an adjunctive approach to asthma management.

Keywords: Bronchial asthma, Litonjua and Weiss hypothesis, vitamin D

O2454: Blood Neutrophil to Lymphocyte ratio in Newly Detected Hypertension and Its Correlation with Staging

Manuj Shukla, A. K. Gadpayle

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Blood neutrophil to lymphocyte ratio (NLR) has emerged as a potential marker of systemic inflammation and has been associated with various cardiovascular diseases. Hypertension, a major risk factor for cardiovascular events, has been linked to increased inflammatory markers. The relationship between NLR and the staging of newly diagnosed hypertension remains unclear and warrants further investigation. Objectives: This study aims to evaluate the role of NLR in newly detected hypertension and its correlation with the different stages of hypertension, as defined by the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines. Materials and Methods: A cross-sectional study was conducted on newly diagnosed hypertensive patients. Blood samples were collected to calculate the NLR, and patients were classified into three groups based on blood pressure readings: Stage 1, Stage 2, and Stage 3 hypertension. Clinical data, including demographic characteristics, medical history, and laboratory results, were analyzed to explore the correlation between NLR and the severity of hypertension. Results: Preliminary results suggest that NLR increases with the severity of hypertension. The NLR in Stage 3 hypertension was significantly higher compared to Stage 1 and Stage 2 groups (P < 0.05). Additionally, a positive correlation was found between NLR and blood pressure readings, with higher NLR values correlating with elevated systolic and diastolic pressures. Conclusion: Our findings indicate that NLR may serve as a useful inflammatory marker in assessing the severity of hypertension. Elevated NLR could potentially reflect a proinflammatory state associated with more advanced stages of hypertension. Further longitudinal studies are needed to assess the predictive value of NLR in hypertensive patients and its potential role in disease management.

Keywords: Hypertension, inflammation, neutrophil to lymphocyte ratio

O2455: Impact of Passive Smoking on Lipid Profiles in Healthy Nonsmoking Women: A Retrospective Study

Debanjan Goswami, Ashok K. Dash

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Passive smoking, or exposure to environmental tobacco smoke (ETS), is associated with several health risks, but its effect on lipid profiles in nonsmoking females is not well documented. This study investigates the impact of passive smoking on lipid levels in healthy women exposed to ETS, particularly focusing on variations in lipid profile in relation to duration of exposure. Objectives: To study the impact of passive smoking on lipid levels in healthy women exposed to ETS, particularly focusing on variations in lipid profile in relation to duration of exposure. Materials and Methods: This retrospective observational study included 100 nonsmoking women aged 18–40 who attended routine health check-ups at Government Rajaji Hospital, Madurai, between April and August 2022. All participants had at least one family member who smoked or had workplace exposure to ETS. Data were collected on demographic details, duration of ETS exposure (categorized as less than 5 years or more than 5 years), and lipid profile levels, including total cholesterol, triglycerides, LDL, HDL, and VLDL. Results: The study findings suggest that passive smoking is associated with adverse lipid profile changes, including increased total cholesterol, triglycerides, LDL, and VLDL levels, along with decreased HDL levels, which indicate an atherogenic shift in lipid profiles among women exposed to ETS. These changes appear to correlate with the duration of ETS exposure. Conclusion: Our study indicates that passive smoking may be a significant risk factor for dyslipidemia, similar to active smoking, potentially increasing cardiovascular risk in nonsmoking women. This effect is likely to increase their risk of cardiovascular diseases.

Keywords: Dyslipidemia, environmental tobacco smoke, passive smoking

O2456: A Study of Renin–Angiotensin–Aldosterone system (RAAS) Changes in Chronic Obstructive Pulmonary Disease

Yanamaddi S. Ram, Suresh B. Gupta

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Chronic obstructive pulmonary disease (COPD) is a systemic disease characterized by lung tissue damage and progressive airflow limitation that is irreversible. COPD affects more than 5% of the world population and is represented by chronic cough and progressive dyspnea. Aim: To study changes in RAAS system (serum renin, serum angiotensin, aldosterone) in COPD. Material and Methods: This is a cross-sectional study which was conducted on 25 patients admitted in IPD of General Medicine department of Sharda hospital. Among 25 patients, 19 patients had history of smoking for more than 10 years and were detected to have FEV1/FVC > 0.7 on pulmonary function test. All patients who were already diagnosed with bronchial asthma, pulmonary Koch, Type 2 DM, liver disease, and hematological disorder have been excluded from this study. Results: The mean age of the population was 52.6 years. 15 males and 10 females were enrolled in this cross-sectional study. The average duration of smoking was recorded to be 21.32 years. The mean renin level was 4.42 + 2.62 ng/mL. The mean Angiotensin 2 level was 0.82 (+ 0.169) ng/mL. The mean Aldosterone was 67.5 (+77.18) ng/dL, and mean IL-2 was 6.72 (+4.11) pg/mL. It was observed that renin, angiotensin 2, aldosterone, and Interleukin-2 levels were raised in 64%, 60%, 68%, and 76% of the study participants, respectively. Conclusion: A correlation between RAAS system and COPD was admitted in this study. Serum renin, angiotensin, and aldosterone were found to be elevated in the majority of smokers. The components of RAAS system can be used as potential prognostic and diagnostic biomarkers in chronic obstructive pulmonary disease in the near future.

Keywords: COPD, RAAS, renin, smoking

O2457: Evaluation of Serum Prolactin Level in Cirrhosis of Liver and its Correlation with Child-Turcotte-Pugh Score

Aditya Goel, Pankaj Bansal

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: With the increasing incidence of liver cirrhosis, the use of a biomarker such as prolactin indicates the severity of the disease and its complications and serves as a tool for early intervention. Aim: To determine the level of serum prolactin among patients with cirrhosis of liver and its correlation with the Child-Turcotte-Pugh score. Materials and Methods: This is an observational cross-sectional study on 50 patients admitted under Department of Medicine, SRMS from May 2023 to August 2024. All the patients are subjected to the routine workup for chronic liver disease including serum prolactin level. Results: The mean age is found to be 45 years with SD Â ± 13 years, the male and female ratio is 3:1; with regard to mean prolactin levels, among the males, it is 50.2 ng/dL, and in females, it is 35.4 ng/dL. The various clinical presentations noted in our study included ascites in 45 (90%) patients, portal hypertension in 39 (78%) of the patients, esophageal varices in 30 (60%) with upper GI bleed in 23 (44.6%) patients, and hepatic encephalopathy (grades 1–4) in 36 (72%) patients. Out of 50 patients, 35 (70%) were of class C in Child Pugh score and the mean prolactin level is found to be 53.638 ng/mL, while normal serum prolactin levels are seen in all patients with Class A of Child Pugh Class with P value < 0.001. Conclusion: Serum prolactin level correlated with the Child Pugh score in predicting the severity of the disease. Patients with a higher serum prolactin have a greater incidence of complications of cirrhosis like PHTN, HE, and esophageal varices.

Keywords: Cirrhosis, CTP score, prolactin

O2458: Lactate/Albumin Ratio as a Better Prognostic Indicator than Lactate Alone in Patients with Sepsis and Septic Shock

Abhishek R. Shinde, Anurag Prasad

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: It is important to have sensitive markers for predicting morbidity and mortality in patients with sepsis to improve the outcomes of such patients. The aim of this study was to assess the prognostic value of lactate to albumin (L/A) ratio with lactate alone. Materials and Methods: This was a single-center retrospective cohort study, with patients who had a suspicion of sepsis. The primary outcome was prolonged ventilatory days and in-hospital stay, with a secondary outcome of in-hospital mortality. Results: A total of 350 patients were included, of which most of the patients belonged to 4050 years, and 56% were female. 60% of patients were admitted to ICU, and of this, 22.5% had ventilatory support for more than 7 days. The average in-hospital stay was 21 ± 5.6 days. The overall in-hospital mortality rate was 34.5%, with that being related to septic shock being as high as 72%. The area under the curve value for lactate was 0.68 (at 95% confidence interval, it is 0.61–0.70, P < 0.05) and for the L/A ratio was 0.72 (at 95% confidence interval, it is 0.65–0.73, (P < 0.05). The cutoff generated was 1.22 (sensitivity 62%, specificity 68%) for the L/A ratio in all septic patients The L/A ratio was a predictor of prolonged ventilatory days and in hospital stay as well as in-hospital mortality (OR 1.47, P < 0.05).Conclusion: The L/A ratio is a better prognostic indicator than lactate alone in patients with sepsis and septic shock for prolonged ventilatory stay, in-hospital stay, and in-hospital mortality.

Keywords: In-hospital stay, lactate/albumin ratio, prognostic, prolonged ventilation, sepsis

O2459: Prevalence of Allergic Bronchopulmonary Aspergillosis in patients with Bronchial Asthma

Neha Aggarwal, Devendra K. Singh, Sonisha Gupta, Tamanna Gahlawat

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Bronchial asthma is a chronic condition, the onset of which usually occurs in childhood, and patient symptoms usually vary with intensity and time. These symptoms can be aggravated by multiple insults like stress, exercise, change in weather, altitude, infections, and exposure to fungi like Aspergillus fumigatus. The severity of bronchial asthma can be reduced when these triggering factors are removed. Aim: To evaluate the frequency of sensitization to aspergillus antigens and the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in asthmatic patients. Methods: Patients attending OPD and IPD in the department of respiratory medicine at a tertiary care center in western Uttar Pradesh. Previously diagnosed cases of bronchial asthma and new cases after screening were included. All patients were then subjected to skin prick test against Aspergillus fumigatus antigen. Result: A total of 80 patients were evaluated. The average age was 36 years. Thirteen patients (16.3%) had a positive skin reactivity to aspergillus antigens out of 80 patients enrolled. Conclusion: Asthmatic patients with ABPA usually experience poor symptom control despite standard treatment of bronchial asthma. In such a scenario, ABPA should be suspected as a reason. All patients with bronchial asthma should be screened for ABPA by skin test for Aspergillus species. If found positive, special consideration is needed to rule out ABPA.

Keywords: ABPA, bronchial asthma, skin prick test

O2460: Study on Coagulation Abnormalities and Long-Term Pulmonary Outcomes among COVID-19 Patients

Robin Bhati, Sonisha Gupta, Devendra K. Singh, Tamanna Gahlawat

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Many patients with severe COVID-19 present with lung function abnormalities; a proportion of patients with severe COVID-19 also present with coagulation abnormalities that mimic other systemic coagulopathies associated with severe infections, such as disseminated intravascular coagulation (DIC) or thrombotic microangiopathy, but COVID-19 has distinct features. Coagulopathy in patients with COVID-19 is associated with an increased risk of death. Aim and Objectives: To study coagulation abnormalities and long-term pulmonary outcomes among COVID-19 patients. Material and Methods: After approval from the institutional ethical committee, a cross-sectional study was conducted in the respiratory medicine department at a tertiary care hospital of western Uttar Pradesh. 106 patients of diagnosed COVID-19 by RT PCR were included. All patients were subjected to coagulation profiles. Results: Among the study participants, 67 (63.21%) were males and mostly above 55 years of age. Prolonged PT, APTT, and INR were found among 54 (50.9%), 55 (51.8%), and 50 (40.2%) of COVID-19 patients, respectively. Prolonged PT, APTT, and INR were more frequently seen among severely (14/21, 66.6%) and critically ill cases (12/16.75%).Conclusion: Elevated D-dimer and fibrinogen in the early stage of the disease with minimally deranged prothrombin time and platelet counts are prominent and distinguishing features. The study findings among COVID-19 patients showed that hypercoagulability, endotheliopathy, and inflammation extend well beyond the normal.

Keywords: Coagulation profile, COVID-19, D-dimer

O2461: The Pattern of Allergic Bronchopulmonary Aspergillosis in Asthmatic Patients

Tamanna Gahlawat, Devendra K. Singh, Sonisha Gupta, Robin Bhati

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Asthma is a chronic respiratory condition marked by wheezing, shortness of breath, and cough and can sometimes be fatal. Aspergillus fumigatus, a common fungus, is closely linked to asthma, causing conditions such as allergic bronchopulmonary aspergillosis (ABPA), aspergilloma, and invasive aspergillosis. ABPA is often misdiagnosed as pulmonary tuberculosis. Aim and Objectives: To determine the prevalence of ABPA in adult asthmatics at a tertiary care hospital using ISHAM criteria. Materials and Methods: After approval from the institutional ethical committee, a hospital-based cross-sectional study was conducted from March 20, 2023 to June 30, 2024. Newly diagnosed or newly diagnosed asthmatic patients from the departments of Respiratory Medicine at a Delhi-NCR tertiary care center were included. All patients underwent X-ray chest, HRCT chest, spirometry, blood eosinophil count, serum total, and specific Ig E for Aspergillus fumigatus. Results: Of 165 asthma patients, 21.81% met the ISHAM criteria for ABPA. Key findings include elevated total IgE (>1000 IU/mL) in 20%, positive Aspergillus-specific IgE in 12.2%, and eosinophil counts >500 cells/microL in 36.4%. Radiological findings favor ABPA in 33.3%. The highest prevalence was in those aged 46–60 and >60 years, with a slight female predominance (54.5%). Conclusion: ABPA is often misdiagnosed as TB, thus delaying the diagnosis of ABPA. Screening for ABPA should be carried out in asthmatic patients especially with poorly controlled symptoms despite standard treatment.

Keywords: ABPA, bronchial asthma, ISHAM criteria

O2462: Assessment of Variability in Tear Film Breakup Time among Computer Users Based on Daily Screen Time

Arpita Singh

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Prolonged computer use has been linked to a reduction in tear film breakup time (TBUT), contributing to the development of dry eye syndrome. This study aims to investigate the variations in TBUT in relation to the number of hours spent on computers each day. Methodology: Participants were categorized into five groups based on their daily computer usage: Group A (less than 2 hours), Group B (2 to 4 hours), Group C (4 to 6 hours), Group D (6 to 8 hours), and Group E (more than 8 hours). All participants underwent testing for TBUT. To compare mean values and determine statistical significance, both Chi-squared tests and analysis of variance (ANOVA) were employed to calculate P values. Results: In this study, the mean age of the study population was 32.18 ± 5.38 years. The mean TBUT in the various groups was found to be 25.83, 21.20, 18.62, 12.40, and 9.43 seconds in the right eye and 26.05, 21.19, 18.57, 12.31, and 9.41 seconds in the left eye in groups A, B, C, D, and E, respectively. Conclusion: It seems there is a significant decrease in TBUT with increasing duration of computer use per day. TBUT can be performed quickly and easily and be used to screen and support diagnosis of dry eye.

Keywords: Computer vision syndrome, daily screen time, dry eye disease, TBUT

Poster Presentation: P2401: The Impact of Air Pollution on Pulmonary Function Tests in Exposure Groups

Ananya Dubey, Muthukrishnan Shobitha, Shalini Rastogi

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Air pollution poses a public health concern linking it to impaired respiratory function which needs exploration. Aim: To compare pulmonary function test (PFT) between individuals with high outdoor poor Air Quality Index (AQI) exposure and those with predominantly indoor exposure and also to examine the correlation between AQI levels and PFT. Methodology: Thirty healthy participants were divided into two groups: a high outdoor exposure group (6–8 hours daily; n = 15) and a predominantly indoor exposure group (less than 2 hours daily; n = 15). Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF) were evaluated. AQI exposure level was categorized according to the National Air Quality Index (NAQI), which classifies AQI as “Good” (0–50) to “Severe” (401–500). Unpaired t-tests assessed the group differences, and correlation analysis between AQI and PFT parameters was done. Results: Significant reductions were observed in FVC and FEV1 among the outdoor-exposure group compared to the indoor group (P < 0.05). Differences in PEF were not statistically significant (P = 0.061). Conclusion: Poor AQI is associated with reduced pulmonary function, namely, FVC and FEV1. These findings underscore the need for public health interventions to mitigate respiratory risks for individuals with high outdoor exposure in regions with elevated AQI.

Keywords: National air quality index, pulmonary function tests, T-test

P2402: Early Detection of Antimicrobial Susceptibility in Bloodstream infections

Shubhra Rao, Tarana Sarwat, Zarine Khan

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: One of the leading causes of mortality for patients admitted to hospitals is sepsis. Despite advances in critical care medicine, sepsis cases are predicted to result in 15–30% mortality. Given how quickly sepsis can develop into a potentially fatal illness, prompt and accurate diagnosis is essential. Administering suitable antimicrobial medication within the time of diagnosing severe sepsis or septic shock is required to reduce morbidity and mortality and prevent antibiotic resistance. Aim: To evaluate direct sensitivity test (DST) as a potential tool to get early and reliable antibiotic susceptibility results. Material and Methods: This cross-sectional study was conducted between April 2024 and August 2024. Blood from all positively flagged culture bottles was Gram-stained. All samples showing monomicrobial Gram-negative bacilli were subjected to DST along with conventional identification and AST and were compared for concordance. Results: Out of 458 blood culture bottles received, 61 flagged positive, of which 32 (53.33%) samples showed growth of Gram-negative bacilli. The isolated bacilli were Acinetobacter species (18.75%), E. coli (43.75%), Klebsiella species (18.75%), and Salmonella species (18.75%). Out of the samples undertaken for the study, essential and categorical agreement were 93.04% and 88.18%, respectively. The major, minor, and very minor errors were 10.66%, 8.04%, and 0.66%, respectively. Conclusion: DST using disc diffusion from positive blood culture broth can help in early targeted antibiotic therapy as it has high concordance with the conventional AST, which is more time-consuming.

Keywords: Antibiotic susceptibility test, bloodstream infections, categorical agreement, direct susceptibility test, E. coli, essential agreement, major, minor, sepsis, very minor errors

P2403: Influence of Aerobic Exercise on Response to Graded Head-Up Tilt and Pulmonary Function Tests in Male Subjects

Christina Zothanpari, Muthukrishnan Shobitha

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Physical activity (PA) is associated with lower morbidity and mortality rates. The head-up tilt (HUT) test is a crucial diagnostic tool for revealing vasovagal syncope. However, the mechanisms governing cardiovascular changes during orthostatic stress in HUT and the effects of exercise on it remain unclear. This study evaluated the influence of aerobic exercise on hemodynamic responses to graded HUT and pulmonary functions in young subjects. Aim: To determine the effect of regular aerobic exercise on pulmonary functions and blood pressure responses to graded head-up tilt in healthy male subjects. Methodology: Healthy males aged 18–30 years, who performed aerobic exercise for at least 1 hour, three times a week for 6 months were compared with the nonexercising subjects. Hemodynamic responses were assessed after 70° HUT. Pulmonary function tests (PFTs) including forced vital capacity (FVC), forced expiratory volume in one second, FEV1%, and peak expiratory flow rate (PEFR) were compared. Results: During 70° passive HUT, the exercising group showed a significant increase in mean arterial pressure and diastolic blood pressure compared to the nonexercising group, suggesting higher orthostatic tolerance in them. Aerobic exercise also significantly increased PEFR. Conclusion: Subjects performing regular aerobic exercise were able to effectively maintain blood pressure during HUT, suggesting higher orthostatic tolerance. Increased PEFR indicates reduced airway resistance in subjects performing regular aerobic exercise.

Keywords: Graded head up tilt, pulmonary function test, vasovagal syncope

P2404: Decoding the Twin Code: Exploring Multimodal Biometrics in Identical Twin Differentiation – A Systematic Review

Sakshi Kumari, Aditi Bhatnagar

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India, Uttar Pradesh, India

Introduction: Identical twins (MZ) arise from a single fertilized egg splitting, sharing identical DNA but differing over time due to behavioral and epigenetic factors. With rising twin births, reliable biometric systems are needed to distinguish them. Unique traits like fingerprints, irises, and palmprints, shaped by random gestational factors, enable differentiation. This survey reviews biometric methods for identifying identical twins, crucial for medical and scientific purposes. Aim and Objectives: Systematic review on multimodal biometrics for identical twin differentiation with the following research question. Primary: Identify the most effective multimodal combinations. Evaluate biometric advancements improving reliability in genetically similar individuals. Material and Methods: Eligibility Criteria: Cross-sectional studies and survey-based studies were included, and those studies were accessible. Systematic analysis and meta-analysis, literature review, and case reports were excluded, with those which were inaccessible. Information Sources: Academic databases like IEEE Xplore, Embase, SpringerLink, ScienceDirect, PubMed, and Google Scholar were systematically analyzed to include all relevant studies. Result: A total number of 16 studies with 1387 pairs of twins were included. Systematic analysis was done to compare all possible biometrics. Conclusion: Limited research, especially in India, needs to include more accurate data on facial recognition, handwriting, ear prints, and iris texture for forensic work. Future studies should focus on improving identification methods in cases where DNA—or less—is the only evidence, ensuring justice even in complex scenarios like identical twins denying involvement.

Keywords: Biometrics, identical twins, identification

P2405: Morphometric Study of Distal End of Femur with Its Clinical Implications

Prakriti Mishra, Prajna P. Samanta, Nirupma Gupta, Aditi Bhatnagar

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Osteoarthritis (OA) of the knee is a common cause of pain and functional limitations. Current surgical treatments for knee OA patients include unicompartmental knee arthroplasty and total knee replacement. The distal end of femur is a key component of the knee joint. It is critical to select a prosthesis that best fit the sizes of the resected surfaces of the distal femur. Morphometric parameters of the lower end of femur can be used to guide treatment and monitor outcomes of knee replacement surgeries. Aim: To study the distal end of femur with its clinical implications. Materials and Method: Fifty dry femur specimens were analyzed at SMS and R, SU’s Anatomy department. Distal femur measurements were taken using digital Vernier calipers, and mean/standard deviation calculated, with graphical displays created for both right and left femurs. Result: Measurements of the distal femur revealed the following (in cm): Bicondylar width: 7.16 (right), 7.25 (left) Medial condyle: 5.28 (right), 5.21 (left) Lateral condyle: 5.40 (right), 5.53 (left) Medial condyle (transverse): 2.66 (right), 2.62 (left) Lateral condyle (transverse): 3.00 (right), 2.97 (left). Conclusion: This study will be beneficial for the planning of knee surgery and designing of knee prostheses, with a database of information of the knee region in the Indian population. It will also be beneficial to the forensic and physical anthropologist.

Keywords: Femur bone, knee arthoplasty, knee joint, morphometry

P2406: The Influence of Familiar Olfactory Stimulation on Long-Term Semantic Memory Recall

Snehil Vijay, Supriya Gupta

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Previous research has shown that olfactory cues can evoke episodic memories as odors have direct connections to the brain’s memory centers, particularly the hippocampus and amygdala. This study explores whether familiar olfactory stimulation can enhance semantic memory recall which stores general knowledge and facts. Objectives: To determine whether consistent olfactory stimulation during both encoding and retrieval influences semantic memory recall. Methods: 100 healthy adults, aged 18–40, no olfactory or neurological impairments. · Physiology department, VMMC. · Olfactory cue: N-butanol (4%) · Memory Assessments: Word Memory Test: To measure verbal semantic memory. Doors Subtest: Assessed visual recognition memory. Two sessions were conducted: Session 1 (Immediate Recall): Encoding and then Recall was tested (20–30 mins later). Session 2 (Delayed Recall): Conducted 1 week later, with only the test group receiving the olfactory stimulus. Paired and unpaired t-tests were performed to compare immediate and delayed recall between groups. Results: Session 1: No significant difference between test and control groups as both had the olfactory stimulus during encoding. Delayed Recall (Session 2): Test group demonstrated significantly higher recall scores in both the WMT and Doors Test A. Olfactory stimulation provided a stable cue that enhanced recall, particularly for verbal semantic memory (WMT), validating the encoding specificity principle in semantic memory recall. Conclusion: Consistent olfactory stimulation enhances long-term semantic memory recall, when provided during both encoding and retrieval. This finding opens avenues for using olfactory cues in educational and clinical settings to improve memory retention.

Keywords: Doors subtest, encoding, olfactory, retrieval, semantic memory, WMT

P2407: Perception of Learning Environment among the First-Year Medical Students Exposed to Competency-based Medical Curriculum: A Review

Ananya Aggarwal, Manoj K. Nandkeoliar, S. B. Sharma

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction The educational environment plays a key role in shaping student performance. The WFME emphasizes certifying medical schools to ensure quality education. In India, the NMC introduced the Competency-Based Medical Curriculum (CBME) in 2019–2020 to improve medical training. While CBME has benefits, student feedback is essential to address remaining challenges. Aim and Objective: Students’ perspective is a valuable tool to assess the success of CBME curriculum. Hence, students’ reviews are accessed to look for the challenges to overcome. Material and Methods: The information has been collected from various research articles that are available on the Internet (online sources) which are taken as reference. Various databases including PubMed, Research Gate, and NCBI were used to find relevant research papers. Only the articles which were relevant to the topic have been selected. All the articles were thoroughly reviewed. The various aspects of CBME are assessed based on the opinions of the medical students. Conclusion: This review discusses improvements for the CBME curriculum to enhance medical education. While CBME shows promise, challenges like faculty support, time management, and technology integration remain. Positive student feedback highlights improved learning outcomes and clinical readiness. Addressing these issues through better infrastructure, interactive methods, and ongoing feedback will help refine CBME for future healthcare needs.

Keywords: CBME, curriculum, education, medical students, NMC

P2408: Comparative Evaluation of Rapid Card Test and Enzyme-Linked Fluorescent Assay for Detection of Anti HCV Antibodies: Study in a Tertiary Care Hospital

Lipika Gaur, Tarana Sarwat, Zarine Khan, Dalip K. Kakru

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Hepatitis C virus (HCV) is a hepatotropic RNA virus that causes both acute and chronic hepatitis. As most cases of initial HCV infection are asymptomatic, early diagnosis requires laboratory testing. Rapid card tests (RCTs) quickly detect the presence of antibodies against HCV, providing an initial indication of infection. Aim: To compare the performance of RCT with the enzyme-linked fluorescent assay (ELFA) for detecting anti HCV antibodies and to determine the seroprevalence of HCV infection. Materials and Methods: The present study was conducted at Sharda Hospital, Greater Noida, from July 2024 to August 2024. Blood samples from 135 patients were tested for anti-HCV antibodies using the automated mini VIDAS system and HCV TRI-DOT RCT obtained from J. Mitra. The performance of RCT as screening test compared to ELFA (reference test in current study) was evaluated using the sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV), and negative predictive value (NPV) calculations. Results: Out of 135 samples, 60 (44.4%) were tested positive for anti-HCV antibodies by RCT. Out of these positive patients, males were predominant in this study, 62.2% (n = 82/135), and the most affected age group was 51–60 years (35.5%). The most common risk factors identified were tattoos (30%), intravenous drug use (26.6%), alcohol use (20%), body piercing (16%), and blood transfusion (6.6%). The sensitivity and specificity of the kit came out to be 98.3% and 97.3%, respectively, with PPV of 96.7%, NPV of 98.6% and DA of 97.7%. Conclusion: RCT is effective time-saving alternative point-of-care testing in emergency, mass screening, and resource-restricted lab settings.

Keywords: Anti-HCV antibodies, diagnostic accuracy, ELFA, HCV, mini VIDAS system, rapid card test

P2409: Chronic Obstructive Pulmonary Disease and its Association with Interleukin 1 Beta: A Review

Amber, Manoj K. Nandkeoliar, S. B. Sharma

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: The third greatest cause of mortality worldwide is chronic obstructive pulmonary disease (COPD), a progressive and long-term illness that obstructs airways. Genetic and environmental variables both have an impact on COPD. COPD patients’ lungs and airways have a chronic inflammatory response that is brought on by smoking, biomass smokes, home pollutants, and so on. These trigger neutrophils and macrophages, resulting in release of various cytokines, among which the proinflammatory cytokine IL1β is the most frequently found innate immune cytokine associated with COPD. Materials and Methods: Literature Search Strategy: A comprehensive search of electronic databases including PubMed/MEDLINE, Google Scholar, Scopus, and Web of Science was conducted. The search was performed using a combination of keywords including “Interleukin-1 beta,” “IL-1β,” “chronic obstructive pulmonary disease,” and “COPD,”. Conclusion: We concluded that IL1β has a major role in airway inflammation. IL1β also increases T-lymphocytes and dendritic cells in lung tissues and induces pulmonary inflammation, and therefore, it has been implicated in the pathogenesis of COPD. Variations in the association of serum levels of IL1β in COPD and also in the polymorphism of IL1β in COPD have been seen. From various studies, we got inconsistent findings; therefore, more studies in the area of IL1β in association with COPD are essential.

Keywords: COPD, cytokines, IL1β

P2410: Knowledge, Attitude, and Practices of HPV Vaccine among Medical and Paramedical Students in a Tertiary Care Hospital of North India: A Cross-Sectional Study

Muskan Garg, Anshu Singh, Akshay Kumar Singh Baghel, Anjali S. Sen

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: In India, cervical cancer is the second most common cancer among women and the second leading cause of cancer deaths in women with 77,348 estimated deaths in 2020. Cervical cancer is preventable through vaccination; two prophylactic vaccines are licensed for prescription in India. For better acceptance of this vaccine, the medical community needs to have appropriate knowledge and acceptance of the HPV vaccine. The present study aims to assess the knowledge, attitude, and practices regarding HPV vaccination among medical and paramedical students and healthcare workers. Materials and Methods: A cross-sectional study assessing knowledge, attitude, and practices of HPV vaccination was conducted between January 2024 and March 2024 among 402 female medical and paramedical students and healthcare workers using a standardized questionnaire, developed for the study. The questionnaire was validated by distributing it to five experts in the field and getting their consensus on each item. Pilot testing was done to further validate the questionnaire and to assess the feasibility of administration of the questionnaire, and necessary changes were made. It was made in English as well as in Hindi. The Hindi questionnaire was translated and back-translated. The study was conducted in a tertiary care teaching hospital of a university in North India. Ethical approval of the Institutional Human Ethical Committee was obtained. Microsoft Excel and IBM SPSS were used for analysis. Results: 73.6% of the participants knew about the existence of a vaccine against HPV. Most of the participants showed a favorable attitude toward getting themselves vaccinated, which is 67.4%; however, almost half, that is, 47.5%, of the participants were vaccinated. Conclusions: Though the knowledge and attitude about the HPV infection and its vaccination are good among medical students, the practice of vaccination still has scope for improvement; emphasis on complete vaccination against HPV is the need of the hour.

Keywords: Cervical cancer, HPV vaccination, healthcare worker

P2411: Serum Interleukin 1 Beta Levels in Essential Hypertension

Sunitha R. Anooj, Manoj K. Nandkeoliar, S. B. Sharma

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Elevated blood pressure (BP) is the primary cause of preventable deaths worldwide. However, its occurrence is on the rise, and it continues to be inadequately identified, managed, and regulated in both urban and rural populations. Interleukin-1β (IL-1β), a pro-inflammatory cytokine, is a key factor in developing essential hypertension. Aim: To establish a relationship between IL-1β levels and essential hypertension. Methodology: A case-control study involved 126 participants recruited from the Medicine OPD at Sharda Hospital, Sharda University in Greater Noida, U.P. with informed consent. Serum samples were analyzed for IL-1β levels using the ELISA method. The results for cases and controls were compared using an independent t-test (MS Excel). A P-value of <0.05 was deemed statistically significant. Results: Cases and controls were age- and sex-matched. The mean serum IL-1β level in cases was 1.48 ± 1.02 pg/mL, and in controls, it was 1.44 ± 1.08 pg/mL. There was no significant difference in mean serum IL-1β levels between cases and controls (P = 0.829) with independent t-test. Conclusion: Essential hypertension may develop as a result of the intricate interactions of genetic origins, clinical and lifestyle variables, and the environmental factors. The association of inflammatory markers IL1B with essential hypertension is not seen in this study, and therefore, further research may be useful in this field. However, some researchers have found significant values of IL B in essential hypertension.

Keywords: Cytokine, hypertension, interleukin 1beta

P2412: Rapid Medical Response: Improving Accessibility and Outcomes with Air Ambulance Services in Trauma

Payal Dey, Amrita Bharti

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Rapid access to emergency medical care is crucial for reducing mortality in critical trauma cases. Air ambulance services are essential for providing timely access to healthcare in remote areas, increasing response time and patient stabilization bridging gaps in trauma care. Aim and Objectives: This study evaluates the implementation and effectiveness of air ambulance services in a developing healthcare system by assessing case profiles, response times, and outcomes. This study identifies parameters for optimizing air ambulance services to improve accessibility and survival rates in severe trauma. Materials and Methods: A retrospective analysis was conducted on 100 cases managed by air ambulance services over a 3 years period. Data were collected on patient demographics, response times, types of trauma, resuscitation measures, and outcomes at tertiary care centers. Statistical analysis was performed using Chi-square and ANOVA tests with SPSS software 24.0, with a significance threshold set at P < 0.05. Results: Out of 100 airlifted patients, a significant majority (72.3%) were from remote areas. The leading causes of trauma were motor vehicle accidents (46.8%) and falls from height (29.4%). In-flight resuscitation, including intubation and intravenous fluid administration, was performed in 58.9%. The average response time from call to airlift was 47 minutes. At tertiary centers, 79.1% of patients had stable vitals, and 12.4% reduction in mortality rates. Conclusions: Air ambulance services are vital for improving trauma care by reducing response times and enhancing patient outcomes. Developing infrastructure, national policies, community awareness, and prehospital training are key to maximizing their impact.

Keywords: Air ambulance, emergency medical response, rapid medical response, resuscitation, trauma care

P2413: Spindle Cell Lesion on Cytology: A Diagnostic Dilemma (A Rare Case)

Jyotsna, Kanak Atri, Seema Goel, Atul Verma, Anshu G. Devra

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Myxoid liposarcoma is a rare and aggressive soft tissue sarcoma that can often mimic other lesions, leading to diagnostic challenges. This case report highlights a unique presentation of myxoid liposarcoma in the arm, initially misdiagnosed as a spindle cell lesion based on cytological and radiological findings. Case Report: A 23-year-old female presented with sudden onset swelling in the right arm accompanied by dull aching pain. Clinical examination revealed a tender, firm, and mobile mass measuring 5 × 5 cm, with normal arterial pulsations and no neurological deficits. Magnetic resonance imaging (MRI) of the right arm suggested a vascular lesion on the anteromedial aspect, and MRI with contrast indicated neurogenic tumor. Fine needle aspiration cytology of the lesion suggested a mesenchymal lesion with uncertain malignant potential. A subsequent biopsy indicated a malignant mesenchymal tumour – atypical lipomatous tumor/well differentiated liposarcoma. Following excision, histopathological and immunohistochemical analyses confirmed the diagnosis of myxoid liposarcoma, classified as FNCLCC Grade 2. Conclusion: This case underscores the importance of considering myxoid liposarcoma in the differential diagnosis of spindle cell lesions, particularly when imaging and cytological findings are inconclusive. These lesions also need to be differentiated from other myxoid tumors like myxofibrosarcoma, fibromyxoid sarcoma, and myxoid chondrosarcoma. Accurate diagnosis is crucial for effective management and treatment. A multidisciplinary approach, integrating clinical, radiological, cytological, and histopathological data, is essential for timely and appropriate intervention in cases of soft tissue masses.

Keywords: Lipoblasts, liposarcoma, myxoid liposarcoma

P2414: Assessment of Safety and Effectiveness of Ensifentrine in COPD Patients: A Review of Clinical Trial Database

Vaibhav Peshion, Nidhi Puthran, Moumita Bala, Shoma Mukherjee

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Chronic obstructive pulmonary disease (COPD) persists as a significant healthcare burden throughout the world and is projected to become more widespread than it already is, following ongoing trends. COPD is characterized by chronic inflammation of the respiratory pathways along with ciliary dyskinesia resulting in ineffective mucous clearance. It is currently incurable, and despite existing treatment options, 5-year mortality rates stagger at 25.4% and prevalence continues to increase. The development of COPD and other comorbidities can be impaired with development of novel treatment options that would help reduce the appearance of exacerbations. Ensifentrine, a recently FDA-approved drug for the maintenance treatment of COPD, serves as a potential candidate for this massive challenge. Ensifentrine is a novel addition to the treatment of COPD because it is a dual inhibitor of PDE-3 and PDE-4 receptors and also alleviates ciliary dyskinesia. When combined with ICS and LAMA/LABA, it reduces the incidence of exacerbations by an average of 40%. Methodology: Data retrieved from clinical trial database for the drug Ensifentrine in COPD patients for the past 7 years (2017 onward) yielded a total 14 clinical trials conducted globally, out of which only five trials were selected for comparison which were completed and with available results. Results: Out of the five trials conducted, two each were in Phase 3 and Phase 2, while one was a Phase 1 trial. The number of patients involved in these studies was 790, 763, 405, 40, and 28, respectively. The Phase 1 study, which aimed to measure pharmacokinetic (PK) parameters (Cmax, AUC, Tmax, and t1/2), showed an improvement in PK parameters with a single-dose nebulizer rather than multiple doses of the drug, with no serious adverse events reported. One of the Phase 3 studies demonstrated an improvement in FEV1 with Ensifentrine. Another study on different doses (0.75, 1.5, 3, and 6 mg) showed an improvement in peak FEV1 and respiratory symptoms, assessed using the Evaluating Respiratory Symptoms questionnaire, after 4 weeks of therapy. The final study compared single versus twice-daily doses of different drug strengths (0.10, 0.30, 1, 3, and 6 mg) administered via MDI, showing significant improvement in PK parameters as well as in the baseline to average FEV1. The most common adverse effects reported were headache, worsening of COPD symptoms, cough, nausea, and hypertension, but these were not significant. Conclusions: Ensifentrine is a promising candidate in revolutionizing the treatment of COPD in reducing morbidity and, in turn, mortality rates. It deserves further trials in India where COPD continues to be an ever-increasing healthcare burden.

Keywords: Clinical trial, COPD, Ensifentrine, FEV1

P2415: Relation between Vitamin D and Insulin Resistance in Type 2 Diabetes Mellitus

Naseem Khan, Manoj K. Nandkeoliar, S. B. Sharma

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: It is worth noting that vitamin D deficiency is very common and may be associated with the pathogenesis of insulin-resistance-related diseases, including obesity and diabetes. Insulin resistance (IR) is the primary pathogenic factor, contributing to impaired glucose tolerance and diabetes complications. Vitamin D deficiency, linked to increase IR and metabolic syndrome, is prevalent in T2DM patients. Vitamin D (VD) may influence insulin sensitivity or pancreatic β-cell activity, thereby contributing to the development of T2DM. This review aims to provide molecular mechanisms showing how vitamin D deficiency may be involved in the development of insulin resistance. More recently, it was also shown that vitamin D prevents epigenetic alterations associated with insulin resistance and diabetes. The impact of vitamin D deficiency on the incidence of various diseases and its relationship with the progression of T2DM is still to be studied further. Conclusion: Although the relationship between vitamin D and insulin resistance in T2DM seems promising, further research is required to fully comprehend the underlying mechanisms and create therapeutic care guidelines that are supported by data. The potential of vitamin D to increase insulin sensitivity and diabetes management is high, but it must be treated cautiously and supported by more scientific evidence.

Keywords: Diabetes mellitus (DM), insulin resistance, type 2 diabetes mellitus (T2DM)

P2416: Association of Serum Vitamin D and Micro Albuminuria in Diabetic Nephropathy

Vanshika Malik, Manoj K. Nandkeoliar, S. B. Sharma

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: A number of health problems, particularly in those with Type 2 diabetes mellitus (T2DM) and its consequences, have been highly associated with vitamin D insufficiency. Therefore, the role of vitamin D in kidney disease among these patients is important. The urine albumin to creatinine ratio (UACR) serves as an important marker for early kidney damage in T2DM patients. Emerging research indicates that vitamin D may be involved in controlling kidney function and preventing diabetic nephropathy. In exploring the link between serum vitamin D levels and UACR in individuals with type 2 diabetes, this review highlights the possible advantages of keeping vitamin D levels appropriate for kidney health. Conclusion: The available evidence reveals a possible link between low vitamin D levels and an increased risk of microalbuminuria in patients with type 2 diabetes. This link highlights the possible role of vitamin D in preserving renal health and managing diabetic nephropathy. While these findings are intriguing, further research is needed to validate them and evaluate whether vitamin D supplementation may effectively prevent renal damage in these patients.

Keywords: Diabetic nephropathy, type 2 diabetes mellitus, urine albumin to creatinine ratio, vitamin D

P2417: Advancements in MDR-TB Treatment Regimens: Findings from the Clinical Trial Database

Khushboo Rani, Shoma Mukherjee

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: India has the second highest burden of MDR-TB in the world after China, with an estimated 99,000 new cases per year. Treatment of MDR-TB is challenging owing to high failure rates and compliance issues, consequently resulting in a rise of drug-resistant strains. Recent years have seen notable advances in the development of shorter and more efficacious regimens. This analysis highlights the findings from clinical trials on MDR-TB, illustrating the path of advancements in treatment efficacy and safety profiles essential for TB control. Aim: The aim of this study was to analyze the clinical trial database and to find out the efficacy and safety of various MDR-TB regimens. Methodology: This study involved a systematic search of the clinical trial database (ClinicalTrials.gov) available in public domain. The articles obtained through this search were then thoroughly reviewed, and comparative tables were created to analyze parameters such as efficacy, safety, and outcomes. Results: One global phase 2/3 study involving 455 participants out of eight (8) completed trials showed promising efficacy of 84% sputum culture conversion rate at 8 weeks with BPaMZ regimen for a 6-month treatment duration that was found to be effective. Four trials comprising delamanid optimized background regimen demonstrated a sputum culture conversion rate between 70% and 82% at 6 and 8 weeks. Another phase 2 trial showed that optimized dosing of levofloxacin enhances efficacy with favorable safety profiles. Safety analysis: In most of the trials, 5–10% of the patients experienced QT prolongation and hepatotoxicity (SAE). Common adverse drug reactions were gastrointestinal issues (15–18%), nausea (12–15%), and elevated liver enzymes (8–10%), and 5–7% patients experienced dizziness and headache. Overall good tolerability was demonstrated by all the trials, and dose adjustments were required in 15%. Conclusion: The findings highlight significant advancements in treatment strategies, with promising efficacy rates and manageable safety profiles in new drug regimens. Continued research and adaptation of these regimens are essential to address evolving drug resistance challenges effectively.

Keywords: Bedaquiline/delamanid optimized background regimen, clinical trial database, MDR-TB treatment regimen

P2418: Correlation of Neck Circumference and Body Mass Index with Overweight and Obesity

Tanya Chopra, Lakshya Passi, Thuraya Abdulsalam A. A. AL-Azazi, Manoj K. Nandkeoliar

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Data from NFHS-5 reveal a substantial increase in individuals with a body mass index greater than 25, highlighting the urgent need for targeted interventions aimed at high-risk populations. Early diagnosis and prevention require accurate, simpler, and affordable diagnostic methods. Neck circumference is a novel index of upper body fat distribution and shall act as a proxy measurement of upper body subcutaneous tissue distributions for classifying obese and overweight. Literature reveals that upper body fat distributions relate to greater neck circumference and with increased risks of noncommunicable lifestyle disorders. Neck circumference has the potential to surpass conventional anthropometric measures as a powerful marker of obesity. Aims and Objectives: To correlate overweight and obesity with neck circumference measurements and establishing cutoff values for the same. Material and Methods: Literature Search Strategy: A comprehensive search of electronic databases including PubMed/MEDLINE and Research Gate was conducted. Conclusion: This review aims to explore the relationship between neck circumference and BMI while considering the broader implications for health assessment. The correlation between the neck circumference and the body mass index as a simple screening measure of overweight and obesity allows the study to explore the utility of neck circumference as a practical and accessible measurement for screening obesity.

Keywords: Body mass index, neck circumference, obesity, overweight

P2419: Cannabinoid Hyperemesis Syndrome: A Misdiagnosis as Gastroenteritis

Pankaj Shah, Kunal Kumar, Abhinit Kumar, Nikhil Nayar, Purvi Vats, Shubhika Aggarwal, Abhinav Dhankar, Sourabh Ojha

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Cannabinoid hyperemesis syndrome (CHS) can often be misdiagnosed due to its overlapping symptoms with other gastrointestinal disorders, such as gastroenteritis. CHS is characterized by cyclic episodes of severe nausea, vomiting, and abdominal pain, typically occurring in chronic cannabis users. This report aims to raise awareness of CHS and its clinical implications. Methodology: A 32-year-old male with a long history of daily marijuana use presented to the emergency department with a 2-day history of severe nausea, vomiting, and diffuse abdominal pain. Initial evaluation suggested viral gastroenteritis, given the recent onset of symptoms and reports of diarrhea. The patient was given supportive care, including fluids and antiemetics. Despite treatment, his symptoms persisted. On further questioning, the patient mentioned that hot showers provided temporary relief, a key feature of CHS. With this information, further investigation led to the diagnosis of CHS. The patient was admitted for 3 weeks. The patient was given oral lorazepam 2 mg twice a day, which was tapered gradually. Cannabidiol oil solution 1 mL was also given daily. Gradually, the patient’s symptoms improved remarkably. The time from marijuana cessation to complete resolution was approximately 3 weeks. The patient was discharged, and motivational enhancement therapy was continued on follow-ups. On subsequent follow-ups, the patient reported that with sustained abstinence from marijuana, he had no return of symptoms. Conclusion: This case highlights the need for increased awareness among healthcare providers regarding CHS, especially in patients presenting with nausea and vomiting after prolonged cannabis use. Early identification can prevent unnecessary interventions and improve patient outcomes.

Keywords: Abdominal pain, cannabinoid hyperemesis, viral gastroenteritis

P2420: Silent Struggles: Depression and Seizures Linked to Frontal Lobe Masses

Sourabh Ojha, Kunal Kumar, Abhinit Kumar, Nikhil Nayar, Purvi Vats, Shubhika Aggarwal, Siddharth Bhargava, Parika Kochhar, Abhinav Dhankar, Pankaj Shah

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Psychiatric disorders can co-occur next to focal neurological symptoms, epileptic seizures, and headaches; brain tumors can less frequently bring about cognitive changes, slowed speech, difficulty sustaining mental functioning, psychiatric symptoms of personality changes, and loss of interest in daily activities; these symptoms may be evaluated as anxiety or depression. Depression is known to be a complication of brain tumors and may sometimes be seen after the presentation of neurological symptoms linked to brain tumors and sometimes after tumor treatment. Methodology: A 35-year-old male from Greater Noida was brought to the OPD with complaints of abnormal body movement, sleep disturbances, low mood, headache, and loss of interest for 2 months. It is insidious in onset and gradually progressive in nature with no significant family or past history of any psychiatric or neurological illness. There was no past history of any illness, and he had a well-adjusted premorbid personality. On MSE, she was kempt, tidy, Mood- Udaas hai, Affect- Dysphoric with Insight Grade 4. When the patient presented in the psychiatry OPD, he was advised Sodium valproate 500 mg BD, Escitalopram 10 mg OD initially, and Clonazepam 0.25 mg BD and SOS, which was tapered in 10 days. Later, on MRI of the brain, it was an incidental finding of a frontal lobe tumor which was mimicking the psychiatric symptoms. Results: This case highlights the importance of the possibility of psychiatric symptoms being the clinical clues for brain tumors was noted and the necessity of neuroimaging tests in cases of recent onset psychosis or mood disorder symptoms, atypical personality changes, and anorexia without body dysmorphic disorder was emphasized.

Keywords: Depression, frontal lobe tumors, headache, seizures

P2421: Acute on Chronic Subdural Hematoma Presenting with Acute Complete Flaccid Paraplegia and Urinary Retention Mimicking an Acute Spinal Cord Injury – A Case Report

Kunal Kanwar, Ravindra Shrivastava, Ashok Bhatnagar, Vijay Anand

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

A subdural hematoma is a type of bleeding inside your head. It happens when blood collects under the dura mater, one of the layers of tissue that protect your brain. It most often happens from head injury and can be fatal. The types of subdural hematomas include: Acute: This is the most dangerous type of subdural hematoma. The symptoms are severe and appear right after a head injury, often within minutes to hours. Pressure on your brain increases quickly as the blood pools. If you are not diagnosed and treated quickly, you could lose consciousness, have paralysis, or even die. Subacute: Symptoms usually appear hours to days or even weeks after the head injury. A subacute subdural hematoma can occur with a concussion. Chronic: This type of hematoma is more common in people older than 65. Bleeding occurs slowly, and symptoms may not appear for weeks or months. Even minor head injuries can cause chronic subdural hematomas. You may not even recall how your head injury happened due to the delay in developing symptoms. Our patient presented with complaints of altered sensorium after fall, leading to loss of consciousness with gcs E3V2M4 Emergency B/L Craniotomy with evacuation of hematoma with duraplasty. The post op period was uneventful with discharge with gcs E4V5M6.

Keywords: Acute spinal cord injury, flaccid paraplegia, subdural hematoma

P2422: Hepatic Hydrated Cyst

Jay Anam, Ashok Bhatnagar, Vijay Anand

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Hydatid disease (HD) is a common parasitic disease which is caused by the larva stage of Echinococcus granulosus with worldwide distribution and has various modes of presentation, and it can involve any part of the human body. It commonly involves liver and lungs and rarely involves the brain, the heart, and other organs. It primarily affects the liver and demonstrates characteristic imaging findings on ultrasonography (US); computed tomography (CT) and magnetic resonance imaging are highly accurate in detecting hepatic hydatid cyst. It can be treated by surgery and conservative management with albendazole and percutaneous aspiration. In our patient who presented with a lump in the right hypochondrium region, on further evaluation, the patient was diagnosed with hepatic hydatid cyst based on clinical presentation, radiological correlation, and serology confirmation. The patient was given albendazole pre- and postoperatively. The patient underwent surgery with deroofing of the cyst and evacuation of the entire hydatid fluid, laminated membrane, and multiple daughter cyst. Follow-up was done for 6 months, and it showed no evidence of recurrence.

Keywords: Hydaitd disease, right hypochondrium region, percutaneous aspiration

P2423: Choledochal Cyst Presenting in a 35-Year-Old Woman – Challenges and Outcomes

Lav Modh, Vikram S. Chauhan, Shilpi Bhattacharya, Pooja Parashar

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Choledochal cyst (CDC), a rare bile duct cyst, was first classified by Todani et al. in 1977. It typically affects young women and children, especially in Asian countries. While the usual symptoms include abdominal pain, jaundice, and an abdominal mass, this case involves a 35-year-old woman with CDC and dilated intrahepatic bile ducts (IHBRD), but without jaundice. Case Reports: A 35-year-old female presented with chronic right upper abdominal pain since childhood and a noticeable lump in the same region for the past year. The pain was intermittent, severe, and colicky in nature, aggravated by food intake, squatting, and weightlifting, but alleviated by analgesics. The lump, progressively enlarging over the past year, was not associated with jaundice, fever, or diurnal variations. The patient also reported intermittent vomiting but had neglected treatment due to personal reasons. There was no significant past or family medical history. Physical Examination: The patient was well oriented, with no signs of jaundice. Physical examination revealed a 12 cm x 10 cm tender lump in the right hypochondrium, firm in consistency, and mobile with respiration. Investigations: Laboratory tests showed decreased hemoglobin (9.60 g/dL), elevated eosinophils (21%), and significantly raised IgE levels (4559.60 IU/mL). Liver function tests showed elevated direct bilirubin (0.53 mg/dL), SGOT (61.20 U/L), SGPT (76 U/L), and alkaline phosphatase (489 U/L). MRCP revealed dilation of the extrahepatic bile duct with extension to intrahepatic ducts, consistent with a giant choledochal cyst (Todani classification IVa) and an anomalous pancreaticobiliary junction. Diagnosis: The diagnosis of choledochal cyst with dilated intrahepatic bile ducts was confirmed based on clinical history, physical examination, and radiological findings. Treatment: The patient underwent cholecystectomy with excision of the Type IVa choledochal cyst and hepaticojejunostomy with side-to-side isoperistaltic jejunojejunostomy under general anesthesia. Discussion: Choledochal cysts are most common in infants and children, with an incidence of 1 in 100,000 to 1 in 150,000 in Western countries and 1 in 13,000 in Japan. They have a fourfold higher prevalence in females. Anomalous pancreaticobiliary duct union (APBDU) occurs in 30% to 70% of cases and may play a role in the development of CDC.

Keywords: Choledochal cyst, lump, young woman,

P2424: Rare Presentation of Dermatofibrosarcoma Protrubens over the Anterior Chest Wall

Nikita Chandak, Akhilesh Dalal, Shashank Rai, Kuldeep R. Sarangal

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive soft tissue tumor characterized by high recurrence rates despite seemingly complete excision. Case report: It is the case of a 39-year-old male with a recurrent DFSP on the left chest wall, which had been growing progressively over 3 years after an initial excision 5 years prior. MRI and histopathology confirmed the diagnosis of recurrent DFSP, with immunohistochemistry for CD34 being strongly positive. The patient underwent a wide local excision with rhomboid flap reconstruction under general anesthesia. The procedure was completed without complications, and the excised tissue was sent for histopathological examination. Postoperatively, the patient had an uneventful recovery, with healthy wound margins and no complications. He was discharged on the fourth day, with suture removal at 10 days. Conclusion: This case highlights the importance of wide local excision with adequate margins and reconstructive surgery in managing recurrent DFSP, offering optimal functional and aesthetic outcomes.

Keywords: Deramatofibrosarcoma protrubens, immunohistochemistry, wide local excision

P2425: A Rare Case Report of Esophageal-Pleural Fistula in a Suspected Case of Mediastinal Mass

Saurabh Bansal, Devendra K. Singh, Sonisha Gupta, Neha Aggarwal

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Esophageal pleural fistula (EPF) is a rare entity which is formed secondary to esophageal instrumentations, surgery, and malignancy or as a rare complication of post pneumonectomy. Spontaneous development of fistula is a very rare entity. Esophagus injury should be considered when the patient presents with retrosternal chest pain, fever, dysphasia, and dyspnea. Contrast-enhanced computed tomography is a very useful imaging technique to evaluate EPF. Supporting investigations include chest x-ray and barium swallow study. Case Report: A 47 years old man had complaints of fever with chills, shortness of breath, loss of weight, and dysphagia since 1 month. O/E vocal fremitus and vocal resonance reduced on the right side. Chest x-ray showed multiple air fluid levels on the right side. CT Chest showed a large lobulated soft tissue density in the mediastinum. On barium swallow, the esophagus appears dilated in its proximal part with a suspicious defect causing contrast seepage into the mediastinum. Discussion: The location, size, length, and severity of the EPF determines the management. The differential causes include aspiration pneumonia, spontaneous pneumothorax, myocardial infarction, aortic dissection, and gastritis. Conservative treatment options include jejunostomy, gastrostomy, tube feeding, local irrigation, and empyema drainage. Definitive management is surgery. Conclusion: EPF, though rare, should be considered, if retrosternal heaviness is not relieved by conventional treatment.

Keywords: Esophageal-pleural fistula, mediastinal mass, large lobulated, soft tissue mass

P2426: Mesothelioma in Patients without Asbestos Exposure

Shubham Naswa, Devendra K. Singh, Sonisha Gupta, Saurabh Bnasal

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Mesothelioma is a rare neoplasm of mesothelial cell of pleura found in approximately one case per million per year. It arises from mesothelial cells lining the visceral cavity, for example, pleura, peritoneum, pericardium, and tunica vaginalis. Case Report: A 70 years old male, teacher by occupation, smoker, and nonalcoholic, presented with chief complaints of right-sided chest pain for 2 months, shortness of breath × 2 months, generalized weakness, and loss of weight × 2 months with past h/o pulmonary tuberculosis, with O/E decrease movement and breath sound and stony dull on the right side of the chest. Tuberculosis workup was negative. CECT chest showed a nodular area of thickening and enhancement along parietal pleura. PET-CT showed low-grade FDG avid small focal nodular pleural thickening. Pleural biopsy showed neoplastic cell suggestive of malignant mesothelioma. Discussion: Mesothelioma affects men in 80% of cases, and it is most frequent around the age of 60 years. The male to female ratio is 4:1 with a predominance of right side over the left. A few cases of mesothelioma without asbestos exposure has been reported in the literature. Conclusion: Though this patient has no history of exposure to asbestos, there were other risk factors like any carcinogen present in the soil; genetic factors may eventually lead to mesothelioma. Early intervention with medical thoracoscopy and biopsy will help in early diagnosis and management.

Keywords: Asbestos, mesothelioma, pleural biopsy

P2427: Chylothorax Due to Tubercular Lymphadenitis: A Rare Phenomenon

Vishal Takhelmayum, Devendra K. Singh, Sonisha Gupta, Robin Bhati

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Chylothorax is a rare clinical condition characterized by high triglyceride and low cholesterol levels in milky pleural aspirate. It is a condition characterized by fluid triglyceride level >110 mg/dL, pleural fluid/serum triglyceride ratio >1, and pleural fluid/serum cholesterol ratio <1. Case report: We report a case of a 45-year-old female patient with no significant past history presenting in the OPD with exertional dyspnea and dry cough for 3 months, loss of appetite, and weight for 2 months with a marked decrease in respiratory sounds on the right side of the lung. CT scan revealed multiple lymphadenopathy with pleural effusion on the right side of the lung. Pleural fluid investigations came in favor of chylothorax. Pleural biopsy revealed MTB detected. The patient was started on ATT to which she responded. We report this case in view of the rarity of this condition in a healthy individual with no evidence of prior lung pathology. Although pathogenesis is not known, enlarged hilar and mediastinal lymph nodes are thought to be associated with compression of cisterna chili and thoracic duct, which leads to an increase in pressure in the lymphatic system causing seepage of chyle in the pleural cavity. Conclusion: Considering the high prevalence of tubercular etiology in a country like India, it should be considered as the underlying etiology in case of chylothorax. As in this case, tuberculosis can be the underlying cause of chylothorax even in the absence of any organ involvement.

Keywords: Chylothorax, triglycerides, tuberculosis

P2428: An Uncommon Case of Delayed Development

Sukriti Amraik, Ranjit Ghuliani, Bindu T. Nair, Praneta Swarup, Poonam C. Vij

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Disorders of neuronal proliferation, migration, and organization can cause a spectrum of abnormalities of CNS structure and/or function. Disorders in neuronal migration cause aberrations in the cellular architecture of the brain including alterations in sulci and gyri and lamination of the neocortex. Case Report: A 5 months old, female child born out 4^th degree consanguineous marriage presented with c/o developmental delay and stiffness of bilateral upper and lower limbs. The child was underweight with normal facies, the head circumference is between median to -1SD, and pupils were B/L symmetrical and reactive, but there was no visual fixation. Fundus examination revealed cortical visual blindness. The child did not respond to noise suggesting hearing disability. There was increased tone bilaterally in upper and lower limbs, noted more in the lower limbs; however, head lag was noted on pull to sit, with rag doll appearance on ventral suspension. MRI Brain revealed bilateral ex-vacuo ventriculomegaly (Rt > Lt), with involvement of fourth ventricle including temporal horn dilatation with irregular margins, paucity of white matter, and myelination with limitation of sulci and gyri in the frontal region suggestive of pachygyria. Agenesis of corpus callosum is also noted. The above-mentioned findings suggest either a disorder of neuronal migration or an intra uterine CMV infection. Conclusion: The highlighting point of this case is that the child presented with history of birth asphyxia; however, examination was not suggestive of HIE. MRI Brain findings were also not conclusive. Further investigation for intrauterine CMV infection, metabolic workup, and whole genome sequencing is planned.

Keywords: Consanguinity, delayed development, lissencephaly, neuronal migration disorder

P2429: Pseudohypoparathyroidism Presenting with Seizures: A Rare Presentation

Vinayak Upadhyay, Ranjit Ghuliani, Meenakshi Bothra, Praneta Swarup

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Pseudohypoparathyroidism (PHP) is a rare inherited condition marked by resistance to parathyroid hormone (PTH), resulting in symptoms resembling hypoparathyroidism, including low calcium and high phosphate levels in the body. This case is being reported due to the rarity of disease. Case Report: We report the case of a 1 month 22 days old female patient, born out of nonconsanguineous marriage, with normal birth history, who presented with complaints of multiple episodes of abnormal body movements, on the day of presentation. Relevant investigations were done to identify the underlying etiology for seizures. Serum calcium was found to be low (total 5.9 mg/dL and ionized calcium 0.6 mg/dL), while the serum phosphate levels were found to be elevated on multiple occasions (8.1 and 9.3 mg/dL). The Vitamin D level was in the insufficient range, and the parathormone level was found to be elevated (280 pg/mL). The patient was initially managed with IV Calcium Gluconate and Antiepileptics, which were later made oral. Calcitriol was also added in view of suspected pseudohypoparathyroidism or resistance at the level of PTH receptors. Conclusion: The highlight of this case is that seizures in the present patient can be attributed to the effects of pseudohypoparathyroidism (PHP), leading to hypocalcemia, which was exacerbated by coexisting vitamin D insufficiency. PHP, although rare, should be considered in the list of possible causes of severe and refractory hypocalcemia during infancy.

Keywords: Alpha, calcitriol, guanine nucleotide-binding protein, pseudohypoparathyroidsm, stimulating (GNAS) activity polypeptide gene, vitamin D

P2430: Systemic Onset JIA with Severe Anemia – A Rare Case

Akanksha Sahu, Jugesh Chhatwal, Shashi Bhushan, Bindu T. Nair, Poonam C. Vij

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Systemic onset juvenile idiopathic arthritis (SOJIA) is a rare, systemic form of juvenile idiopathic arthritis with significant morbidity and also mortality. Anemia, although common in inflammatory diseases, is rarely the presenting feature in SOJIA and can complicate diagnosis and outcome. Case Report: A 7 years old girl presented with a history of fatigue and fever since 2 weeks. Physical examination revealed a sick looking, severely undernourished girl with severe pallor in respiratory distress, generalized lymphadenopathy, multiple joint swellings, hepatosplenomegaly, and a maculopapular rash. Investigations showed severe anemia, elevated inflammatory markers, and raised ferritin levels. The patient also had past history of fever, joint pain, and rashes on and off for the past 10 months treated SOS from outside. Given the clinical presentation and laboratory findings, a diagnosis of SOJIA was made. She was transfused PRBCs and started on IV methylprednisolone with supportive measures. Discussion: Anemia in SOJIA results from a combination of poor iron absorption, chronic inflammation, bone marrow suppression, and iron sequestration. Presence of severe anemia impacts the clinical presentation as coexisting cardiac, and lung dysfunction can worsen. This may also be a reflection of associated macrophage activation syndrome, a dreaded complication. Instituting appropriate therapy for anemia will be helpful in improving the outcome. Early recognition and treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and bDMARDs are critical in managing SOJIA. Conclusion: Timely intervention for anemia along with other specific management is important for improving the outcomes in SOJIA, especially in atypical presentations where anemia may overshadow the classical signs of the disease.

Keywords: Macrophage activation syndrome, severe anemia, SOJIA

P2431: Inborn Error of Metabolism: A Diagnostic Dilemma in Pediatrics

Tanya Khatter, Ranjit Ghuliani, Praneta Swarup

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: SCN2A-related disorders are genetic conditions resulting from pathogenic variants in the SCN2A gene, which encodes the voltage-gated sodium channel, NaV1.2. This channel is essential for the proper functioning of neurons and is implicated in neurodevelopmental and neuropsychiatric disorders. Case Report: A 10 months male presented with complaints of abnormal body movements, mild developmental delay, and history of regression of milestones. On examination, b/l lower limb tone and power were reduced. Second degree consanguinity is present. Blood investigations and MRI were normal. Whole exome sequencing + mitochondrial sequencing were done, which was suggestive of the heterozygous variant of uncertain significance consistent with the phenotype of channelopathy detected. Conclusion: SCN2A-related disorders are a group of genetic conditions associated with mutations in the SCN2A gene, significantly impacting neurodevelopment and epilepsy. Early identification through clinical evaluation and genetic testing is crucial for effective management. A multidisciplinary approach and regular monitoring are essential to address the needs of affected individuals as they grow, highlighting the importance of clinician awareness for timely diagnosis and intervention.

Keywords: Genetic testing, inborn error of metabolism, SCN2A gene, seizure disorder

P2432: Thoracic Adenitis in a 12-Year-Old Patient with Persistent Fever and Cough: A Diagnostic Challenge in Pediatric Tuberculosis

Alisha Jain, Ranjit Ghuliani, Bindu T. Nair, Pradeep Singh, Poonam Vij, Praneta Swarup

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Pulmonary tuberculosis (TB) presents differently in children and adults. While adults often develop cavitary lesions, children typically show a primary complex, with fewer bacilli, making CBNAAT less reliable. As a result, the diagnostic yield from CBNAAT is lower in pediatric patients. The NTEP pediatric algorithm emphasizes exploring extrapulmonary sites, such as lymph nodes, for TB bacilli. This case highlights the challenges of obtaining confirmatory samples via CBNAAT and underscores the importance of clinical features and imaging in diagnosing pediatric thoracic adenitis. Case Report: A 12-year female presented with a 20-day history of high-grade fever and intermittent cough, with a history of TB contact. Initial tests showed a positive Mantoux, elevated CRP (47.18), and a negative fever work-up. CBNAAT of gastric aspirate was negative. Chest X-ray revealed right paratracheal lymphadenopathy, and HRCT showed mediastinal lymphadenopathy with multiple enlarged nodes in the pretracheal, paratracheal, precarinal, right hilar, and subcarinal regions, including a prominent 18 mm node in the right paratracheal area. Conclusion: This case emphasizes the role of HRCT in diagnosing pediatric thoracic adenitis in suspected primary pulmonary TB cases where CBNAAT is negative, and sputum samples may be unavailable. Imaging, particularly HRCT, can facilitate early initiation of ATT, potentially improving patient outcomes.

Keywords: High-resolution computed tomography, mediastinal lymphadenopathy, tuberculosis

P2433: “Pleural Effusion, a Complication of PICC Line” in a Neonate

Cheerla J. Kumar, Meenakshi Bothra, Smita Nair, Bindu T. Nair

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Pleural effusion, defined as fluid accumulation in the pleural space, occurs if the rate of filtration increases or if the rate of lymphatic clearance decreases or if both these mechanisms are present. Any change of the pulmonary venous hydrostatic pressure, lymphatic pressure, blood oncotic pressure, and local tissue trauma or inflammation can lead to pleural effusion. Diagnosis of the etiology is important for subsequent management. Case Report: A single, preterm, 33 weeks, male baby with a birth weight of 2.07 kg was born to a primi mother via normal vaginal delivery in Sharda hospital, Greater Noida. Post delivery, the baby required NICU care due to pre maturity, On day 2 of life, the baby was kept on CPAP support and was managed symptomatically with IV Antibiotics (Taxim, Amikacin) and UVC was secured. At 52 hours of life, the baby had multiple episodes of apnea and seizures and hence was kept NPO. IV Levetiracetam was started, and antibiotics were upgraded (Meropenem, Amikacin), As the baby was sick, requiring multiple injectables, PICC line was secured and LP was done on the same day. On day 6 of life, there was change in respiratory pattern; hence, USG chest done s/o moderate left-sided pleural effusion. On day 7 of life, PICC line was removed, following which pleural effusion resolved within the next 48 hours. The baby was subsequently weaned off to CPAP support and gradually to room air. Feeds were gradually initiated, with katori spoon feeds, followed by breast feeding, and there was no recurrence of respiratory distress. Conclusion: PICC is widely used in NICU worldwide for administering multiple drugs, iv fluids, and TPN to premature babies. Several complications have been reported, including pericardial effusion with or without cardiac tamponade, pleural effusion, ascites, venous thrombosis, catheter removal difficulties, phlebitis, and infection. Pleural effusion in a neonate may result from chylothorax, hydrops fetalis, extravasation of PICC or umbilical venous catheter, parapneumonic effusion, congestive heart failure, or other less common conditions. Diagnostic chest tap for pleural fluid analysis is essential for subsequent management.

Keywords: PICC line, pleural effusion, UVC

P2434: Hidden Hunger: Unveiling Vitamin B12 Deficiency in an Exclusively Breastfed Infant Presenting with Severe Acute Malnutrition

Deepakshi Teotia, Meenakshi Bothra, Smita Nair

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Vitamin B12 is important for hematopoiesis, CNS myelination, and psychomotor development. Its deficiency in infants can have profound consequences. Despite the importance of breastfeeding, inadequate maternal nutrition can compromise an infant’s vitamin B12 levels. Case Report: This is a case of a 6-month-old exclusively breastfed infant who presented with features of SAM along with findings suggestive of anemia. The infant’s mother followed a strict vegetarian diet and had little to no intake of vitamin B12-rich foods. The infant exhibited significant weight loss and irritability. Laboratory results showed hemoglobin of 5.3 g/dL. The general blood picture suggestive of macrocytic anemia, Vitamin B12–159 pg/mL. Following diagnosis, the infant received blood transfusion and vitamin B12 supplementation along with counseling for nutritional rehabilitation. Within 1 week, notable improvements were observed, including weight gain and an increase in appetite and energy levels. Conclusions: Through this case, we seek to inform healthcare providers and caregivers about the critical role of vitamin B12 in infant health, promoting better practices for maternal nutrition and infant feeding. Hence, routine screening for vitamin B12 deficiency in at-risk infants can facilitate early detection and intervention, ultimately promoting healthier outcomes and optimal development.

Keywords: Exclusive breast feeding, severe acute malnutrition, hidden hunger, Vitamin B12 deficiency

P2435: Hemoglobin D-Punjab Variant Presenting as Hypersplenism

Priyanka Agarwal, Jugesh Chhatwal, Shashi Bhushan, Aditi Mishra

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Hemoglobin D-Punjab is a rare hemoglobin variant resulting from a point mutation in the beta-globin gene that causes a substitution glutamine for glutamic acid in in the beta-globin chain often leading to mild hemolytic anemia with or without splenomegaly. A case of 5-year-old girl diagnosed as HB D Punjab is being presented here. Case Report: A 5-year-old girl born out of nonconsangious marriage presented to OPD with history of weakness, irritability, and lethargy (of 5 days duration) with no other significant complaints. On thorough examination, she was severly anemic, mildly icteric with no edema and lymphadenopathy. Growth parameters were within the normal range for age and gender. Systemic examination was noted to have hepatosplenomegaly (palpable liver 3 cms below RCM and palpable spleen 4 cm below LCM), while the rest of the system was normal. Her laboratory tests showed Hb 4.9 gm/dL, PCV 18.8%, TLC-2850 cells/cumm, DLC (P44%, L42%), and PC 1.14 lakhs/cumm. RC 2.8%. HPLC s/o of Hb D-Punjab variant. The patient was transfused with packed red blood cells, leading to a significant reduction in splenomegaly and improvement in her peripheral blood counts, whereas the sibling and father are normal. The girl presents with pancytopenia and hepatosplenomegaly in view of peripheral blood smear and reticulocyte count suggestive of hemolytic picture; HPLC was done, which shows Hb D-Punjab variant. She also had leucopenia and thrombocytopenia in view of significantly enlarged spleen. The possibility of hypersplenism was kept in mind. Conclusion: On subsequent follow-up Hb, TLC, platelets were increased. The present poster highlights an usual presentation Hb D Punjab variant.

Keywords: Hemoglobin D-Punjab, hemolytic anemia, hypersplenism, pancytopenia

P2436: A Case of Acute Disseminated Encephalomyelitis

Israr Alam, Ranjit Ghuliani, Praneta Swarup

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Acute disseminated encephalomyelitis is an autoimmune –encephalitis postulated to follow a viral infection. It is the abrupt development of multiple neurologic signs related to an inflammatory, demyelinating disorder of the brain and spinal cord. The patient presents with altered consciousness, convulsions, motor deficits, ataxia, and visual dysfunction. It can clinically resemble multiple sclerosis. CSF may reveal pleocytosis. MRI shows characteristics scattered lesions in the white matter, at times affecting the grey matter. Treatment includes pulse corticosteroids, intravenous immunoglobin, and plasmapheresis.^[2] Case Report: A 3-year-old male presented with a 1-week history of fever, headache, and vomiting. He was conscious, alert, and oriented but had brief, severe frontal headaches (5–10 min, 4–5 episodes/day) causing excessive crying, though he remained playful in between. No meningeal signs, cranial nerve, or sensorimotor deficits were noted. Fundus exam showed no signs of raised intracranial pressure. Blood tests showed elevated CRP, with other investigations normal. CSF revealed a count of 10 lymphocytes, with protein −34 mg/dL, sugar-55, but no growth on culture NMDA receptor antibody, were negative. RI Brain with contrast revealed multifocal hyperintense lesions in the thalami, left caudate nucleus, putamen, and scattered areas in the brain, suggestive of multifocal encephalitis involving deep gray matter. Conclusion: Acute disseminated encephalomyelitis is a rare, autoimmune-mediated, inflammatory demyelinating disorder of the central nervous system. Timely recognition and early management can significantly improve patient outcomes.

Keywords: Acute disseminated encephalomyelitis (ADEM), autoimmune encephalitis, IVIG (intravenous immunoglobulin), plasmapheresis

P2437: A Case of Infantile Tremor Syndrome

Manish Shaw, Rajeev K. Thapar

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Infantile tremor syndrome (ITS) is a condition marked by symptoms such as tremors, anaemia, skin pigmentation, developmental regression, and muscle weakness. Cases of ITS have mainly been reported in the Indian subcontinent.^[1] It is a self-limiting disorder that affects infants and young children.^[2] While research and literature on ITS have been available for over 60 years, the exact cause of the syndrome remains unidentified.^[3] Case Report: A 6-month-old infant presented with abnormal body movements started at 3 months of age. On examination, the cry, tone, and activity of the child were normal with the movements present mostly in the awake state. EEG was suggestive of slowing of waves. Blood investigations were normal, with only change being Vit B12 deficiency. Other systemic investigations were normal. MRI Brain with contrast was normal with likely diagnosis indicating toward ITS. Conclusion: Efforts to identify the precise cause of ITS in the Indian subcontinent have had limited success. It appears that a crucial link is missing, preventing a full understanding of the syndrome’s etiology. Several questions remain unanswered and require further investigation, including the varying types of anemia, the higher prevalence in males, the occurrence of tremors only in some undernourished children, the uncertain role of Vitamin B12, and the connection to delayed complementary feeding. Keywords: Pigmentation, regression, tremor

P2438: A Rare Case of Multi-Drug-Resistant Early Onset Citrobacter Sepsis in a Term Neonate

Adeeba Ahmed, Shashi Bhushan, Supriya Mahajan

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Citrobacter species, a Gram-negative bacterium, is a relatively rare cause of infections in newborns; with incidence of 3–6%. Neonates, particularly preterm and immunocompromised, are vulnerable to Citrobacter species, which is known to cause a wide spectrum of infections, including sepsis, UTI, meningitis, and long-term neurological deficits^[2] Resistance to Colistin, the last line therapy for infections caused by multi-drug-resistant Gram-negative bacteria, limits treatment options. Therefore, combination therapy involving costly and potentially hazardous antibiotics presents significant therapeutic challenges.^[3,4] Case Report: A term outborn neonate delivered vaginally presented with respiratory distress and required NICU admission with respiratory support. During the course of NICU stay, the baby developed neonatal seizures on day 2 with clinical suspicion of early onset neonatal sepsis. Investigations revealed a positive sepsis screen and sterile blood culture, and antibiotic therapy was initiated as per NICU protocol. Metabolic and structural abnormalities were ruled out. On day 3 of life, antibiotics were revised to Meropenem and Amikacin in view of suspected CNS infection. CSF studies showed abnormal biochemical parameters. Despite upgradation of antibiotics, therapeutic response was inadequate. The baby had persistent respiratory distress with abnormal chest X-ray findings for which tracheal secretions culture was done, which showed growth of Citrobacter freundii. resistant to all drugs, partial resistance to Colistin, and sensitivity to Tegecycline. Hence, antibiotic therapy was revised to I.V Meropenem and Colistin since the safety profile of Tegecycline is not established yet in neonates. The baby showed good clinical response with normalization of hematological parameters. Conclusion: Citrobacter infections in neonates represent serious clinical challenges due to high morbidity and mortality rates, possibility of vertical transmission, and recent emergence of resistance to major antibiotics including Colistin. Early identification and treatment of resistant strains and preventive strategies should combat the spread of MDR strains in NICUs.

Keywords: Citrobacter, Gram-negative, multidrug resistance

P2439: A Case of Op Poisoning – Intermediate Syndrome

Sachin Goel, Rajeev K. Thapar, Praneta Swarup

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Organophosphorus poisoning in children typically occurs through accidental ingestion and inhalation. Children are particularly vulnerable to OP toxicity due to their smaller body size and behavioral tendencies such as hand-to-mouth actions that increase the risk of exposure. The toxic effects of OPs are primarily due to the inhibition of acetylcholinesterase, an enzyme responsible for breaking down acetylcholine in the nervous system. Intermediate syndrome is a serious complication of OP poisoning that requires prompt recognition and management. Case Report: A 12-year-old male child was brought to the Emergency Room (ER) intubated, who came from another hospital with a suspected history of organophosphorus (OP) poisoning. The patient reportedly ingested insecticide 3 days prior to admission, followed by the development of nausea, vomiting, profuse sweating, abnormal body movements, and altered sensorium. The exact status of atropinization and pralidoxime administration was unclear at the time of admission. Atropine infusion was titrated to control cholinergic symptoms. Pralidoxime was administered for 7 days as per standard management protocols. The child’s general condition improved, and ventilatory support was reduced. Sedation was tapered, and the patient was extubated and placed on oxygen via mask. Atropine infusion was reduced, but the child developed worsening of respiratory distress, with symptoms of bronchorrhea and bradycardia. The patient was reintubated due to respiratory distress and increased secretions. Muscle weakness likely contributed to respiratory failure and the need for reintubation. Conclusion: This case highlights the complexity of managing OP poisoning, particularly when the patient presents late and the status of atropinization and pralidoxime administration is unclear. The development of intermediate syndrome, delayed cholinergic symptoms, and respiratory failure required careful monitoring and management, including ventilatory support, atropine infusion, and supportive care.

Keywords: Atropine, intermediate syndrome, organophosphorus poisoning

P2440: A Case of Crigler Najjar Type 2

Gurmeet Singh, Ranjit Ghuliani, Praneta Swarup

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Crigler-Najjar syndrome type-2 (CN-2) is a rare genetic disorder inherited in an autosomal recessive pattern, leading to nonhemolytic jaundice. It is caused by a significant reduction of the enzyme UDP-glucuronosyltransferase, resulting from a mutation in the UGT1A1 gene. This deficiency leads to hyperbilirubinemia, which may become evident shortly after birth. In severe cases, the condition can cause dangerously high bilirubin levels, potentially leading to permanent brain damage. Therefore, early diagnosis and intervention are critical. Case Report: A 13-year-old male child presented with complaints of pain abdomen for the past 1 week. On examination, he was jaundiced and his parents reported that it has been present since birth. USG Abdomen – s/o mesenteric lymph node largest measuring ~5.5 mm. Gastroenterology reference was done s/o? CN-2 was advised to get UGT1A1 genotype testing done, and the patient was given Tab Phenobarbitone for 3 days. Exon sequencing report was awaited. Conclusion: Type II CN is rare and difficult for doctors to diagnose early. However, with thorough evaluation and careful history-taking, it can be identified. The progression of complications, including a lasting risk of neurotoxicity and acute cholangitis—both of which can be fatal later in life—can be slowed with lifelong treatment using phenobarbital, proper hydration, dietary adjustments, lifestyle changes (such as avoiding stress), and counseling on the risks of consanguineous marriage. Further research is needed to explore the molecular genetics and various mutations associated with this syndrome, which could help refine treatment approaches.

Keywords: Crigler-najjar, jaundice, unconjugated

P2441: A Case of Pineoblastoma

Nandini Singh, Ranjit Ghuliani, Praneta Swarup, Priya Ambawata

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Pineoblastoma is a rare and aggressive embryonal tumor of the pineal region primarily affecting children. It comprises less than 1% of overall primary brain tumors. Standard therapy for older children and adolescents includes maximal safe surgical resection, followed by craniospinal irradiation and chemotherapy.^[3] Case Report: A 19-month-old female child, a late-preterm infant with a normal perinatal history and who has achieved all developmental milestones expected for her age, presented with complaints of being unable to walk for the past 2 months and vomiting (on/off) for the past 1 month. On examination, there was reduced tone and power in both lower limbs, with normal deep tendon reflexes. Bilateral squint was noted. Fundoscopy revealed signs suggestive of raised intracranial pressure. Blood tests were within normal limits, and other systemic examinations showed no abnormalities. MRI of the brain with contrast revealed a well-defined, lobulated mass in the region of the pineal gland, measuring approximately 2.2 × 2.8 × 3.7 cm (AP × TR × CC). The mass is causing upstream dilation of the bilateral lateral and third ventricles (Evans’ Index 0.39) along with periventricular ooze, consistent with a likely diagnosis of pineoblastoma. The patient was referred to a neurosurgeon for further management. A ventriculoperitoneal shunt procedure was performed, followed by an endoscopic third ventriculostomy and tumor biopsy. Histopathology results are awaited. Conclusion: It is an extremely rare cancer that originates in the pineal gland and must be distinguished from other tumors in that region through histopathological examination and managed accordingly.

Keywords: Brain tumor, chemotherapy, irradiation, Pineoblastoma

P2442: A Rare Case of Unilateral Neonatal Congenital Dislocation of Knee [Idiopathic]

Romana A. Wani, Shashi Bhushan, Amit Gupta, Virender K. Gautam, Prashant Tiwari

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Unilateral congenital dislocation of the knee in neonates is a rare entity, with an estimated incidence of nearly 1 in 100,000 live births, characterized by abnormal positioning of the knee joint at birth, associated with other congenital musculoskeletal conditions (development dysplasia of hip, club foot, arthrogryposis). Shortened quadriceps femoris is determined to be the main underlying pathology. Causes include genetic predisposition, intrauterine positioning, and other musculoskeletal anomalies. Diagnosis is clinical, identifying a hyperextended knee at birth, confirmed radiologically. Early intervention is crucial to prevent deformities, starting with conservative management; surgical release may be required. Case Report: A female neonate was born vaginally at 38 weeks of gestation to a 22-year-old mother with a birth weight of 2.33 kg with uneventful antenatal and natal history. There was no history of difficult delivery. Immediately after birth, there was hyper extension of the left knee joint. Neurological examination was normal, and radiographic imaging confirmed unilateral dislocated knee joint. Clinical screening for congenital anomaly at birth revealed no other abnormal findings. Other investigations showed no evidence of other congenital anomalies. USG abdomen was done to exclude other associated congenital anomalies revealed right adrenal adenoma. The pediatric surgeon advised serum cortisol levels, report awaited. Pediatric orthopedic consultation is recommended weekly long leg casting. Conclusion: This case emphasizes the need to consider unilateral congenital knee dislocation in neonates with abnormal limb positioning. Early treatment generally leads to good outcomes, while delays can cause deformity and disability. A multidisciplinary approach is key for optimal care, and further research will improve treatment options.

Keywords: Hyperextended knee, multidisciplinary approach, neonatal congenital dislocation

P2443: Candida Arthritis of Bilateral Knee Joints with Unilateral Prosthetic Joint Infection by Candida Parapsilosis Successfully Treated with Fluconazole: A Rare Case Report

Prashant Tiwari, Virender K. Gautam, Supriya Mahajan

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Osteoarticular candidiasis is a rare entity with only 332 cases worldwide, of which Candida arthritis accounts for 112 (33.7%) cases. Candida parapsilosis accounts for only 11% cases. Objectives: To report a case of Candida arthritis of bilateral knee joints with right-sided prosthetic joint infection by Candida parapsilosis in immunocompetent patients successfully treated with fluconazole. Case Profile: A 53-year-old female presented with swelling, varus deformity, and medial jointline tenderness in bilateral knees (right > left) since 1 month with X-ray suggestive of grade 4 Osteoarthritis knee. Right total knee arthroplasty was performed, following which the right knee showed bloody discharge on postoperative day 9. Right knee biopsy and aspirate revealed white, smooth, pasty colonies on culture which was identified as Candida parapsilosis via Vitek 2 Compact system. Intraoperative right knee tissue taken during tibial insert replacement of the right knee also demonstrated Candida parapsilosis on culture. Left knee arthrotomy was performed in view of pus discharge from left knee (nonoperative). Intraoperative left knee pus sample and left knee tissue also revealed Candida parapsilosis on culture. Blood culture was sterile, but the patient on detailed scrutiny revealed history of receiving numerous intra-articular injections of anonymous drug in both knees 7 months back. All antibiotics were stopped, and the patient was solely put on IV fluconazole for 2 weeks, after which she showed miraculous symptomatic improvement. Conclusion: A high level of clinical suspicion is required to diagnose Candida parapsilosis arthritis with proper history of direct intra-articular inoculation along with timely antifungal therapy and surgical intervention.

Keywords: Candida arthritis, candida parapsilosis, prosthetic joint

P2444: Comparative Efficacy of Corticosteroid versus Platelet-Rich Plasma in de Quervain’s Stenosing Tenosynovitis

Varun Dhattarwal

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: De Quervain’s stenosing tenosynovitis (dQSTS) causes pain and restricted movement due to tendon inflammation. This study compares the efficacy of corticosteroid injections and autologous platelet-rich plasma (PRP) therapy in treating dQSTS. Objective: To compare the clinical outcomes of corticosteroid therapy and PRP therapy in patients with de Quervain’s tenosynovitis. Methodology: A total of 48 patients were randomized into two groups: Group A (n = 23) received corticosteroid injections, while Group B (n = 25) was treated with autologous PRP injections. Follow-ups were conducted at Day 0, Week 1, Month 1, and Month 6. Outcome measures included pain (Visual Analog Scale, VAS) and functional scores (Mayo’s wrist score). Results: At the second treatment dose, 52.17% of patients in Group A and 84% in Group B showed recovery. At 6 months, 56.52% in Group A and 12% in Group B had recurrence. Significant improvements were observed in Group B, with a P-value of <0.001 for VAS and 0.001 for Mayo’s wrist score. No serious complications were noted. Conclusion: PRP injections demonstrated superior efficacy over corticosteroids in managing de Quervain’s stenosing tenosynovitis, with better long-term outcomes, reduced recurrence, and improved functional recovery.

Keywords: Corticosteroid injection, De Quernain’ stenosing tenosynovitis, PRP

P2445: Traumatic Glaucoma after Blunt Ocular Trauma

Pooja Singh

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Blunt trauma is the most prevalent cause of one-sided blinding ocular injuries and can result in secondary glaucoma. Often, this type of glaucoma may go unnoticed until glaucomatous optic neuropathy (GON) develops. It is crucial to address this condition promptly as delays in treatment can result in further progression. Case Presentation: Our case is a 22-year-old male who presented to Eye OPD with alleged history of trauma with a cricket ball 1 hour back with chief complaints of RE pain and blurring of vision. The patient was apparently well 1 hour back before coming to emergency when he was hit in the right eye with the cricket ball, following which he developed diminution of vision, which was associated with pain and watering. He came to Sharda Hospital Emergency and was started on medical treatment. O/E there was corneal edema, grade 1–2 hyphema, pupil sluggishly reacting, gonioscopy, AC details, and fundus examination CNBA d/t hazy media. There was no history of diplopia, floaters, flashes of light, or restriction in eye movements. On follow-up visits, there was aggravation of pain and further diminution of vision associated with photophobia and raised IOP, and the patient was admitted for the same. Initially, medical management was given, but IOP still remained very high with deterioration of vision for the next 3–4 days. Ultimately, A/C paracentesis with irrigation and aspiration was done, after which patients improved significantly. Discussion-Blunt trauma produces tears in the iris or ciliary body causing bleeding from the small branches of major arterial circle into AC. Without timely intervention, it may lead to PAS, rebleed, posterior synechae, pupillary block, corneal blood staining, and optic atrophy due to raised IOP. Conclusion: Blunt eye injuries can result in secondary glaucoma. Comprehensive evaluations and prompt interventions are essential to protect the patient’s vision and prevent additional damage to the optic nerve.

Keywords: Blunt trauma, GON, traumatic glaucoma

P2446: Blepharophimosis Syndrome – A Rare Genetic Disorder

Ankita Singh

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Blepharophimosis syndrome, BPES, stands for blepharophimosis, ptosis, and epicanthus inverse syndrome. It is a rare autosomal dominant disorder associated with mutations in the FOXL2 gene. The four traditional clinical signs—telecanthus, epicanthus inversus, ptosis, and blepharophimosis—are present in every form. Type I is linked to early ovarian failure. Only the traditional facial traits define type II is characterized exclusively by the conventional facial phenotypes without any accompanying ovarian dysfunction. Objectives: To discuss the pathophysiology, clinical features, diagnosis, and management of Blepharophimosis syndrome. Case History Findings: A 47-year-old male presented with drooping of the eyelids since birth with no history of any systemic diseases. Similar complaints were present in more than one family member from different generations. On examination, chin lift, high arched eyebrows, small palpebral aperture, ptosis, epicanthal inversus, and telecanthus were noticed with good bells phenomenon and no restrictions of extraocular muscle movements. Conclusion: Blepharophimosis syndrome is a genetic disorder, and diagnosis is based on clinical examinations and can be confirmed through genetic testing. Early surgical intervention for ptosis is crucial to prevent the onset of amblyopia.

Keywords: Blepharophimosis, BPES, telecanthus

P2447: Challenge for Obstetricians – Cesarean Scar Ectopic Pregnancy

Priyanka Choudhary

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Cesarean scar is defined as when a blastocyst implants on a previous cesarean scar. The incidence of cesarean scar ectopic has increased due to an increase in number of cesarean deliveries. Early diagnosis of this can be done by using sonography. Incidence: 1 case in 2000 normal pregnancies and has increased along with cesarean delivery rates. It is very important because a delay can lead to increased maternal morbidity and mortality. Aim: To study the efficacy of various treatment modalities. Material and Methods: Case series of patients managed with different approaches. Conclusions: Cesarean scar ectopic pregnancies can have very fatal and poor outcomes; thus, it is important that early and accurate diagnosis of cesarean scar pregnancy is obtained in order to avoid complications and preserve fertility.

Keywords: Cesarean sections, fertility, methotrexate, scar ectopic pregnancy, uterine rupture

P2448: A Rare Case of Late-Onset Kearns-Sayre Syndrome: Challenges in Diagnosis and Multidisciplinary Management

Abhishek R. Shinde, Anurag Prasad, Shrey K. Srivastava

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Kearns-Sayre syndrome (KSS) is a rare mitochondrial disorder with onset typically before age 20. It is characterized by progressive ophthalmoparesis, pigmentary retinopathy, and multisystem involvement, which can include cerebellar ataxia, cardiac conduction block, and various endocrinopathies. Case Report: We present the case of a 48-year-old female who experienced generalized myalgia, fatigue, ptosis, and visual disturbances over 2 months, severely affecting her routine activities. Her history revealed recurring symptoms over 15 years, including past frontalis sling surgery for ptosis. Examination showed bilateral ptosis and external ophthalmoplegia. A biceps muscle biopsy confirmed KSS, revealing ragged red fibers. Eye examination indicated early lenticular degeneration and retinal pigment deposits in the nasal quadrant. The patient received coenzyme Q supplementation and supportive therapy to slow disease progression and improve functional outcomes. Despite the lack of curative treatment, early diagnosis allowed for targeted interventions to manage symptoms effectively. Conclusion: Kearns-Sayre syndrome is a critical but often overlooked cause of proximal muscle weakness, particularly in patients presenting with bilateral ptosis. Clinicians should maintain a high index of suspicion for KSS in cases of unexplained myopathy with ocular and systemic manifestations. Timely diagnosis and supportive care can prevent further complications and enhance patient quality of life.

Keywords: Coenzyme Q, Kearns-Sayre syndrome (KSS), progressive ophthalmoparesis

P2449: Unusual Presentation of Subcutaneous Sarcoidosis

Jaishree Sharma, Anurag Prasad

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Sarcoidosis is a multisystem granulomatous disease that can affect any combination of organ systems. Although the vast majority of patients are diagnosed due to pulmonary symptoms or findings of hilar lymphadenopathy, as many as 25% of patients with sarcoidosis have skin findings. However, because of the high variability in their presentation, initial diagnosis of sarcoidosis is rarely made based on dermatologic manifestations. Case Report: A 57-year-old female with obesity, Type II diabetes mellitus, osteoarthritis, gout, and hypothyroidism presented to clinic with subcutaneous nodules on her bilateral upper extremities. Two years prior to presentation, the patient had a rash on her lower extremities. Biopsies at that time revealed both a neutrophilic dermatosis as well as a lymphocytic infiltrate. On examination EXT: numerous subcutaneous nodules over dorsum of bilateral forearms and hands ranging from 1–5 cm in diameter were seen; some are tender and slightly erythematous. Workup of her hypercalcemia revealed low PTH and PTHrp, elevated 1,25-dihydroxyvitamin D, and borderline elevated angiotensin converting enzyme. CT scan of the chest, abdomen, and pelvis revealed diffuse lymphadenopathy as well as several lung nodules consistent with systemic sarcoidosis. Conclusion: Subcutaneous sarcoidosis is an uncommon form of the disease and can be easily misdiagnosed due to its resemblance to other dermatologic or rheumatologic conditions. Timely biopsy and histopathological confirmation are essential for accurate diagnosis. This report emphasizes the importance of considering sarcoidosis in the differential diagnosis of subcutaneous nodules and underscores the role of multidisciplinary evaluation to guide diagnosis and management.

Keywords: Dermatological, sarcoidosis, subcutaneous nodules

P2450: Subacute Sclerosing Panencephalitis is a Chronic, Progressive Demyelinating Disease Associated with Infection of Brain Tissue with Measles Virus

Pulkit Singh, Ashok K. Dash, Aakash Bharti

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Subacute sclerosing panencephalitis is a chronic, progressive demyelinating disease associated with infection of brain tissue with measles virus. Case Report: A previously asymptomatic 16-year-old male developed insidious, progressive mental detoratiation manifesting in the form of poor school performance, mood changes, myoclonus, and an eventual bedridden state. Intubated at another center due to respiratory failure, he presented to the ER. CSF studies revealed lymphocytosis, mildly raised protein levels (98 mg/dL), normal sugar levels (60 mg/dL), and detectable IgG rubella antibodies. T2FLAIR showed hyper intensities in B/L frontal regions on MRI. EEG showed periodic complexes every 5–10 seconds. The patient was given IV isoprinosine; however, there was no improvement in mental function. Discussion: SSPE should be considered as a differential in an encephalopathy of chronic, progressive duration in an adoloscent patient. However, current medical therapies are limited, with devastating squealae and near 100% fatality rates. Conclusion: The relentless and fatal course of SSPE underscores the importance of measles vaccination.

Keywords: Measles, SSPE, vaccination

P2451: Intersecting Infections: The Challenge of Tubercular Meningitis with Transverse Myelitis

Manik Gakhar, Abhishek Deepak

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Transverse myelitis is an inflammatory condition causing spinal cord injury, with symptoms such as weakness, sensory changes, and autonomic dysfunction. Mycobacterium tuberculosis is a rare cause of transverse myelitis, and diagnosis requires cerebrospinal fluid (CSF) analysis, MRI of the spinal cord, and biochemical or bacteriological confirmation. Symptoms progress over hours to weeks, with common findings including lower limb paraesthesia (80–95%), partial leg paralysis (50%), sensory changes (80%), and bladder dysfunction (almost 100%). Case Report: A 20-year-old female presented with worsening neurological and systemic symptoms over 20 days, including fever, urinary retention, headache, weakness, and altered sensorium. Examination revealed decreased mental function, positive Kernig’s and Brudzinski’s signs, decreased lower limb tone, complete lower limb paralysis, moderate upper limb weakness, and absent lower limb reflexes. Investigations include CSF analysis that shows elevated protein (608.2 mg/dL), low glucose (15.7 mg/dL), lymphocytic pleocytosis (90% lymphocytes), and positive ADA (17.69 U/L), suggesting tuberculous meningitis. CBNAAT (GeneXpert) confirmed Mycobacterium tuberculosis infection. So, the patient is diagnosed with tuberculous meningitis complicated by transverse myelitis. Management of this case included anti-tubercular therapy, which was started, improving fever and mental status within 5 days. Persistent lower limb paralysis prompted MRI, which confirmed myelitis. IV Solumedrol (30 mg/kg/day) improved lower limb function significantly over 7 days, with continued improvement after 14 days of oral steroids. Conclusion: Tuberculosis should be considered in noncompressive myelopathies, particularly in high TB-burden regions, even in the absence of pulmonary symptoms.

Keywords: Meningitis, myelopathy, transverse myelitis, tuberculosis

P2452: Clubbing as an Unusual Presentation in Chronic Liver Disease

Shivam Singh, Anurag Prasad

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Portopulmonary venous anastomosis (PPVA), or fistula, is a rare vascular connection between the portal venous system and the pulmonary veins near the left atrium. The presence of such porto-venous shunts in cases of liver cirrhosis is uncommon and, when present, may indicate the development of portopulmonary hypertension (POPH). There is limited literature on the association of PPVA with significant clinical manifestations such as hypoxia and clubbing. Case Report: A 46-year-old male farmer, with a history of alcohol and tobacco use, was admitted with symptoms of generalized weakness, altered mental status, and shortness of breath persisting for 3 days. On examination, the patient displayed pallor, jaundice, clubbing, bilateral pedal edema, gynecomastia, ascites, and bilateral chest crepitations. Laboratory results indicated normocytic normochromic anemia, low albumin levels, mild transaminitis, and a prolonged INR of 1.9. Hepatitis screening was negative. An ultrasound revealed increased echogenicity, ascites, and splenomegaly, while an esophagogastroduodenoscopy (EGD) showed grade 2 esophageal varices. Autoimmune markers (pANCA, AMA, SMA, ANA) and MRCP were performed to exclude primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC), yielding negative results. Given his worsening hypoxemia and severe (grade 4) clubbing, further investigation was conducted. A CT angiogram of the chest and abdomen identified a fistulous connection between the right pulmonary vein and portal vein in the right lower lobe, alongside multiple enhancing collaterals in the peri-splenic and peri-pancreatic regions, indicative of portal hypertension and liver parenchymal changes. The patient was diagnosed with decompensated chronic liver disease (CLD) and clubbing secondary to PPVA. Conclusion: While PBC and PSC are known rare causes of clubbing in CLD, this case highlights PPVA as the underlying cause of clubbing in CLD.

Keywords: CLD, clubbing, portopulmonary hypertension, portopulmonary venous anastomosis (PPVA),

P2453: A Rare Case Report of Tuberculosis of the Sacroiliac Joint

Desai J. Manharlal, Pankaj Bansal

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: In developing countries, tuberculosis remains a significant health concern, including in the musculoskeletal system. Spinal tuberculosis with neurological involvement can lead to severe outcomes if untreated. The sacroiliac joint, being a true synovial joint, is susceptible to TB, often presenting with vague pain and nonspecific imaging results. Early diagnosis is challenging due to subtle symptoms and limitations in imaging. Case Presentation: A 48-year-old female presented with insidious, intermittent lower back pain radiating to the lower limb, lasting 6 months. History of recurrent fever, weight loss, and reduced appetite were noted. Clinical examination revealed a right-sided neck swelling and tenderness over the sacroiliac joint. Imaging showed right sacroiliac joint erosion and lymphadenopathy. Laboratory tests indicated elevated ESR, CRP, and mild anemia, with FNAC of the lymph node showing granulomas. The patient was started on anti-tubercular therapy (ATT). Conclusion: This rare case of sacroiliac joint tuberculosis underscores the importance of thorough clinical evaluation and imaging for timely diagnosis. Early initiation of ATT, based on a high index of suspicion and imaging, can lead to improved patient outcomes.

Keywords: Sacroilitis, spinal tuberculosis, tuberculosis

P2454: Enterococcal Emphysematous Pyelonephritis in a Diabetic Patient Presenting as Acute Pancreatitis: Two Pathologies in One Patient

Monty Bansal, Ashok K. Dash

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Emphysematous pyelonephritis (EPN) is a severe, necrotizing renal infection commonly seen in patients with uncontrolled diabetes, typically caused by Enterobacteriaceae. This report presents a rare case of EPN due to Enterococcus in a diabetic patient, initially presenting with acute pancreatitis. Case Presentation: A 56-year-old female with a history of type 2 diabetes, hypertension, and hypothyroidism, who was noncompliant with her diabetes and hypertension medications, was admitted in medicine department, Sharda hospital, on 27.10.23 with abdominal pain, vomiting, and diarrhea for the past 6 days. The pain was localized to the epigastric and right upper quadrant regions, moderate to severe in intensity. Two weeks prior, she experienced burning micturition and fever, which had resolved with local treatment. On admission, she was diagnosed with acute pancreatitis, severe sepsis, and acute kidney injury. A CT scan, performed to assess pancreatitis severity, incidentally revealed gas in the renal parenchyma, confirming EPN caused by Enterococcus species. A nasogastric tube was inserted and the patient was kept NPO initially, and IV fluids and IV antibiotics were administered along with insulin and thyroxine. Antibiotics were adjusted based on culture results and were allowed for soft low fat and low protein diet. Her condition improved with normalization of creatinine levels and leucocytosis. By day 9, the patient recovered and was discharged on antidiabetic medications and thyroxine. Conclusion: This case underscores the importance of considering multiple diagnoses in diabetic patients presenting with abdominal pain. Emphysematous pyelonephritis, often caused by glucose fermentation in renal tissues, can be identified through CT imaging. This patient presented with acute pancreatitis, and EPN was picked up incidentally in an early stage because of the protocol to perform CT scan in acute pancreatitis

Keywords: Diabetes mellitus, enterococcus, EPN, pancreatitis

P2455: Exceptional Pemphigus Case Report: A Scarcely Seen Presentation

Arushi Suhag

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Pemphigus is a known but rare autoimmune mucocutaneous blistering condition having four variants: pemphigus vulgaris, pemphigus foliaceous, IgA pemphigus, and paraneoplastic pemphigus. The two principal varieties are pemphigus vulgaris (PV) and pemphigus foliaceus (PF). Literature shows that Pemphigus vulgaris targets desmoglein 3 (Dsg3) and desmoglein 1 (Dsg1), hence affecting skin and mucosa both. However, Pemphigus Foliaceous targets only Dsg1, hence affecting only superficial skin, and does not affect mucosa. There have been very few case reports about the occurrence of both vulgaris and foliaceus in the same patient. We report a case having concomitant Pemphigus vulgaris of oral mucosa and Pemphigus foliaceus of chest and back. Case Description: A young male patient was referred to the ENT outpatient department with complaints of oral lesions along with ulcers for 3 months and fluid-filled crusted lesions over the scalp, chest, and back for 1 month with no comorbidities. Examination was done, and biopsy was taken from the lesions of buccal mucosa that revealed histopathological features of pemphigus vulgaris. The patient was then referred to the department of dermatology for lesions on the back and chest for which a biopsy and tzank smear were taken, which showed features of pemphigus foliaceus. The patient was treated with oral and topical steroids with broad-spectrum antibiotics, supportive multivitamins, and probiotics to prevent any secondary infection. Discussion: The quintessential lesion of pemphigus is a thin-walled bulla emerging on otherwise normal skin or mucosa, which swiftly breaks and continues to extend peripherally, ineluctably leaving large denuded areas. It also displays positive “Nikolsky’s sign” – the capability to induce peripheral extension of a blister and/or removal of epidermis as a consequence of applying tangential pressure with a finger or thumb to the involved skin, peri-lesional skin, or normal skin in patients affected or suspected with pemphigus. There have been a few studies describing about the transitions and concomitant involvement of both the subtypes. The mainstay of treatment modalities remains limited to oral and topical tapering doses of steroids; some patients have also known to benefit by biological agents like Mycophenolate Mofetil (MMF) and Azathioprine. Conclusion: This rare case report helps in understanding the scarcely seen presentation of pemphigus wherein there is simultaneous occurrence of both the variants, vulgaris and foliaceus. It states that there should be more vigilant clinical examination in all such patients to rule out other subtypes hence leading to better treatment outcomes and good disease prognosis.

Keywords: Pfoliaceous, pvulgaris, variants

P2456: Sudden Onset Palatal Palsy – An Iceberg in ENT

Pooja Bhati

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Unilateral acquired isolated palatal paralysis is an uncommon condition usually seen in children. It occurs due to isolated involvement of the pharyngeal branch of the vagus nerve, which supplies motor fibers to muscles of the pharynx and soft palate. The causes include viruses such as varicella zoster virus, herpes simplex virus (HSV), measles virus, and Coxsackie A9 virus. Case Description: A 15-year-old child presented with complaints of dysphagia since 10 days followed by dysgeusia. The patient also had complaints of episodes of nasal regurgitation with liquids. Previous history of fever was present, 1 episode 15 days ago, not associated with chills or rigors and subsided with medication. There was no history of facial weakness, nausea, and vomiting. Complete systemic and ENT examination was performed. The patient was found to have deviation of uvula on the left side associated with left side vocal cord palsy. Serum samples to rule out viral illnesses were sent and found to be positive for hepatitis E. Discussion: The prognosis is usually good, which responds to steroids. It is documented in literature that palatal palsy is acute in onset, appearing in infancy (96%), predominance in males (79%), recent respiratory infection (35%), and an excellent prognosis for recovery (85%). Our patient improved with 10 days tapering dose of steroids without any residual deficit. Conclusion: The prognosis is usually good, which responds to steroids. Palatal palsy is acute in onset, appearing in infancy (96%), predominance in males (79%), recent respiratory infection (35%), and an excellent prognosis for recovery (85%).

Keywords: HSV, palatal paralysis, vagus nerve

P2457: Tonsillar Schwannoma: A Rare Case Report

Saurabh Singh

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: A schwannoma is a benign, locally aggressive tumor that occurs due to the proliferation of Schwann cells of the nerve sheath. These tumors may involve any cranial nerve and hence are routinely missed on diagnosis. Conclusion: Schwannoma is a rare entity in the tonsil and it is challenging to diagnose a unilateral tonsillar mass as very few cases have been reported so far for the same. A complete surgical excision will suffice, and recurrence can be avoided in long-term follow-up.

Keywords: Schwannoma, schwann cells, tonsillar mass

P2458: Fluminant Rhino-Orbital Cerebral Mucormycosis with Cavernous Sinus Thrombosis with Opthalmoplegia – A Case Report

Kanika Arora

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Mucormycosis represents a group of life-threatening infections caused by fungi of the Mucorales of subphylum Mucormycotina. It is a rare life-threatening fungal infection seen in immunocompromised or diabetic patients. Mucormycosis is an emerging angioinvasive infection. Conclusion: This poster has presented classical clinical features of cavernous sinus thrombosis and rhino-orbito-cerebral mucormycosis. A high index of suspicion is required for diagnosis of mucormycosis. Early diagnosis with antifungal therapy with surgical debridement is the treatment of choice. Reversal of predisposing factor if possible. In patients with intracranial involvement, fatality rates can exceed 80%.

Keywords: Angioinvasive infection, cavernous sinus thrombosis, Mucor mycosis, mucorales

P2459: Epiglottic Cyst – A Case Report

Riya Thakral

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Laryngeal cysts constitute approximately 5% of benign laryngeal lesions. The majority of cysts originate from the epiglottis. Epiglottic cysts are generally benign lesions which can affect all age groups, but with increased frequency in adults. Laryngeal cysts are classified into two groups: epithelial and nonepithelial. Depending on their location and size, they can cause airway obstruction and potentially lead to sudden death. The cysts are usually soft and compressible, pedunculated than sessile. Their size ranges from 1 mm to 5 cm in diameter. We report a case of a large epiglottic cyst presenting with dysphonia and dysphagia. Case Description: A 17-year-old female presented to ENT OPD, with complaints of dysphagia and dysphonia since 8–9 months. There was no h/o dyspnea. On examination of the throat, oral cavity was normal. A pearly white globular soft swelling was seen on the lingual surface of the epiglottis obscuring the vision of anterior part of the vocal cords without compromising the airway. Routine investigations were done, and the patient was subjected to CT scan from the skull base to thoracic inlet, which revealed an isodense soft-tissue shadow on the epiglottis obscuring 1/3d of the laryngeal inlet. Based on this, the patient was taken up for microlaryngoscopic excision of the epiglottic cyst under GA and histopathological diagnosis was ductal cyst. Discussion: Mucous cysts are pseudocysts because no true lining is present. They are also called mucous retention cyst or mucoceles. From a l0-year review of Mayo - clinic experience, DeSanto et al. reported that 52% of laryngeal cysts originate from the epiglottis with most arising from the lingual surface. The pathophysiology underlying these cysts is thought to be the inflammation of the larynx, leading to obstruction of gland ducts and in turn causing retention of mucus and ultimately the formation of cysts. Most adult epiglottic cysts are detected in the 6th decade, presenting symptoms of epiglottis cyst which vary with cyst size, age of the patient, and extension into the airway. Epiglottic cysts in neonates often cause sudden infant death. Adult epiglottic cysts often cause a lumpy sensation in the throat but seldom produce respiratory distress. Conclusion: An epiglottic cyst can be one of the causes of airway obstruction. Treatment of epiglottic cysts depends on the size and severity of airway obstruction. Patients with an asymptomatic epiglottic cyst can be observed; larger cysts require surgery. Early diagnosis is necessary. Maintaining the airway and preventing the rupture of cysts play a crucial role in the airway management of epiglottic cysts.

Keywords: Cyst, epiglottis, excision

P2460: Conquering the Monster: Intensive Dose Nitroglycerin in SCAPE in ER

Ekta Kapoor

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: The most severe kind of acute pulmonary edema is known as sympathetic crashing acute pulmonary edema (SCAPE). Understanding this illness is crucial since it is prevalent in Emergency Department and, with proper management, has drastic results. In SCAPE, a rapid increase in blood pressure can cause immediate heart failure and lung fluid buildup. Although high-dose nitroglycerin (NTG) has become a popular therapy option, there is still disagreement about the best way to administer it and the use of ACE inhibitors and loop diuretics as adjunct treatments. Case Presentation: We present a case of 62-year-old male who presented to Emergency Department with complaints of sudden onset shortness of breath and tachypnea, associated with excessive diaphoresis. The patient was a known case of hypertension, noncomplaint with medications. On examination: BP – 280/180 mm hg; B/L coarse crepitations in diffuse lung fields. ECG was suggestive of Sinus tachycardia. The patient was put on oxygen supplementation and NTG infusion. Conclusion: A downward spiral of deteriorating cardiac failure, increased sympathetic outflow, and enhanced afterload lead to SCAPE. High afterload as a result of systemic vasoconstriction and hypertension is the primary, defining pathophysiological characteristic of SCAPE. For SCAPE patients, high intravenous NTG dosages have proven to be safe and effective. Mechanical ventilation and death are avoided by administering an ultra-high dosage bolus, probably the greatest dose ever, and a sustained high-dose infusion of NTG for SCAPE in conjunction with noninvasive ventilation.

Keywords: ACE inhibitors, nitroglycerin, SCAPE, pulmonary edema

P2461: The Bedside Oracle – Assessing the Diagnostic Accuracy of Optic Nerve Sheath Diameter as a Marker of Raised Intracranial Pressure in Traumatic Brain Injury

Sarthak Mishra, Saifa Latheef, Harsh Vardhan

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Optic nerve is enclosed by a perineural space filled with cerebrospinal fluid (CSF) and the dural sheath. Increased intracranial pressure caused by the displacement of CSF causes a further increase in the amount of CSF within perineural space, which leads to the expansion of the dural sheath around the optic nerve. Several studies have reported the measurement of optic nerve sheath diameter (ONSD) as an indicator of and for effective management of raised ICP in the Emergency Department. Aims and Objectives: The aim was to evaluate the role of bedside sonographic measurement of the ONSD in the assessment of elevated intracranial pressure in patients with traumatic brain injury (TBI) presenting to the emergency department (ED). Materials and Methods: A prospective observational study of ED patients presenting with a history of acute traumatic head injury was done. Ocular ultrasound was done using a 7.5 Hz to 10 Hz linear probe on closed eyes of the patients. Three measurements were taken for each eye 3 mm posterior to the globe, following the mean binocular ONSD measurement for each patient. A noncontrast computed tomography of the head was obtained as a part of normal protocol for the management of TBI, and the findings were compared. A mean bipolar ONSD >5 mm was considered abnormal. Results: A total of 50 patients were enrolled in the study. The relationship of ONSD with CT scan findings was highly significant. The sensitivity of the bedside sonographic measurement ONSD to detect raised ICP was 93.2% and the specificity was 91.1% when compared with CT scan. The positive predictive value of the ONSD measurement was 89.1%, and the negative predictive value was 94.4%. Conclusion: This study underscores the clinical utility of bedside point-of-care ONSD measurement as a valuable adjunct to primary survey and enhancing neurocritical care especially in resource limited settings.

Keywords: Intracranial pressure (ICP), optic nerve sheath diameter (ONSD), point-of-care ultrasound (POCUS), traumatic brain injury (TBI)

P2462: Beyond the Pain: Perimyocarditis Masquerading as Acute gastritis

Maharshi Patel

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Acute pericarditis is the most common cause of inflammatory heart disease, followed by myocarditis and infective endocarditis. Although typically benign and self-limiting, acute pericarditis can lead to severe complications, such as cardiac tamponade, which is potentially fatal if undetected, as well as recurrent and chronic constrictive pericarditis. It may present as an isolated condition or part of a systemic disease. However, not all cases in the emergency setting are immediately recognized; acute pericarditis can sometimes masquerade as conditions like acute gastritis. This report discusses a 19-year-old male with epigastric discomfort and suspected with acute gastritis who was later diagnosed with perimyocarditis. Discussion: Delayed diagnosis of acute pericarditis can lead to complications such as perimyocarditis. The utility of point-of-care ultrasound (POCUS) and echocardiography, alongside ECG and laboratory investigations, is critical in identifying these complications. Conclusion: This case highlights an atypical presentation of acute pericarditis in a young patient with symptoms of epigastric discomfort. Although often benign, acute pericarditis can sometimes mimic gastrointestinal or noncardiac conditions, risking delays in diagnosis and treatment. Early detection is crucial to prevent severe complications, such as cardiac tamponade. Point-of-care echocardiography and classical ECG signs are valuable tools for prompt diagnosis and effective intervention. Clinicians should maintain a broad differential diagnosis to ensure timely and accurate identification, ultimately improving outcomes for patients with inflammatory heart disease presenting with nonspecific symptoms.

Keywords: Acute gastritis, infective endocarditis, perimyocarditis

P2463: Isolated ST Elevation, Should Code Stemi be Activated?

Jitesh Sethi

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: The electrocardiogram (ECG), which offers priceless insights into cardiac electrical activity, continues to be a cornerstone in the diagnosis and treatment of cardiovascular disorders. In the Aslanger Pattern, which was initially identified by Aslanger et al., they discovered a particular ECG pattern that raises concerns for acute inferior wall MI in patients who have simultaneous multivessel illness but do not meet STEMI criteria or have continuous ST-segment elevation.^[1] The Aslanger Pattern^[1] is characterized by: Inferior STE isolated to lead III Concomitant ST depression in any of V4–V6, with a positive/terminally positive Twave ST segment in V1>V2 Recognizing this phenomenon, which is typically seen in 6.3% of NSTEMI^[1] and in 13.3% of STEMI patients^[2] and is known to be a predictor of greater infarct size and higher mortality, is essential for correctly interpreting ECG results and making the right treatment decisions. Conclusion: Here, we describe a novel ECG pattern that, in patients with concurrent critical lesion(s) in coronary arteries other than the artery associated to the infarct, indicates inferior MI. Individuals who exhibit this pattern are more likely possess multivessel disease having high mortality. Early detection of this pattern on a 12-lead ECG facilitates prompt management, preventing irreparable myocardial tissue alterations and ischemia.

Keywords: Aslanger pattern, ECG, STEMI, ST elevation

P2464: Unveiling Crusted Scabies: From Identification to Intervention

Isha Singla

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Crusted scabies is a rare and highly contagious form of scabies marked by an overwhelming infestation of Sarcoptes scabiei mites in the skin, especially in immunocompromised individuals. It is characterized by large crusted lesions and thick hyperkeratosis. Case report: A 70-year-old male presented with multiple yellowish brown thickened lesions present extensively over the body. The lesions were associated with mild itching which increased at night. He was a known case of uncontrolled type 2 diabetes mellitus and hypothyroidism since 1 year. On examination, multiple well-defined yellowish brown crusted hyperkeratotic lesions with a “built-up sand” appearance were present on interdigital web spaces of bilateral hands and feet, abdomen, thighs, groin, penis, scrotum, and buttocks. On dermoscopy, numerous curvilinear burrows were seen in a noodle-like pattern displaying gray edged line sign, delta sign, and jetliner with contrail sign. KOH mount skin scrapings revealed mites and eggs, and histopathology revealed scabies mite in epidermis. The patient was treated with oral ivermectin 12 mg and topical 5% permethrin. Discussion In this case, the patient exhibited classic thick, adherent crusts seen in crusted scabies. Diagnosis was confirmed through microscopic examination and histopathology, revealing the presence of Sarcoptes scabiei mites and eggs within the hyperkeratotic debris. In conclusion, crusted scabies represents a challenging dermatological condition due to its rarity, varied clinical presentation, and rapid transmission potential and requires prompt recognition, aggressive treatment, and meticulous infection control measures to mitigate the risk of complications and prevent outbreaks.

Keywords: Crusted scabies, dermoscopy, sarcopetes scabiei

P2465: Palmoplantar Lichen Planus – A Case Report

Rabia Alam

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Palmoplantar lichen planus is one of the rare variants of lichen planus. It presents as pruritic, red-purple, scaly papule on the palms and soles. Due to its clinical resemblance to many other common dermatological conditions, it is often misdiagnosed. While the diagnosis is primarily clinical, dermoscopy plays a valuable role, with histopathology remaining the gold standard for confirmation Case Report: Here, we present the case of a 23-year-old female patient, who presented with itchy lesions on palms and soles for 20 days along with burning sensation in mouth for 1 month. On routine investigations, all serological markers were negative, and histopathology showed band-like lymphocytic infiltrate obscuring the epidermodermal junction, suggestive of lichen planus. The patient showed significant improvement on treatment with oral corticosteroids and acitretin. Discussion: Unlike the general clinical picture of lichen planus, involvement of only palms and soles is seen in palmoplantar variant of lichen planus, where lesions are commonly seen on the internal plantar arch of sole and the thenar and hypothenar eminence of palms. Here, there is lack of the classical features of the disease. For early diagnosis and treatment, it is important to know about this rare variant of lichen planus and differentiate it from other similar appearing conditions. Conclusion: Palmoplantar lichen planus is rare, with violaceous papules on palms and soles. Diagnosis requires clinical examination, dermoscopy, and histology. Early detection and treatment are essential to alleviate symptoms and prevent complications.

Keywords: Palmoplantar lichen planus, rare variant, serological marker, Papules

P2466: Tamoxifen-Induced Hyperpigmentation: A Diagnostic Dilemma between Melasma and Lichen Planus Pigmentosus

Shivam Garg

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Introduction: Tamoxifen is a selective estrogen receptor modulator used in the treatment of hormone-sensitive breast cancers, such as estrogen receptor-positive (ER+), progesterone receptor-positive (PR+), and both. It is commonly used in early-stage invasive breast cancer and ductal carcinoma in situ (DCIS). Tamoxifen functions by inhibiting estrogen receptor activity, leading to decreased DNA synthesis and estrogen effects. Case Report: A 70-year-old woman presented with hyperpigmentation on her face and neck for 4–5 years, which progressively spread to the chest, back, and upper extremities. She had undergone a simple mastectomy for atypical ductal hyperplasia (ER+/PR+/HER2−) in 2012 and had been on Tamoxifen since. Physical examination revealed symmetrical slate-gray pigmentation in sun-exposed areas. Skin biopsy showed atrophy of squamous epithelium, loss of rete ridges, and lymphohistiocytic infiltration in the upper dermis, with abundant melanin around small blood vessels. Conclusion: This case highlights a rare side effect of Tamoxifen and underscores the diagnostic challenge in distinguishing between various pigmentation disorders, such as melasma and lichen planus pigmentosus, in patients undergoing Tamoxifen therapy for breast cancer.

Keywords: Breast cancer, dermatology, hyperpigmentation, lichen planus pigmentosus, melasma, tamoxifen

P2467: Acute Post Partum Uterine Inversion with Asystole: An Obstetric and Anesthetic Challenge

Praveen Kumar, Alaksh Kher, Mrinalini Singh

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Acute postpartum uterine inversion is rare. It is a potentially life-threatening complication of vaginal delivery and should be excluded in case of sudden PPH and collapse. Case report: A 25 yr/F G3P2L2A0 presented to our hospital with inverted uterus and undocumented bleeding per vaginum. Pale, drowsy, BP = 65/30 mmHg, PR = 140 bpm, RR = 34/min. O/E grade 3 uterine inversion with blood clots present. Immediate fluid resuscitation started. Manual uterine repositioning attempted. Intraoperative management: Continuous fluid resuscitation, Induced with Ketamine and Scholine and intubated > asystole, CPR started. After 2 min, pulse and BP were not recordable and Adrenaline 1 mg IV stat given, CPR continued. After the second dose of Adrenaline, she developed ventricular fibrillations. She was immediately given three consecutive DC shocks. She developed ventricular tachycardia, and Amiodarone was given. She achieved NSR, BP = 102/48 mmHg, PR = 128 bpm, was started on Noradrenaline given, correction of acidosis done. Two units BT given with gynaecological intervention done, Bakri balloon, inserted and kept in position. Oxytocin started; Carboprost and Methergin given. The patient stabilized, was extubated, Bakri balloon removed and discharged. Discussion: Uterine inversion is a rare complication. Management has two important components: the immediate treatment of the hemorrhagic shock and reposition of the uterus. Mostly reduction is achieved by nonsurgical means, that is, manually or Bakri balloon, rarely requires surgical- transabdominal or transvaginal methods. Uterine repositioning requires tocolysis; however, GA remains the treatment of choice if reduction is difficult, or the patient becomes hemodynamically unstable.

Keywords: Asystole, anesthetic challenge, postpartum uterine invasion

P2468: Efficacy of Bilateral Scalp Block in Reducing Anesthetic Requirements in Geriatric Patients Undergoing Intracranial Surgery

Arshiya Gupta

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Conventional general anesthesia (GA) is often poorly tolerated by geriatric patients with multiple comorbidities, especially during intracranial surgeries. Effective scalp blocks can significantly reduce the need for systemic anesthetics, thereby minimizing hemodynamic and respiratory complications. Case Report: A 78-year-old male presented with gradual deterioration of sensorium and left-sided hemiparesis, known case of hypertension, coronary artery disease, and obstructive sleep apnea. MRI revealed bilateral subdural hematoma with a left-sided midline shift. The patient underwent bilateral subdural hematoma evacuation via burr-hole. Methodology: Preoperatively, his vitals were stable (BP: 140/80 mmHg, HR: 92/min, spo2:97% on R.A). Then the patient was taken for preanesthetic checkup, and informed consent was taken, and the patient was taken into OR. Induction of general anesthesia was done with propofol, fentanyl, and cis-atracurium followed by insertion of I-gel supraglottic airway device, and anesthesia maintenance was done with a mixture of oxygen and sevoflurane. Then a bilateral scalp block was performed with 75 mg of 0.5% bupivacaine. Intraoperatively, the patient was hemodynamically stable. The I-gel was then removed while the patient was fully awake. Postoperatively, the patient exhibited improved neurological status (E4V5M6) within 6 hours and demonstrated no new deficits, with motor power improvement by day 2. He was discharged on the fourth day. Conclusion: Bilateral scalp block is a beneficial adjunct for reducing anesthetic requirements in geriatric patients with comorbidities undergoing short intracranial surgeries.

Keywords: Bilateral scalp block, intracranial surgery, geriatric patients

P2469: Delayed Aspiration of Air Emboli from the Central Venous Catheter in a Case of Suspected Massive Venous Air Embolism – A therapeutic Success

Shefali, Anshil Bhatiya

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Venous air embolism (VAE) is a rare but potentially life-threatening complication in neurosurgical procedures. While often clinically benign, significant VAE can lead to severe cardiopulmonary and neurological consequences. Case Presentation: A 40-year-old male with a history of head trauma from a road traffic accident was admitted with a Glasgow Coma Scale (GCS) score of E1VTM4. Neuroimaging revealed hemorrhagic contusions and a midline shift. During emergency decompressive craniectomy, a superior sagittal sinus injury led to hemodynamic instability, with sudden drops in EtCO2, blood pressure, and SpO2, suggesting VAE. Despite initial resuscitation measures (head-down positioning, saline flooding, and 100% oxygen), hemodynamic instability persisted. Intervention: After surgery, given the persistence of instability, an electrocardiogram (ECG)-guided central venous catheter (CVC) was inserted in right subclavian vein to aspirate the suspected air embolism. 80 mL of air was successfully aspirated from the CVC, leading to immediate improvement in blood pressure, heart rate, and oxygen saturation. Results: Following aspiration, the patient’s condition stabilized. Postoperatively, he showed gradual neurological recovery, with a GCS improvement to E3VTM6 by day 9. The patient was extubated after tracheotomy and discharged on postoperative day 20. Conclusion: This case underscores the importance of early recognition and management of VAE in neurosurgery. ECG-guided CVC aspiration is a highly effective method for diagnosing and treating VAE, providing both diagnostic specificity and therapeutic benefits in critically ill patients.

Keywords: Air emboli, central venous catheter, GCS

P2470: HELLP: Lscs wit LSCS

Jasmeet K. Gulati, Shivika Nath, Alaksh Kher, Anshil Bhatiya

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Single-lung ventilation, also known as ‘one-lung’ ventilation, involves ventilating one lung and letting the other collapse to provide surgical exposure in the thoracic cavity or isolating ventilation to one lung. A 3-year-old male with 12 kg weight presented with fever from 15 days and difficulty in breathing from 2 days. CT chest suggestive of? Rt Pleural effusion? RT Empyema. Methodology: Following preanesthetic checkup and after taking informed consent, the patient was taken to the OT. Pt was intubated with a 4.5 mm cuffed ETT after inducing the patient with Inj Fentanyl, Inj Propofol, and Inj Atracurium. A pediatric fiberoptic bronchoscope was used to confirm the position. The left lateral decubitus position was used during the procedure. Intravenous intermittent Atracurium and Sevoflurane were used to maintain anesthesia. The hemodynamics remained normal. Following the procedure, the patient was extubated. Bilateral air entry was confirmed. The patient was hemodynamically stable. Conclusion: When administering one lung ventilation technique to infants and children undergoing VATS, it is important to consider the respiratory insult that OLV causes while under general anesthesia as well as the position of the patient during the procedure.

Keywords: Anesthetic challenge, one lung ventilation, VATS

P2471: Hypertrophic Cardiomyopathy with CKD in Pediatric Patients; Challenges in Anesthetic Management

Akhilesh Chopra, Shivika Nath

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Renal disease is a rare but significant cause of morbidity and mortality in children and has implications for conduct of GA. Children with CKD requiring surgery are considered complex and high risk. Perioperative anesthetic management of patients with HCM for any type of surgical procedure has an increased risk of morbidity and mortality related to the propensity for arrhythmias and myocardial ischemia.^[2] In accordance with mentioned researches, we present the following case report. Case Description: An 8-year-old male child with HCM, CCF, and CKD who presented for emergency percutaneous nephrostomy. In PAC checkup, the patient was categorized as ASA Class 5(E) and GA was planned. Conclusion: Children with HCM and CKD have been considered to be high-risk candidates for GA, which requires cautious fluid management and meticulous control of arterial pressure. The goals of perioperative care for patients with HCM are to limit the dynamic consequences with avoidance of any cardiac events.^[2] Such cases present unique challenge and require a multidisciplinary team preserving renal and cardiac functions for better postoperative outcomes.

Keywords: Chronic kidney disease, hypertrophic cardiomyopathy, pediatric

P2472: Anesthetic Management of a Patient with Help Syndrome in lscs

Runjhun Swarnkar

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Pregnancy-induced hypertension (PIH) can progress to severe complications like preeclampsia and HELLP syndrome, a life-threatening condition characterized by hemolysis, elevated liver enzymes, and low platelet count. Anesthetic management of such cases, especially during cesarean section, presents significant challenges due to coagulopathy and hemodynamic instability. Case Report: A 26-year-old female, multigravida at 36 weeks gestation with a history of PIH, presented with severe hypertension (186/104 mmHg), thrombocytopenia (platelet count 47,000/mm³), and anemia. Laboratory findings included elevated bilirubin and liver enzymes. The patient was diagnosed with HELLP syndrome and was scheduled for emergency cesarean section. Given the risks associated with neuraxial anesthesia, general anesthesia was chosen. Rapid sequence induction with propofol and succinylcholine was performed, followed by tracheal intubation. Intraoperatively, the patient received platelet concentrate, and fentanyl and atracurium were used for anesthesia maintenance. The neonate had an APGAR score of 7 and 9, and the patient remained stable postoperatively. Discussion: Anesthesia for HELLP syndrome requires careful assessment of coagulopathy and organ dysfunction. General anesthesia is often preferred due to the risk of bleeding with neuraxial techniques in patients with low platelet counts. Rapid sequence induction and appropriate hemodynamic management are crucial for minimizing complications. Conclusion: In patients with HELLP syndrome undergoing cesarean section, general anesthesia with rapid sequence induction is a safe and effective option, ensuring maternal and fetal stability.

Keywords: APGAR score, coagulopathy, HELLP syndrome

P2472: Subcutaneous Emphysema Post Road Traffic Accident: A Case Study and Review of Management

Usha Vasandani, Ankit

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background and Objectives: Subcutaneous emphysema, a rare but potentially serious condition, occurs when air is trapped within the subcutaneous tissues. It is commonly associated with trauma and can be seen in patients after a road traffic accident (RTA). This condition can present with varying symptoms, from minor swelling to severe respiratory distress, depending on the extent of air infiltration. The purpose of this study is to examine the pathophysiology, clinical presentation, diagnostic approach, and management of subcutaneous emphysema secondary to RTA. Case Description: This poster presents a case of a 65-year-old male patient involved in a high-speed RTA, resulting in multiple rib fractures and subsequent subcutaneous emphysema. Upon examination, palpable crepitus was observed over the chest and neck regions, indicative of subcutaneous air. Imaging, including X-ray and CT scan, confirmed the presence and extent of air leakage into the subcutaneous tissues. Bilateral pneumothorax was present, and the patient was having shortness of breath at the time of presentation (SPO2 – 95% at 5 liters of oxygen). Management: Treatment included monitoring respiratory function, administration of supplemental oxygen to facilitate air absorption, and conservative measures for pain management. Due to the lack of complications and stable respiratory status, invasive procedures were avoided, and the patient experienced gradual reabsorption of the subcutaneous air over several days. Conclusion: This case highlights the importance of prompt diagnosis and a tailored management approach for subcutaneous emphysema post-RTA. Conservative treatment is often sufficient, but careful monitoring is essential to detect potential complications such as pneumothorax or airway compromise. Enhanced awareness and early intervention can significantly improve outcomes for patients experiencing this condition post-trauma.

Keywords: Conservative management, respiratory monitoring, road traffic accident, Subcutaneous emphysema, trauma

P2473: Anesthetic Management for Ruptured Ectopic Pregnancy in a Patient with Dual Valve Replacement with Ongoing Atrial Fibrillation

Jagnoor D. Kaur, Nupur Agarwal, Shivika Nath

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Patients with prosthetic heart valves are a challenge to any anesthesiologist due to the risk of infective endocarditis, bleeding, and thrombosis. AF can present as paroxysmal, persistent and permanent. Case Description: We present successful anesthetic management of a 32-year-old female, second gravida k/c/o hypothyroidism with C/O of pain abdomen, “spotting” p/v with H/O dual valve replacement (mitral and aortic valves) 3 years ago. The patient was planned for emergency laparotomy. Conclusion: The salient features of perioperative management of the patient with artificial valve are endocarditis prophylaxis, prevention and management of hemorrhage due to ongoing anticoagulants, and stability of hemodynamics in case of adverse events like arrythmias. Our goal is to maintain stable rate, rhythm, and anticoagulation in patients with prosthetic heart valves undergoing emergency surgery to avoid perioperative complications.

Keywords: Anesthesia management patient consent: yes, atrial fibrillation, ectopic pregnancy

P2474: Intraoperative Sympathetic Crashing Acute, Pulmonary Edema much Resuscitation is Enough?

Hadiya Ajaz, Ram M. Sharma, Manish Bharti

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Perioperative/postoperative flash pulmonary edema is common and can be life-threatening. This adds to morbidity and mortality and causes unpredictable ICU admission. There are multiple reasons described in the literature; however, at times, it is difficult to establish the exact cause of pulmonary edema. There are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema (1). We describe a case of intraoperative sympathetic crashing pulmonary edema (SCAPE) possibly due to over resuscitation. Objectives: Identify cause of pulmonary edema in young ASA grade 1 patient. Methodology: Study design: Restrospective case report. Study period: 23rd to 25th May 2023. Study area: ICU, School of medical science and research, Sharda Hospital, Greater Noida. Case details: A 23 years old man with 18 days old fracture right ulna was listed for open reduction and internal fixation with plating under general anesthesia (GA). His clinical examination was unremarkable; the complete blood count, biochemical profile, and preoperative ECG were within normal limits. The patient was accepted in ASA PS grade 1 for anesthesia. GA was induced with fentanyl, midazolam, propofol, and trachea intubated with vecuronium. Anesthesia was maintained with oxygen, nitrous, sevoflurane, and controlled ventilation to maintain normocapnia. Surgery started after cleaning and draping. The surgeon noticed some blood clots around the fracture, which were cleaned and washed. After about 30 min of starting surgery, tourniquet was applied as requested by the operating surgeon. Drilling was done around the fracture site to insert screws and fix plates. After about 1 hour and on drilling of the sixth hole in the ulnar bone, the patient suddenly had an attack of ventricular tachycardia as noticed on cardiac monitor. It was managed by administering 5 mL of 2% Lignocaine and Inj Amiodarone 300 mg. Subsequently, patients had asystolic cardiac arrest as noted by absence of pulse and flat line on cardiac monitor. CPR was started immediately as per ACLS protocol, and the patient was administered 04 ampoules of adrenaline before ROSC was achieved. After a while, the patient had second asystolic cardiac arrest, revived with chest compression and 02 ampoules of adrenaline. At this point, the patient developed flash pulmonary edema with copious amounts of pink frothy secretions noticed in ETT. Surgery was completed quickly, and the patient was shifted to ICU on hand ventilation with Bains circuit. The patient had received about 400 mL of Ringer’s lactate till now. On arrival to ICU, the patient was hypotensive on noradrenaline and adrenaline infusion and pink frothy secretions were bubbling out of ETT. Vitals signs of SpO2 65%, HR 145/min, NIBP 96/50 mm Hg, ECG showed sinus tachycardia. It was considered flash pulmonary edema. The patient was placed on mechanical ventilation with ACVC mode. Infusions of fentanyl and atracurium were started to maintain sedation and paralysis. Inj frusemide 40 mg injected stat; maintenance fluids continued. Arterial blood gas analysis on arrival to ICU shows severe metabolic and respiratory acidosis (pH 7.222, PCO2 51.8 mm Hg, PaO2 82.0 mm Hg, Lactate 5.3 mmol/lHCO3 18.2 mmol/L) and high lactate. Arterial line and central line placed immediately, and infusions of inotropic agents optimized to maintain MAP >65 mm Hg. Chest radiograph taken in ICU showed diffuse interstitial and alveolar infiltrates. Result: The patient showed diuretic response with good urine output following diuretic administration. Gradually, SpO2 improved over the next 24 hours to 95 to 98% and hemodynamic parameters starting improving. Arterial blood gases were repeated every 4 hourly that showed correction of respiratory and metabolic parameters. Inotropic medications noradrenaline and adrenaline were tapered. Slowly, the patient stabilized over the next 24 hours and extubated. The patient continued to make steady recovery over the next 02 days and shifted out of ICU after 03 days. Conclusion: Preoperative risk factors for increased cardiovascular morbidities – Light plane +/− Possibility of pseudo V tach ++ Possibility of lidocaine-amiodarone drug interaction ++ Possibility of epinephrine leading to sympathetic crisis and pulmonary edema +++ Possibility of perioperative ACS – Possibility of takosobtu (stress) cardiomyopathy+

Keywords: ACLS protocol, acute pulmonary edema, sympathetic crashing, resuscitation

P2475: Management of a Traumatic Cervical EDH Presenting as Hemiparesis in an Elderly Female Mimicking Thrombosis of Intracranial Flow Diverter in situ

Sonam, Mrinalini Singh, Vikas Bhardwaj

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Case Report: A 63-year-old female with a history of hypertension and an intracranial flow diverter presented with right-sided hemiparesis after a minor fall. She was on aspirin and clopidogrel. Initial assessment suggested flow diverter thrombosis. MRI of cervical spine: EDH at C4-C5 vertebral level indenting cord with associated edema. No associated vertebral fracture. Management: Clopidogrel stopped; aspirin continued; active physiotherapy started. Day 10, power improved to 4/5 in both (R) UL and LL Clopidogrel was resumed on day 10. She started walking with support and was discharged on day 15. Conclusion: Cervical EDH can present with hemiparesis and should be considered during initial screening. Also, in a patient considered high-risk for surgery, conservative management can be considered.

Keywords: Esophageal pleural fistula, hemiparesis, traumatic cervical EDH

P2476: A Rare Case Report of Esophageal-Pleural Fistula in a Suspected Case of Mediastinal Mass

Saurabh Bansal, Devendra K. Singh, Sonisha Gupta, Neha Aggarwal

School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Esophageal pleural fistula (EPF) is a rare entity which is formed secondary to esophageal instrumentations, surgery, and malignancy or as a rare complication of post pneumonectomy. Spontaneous development of fistula is a very rare entity. Esophagus injury should be considered when the patient presents with retrosternal chest pain, fever, dysphasia, and dyspnea. Contrast-enhanced computed tomography is a very useful imaging technique to evaluate EPF. Supporting investigations include chest x-ray and barium swallow study. Case Report: A 47 years old man had complaints of fever with chills, shortness of breath, loss of weight, and dysphagia since 1 month. O/E vocal fremitus and vocal resonance reduced on the right side. Chest X-ray showed multiple air fluid levels on the right side. CT Chest showed a large lobulated soft tissue density in the mediastinum. On barium swallow, the esophagus appears dilated in its proximal part with a suspicious defect causing contrast seepage into the mediastinum. Discussion: The location, size, length, and severity of the EPF determine the management. The differential causes include aspiration pneumonia, spontaneous pneumothorax, myocardial infarction, aortic dissection, and gastritis. Conservative treatment options include jejunostomy, gastrostomy, tube feeding, local irrigation, and empyema drainage. Definitive management is surgery. Conclusion: EPF, though rare, should be considered, if retrosternal heaviness is not relieved by conventional treatment.

Keywords: Dysphasia, mediastinal mass, retrosternal chest pain

P2477: Intraoperative Sympathetic Crashing Acute Pulmonary Edema – How Much Resuscitation is Enough?

Hadiya Ajaz, Ram M. Sharma, Manish Bharti

School of Medical sciences and Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India

Background: Perioperative/postoperative flash pulmonary edema is common and can be life-threatening. This adds to morbidity and mortality and causes unpredictable ICU admission. There are multiple reasons described in the literature; however, at times, it is difficult to establish the exact cause of pulmonary edema. There are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema (1). We describe a case of intraoperative sympathetic crashing pulmonary edema (SCAPE) possibly due to over resuscitation. Objectives: Identify cause of pulmonary edema in young ASA grade 1 patient. Methodology: Study design: Restrospective case report. Study period: 23rd to 25th May 2023. Study area: ICU, School of medical science and research, Sharda Hospital, Greater Noida. Case details: A 23 years old man with 18 days old fracture right ulna was listed for open reduction and internal fixation with plating under general anesthesia (GA). His clinical examination was unremarkable; the complete blood count, biochemical profile, and preoperative ECG were within normal limits. The patient was accepted in ASA PS grade 1 for anesthesia. GA was induced with fentanyl, midazolam, propofol, and trachea intubated with vecuronium. Anesthesia was maintained with oxygen, nitrous, sevoflurane, and controlled ventilation to maintain normocapnia. Surgery was started after cleaning and draping. The surgeon noticed some blood clots around the fracture, which was cleaned and washed. After about 30 min of starting surgery, tourniquet was applied as requested by the operating surgeon. Drilling was done around fracture sites to insert screws and fix plates. After about 1 hour and on drilling of the sixth hole in the ulnar bone, the patient suddenly had an attack of ventricular tachycardia as noticed on cardiac monitor. It was managed by administering 5 mL of 2% Lignocaine and Inj Amiodarone 300 mg. Subsequently, patients had asystolic cardiac arrest as noted by absence of pulse and flat line on cardiac monitor. CPR was started immediately as per ACLS protocol, and the patient was administered 04 ampoules of adrenaline before ROSC was achieved. After a while, the patient had second asystolic cardiac arrest, revived with chest compression and 02 ampoules of adrenaline. At this point, the patient developed flash pulmonary edema with copious amounts of pink frothy secretions noticed in ETT. Surgery was completed quickly, and the patient was shifted to ICU on hand ventilation with Bains circuit. The patient had received about 400 mL of Ringer’s lactate till now. On arrival to ICU, the patient was hypotensive on noradrenaline and adrenaline infusion and pink frothy secretions were bubbling out of ETT. Vitals signs of SpO2 65%, HR 145/min, NIBP 96/50 mm Hg, and ECG showed sinus tachycardia. It was considered flash pulmonary edema. The patient was placed on mechanical ventilation with ACVC mode. Infusions of fentanyl and atracurium were started to maintain sedation and paralysis. Inj frusemide 40 mg injected stat; maintenance fluids continued. Arterial blood gas analysis on arrival to ICU shows severe metabolic and respiratory acidosis (pH 7.222, PCO2 51.8 mm Hg, PaO2 82.0 mm Hg, Lactate 5.3 mmol/lHCO3 18.2 mmol/L) and high lactate. Arterial line and central line placed immediately, and infusions of inotropic agents optimized to maintain MAP >65 mm Hg. Chest radiograph taken in ICU showed diffuse interstitial and alveolar infiltrates. Result: The patient showed diuretic response with good urine output following diuretic administration. Gradually, SpO2 improved over the next 24 hours to 95 to 98% and hemodynamic parameters starting improving. Arterial blood gases were repeated every 4 hourly that showed correction of respiratory and metabolic parameters. Inotropic medications noradrenaline and adrenaline were tapered. Slowly, the patient stabilized over the next 24 hours and extubated. The patient continued to make steady recovery over the next 02 days and shifted out of ICU after 03 days. Conclusion: Preoperative risk factors for increased cardiovascular morbidities – Possibility of pseudo V tach ++ Possibility of lidocaine-amiodarone drug interaction ++ Possibility of epinephrine leading to sympathetic crisis and pulmonary edema +++ Possibility of perioperative ACS – Possibility of takosobtu (stress) cardiomyopathy+

Keywords: Intra-operative sympathetic crashing, pulmonary edema, SCAPE

P2478: Forgotten Double-J Stent: A Rare Case Report

Varshney Govind, Chauhan V. Singh, P. D. Gupta, Bhattacharya Shilpi

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Ureteral stent or Double-J stent is used in urology to help pass the urine from the kidney to the bladder when the flow is blocked due to the presence of kidney stones, tumors, strictures, and so on. A long-term indwelling double-J stent causes various urological complications including encrustation, formation of vesical calculus, and pelviuretric junction obstruction as a delayed and rare complication. Case Report: We present a case involving a 38-year-old female who had a Double-J stent placed 8 years back and did not get it removed further getting complicated with encrustation around the stent with vesical calculus for which the patient had a cystolithotomy and presented with pelviureteric junction obstruction after 2 months. Discussion: Double-J stents are commonly used in urological procedures but can cause complications if left in place too long. A study in India found that lack of information (38.16%) and poor economic status (23.32%) were major factors in neglecting stent control. Proper patient counseling on stent removal is crucial to avoid complications While pyeloplasty remains the standard treatment with about 90% success, endoscopic options are less invasive but less successful. Conclusion: The Double-J stent, widely used in urology, can cause complications like pelviureteric junction obstruction if neglected. Patients must be counseled on its placement, risks, and the importance of timely follow-up, removal, or replacement to avoid adverse outcomes.

Keywords: Double-J stent, indwelling catheter, pelvi-ureteric junction obstruction

P2479: Incidental Discovery of Renal Tuberculosis Postnephrectomy for Nonfunctioning Kidney – A Case Report

Subhajit Kar, Ashish Trehan, Ashish Moudgil, Ravi Kale

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Extra pulmonary TB (EPTB) constitutes 15–20% of all TB cases, and genitourinary TB (GUTB) constitutes approximately 20% of EPTB cases. Urinary TB is often asymptomatic, but continuous infection can gradually impair renal function by causing destruction of renal tissue and fibrosis during the healing process, leading to obstruction, loss of function, and over time a nonfunctioning kidney (NFK). Case Summary: A 28-year-old male came with complaints of pain and lump in the right lumbar region for 4 years. On examination, a firm lump in right lumbar region measuring approx. 8 × 6 cm was seen. CT Urography revealed a well-defined cystic lesion 8 × 7.7 × 10 cm in size in right renal pelvis communicating with calyces causing gross hydronephrosis with severe thinning of renal parenchyma likely due to pelvis ureteric junction obstruction. 99 m TcDTPA scan showed no functioning of right kidney. The patient underwent laparoscopic nephrectomy. HPE report was suggestive of tuberculosis. The patient was started on ATT. Discussion: Renal TB is an insidious condition with late onset symptoms, delay in treatment, and a high organ destruction rate and therefore an increased incidence of renal failure. About 26.9% of cases present with unilateral nonfunctioning kidneys. Only half of all patients with renal TB are symptomatic at presentation. Renal tuberculosis presenting as giant hydronephrosis is a rare urological entity. For urogenital tuberculosis diagnosis, imaging techniques are up to 91.4% sensitive. Contrast CT Urography is the most important diagnostic tools for evaluation of anatomic details of the urinary system in tubercular disease. Surgical management is mandated in up to 55% of renal tuberculosis patients. Conclusion: Genitourinary tuberculosis has many clinical and radiological manifestations and is present with nonspecific symptoms; hence, diagnosis is usually delayed. Therefore, it is essential to have a high index of suspicion in mind for early detection.

Keywords: Renal tuberculosis, postnephrectomy, nonfunctioning kidney

P2480: Clinico-Dermoscopic-Histopathological Correlation of Partial Unilateral Lentigenosis – A Case Series

Alok Jindal, Kritika Bansal, Shitij Goel

School of Medical Sciences and Research, Sharda Hospital Sharda University, Greater Noida, Uttar Pradesh, India

Background: Partial unilateral lentiginosis (PUL) is an unusual pigmentary disorder characterized by multiple lentigines that are grouped within an area of normal-appearing skin. Lesions are often in a segmental pattern with a sharp demarcation at the midline. Aim: Correlation between clinical-dermoscopic-histopathological features of partial unilateral lentiginosis. Case Series: This present study aims to evaluate the clinic-dermoscopic-histopathological characteristics of PUL. The case series included 8 cases of partial unilateral lentiginosis. A detailed clinical evaluation and local examination have been carried out. Dermoscopic examination was performed to assist the diagnosis. Histopathological examination to confirm the clinical diagnosis was carried out in addition to other tests. Then the patient was enrolled for Nd-Yad laser. Methods: Hospital-based observational study. The patient presenting to Dermatology OPD in the past 1 year with the complaints of hyperpigmented macules on the body. Dermoscopy and histopath biopsy were done after confirming the diagnosis of partial unilateral lentiginosis. Eight patients were included in the study. Results: Out of 8 cases, 7 cases were present in females and 1 was male. The common presentation includes lesions present at birth, but also, some adult cases have been reported so far. Three out of eight patients had been diagnosed with adult-onset disease. Dermoscopy was done in all cases; out of 8 cases, 7 showed the features of simple lentigo and 1 showed the feature of ink-spot lentigo. Histopathology was done in all the patients, and findings were consistent the diagnosis of lentigens. Conclusion: Hence, this study highlights the demographic profile of partial unilateral lentiginosis and correlation between clinical-dermoscopic-histopathological features of partial unilateral lentiginosis.

Keywords: Café au lait spots, dermoscopy, freckles, histopathology, lentigines, lentiginosis, partial unilateral lentiginosiss