Electronic-ISSN:0975-5160| Print-ISSN: 2820-2651


1. A Prospective Study of Congestive Heart Failure and its Prognosis Using the 3C: Reactive Protein as A Measure of Disease Severity
Priyanka Kumari, Raj Bhushan, Kunal Kumar Maurya
Aim: The aim of this study to evaluate the cardiac failure and its prognostication with 3C: Reactive protein as a marker of severity. Methods: The cross-sectional analytical study was conducted in the Department of General Medicine, Nalanda Medical College and Hospital, Patna, Bihar, India, , after taking the approval of the protocol review committee and institutional ethics committee.  The non probabilistic sample was composed of 90 non consecutive patients of both sexes. Chagas disease was confirmed by 3 serological tests: direct agglutination, immunofluorescence, and enzyme- linked immunoassay (ELISA), according to previously established protocols, and patients with 2 or more positive assays were accepted as positive. Results: The average age of the participants was 51.4±2.7 years for the population of healthy volunteers and 63.2±1.7 years for seropositive patients. The average age of patients according to phase of Chagas disease was as follows: Phase I, 57.9±3.0; Phase II, 63.7±2.7, and Phase III, 69.3±2.2 years, respectively, with a significant difference observed in Phase II and III patients versus the control group and Phase I patients. In the means calculated for the echocardiographic parameters, in particular, left ventricular end- diastolic diameter, left ventricular end-systolic diameter, left atrial diastolic diameter, right ventricular diastolic diameter which indicate chamber dilation, significant quantitative increases were confirmed with respect to the degree of the disease (P<.05). An assessment of left ventricular end-diastolic volume and left ventricular end-systolic volume showed a significant increase (P<.05) as the disease progressed. Mean absolute CRP values in the study group showed a significant progressive increase (P<.005) in Phase I (0.3±0.06 mg/dL), Phase II (0.7±0.3 mg/dL), and Phase III (4.2±1.4 mg/dL), respectively, with a substantial, significant difference in serum values between patients with Phase III Chagas disease and those with Phases I or II. The control group expressed similar mean values (0.21±0.05) to those of Phase I patients. Conclusion: Elevated IL-6 concentrations were related to the phase of Chagas disease, indicating that once these patients have progressed beyond the acute phase, they experience a chronic inflammatory process, which becomes more severe with progression to Phase III status.

2.A Cross-Sectional Observational Study Evaluating the Prevalence and Effects of Allergic Rhinitis in School-Aged Children (3-15 Years Old)
Jitendra Kumar, Kalpana Kumari
Aim: To evaluate the prevalence and impact of allergic rhinitis in school going children. Methods: A cross-sectional observational study was conducted in the Department of ENT, Jannayak Karpoori Thakur Medical College, Madhepura, Bihar, India for 1 year. 200 parents of school going children attending OPD in community health center were included in this study. Participants were aged 20 years or above, currently residing in Bihar and parent/guardian of at-least one child aging 3 to 15 years, having frequent episodes of allergic rhinitis. Results: 74.5% of subjects responded that the child’s nose problem was worse during specific months of the year; and 60.5% said that the problem is accompanied by itchy–watery eyes. 90 patients found this eye-nose problem with a source of allergy. 17% of subjects agreed to this problem impacting daily activities and hence QoL. This study showed a prevalence of 30% for nasal symptoms and 15% for allergic rhino-conjunctivitis respectively. Distribution of symptoms showed that blockers constituted as much as 59.5% of the total study group. Moderate to severe persistent allergic rhinitis, as classified as per ARIA guidelines, was most common type of allergic rhinitis with as many as 35% of patients studied. Minimum 55% of subjects had one or more co-morbidity (mainly bronchial asthma 55%), whereas 21% children had 2 or more co-morbidities. Conclusion: The Indian population, especially children, suffering from prevalence of allergic rhinitis is increasing over past many years. Allergic rhinitis is associated with number of co-morbid conditions such as asthma, sinusitis, otitis media, etc.

3.Retrospective examination of the trans-nasal endoscopic correction of cerebrospinal fluid rhinorrhoea
Badal Kumar, Jitendra Kumar
Aim: The aim of this study to evaluate the trans-nasal endoscopic repair of cerebrospinal fluid rhinorrhoea. Methods: The retrospective study was conducted in the Department of ENT, Jannayak Karpoori Thakur Medical College, Madhepura, Bihar, India for 1 year, On the basis of medical records of 20 patients (13 males and 7 females) who had CSF rhinorrhoea and underwent trans-nasal endoscopic repair in Department of ENT. Patients were assessed for demographic profile, etiology of CSF leak and its duration, endoscopic findings, radiographic findings, location of leak, surgical repair and post-operative outcome. Retrieved data was represented in frequency and proportion in tabulated form for evaluation of results. Patients with defect size less than 1.5 cms; cases involving cribriform, ethmoid, sphenoid or frontal recess region of skull base were included in this study. Results: Etiological factor for CSF leak was found to be accidental trauma in 65% cases. In 3 patient causes was iatrogenic resulting from polypectomy. Spontaneous rhinorrhoea was observed in 20% subjects. Majority of patients (70%) presented with intermittent leaks whereas 30% were suffering from continuous type of leakage. Radiographic examination revealed bony defects in all these cases with concurrent meningocele and Meningo- encephalocele in 10 % and 55% cases respectively. Most common location of defect in this cohort was cribriform plate of ethmoid (80%) whereas it was fovea ethmoidalis in 20% patients. Cysternography was carried out in 30% patients to delineate the defect because of doubts in defining the lesion by HRCT/MRI in these cases. Fat, middle turbinate (MT) mucosa and septal bone were used as graft to fill the defects in 55% cases. 10 % of patients were treated by fat, MT mucosa and inferior turbinate mucosa. Fat, MT mucosa and septal cartilage were used in 10% and in 25% cases fat, septal mucosa and fibrin glue were used as grafts to seal the dehiscence. Post-operatively, lumbar drain was used in 38% cases only. Conclusion: The endo-nasal endoscopic closure is a safe and effective technique for repair of CSF rhinorrhoea. There is minimal intranasal trauma. An overall rate of successful repair was 100%.

4.Occupational Exposure to Toluene Presenting as Acute Ischemic Stroke: A Case Report
Hashash Singh Ishar, Rahul Jain, Pankaj Rathi, Dinesh Chouksey
Background: Toluene as a chemical is a major component of organic industrial solvents that is known to cause neurotoxicity. Chronic toluene exposure can result in a wide array of neurological manifestations. Toluene induced strokes are sparsely described in literature. Case presentation: The case is of a 32 years old female working in a chemical industry who presented with acute focal neurological deficit and was exposed to vapours of toluene. Conclusion: Occupational exposure to toluene, a volatile toxin can result in cerebral infarction and thus adequate safety measures should be taken to prevent exposure and damage to the nervous system.

5.A Study on Cross Sectional Online Assessment of Attitude of Medical Students Towards Mental Illnesses
Sunil Kumar, Divya Sharma, Himadri Sisodia, Bharat Agarwal
Background: Attitudes and belief toward mental illnesses are important factors that affect perception of mental health. Knowing the attitude of medical students towards psychiatry and mental illnesses is of utmost importance as they are future care provider. Current study is conducted to assess the attitude of medical students towards mentally ill patients and mental illnesses, to identify correlation of attitude score with personal and family history of mental illness and, to compare the score among students of the three year-wise groups. Method: The study population included 219 students of first, second and third professional MBBS.  We designed an online data collection tool and executed it using the Google Forms. The Google Form link to the questionnaire was sent to the enrolled participants via the identified WhatsApp groups or individual number. Beliefs toward Mental Illness (BMI) scale was used to assess attitude towards mental illnesses which is a 21‑item self-report measure of negative stereotypical views of mental illness. The results of the study were examined and analyzed by using Statistical Package for Social Sciences (SPSS 25.0). Results: Out of total 21 items of the BMI scale, students showed positive attitude on majority of items. The mean score for BMI scale and per item mean score for the scale were towards positive attitude. Majority of students agree that a mentally ill person is more likely to harm others than a normal person and that mental disorders would require a much longer period of time to be cured than would other general diseases. Higher per item mean score for dangerousness and, incurability subscale showed their negative attitude. An increasing trend of positive attitude has been seen with an increase of education level and exposure towards the subject. Conclusions: Medical students show variable scores on belief towards mental illness scale, its subscales and, individual items. Admitting this prevailing stigma needs to be acknowledged and openly discussed with medical students in order to overcome these views. Providing adequate education on mental illnesses and attached negative attitudes or myths can change these negative beliefs.

6.Phytochemical analysis, Antioxidant and Analgesic Activity of Acetone Extract of Curcuma Amada Roxb Rhizome
Anil Kamboj, Randhir Singh
Curcuma amada Roxb., often known as amba haldi, is a highly rhizomatic aromatic herb that contains a number of phytoconstituents. This study was done to investigate the antioxidant and analgesic properties of C. amada acetone extract. In-vitro antioxidant activity was assessed using the DPPH (2, 2-Diphenyl-1-picrylhydrazyl) free radical scavenging assay and the nitric oxide scavenging assay, while in-vivo analgesic activity was assessed using the tail flick method and the formalin induced pain test in male wistar rats weighing 150–200 gm at different doses (100 mg/kg, 200 mg/kg, and 400 mg/kg). According to the findings, the acetone extract of C. amada had antioxidant and analgesic efficacy at all three doses of 100 mg/kg, 200 mg/kg, and 400 mg/kg as compared to the control group. C. amada acetone extract exhibited in-vitro antioxidant as well as in-vivo analgesic activity in experimental animals.

7.Effectiveness and Tolerance Profile of Thiocolchicoside and Tolperisonein Acute Low Back Pain with Musculoskeletal Stiffness Through Telemedicine Consultation During Lockdown Period of Second Wave of COVID-19 Pandemic in Eastern Part of India.
Pandey SK, Kumar D, Kumar S, Mallik AK, Jena D
Background: Adult population commonly report acute low back pain and muscle stiffness during the lockdown period of coronavirus disease 2019 (COVID-19) pandemic which can be attributed to restricted mobility, prolonged home stay, work from home with poor ergonomic support and longer period of immobility due to COVID-19 infection. Objective: The study intended to compare the effectiveness and tolerance profile of tolperisone and thiocolchicoside in acute low back pain with muscle stiffness. Settings and Design: This was an open label prospective study, conducted at atertiary care centre in the eastern part of India. The study was carried out during the lockdown period of second wave of COVID-19 pandemic through telemedicine consultation. Material and Methods: Numerical pain rating score(NPRS) at rest and movement, and finger to floor distance(FFD) were used for evaluating the effectiveness of drugs while Physician global assessment score and side effect of the drugs were used for evaluating the tolerance profile. Results: Total 88 patients were enrolled, and equally divided into two groups. Mean age was 34.15±8.68years and 33.06±7.39 years respectively in group A and Group B. NPRS and FFD were significantly reduced in both the groups at day 3 and day 7 (p<0.05). On within group analysis there was no significant reduction in NPRS at day 3 and day 7 (p>0.05).Within group analysis also displayed no significant improvement (p>0.05) in tolerance profile at day 3 and day 7, butinter-group analysis showed a better tolerancein group B compared to group A. Conclusions: Both tolperisone and thiocholchicoside are effective centrally acting muscle relaxants in acute low back pain associated with muscle stiffness, but tolerance profile is poor with tolperisone as compared to thiocolchioside.

8.A Radiographic Evaluation of Total Hip Arthroplasty Done in Cases of Displaced Fracture Neck of Femur
Anshu Anand, Ajoy Kumar Manav
Aim: Radiological assessment of Total Hip Arthroplasty in Displaced fracture Neck of femur. Materials and Methods: This observational study was carried out in the Department of Orthopedics, Patna Medical College and Hospital, Patna, Bihar, India. Total 120 patients were patients treated with total hip replacement. Plain X-ray pelvis with both hips and proximal femur-AP view and X-ray of the operated hip lateral view were evaluated. Results: Out of 120, 85 patients were male and 35 females, most of the patients in were above 50 year and followed by 45-50 year. Patients scored 47.3% excellent, 27.3 good, 10.9% fair and 14.5% patients scored poor. The acetabular cup inclination 85 neutral, 15 vertical and 10 horizontal positions were seen. We had 82 central, 15 each in valgus and 13 varus positions. There were 2 subsidences and 1 migration seen, and Class II heterotopic ossification was noted in 4 hips, i.e., 6 % incidence that underwent THA. We had 2 cases of dislocation (1.8%). Conclusion: The result of this study shows that Total Hip Arthroplasty gave better results in Displaced Intracapsular Neck of femur fractures radiologically.

9.Anterior cruciate ligament and meniscal injuries of the knee: MRI and arthroscopic findings
Bibek Kumar Rai, Ajoy Kumar Manav
Aim: Study of correlation between MRI and arthroscopic findings in anterior cruciate ligament and meniscal injuries of the knee joint. Methods: This cross-sectional study   was carried out in the Department of Orthopaedics, Patna Medical College and Hospital, Patna, Bihar, India from July 2018 to March 2019. Total 30 patients with suspicion of traumatic ligament or meniscal injuries of the knee joint and 18-50 years of age group were included in this study. Initially, proper history of the patient was taken, and thorough clinical examination was performed by a qualified orthopaedic surgeon. Plain radiographs of the involved knee joint were taken to rule out degenerative changes, loose bodies and fractures around the knee joint. MRI of 1.5 Tesla was done on the involved knee joint. After the pre-anesthetic check-up and consent, diagnostic arthroscopy of the involved knee was done by an experienced and qualified orthopaedic surgeon. Findings of the MRI and arthroscopy are noted down and compared. Results:  On MRI all 30 patients showed ACL tear. Comparison between MRI and arthroscopy findings for ACL tear showed 28 patients being true positive and one patient being false positive. The Sensitivity, PPV, Accuracy of MRI scan in detecting ACL injury in our study were 96%,100% & 96% respectively. Fisher exact test was employed to calculate the statistical significance and p value. Here the p value for ACL tear is 1, which is statistically not significant. MRI showed medial meniscus tear in all 18 patients. Comparison between MRI and arthroscopy findings for ACL tear showed 12 patients being true positive, 3 patients being false positive, 3 patients being false negative and 9 patients being true negative. The Sensitivity, specificity, PPV, NPV, Accuracy of MRI scan in detecting medial meniscal injury in our study were 78.7%, 82.8%, 82.8%, 78.7 & 81.0% respectively. Here the p value for medial meniscal tear is 0.027 and is significant. 7 patients showed lateral meniscus tear on MRI. Comparison between MRI and arthroscopy findings for ACL tear showed 5 patients being true positive, 2 patients being false positive, 6 patients being false negative and 17 patients being true negative. Conclusion: Arthroscopy still remains the gold standard in diagnosing the internal knee lesions and is highly useful in patients with persistent symptoms or in case of strong clinical suspicion in spite of normal MRI.

10.Assessment of Epidural Butorphanol, Nalbuphine and Fentanyl for Post-Operative Analgesia in Lower Abdominal Surgeries: A Comparative Study
Prashant, B.K. Kashyap
Aim: The aim of this study to compare the epidural butorphanol, Nalbuphine, and fentanyl for post-operative analgesia in lower abdominal surgeries. Methods: This prospective randomized double-blind study was done the Department of Anaesthesia and Critical Care, Patna Medical College and Hospital, Bihar, India, from July 2019 to June 2020. A total of 60 patients were included in this study. Patients were randomly divided into three groups of 20 each. Group A – Butorphanol group, Group B – Fentanyl group and Group C – Nalbuphine group. 60 patients of age ranging from 20 to 60 years (20 in each group) of the American Society of Anesthesiologists (ASA) I and ASA II group were selected on the basis of inclusion and exclusion criteria outlined below. Results:  The mean time of onset of analgesia was 11.88 minutes, 6.87 minutes, and 14.89 minutes in Groups A–C, respectively.  Statistical analysis showed that onset of analgesia was faster in fentanyl group compared to other two groups (p<0.05). The mean duration of analgesia was 484.71 minutes in Group A, 181.55 minutes in Group B and 297.65 minutes in Group C. The duration was thus significantly longer in butorphanol group.There mean RR increased 6-8 hrs onward postoperatively in Group Ι, 4 hrs onward in Group B and immediately postoperatively in Group C. This hyperventilation was probably due to the onset of pain after analgesic effect of respective drugs curtailed off over time. The rate came down after administration of rescue analgesic, further confirming the assumption. The mean pain score recorded was significantly lower in Groups A and B than in Group C. All the patients in Groups B and C required analgesic supplementation within first 2-4 hrs and 4-6 hrs, respectively. Whereas 7 patients of Group A required supplementation within 6-8 hrs, 14 patients between 8 and 10 hrs. Conclusion: Opioid analgesics with local anesthetics are extremely safe, effective and reliable method of post-operative pain relief. The addition of fentanyl produces faster onset of analgesia with adverse effects like sedation and pruritus than butorphanol and nalbuphine when given epidurally along with 0.125% bupivacaine.

11.The Role of the Dynamic Hip Screw with Locking Side Plate in the Treatment of Intertrochanteric Fractures in the Elderly
Ramashish Yadav, Ram Sagar Pandit, Nand Kumar
Aim: Role of dynamic hip screw with locking side plate in intertrochanteric fractures in elderly patients. Methods: A prospective study was conducted in the Department of Orthopaedics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 15 months. 50 Patients of intertrochanteric fractures who were operated with DHS with locking side plate were included in this study. The fixation, fracture consequences, functional outcome and complications were assessed clinically and radiologically in immediate post-operative period and on follow-ups at six weeks, three months, six months and one year. Young patients (<55 years, non-osteoporotic bone), fractures with sub trochanteric extension and pathological fractures were excluded from study. The patients were evaluated clinically and radiologically, with details like range of motion, limb- length discrepancy, infection and deformity noted. Evaluation of the clinical outcome was done by modified Harris hip score approximated to the nearest single decimal at the last follow-up. Results: The average age of patients in the group was 62.5 years with male preponderance. The number of female patients increased in the 7 and 8 decades. No side predilection was noted. The mode of injury in 92 percent was fall and 18 patients were diagnosed with hypertension post admission, 9 with diabetes mellitus and other 9 had some systemic involvement. The mean trauma-surgery interval was 4.5 days. Trauma surgery interval and functional outcome by Harris hip score was statistically significant (p value=0.021) and was inversely proportional. Closed reduction was achieved in 40 patients while 10 required open reduction. The mode of reduction was statistically not significant.  In our study, union was achieved in all patients with clinico-radiological union was evident ranging from 10 to 18 weeks. Male patients had a better functional outcome by Harris hip score, which was statistically significant (p value=0.031). Conclusion: In the ever-progressive world of orthopedics, time has witnessed several design modifications in the mode of fixation and implants. Locking plate DHS has been proven better mechanically and positive impact on rehabilitation and weight bearing is being observed along with a decline in the failure rates.

12.To Assess the Association Between the Duration of Diabetes Mellitus, Microalbuminuria and Hyperlipidemia with Severity of Diabetic Retinopathy
Utkarsh Bhardwaj, Navin Chandra, Rajesh Tiwary
Aim: The aim of this study to evaluate the correlation of duration of diabetes mellitus, microalbuminuria, hyperlipidemia with severity of diabetic retinopathy. Methods: The prospective cross-sectional study which was carried in the Department of Ophthalmology, Nalanda Medical College and Hospital, Patna, Bihar, India from July 2017 to July 2018. Total 220 patients were included in this study. For the study, type II DM is defined as a fasting plasma glucose of more than or equal to 126 mg/dl or 2-hour post glucose load plasma glucose of more than or equal to 200 mg/dl or a random plasma glucose of more than or equal to 200 mg/dl in the presence of symptoms of hyperglycemia. All the biochemical assessments were done using an Auto analyzer. Results: A total of 220 subjects of either gender were included in our study, out of which 125 (56.82%) were females and rest were males 95; 43.18%). On ophthalmologic examination we found that only 112 out of 220 diabetics suffered from diabetic retinopathy and the rest 108(49.09%) did not show any signs of diabetic changes in the fundus. Out of 112 patients in the retinopathic group, 57 (25.91%) of them suffered from very mild to moderate NPDR, 32 (14.55%) patients showed signs of severe to very severe NPDR and only 23 (10.45%) had proliferative diabetic retinopathy. statistically significant association was found between the severity of retinopathy and duration of diabetes (p < 0.001). Majority of patients (85%) of Grade 0 microalbuminuria (< 2.5 mg/mmol) had no Retinopathy. A statistically significant association between microalbuminuria grade and severity of retinopathy was observed (p < 0.001). Out Of 220 patients of diabetes, total cholesterol was found to be desirable (< 200 mg/dl) in only 70 (31.82%) patients. Out of these 70 patients with desirable cholesterol majority (60%) had no retinopathy (Group I), 21.43% had very mild to moderate retinopathy (Group IIA), 12.86% had severe to very severe retinopathy (Group IIB) and 5.71% had proliferative diabetic retinopathy (Group IC). In microalbuminuria grade l, prevalence of retinopathy in patients having desirable cholesterol levels was lower as compared to those having borderline or high cholesterol levels and this difference was found to be statistically significant (p = 009). Conclusion: Duration of diabetes and microalbuminuria have been found to be the independent risk factors for diabetic retinopathy, but serum cholesterol levels did not show an independent role in our study.

13. KAP Study of Pharmacovigilance Among Medical Students: A Cross-sectional Questionnaire Study
Swetabh Verma, Amit Kumar Ambasta, Asha Kumari, V K Mishra
Aim: Knowledge, attitude and practice of pharmacovigilance among medical students. Methods: A cross-sectional questionnaire study was conducted in the Department of Pharmacology Darbhanga Medical College , Darbhanga Bihar India for 1 year (1 September 2020 – 31 August 2021). The total number of students in the study was 100. The study participants were 2nd year MBBS students. Total 20 questions were given to the students and they were given one day to fill the answers in the questionnaire. Results: 94% students gave correct definition of pharmacovigilance. 45% students were aware that the most important purpose of pharmacovigilance is to identify safety of the drug. 95% students were having knowledge about existing National pharmacovigilance programme of India. Only 22% were aware about regulatory body responsible for monitoring ADRs in India, i.e. central drugs standard control organization (CDSCO). 96% gave correct answer of side effect occurring during pregnancy as teratogenicity. Total 46% students said that reporting ADR is professional obligation for them. 98% said that reporting ADR is necessary.95% said that Pharmacovigilance should be taught in detail to healthcare professionals. Only 37% students were agreeing about having Pharmacovigilance center in every hospital. Among students, 42% have read article on prevention of ADR. 25% have experienced ADR in patients during their clinical posting. 22% reported ADR to Pharmacovigilance center. 98% have seen ADR form. 95% have been trained on how to report ADR (Table 3). Conclusion: The students gave correct answer of knowledge-based questions. So, knowledge of pharmacovigilance is gradually improving. The study will bring awareness among students towards pharmacovigilance and help them in monitoring adverse drug effects.

14. One-time use of Second-Generation Anti Histaminics on Healthy Human Volunteers’ Cognitive and Psychomotor Function
Sachida Nand Sachit, Rajesh Kumar Pandey, Asha Kumari, V K Mishra
Aim: Study of effect of a single dose of second generation antihistaminics on cognitive and psychomotor function in healthy human volunteers. Methods: A single blind prospective, case control study was conducted in the Department of Pharmacology Darbhanga Medical College, Darbhanga Bihar India for 14 months (1 August 2020 – 31 September 2021). A pilot study was conducted to test feasibility and operational efficiency of certain procedure or unknown effect. 100 healthy human volunteers of both sexes between 18-25 years were registered. Subjects were divided in five groups from A to E (20 subjects in each group). Participants of group A served as control group; that is no antihistaminics was given to them (placebo, Tab. folvite 5 mg, wythe). Participants of group B were given first generation antihistaminic, promethazine 25 mg (Tab. avomine 25 mg, nicholas piramal) and this group was taken as positive control group. Rests of three groups were given second generation antihistaminics. Results: Total 100 volunteers were registered, among them 30were male and 70 were female. Mean age of volunteers was 20.46±1.06 years. Results were described in table. Significance of difference was analyzed by paired t-test p value less than 0.05 considered as significant. We observed no statistically significant difference on various test parameters both predose mean and post dose mean with placebo (p value>0.05) There was statistically significant difference observed on perceptual speed test (p value=0.013 and t-value=2.845, 95% confidence interval 1.378-9.822),Stanford Sleeping Scale (p value 0.001and t value- 4.063, 95% confidence interval 2.546 to 0.787) and BVRT (p value=0.004 and t value=3.5, 95% confidence interval 0.181 to 0.753) while no statistically significant effect has been observed in other tests variable (p>0.05). Predose and post dose mean of SSS is expressed in number. In female (p value<0.008) highly significant. In group C there was a statistically significant difference observed in DSST (P value=0.046, t value=2.84, 95% confidence of interval 0.093 to 10.174) and FTT (P value 0.001, t value 4.075, 95% confidence of interval 10.675 to 34.392) while no statistically significant effect was observed in other test variable (p value>0.05). There was no statistically significant effect was observe in any test parameter (group D) p value>0.05 for all parameters. Statistically significant difference in DSST was observed with loratadine (p value=0.034, t-value=2.348, 95% confidence interval range 0.404 to 8.929) while no statistically significant effect was been observe in other test variable (p-value>0.05). Conclusion: The sedative effect of promethazine and alteration in cognitive and psychomotor function. Cetirizine and loratadine with a single dose there was no sedation but they alter the some parameter of psychomotor function. Cetirizine altered the DSST and FTT score. Loratadine altered the DSST only.

15. Anxiolytic Activity of Extract of Flowers of Clitoria Ternatea Linn
Prashant Kumar Dhakad, Rajveer Singh, Siddhi Kumari Yadav, Priya Singh
Clitoria ternatea (CT) or commonly known as butterfly pea originates from the Fabaceae family. Parts of the plant such as its leaves, flowers, and roots are believed to possess sought-after medicinal values such as analgesic, antipyretic and antiinflammatory properties. The plant also possesses a number of advantages such as antioxidant, antidiabetic, antimicrobial, anthelmintic, hepaprotective, antiasthmatic and anxiolytic properties that are beneficial and useful in reducing health disorders. This plant has a long use in traditional Ayurvedic medicine for several diseases and the scientific studies have reconfirmed those with modern relevance. It has high calcium concentration, which is a significant source of calcium brewed as an herbal drink.

16. Antioxidant and Antibacterial Activity of Vitis Vinifera
Ganesh Narayan Sharma, Sandeep Singh, Priya Singh, Siddhi Kumari Yadav
Grapes (Vitis vinifera) are usually known grape species that belong to the Vitis genus in the Vitaceae family and come from western Asia and southern Europe. This normally grows well in temperate countries. Many studies show that the consumption of grapes and various other parts of the fruit, especially the leaf, provides many health benefits. These are universally appreciated fruit for their delicacy, nutrition and are recognised as a functional food. The skin leaf and seeds of grapes are known to be rich sources of phenolic compounds, both flavonoids, and non-flavonoids. Grape leaf expressed high antioxidant and antimicrobial properties compared to grape skin extract which explained the medicinal activities of grape leaf extract. This review highlights the antioxidant and antibacterial activity of Vitis vinifera leaf. The various scientific databases and search engines such as PubMed, Elsevier, Springer, Frontiers, Google Scholar, Scopus, Science Direct, and MDPI provide various informations about the antioxidant and antibacterial properties of Vitis vinifera leaf, seed, stem. In some countries, grapes are utilised for traditional uses, such as drug therapy for blood- forming, anemia, allergies, wound care, colds and flu, carminative, bronchitis, diarrhoea, and anti- phlegm. The main phytochemical compounds in Vitis vinifera are phenolic compounds, aromatic acids, flavonoids, proanthocyanidins, and stilbenoids. Vitis vinifera has been highlighted by its many positive effects on human health, including antibacterial, anti-inflammatory, and antioxidant activity due to its rich phytochemical content. Vitis vinifera shows as a vital and renowned source of compounds with important biological activity. Wines and winery bioproducts, such as grape pomace, skins, leaf and seeds, are rich in bioactive compounds against a wide range of human pathogens, including bacteria, fungi, and viruses. However, little is known about the biological properties of vine leaves.

17. A Retrospective Clinical Analysis of Outcome in Management of Head Injury in Patients with Highway Road Accidents
Bipin Kumar, Kaushal Kishore
Aim: A clinical analysis of outcome in management of head injury in patients with highway road accidents. Methods: A retrospective study was conducted in the Department of Forensic Medicine and Toxicology, SKMCH, Muzaffarpur, Bihar, India for 15 months. The data was collected regarding demography, mode of injury, clinical presentation, and condition at admission, treatment given, hospital stay and outcome of these patients. All patients were clinically evaluated by a team comprising of doctors from surgical, medical and orthopedics specialties in the emergency department and subsequently admitted and treated at Neurosurgery. Plain CT scan head along with X-ray of cervical and for dorso- lumbar spine were carried out to rule out other injuries. Whenever necessary, CT scans of spine, USG abdomen (FAST). Results: Out of total number of cases, 100 were present with road traffic accidents with 16(16%) patients with head injury as cause of death. According to the data collected 50 (50%) patients were under alcoholic influence, 95(95%) patients had history of LOC, 52 (52%) patients had ENT bleed and 9 (9%) had CSF leak at the time of admission. At the time of admission Glasgow coma scale (GCS) score of less than 8 was seen in 33 (33%) cases. GCS between 9 to12 was seen in 51 (51%) cases and GCS between 12 to 14 was seen in 16 (16%) patients. 35 (35%) patients were managed conservatively using anti-epileptics, diuretics and osmotic agents. In patients with less than 8 GCS, ICP monitoring was done initially, 40 (40%) patients underwent craniotomy and evacuation, 3 (3%) patients underwent craniotomy and decompression and 25(25%) patients underwent burr hole and evacuation of clot. According to Glasgow outcome scale (GCS) of these patients, 85 (85%) of patients had good recovery, 15 (15%) patients died in the course of treatment. Conclusion: it is concluded that, RTA is an unfortunate economic burden for our nation. Head injury due to RTA is a recognized major public health problem causing death and disability among the population.

18. A Retrospective Study to Evaluate the Maternal and Fetal Outcome of Malaria in Pregnancy
Sudha Kumari
Aim: The aim of this study to evaluate the maternal and fetal outcome of malaria in pregnancy. Methods: this retrospective study of pregnant women was conducted in the Department of Obstetrics and Gynecology Katihar Medical College and Hospital,Katihar, Bihar, India .  Detailed history and clinical examination was done to ascertain the cause of fever. Haemoglobin, total and differential leucocyte count, rapid diagnostic tests (RDTs) for malaria, routine urine examinations were done. Microscopy of blood smears was done for species identification for all malaria positive pregnant women. A total of 50 patients were found to be smear positive for plasmodium. Results: A total of 12100 pregnant women attended our hospital  during study period out of which 50 were positive for malaria. Prevalence of malaria in pregnancy during the study period was 0.41%. Among the malaria cases, 30 cases were primigravidae and 20 were multi-gravidae, accounting for 60% and 40% respectively. Out of 50 cases, P. falciparum, vivax, and mixed malaria accounts for 24%, 30% and 8% cases respectively showing the predominant pathogen as P. vivax. Out of 50 cases, maternal anemia was present in 16 cases of which 10 (20%) were primigravida and 6 (12%) were multi-gravida. Maternal thrombocytopenia was seen in 14 cases of which 10 (20%) were primigravida and 4 (8%) were multigravida. Complications caused by different pathogens accounted for maternal anemia were 83.33% and 16.67%, maternal thrombocytopenia were 42.86% and 57.14% of P. vivax and falciparum respectively.Obstetric complications caused by P. vivax and falciparum accounted for 33.33% and 66.67% of spontaneous miscarriage, 75% and 25% of preterm deliveries, 75% and 25% of low birth weight babies, 0% and 100% of perinatal deaths respectively.Obstetric outcomes includes, 10 cases (20%) of spontaneous miscarriage, all belonging to first trimester, 12 cases (24%) of preterm deliveries, 16 (32%) cases of low birth weight babies and 1 case (2%) of perinatal death. Conclusions: We concluded that the malaria affects both pregnant female and  fetus. So all patients with fever in pregnancy must have screening for malarial parasite and treated adequately by medicine and help to improve the maternal and fetal outcome.

19. A Evaluation of Antidiabetic Activity of the Pulp of Tamarindus Indica Linn.
Aishwarya Shishodia, Prashant Kumar Dhakad, Shubangi Gumber
Tamarindus indica belongs to family Caesalpiniaceae. Tamarindus indica is believed to have antidiabetic, hepatoprotective and many other medicinal properties. Different parts of the plant possess some or the other activity which makes this plant more useful. Besides, many of its beneficial effects, one of the significant effects is management of diabetes. Because of its multiple mechanisms of action, it provides better management of diabetes as compared to synthetic compound, because insulin and oral hypoglycaemic drugs have undesirable side effects. Present article focuses on the antidiabetic activity of Tamarindus indica along with its mechanism in the body.