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.