INTRODUCTIONOver the decade, hundreds of studies have specifically focused on the effects of stressors on cortisol activation. The process by which this regulation is achieved is complex and our understanding of it has evolved markedly over the last century. Physical stressors, psychological stressors are capable of activating the HPA axis; a number of studies have reported that laboratory tasks can increase cortisol levels.1 Salivary cortisol offers a non-invasive and stress-free alternative to serum. In the last few years, saliva analysis has been a useful method of choice for hormone analyses. Numerous articles have described the use of saliva for analytical purposes in clinical investigations (i.e. in the field of endocrinology, neuroendocrinology) and in physiological research. 2A growing body of research evidence supports the belief that certain yoga techniques may improve physical and mental health through down-regulation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). The HPA axis and ABSTRACT Background: Yoga is a spiritual discipline for the development of a state of mental and physical health, well-being, it has also been used clinically as a therapeutic intervention. This study observes the effects of yoga poses on salivary cortisol. Salivary cortisol is potential biomarker of psychological stress. Nonetheless, psychobiological mechanisms stimulate the hypothalamus-pituitary-adrenal axis (HPAA) can only indirectly be assessed by salivary cortisol measures. The unlike instances that control HPAA sensitivity (e.g.-hippocampus, hypothalamus, pituitary, adrenals) and their respective modulators, receptors, or binding proteins possibly will all have an effect on salivary cortisol measures. Possible fundamental mechanisms proposed leading to enhanced vagal activity and decrease cortisol. The drop in cortisol, sequentially, may give positive outcome. Methods: Healthy medical student volunteers (N=40), males and females, ranged in age from 18 to 25 years (mean age: 23.3years), participated in the present study. They are divided in two groups one is Yoga Group and second is Control Group. Each group consist 20 subjects. Morning saliva samples were collected of both groups. Levels of cortisol in the saliva samples were determined and compared with levels in comparison samples of saliva obtained after three-month of yoga practice. Results: In all subjects who received yoga (n=20), the change in salivary cortisol level was significant (10.27±2.54 ng/ml; 4.023±1.82ng/ml; P= 0.00); it was not so in those who were not practicing yoga (11.43±3.77ng/ml; 10.27±2.54 ng/ml; P=0.06). Salivary cortisol level significantly decreased and reacted positively to yoga practicing subjects. Conclusions: The effort of comparing the effects of yoga on salivary cortisol seems to indicate that it is a promising modality for stress management. Everyone should practice yoga for stress management to improve their day today life because yoga as one of the approaches of stress reduction.

Background: Drug-resistant tuberculosis is a major public health problem throughout the world and accounts for substantial morbidity and mortality rates in India, too. Early diagnosis is the corner stone of tuberculosis treatment. State-level and cluster-wise variations in drug resistance is a possibility and should be regularly checked in from time to time. Materials and Methods: The present prospective cohort study (January 2019 to May 2022) was conducted in Darbhanga Medical College and Hospital on drug-resistant pulmonary tuberculosis patients. Sputum specimens were collected from designated centers. Rapid molecular drug-resistance testing (genotypic tests) and growth-based drug-susceptibility testing (DST) (phenotypic tests) were performed in the National Tuberculosis Elimination Program certified Laboratory. Results: A total of 268 patients with drug-resistant pulmonary tuberculosis were included in the study group. The treatment outcomes revealed as cured in 100 (37.31%); treatment completed in 43 (16.04%); died in 56 (20.89%); treatment failed in 22 (8.21%); loss of follow up in 34 (12.69%); and transferred out in 13 (4.85%) drug-resistant pulmonary tuberculosis patients. Adverse events were recorded in 199 (74.25%) of the drug-resistant pulmonary tuberculosis patients. Conclusions: Drug-resistant pulmonary tuberculosis patients are a matter of concern and need to be addressed.

Background: Dehydroepiandrosterone sulfate (DHEAS), secreted by adrenal cortex, acts in the human body as a neurosteroid, cardio-protective, anti-diabetic, anti-obesity and immune-enhancing agent. It is also reported as a youth hormone. But due to various stimulators of stress, and also as an antagonist of cortisol, DHEAS level decreases. Yoga and meditation regulates the level of hormones and neurotransmitters that affect physiological function.Methods: This study was performed on 1st yr. medical students whose DHEAS level was low due to acute stress. 55 medical students were selected as participants through counseling and were divided into Yoga group (n= 27) and control group (n=28). Their morning serum DHEAS level was assessed and yoga group were instructed to practice Yoga (1hr/day for 12 weeks) under supervision of Yoga instructor. No such instruction was given to control group.Results: As a marker of youth and immunity, increase in DHEAS level decreases susceptibility to infections, reduces aging process as well as improves other functions. Yoga and meditation is documented to increase DHEAS level in regular practitioners. Statistical analysis has shown an increase in morning S. DHEAS level in yoga practitioners. Pre-study and post study values were 3.5±2.48 and 3.61±1.73 respectively in yoga group (overall 3.1% increase, P Value = 0.025, significant at 0.05) whereas 3.36±1.98 and 2.58±1.49 respectively in control group (23.2% decrease, P Value =0.84, not significant).Conclusions: This study concludes that practicing Yoga has significantly raised S. DHEAS level in medical students and improved their immunological status as well as enhances mood and behavior.

Background: tress at any stage of life virtually produces several respiratory limitations and reduces tolerance to physical efforts, sometimes leading to pulmonary diseases in individuals. Various yoga and Pranayama like Kapalbhati and Nadi-sodhan involves powerful strokes of exhalation, which trains the subject to make full use of diaphragm and abdominal muscles.Methods: This study is performed on 1st yr. medical students whose stress level is in higher side due to academic burden. 55 medical students were selected as participants through counseling and were divided into Yoga group (n= 27) and control group (n=28). Pulmonary functions of subjects were tested using Pony FX advanced desktop spirometer manufactured by Cosmed. Yoga is performed 1 hr/day for 6 days /week for 12 weeks by yoga group.Results: Pulmonary functions tested in Yoga and control group were FVC, FEV1, PEF and FVC/FEV1. There were significant improvements in pulmonary functions in yoga group. In Yoga group (FVC- 5.8% increases, FEV1- 5.2% increase, PEF- 34% increase and FVC/FEV1- 3.15% increase). In control group also, all parameters increased but P value was not significant.Conclusions: This study concludes that practicing Yoga has shown a significant improvement on pulmonary functions in 1st year medical students.

Background:A good and an effective empirical treatment of SBP is not possible unless bacteriological spectrum and their antibiogram is clear. This becomes more important in country like India due to high antibiotic resistance. Authors aim was to assess the prevalence of SBP, clinical and microbiological profile of its variants, in patients with cirrhosis seeking care at a tertiary care teaching hospital.

Background: Antibiotic policy and appropriate antibiotic prophylaxis cannot be designed unless data is available about bacteria colonizing the bile associated with gall bladder disease.  Authors aim was to assess the clinical profile and pattern of bacterial isolates from bile aspirates of cholecystectomy patients seeking care at a tertiary care teaching hospital.Methods: Patients who underwent cholecystectomy for various hepatobiliary ailments during year 2017-18 formed the study population. Bile aspirates were collected during cholecystectomy and sent to the microbiology laboratory. Ultrasonography, computed tomography and MRCP were done to confirm the gall bladder pathology before surgery.Results: Out of total eighty-six patients, bacterial growth was observed in 28 (32.56%) subjects. As per division of bile samples, maximum number of study participants (39.29%) having bactibilia were seen in Group II. Group with second highest number of patients showing bactibilia was Group III with 9 subjects (32.14%). Eight subjects (28.57%) exhibited bacterial growth in bile aspirates in Group I subjects. Three patients (10.71%) showed bile infected with multiple bacteria i.e. polymicrobial infection. The gram-negative preponderance was seen in all the three groups with Escherichia coli being most common in group I and II. Pseudomonas aeruginosa was isolated in majority of the patients in group II and III.Conclusions: It is advised that all patients undergoing cholecystectomy must have their bile aspirated during cholecystectomy and sent for microbiological examination and culture. It will help in choosing appropriate antibiotic to prevent infection.

Background & Method: Aim of this study is to Study the quality of life post Endoscopic Dacryocystorhinostomy. The records of patients who underwent Endoscopic DCR in the last five years were retrieved from the archival records of Department of Otorhinolaryngology and Head-Neck Surgery, K.G.M.U and were reviewed for demographic data, laterality, pre-operative complaints, co-morbidities, clinical and surgical profiles, adjunctive procedures, complications, and success rates at the last follow up. Result: On comparing pre to post op swelling around eye status, it was found that at pre op the mean swelling score was 2.90±2.33 which was reduced to 0.50±1.03 at post op. So a mean reduction of 2.40±0.14 was observed which was significant statistically (p<0.001). On comparing pre to post op general condition status, it was found that at pre op the mean condition score was 0.08±0.48 which was unchanged at post op. Conclusion: Endoscopic DCR has improved the treatment of Nasolacrimal duct obstruction, with outcome as comparable to external DCR. Thus the present study state Endoscopic DCR as an effective and safe alternative to external DCR with improved patient satisfaction.

Background: The small intestine, like the rest of the gastrointestinal tract, is an intelligent organ. It generates a wide variety of motor patterns to meet motility requirements in different situations. Its basic motor function after a meal is to mix the chyme with exocrine and intestinal secretions, agitate its contents too.Methods: In vitro study is done to explore the effect of 1st generation antihistaminic (chlorpheniramine maleate) and second generation antihistaminic (Fexofenadine) on amplitude of gut motility by isolated rabbit gut preparation on Dale’s Organ bath, part of terminal ileum is used for study. Eight rabbits weighing 2 to 4.5 kg were used for study. The effect of antihistaminic observed that both drugs reduce amplitude.Results: The effect of Chlorpheniramine malete and Fexofenadine on amplitude observed and it found that both decrease the amplitude significantly.Conclusions: This study establishes a correlation between amplitude of gut and effect of antihistaminic suggests that antihistaminic drug both first generation and second generation decreases the amplitude of gut motility with a significant response.