Agartala Government Medical College Research Articles

Multimodal Sensory Stimulation among Very Low Birth Weight Preterm Newborns: A Quasi-experimental Study at a Tertiary Care Hospital in Agartala, Tripura, India

Introduction: There is a continuous search for an effective intervention to help preterm low birth weight neonates overcome their poor growth and developmental outcomes. Most researchers have examined the effect of Oromotor Stimulation (OMS) on feeding performance. Studies exploring Multimodal Sensory Stimulation (MSS) on various outcome parameters are sparse and reveal inconsistent results. Aim: To analyse the effectiveness of MSS in improving weight gain, length of hospitalisation, and feeding performance in preterm Very Low Birth Weight (VLBW) neonates. Materials and Methods: This quasi-experimental study was conducted between June 2021 and December 2022 in the Paediatrics Department of Agartala Government Medical College, Agartala, Tripura, India. A total of 104 hospitalised neonates with gestational age from 28 to less than 37 weeks and birth weight from 1000 to less than 1500 grams (VLBW) were included in the study. All neonates received standard care and Kangaroo Mother Care (KMC). On the advice of some faculties, several of them also received MSS. All neonates were divided into two groups: those who received MSS and those who did not, and they were monitored until discharge. Mean hospitalisation length, weight gain, and transition time were derived and statistically analysed using Chi-square and Mann-Whitney U tests. Results: In the present study, the mean gestational age was 32.04±1.75 and 32.679±1.19 weeks, and the M:F ratio was 1.43:1 and 1.30:1 in the MSS-given and MSS-not given groups, respectively. Mean weight gain was significantly higher in the MSS-given group (97.00±123.09 g versus- 23.42±43.96 g). Mean hospitalisation length was longer in the MSS-given group, but transition time did not differ significantly across the groups. Conclusion: Multimodal sensory stimulation is effective in promoting weight gain in preterm VLBW neonates.

COVID-19 vaccination status and treatment outcome: An observational study in a dedicated COVID Hospital of North East India

: Vaccination has been recommended to curve the COVID-19 pandemic. Associations of death among COVID-19 patients with their COVID-19 vaccination status and various co-morbidities are ill understood. Tocompare the proportions of death between COVID-19 vaccinated and un-vaccinated and to determine the association of vaccination status and selected co-morbidities with death among COVID-19 patients treated in the DCH of Tripura. : This secondary data based cross-sectional study was conducted in the DCH of Agartala Government Medical College using medical records of 2354 COVID-19 patients treated during second and third quarters of 2021, chosen by simple random sampling. A pre-designed proforma was used to extract data regarding demographics, vaccination status, co-morbidities, vitals, treatment outcome etc. from the case-sheets. Binary regression model was utilized for predicting the probability of death due to COVID-19 using important predictor variables. Majority i.e. 68% patients were aged between 18 to ≤60 yr, 56.7% were male, 38.3% had co-morbidities, 11% received single dose, 9.6% received two doses and 79.4% had no COVID-19 vaccination. Death rate was 5.8% among first dose recipients, 9.3% among second dose recipients and 11.4% among un-vaccinated. Overall death rate was 7.4%. Binary regression model has shown that older age, poor oxygen saturation during hospitalization, chronic kidney disease, hypertension and diabetes mellitus are having significant enhancing effect and vaccination having protective effect upon death. Old age, diabetes mellitus, hypertension and chronic kidney disease have enhancing and vaccination has got protective effect against death due to COVID-19.

Comparison of Serum Calcium, Magnesium, and Zinc amongst Preeclampsia and Normotensive Pregnant Women attending a Tertiary Care Teaching Hospital in Tripura, Northeast India

Introduction: Preeclampsia is one of the most frequently encountered medical complications of pregnancy. If left untreated, it exerts serious medical complications for both the mother as well as baby. As a multifactorial progressive disease, identifying potential biomarkers for predicting preeclampsia is crucial for disease stratification and targeted therapy. There is a growing interest in early detection of micronutrient deficiencies, such as calcium, magnesium, and zinc, to understand the causes of preeclampsia development. Aim: To compare the serum levels of calcium, magnesium, and zinc in women with preeclampsia and normotensive pregnant women attending Agartala Government Medical College and Govind Ballabh Pant Hospital, Agartala, Tripura, India. Materials and Methods: This cross-sectional observational study was conducted at Agartala Government Medical College, Agartala, Tripura, India, from January 2020 to December 2021. The study included primigravida women aged between 18 and 35 years, in their third trimester of pregnancy, with a singleton pregnancy. Sixty preeclampsia patients and 60 normotensive pregnant women were enrolled, and various biochemical parameters like serum calcium, magnesium, zinc, uric acid, urea, creatinine, Alanine Transaminase (ALT), and Aspartate Transaminase (AST) were analysed. Data were statistically analysed using the student t-test and Chi-square test. Results: The mean age (in years), gestational age (in weeks), and Body Mass Index (BMI) (Kg/m2 ) of the study subjects and control group were 26.02±4.69 and 23.4±3.81, 34.78±2.41 and 33.51±2.79, and 27.97±3.82 and 26.03±4.26, respectively. The authors observed that the levels of biochemical parameters like serum creatinine, AST, ALT, and uric acid were increased in preeclampsia. Furthermore, the serum concentrations of calcium, magnesium, and zinc were significantly decreased in preeclampsia. Conclusion: This study demonstrated that preeclamptic women have reduced levels of serum calcium, zinc, and magnesium compared to normal pregnant women. Therefore, dietary supplementation of these essential nutrients, either individually or in combination, may help prevent preeclampsia at an early stage and improve foetal outcomes.

A STUDY REGARDING THE ACCEPTANCE AND ATTITUDE TOWARDS COVID-19 VACCINATION AMONG HEALTH-CARE WORKERS: AN OBSERVATIONAL STUDY IN A TEACHING HOSPITAL

Background: Nationwide COVID-19 vaccination has been launched since 16th February 2021 and health care workers are offered to get vaccinated at rst. Vaccine coverage is a yardstick in measuring success of vaccination program. Despite cost-free, its acceptance among healthcare workers is not encouraging. Objectives: 1. To estimate coverage of COVID-19 vaccination among different categories of health care workers working in Agartala Government Medical College. 2. To study their attitude towards vaccination.3.To determine the association between selected socio-demographic parameters and vaccination. Methodology: Study Design: Cross-sectional study. Hospital based. Study population: Health care workers of A Setting: Sample size: GMC. 300 health care workers. Sampling: Convenient sampling .Study period: February 2021. A pretested structured and vali Study tool: Result: dated interview schedule. Out of 300 participants, 51% HCWs has received vaccination. Among 51% HCWs 37.9%doctors, 61%technicians and 100%nurses and other HCWs received the vaccine. 51% HCWs accepted the vaccination as protective for COVID-19 and had an attitude to receive the 2nd dose. Data management: Data analysis performed in computer using SPSS-25 for windows. Mean and SD will be used to summarize the continuous data and proportions for the categorical ones. P-value <0.05 will be considered signicant. Conclusion:Currently, during this COVID-19 pandemic, only approximately 51% of the HCWs got a dose of COVID-19 vaccine and majority had an attitude towards receiving the 2nd dose. In the context of a pandemic, vaccine hesitancy is a major barrier to implementing vaccination campaigns. To maintain benets of vaccination programmes, understanding and addressing vaccine hesitancy will be crucial to their successful implementation.

CLINICAL CHARACTERISTICS, MANAGEMENT PRACTICES AND IN-HOSPITAL OUTCOMES OF SCRUB TYPHUS PATIENTS IN A TERTIARY CARE CENTER IN THE NORTH EASTERN STATE, TRIPURA

Background- With the changing epidemiology, scrub typhus is now among the commonest causes of AFI in India and a high suspicion should be maintained, and an early diagnosis and promt management is warranted to prevent complications. Objective - Clinical characteristics, management practices and in-hospital outcomes of scrub typhus patients. Methods- a Cross-sectional retrospective study was conducted among 110 scrub typhus patients attending Agartala Government Medical College and GB Pant Hospital, a tertiary care centre of Tripura in last one year period. Their clinical profile, laboratory studies and management has been recorded and data has been evaluated with SPSS 21.0 for windows with p- value <0.05. Results- the commonest presenting symptoms of scrub typhus are high-grade fever with chills , headache and it most commonly effects farmers. Most commonly effected age group was 40-50 years of age. Most of the patients were from West Tripura followed by Khowai Tripura and least patients were from North Tripura. Predominately it occured in September, October and November i.e. in post monsoon period. The pathognomonic eschar was present in 43% patients and rarest presentation was paraparesis (0.9%). Lymphadenopathy (9%), neck rigidity (6%), hepatomegaly (10%), splenomegaly (4%), acute respiratory distress syndrome was seen in 14% patients. Hepatic involvement was the most common complication seen in our study (42%). Anemia was present in 25% and thrombocytopenia was present in 22% patients. Subside of fever to doxycycline injection seen in 73% on day1 and 84% on day2. 19% Patient required icu admission. 9% developed ARDS and 6% required ET tube intubation and mechanical ventilation. 6% developed hypotension requiring inotropic support. 4% developed severe thrombocytopenia(<10,000) required platelet transfusion. 11% developed acute kidney injury requiring haemodialysis. Survival rate were 93% and mortality 7%. In conclusion, scrub typhus became the leading infectious cause of acute febrile illness in North eastern state, Tripura. A high suspicion should be maintained, and an early diagnosis and promt management is warranted to prevent mortality and morbidity of patients.

Knowledge and practice regarding cervical cancer prevention among women in a rural area of Tripura, India

Background: Cervical cancer is commonest in developing countries and the third most common form of cancer among women worldwide which presents a later stage causing high morbidity and mortality. PAP smear discovered in 1941 was a revolutionary screening test but acceptance is poor. Objective was to detect the level of awareness regarding prevention of cervical cancer among rural women and to study the determinants of awareness regarding prevention of cervical cancer.Methods:A community based cross-sectional study was conducted in rural field practice area of Agartala Government Medical College for two months among 131 women chosen by multistage sampling, aged 15 years and above. Quantitative data were collected by administering a structured interview schedule. Chi square test was applied for testing the significance of study findings and p<0.05 was considered statistically significant.Results: About 78% of the study women were primary educated and 33.3% of the study women have heard about cervical cancer and health care providers were the source of information for 34.04% of the respondents. 99.2% of the women didn’t hear about PAP smear, nor they have any idea of vaccination. They didn’t undergo any screening test and cited “absence of symptoms” as the main reason.Conclusions:Majority of the studied women didn’t have any clear idea of cervical cancer, screening and vaccination and level of awareness was very low. Intensified health educational programs should be launched. Health workers and physicians must play critical role in counselling. Information about safety, efficacy, insurance coverage etc. to be facilitated for active HPV vaccination.

Antibody Responses of SARS-CoV-2 Vaccines amongst Health Care Workers in a Tertiary Care Hospital in Tripura, India: A Cross-Sectional Study.

Vaccines against COVID-19 plays an important role in limiting the spread of SARS-CoV-2 infections and also in curbing mortality and morbidity due to COVID-19. To estimate the anti-spike antibody response after receiving the second dose of SARS-CoV-2 vaccines amongst health care workers of a tertiary care hospital in Tripura, India. A cross- sectional study was conducted from 1 July to 20 August 2021 at Agartala Government Medical College and GBP Hospital, Agartala among 561 health care workers who had received first and second doses of SARS-CoV-2 vaccines and had completed 14 days after receiving the second dose. The present study showed that health care workers who had received both doses of COVID-19 vaccine had 99.5% seropositivity to anti-spike antibody. The median SARS-CoV-2 anti-spike antibody titter was 250 with an IQR (211.55-250). Seropositivity rate was higher among Covishield recipients (99.8% [550/551]) as compared to Covaxin recipients (80% [8/10]) and it was found to be statistically significant (P = 0.000). The present study suggests that a good immune response was elicited against spike antigen of SARS-CoV-2 after two complete doses of Covishield (ChAdOx1-nCoV-19) or Covaxin (BBV152).

Maternal anemia in various trimesters of singleton pregnancies and its correlation with birth weight: An observational study

Background: Anemia is a very important preventable nutritional disorder affecting pregnant ladies which may have some adverse effects on the neonatal survival and development. Birth weight was correlated with changes in maternal hemoglobin concentration in various trimesters as it is important for determining child survival and development. Aims and Objectives: The aim of the study was to assess the correlation between maternal hemoglobin levels in various trimesters and neonatal birth weight. Materials and Methods: The study enrolled all pregnant women within age group 15–35 years who gave birth at Agartala Government Medical College and GBP Hospital from June 15, 2017 to August 15, 2017. Pregnant women were included into the study following delivery by simple random sampling into cases (Pregnant women who delivered low birth weight babies <2500 g) and control group (Pregnant women who delivered normal birth weight babies ≥2500 g). Antenatal data were collected from hospital case sheet and labor room register. Data were analyzed using descriptive statistics and presented as Mean + SD. P < 0.05 (P < 0.05) was considered statistically significant. Results: Mean hemoglobin concentration was normal (˃11 g/dl) in all three trimesters among the controls but it is found to be <11 g/dl in second and third trimesters of the case group. The mean birth weight of the babies was 2.151(± 0.2386) kg in case group and 3.047(± 0.3666) kg in control group. Conclusions: It was found that maternal hemoglobin concentration has a positive correlation (r > 0) with neonatal birth weight in all three trimesters in both cases and controls which is statistically significant (P < 0.05).

Compliance to iron and folic acid tablets among pregnant women attending antenatal clinic in Agartala Government Medical College

ABSTRACTIntroduction:Anemia is a public health problem worldwide, and in pregnancy, the main cause of anemia is nutritional. Non-compliance to iron and folic acid supplement plays a role in the high prevalence of anemia in pregnant women.Objectives:The objectives were to find out the proportion of compliance to iron and folic acid tablets (IFA) among pregnant women and to determine factors associated with it.Methods:A cross-sectional study was conducted among 240 pregnant women attending antenatal clinic in Agartala Govt. Medical College, from 15th June to 14th September 2019. Subjects were recruited through consecutive sampling. A pretested, predesigned, semi-structured interview schedule was used to collect information. Data were analyzed using SPSS 15.0. Chi-square and Fisher’s exact tests were used to find out the association of compliance with independent variables. P value of < 0.05 was considered as significant.Results:Majority (56.3%) of the participants were in the age group of 20–29 years and were housewives (92.1%), Hindu (93.8%), and completed secondary education (34.6%). The proportion of compliance to IFA among pregnant women was 52.5% (n = 126), and the reason for non-compliance (n = 114) in the majority was side effects of IFA (35.09%), followed by forgetfulness (28.07%). Factors like age, religion, education, socio-economic status, birth order, number of antenatal visits, or number of IFA consumed daily have not shown any significant association with this compliance.Conclusion:This study highlighted that only around half of the pregnant women are compliant with IFA, and this situation demands for information education and communication activities to generate awareness.

Role of Infrared Imaging for Detection of Subclinical Inflammation of Joints: A Prospective Cohort Study

Introduction: The detection of inflammation is important for diagnosis of inflammatory joint diseases and its severity. There are clinically doubtful cases of inflammation of joints. Advanced thermal cameras are able to detect the presence of inflammation. Hence, thermal imaging technology has been used for detection of this type of subclinical inflammation of joints. Aim: To study the efficacy of infrared imaging to detect the subclinical inflammation of joints in doubtful cases of arthritis. Materials and Methods: A prospective cohort study was conducted for a period of one year from January 2016 to June 2017. The study comprised of 60 patients of all age groups. Patients with joint pain attending Out Patient Department (OPD) of Physical Medicine and Rehabilitation Department (PMR), Agartala Government Medical College (AGMC) and Govind Ballav Pant Hospital (GBPH), Agartala, India, irrespective of the duration of illness and diseases were selected considering inclusion and exclusion criteria. They were evaluated clinically (swelling, tenderness, redness, increased temperature and the presence of restriction of movement) for presence of inflammation in the joint. Blood tests were done for Acute Phase Reactant (APR) namely Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) and infrared imaging of the respective joints were taken. On the basis of clinical examination all these patients were divided in three groups: (i) patients with inflamed joint; (ii) non inflamed joint; and (iii) doubtful inflammation of joints. Infrared imaging of all the respective joints of all the patients were compared with the respective results of APR for presence of inflammation. Values more than the normal range of APR were considered as positive marker for inflammation. The data was analysed statistically by calculating sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) using MATLAB 2013b software. Results: Out of 60 cases, 37 (61.66%) patients showed clinically inflamed joints, 10 (16.66%) showed no inflammation and there were 13 (21.66%) clinically doubtful cases of inflammation. The results were statistically analysed and the sensitivity, specificity, PPV and NPV of infrared imaging for detection of joint inflammation were 91%, 80%, 94% and 72%, respectively. Conclusion: Infrared imaging is a very sensitive tool for the detection of inflammation of joints and is very useful for detection of subclinical inflammation of joint.

Clinical Profile and Short Term Outcome of Acute Encephalitis Syndrome in Children: An Observational Study from a Tertiary Care Centre, Tripura, India

Introduction: Acute Encephalitis Syndrome (AES) is a group of neurologic manifestation caused by wide range of microbes, chemicals and toxins. Japanese Encephalitis Virus (JEV) is the major cause of AES in India. Isolation of aetiological agent in AES cases presents a fundamental challenge to prevention and management. Lack of study on AES in the paediatric population of Tripura prompted the authors to take up this study. Aim: To determine the clinical profile and short term outcome of children with AES from Tripura, India. Materials and Methods: This hospital-based cross-sectional observational study was conducted from November 2017 to April 2019 in the Department of Paediatrics at Agartala Government Medical College (AGMC), Tripura, India. Total 100 children, from 1 month to 12 years of age, fulfilling definition of AES were enrolled in the study. All the cases were managed as per institutional treatment protocol and were followed-up at 1 and 3 months following discharge. Case record, patient profile records and reports of investigations were the study tools. Chi-square test and Fisher’s-exact test were used as per applicability to test the significance of difference of proportions using Statistical Package for the Social Sciences (SPSS) version 15.0. The difference was considered significant for a p-value &lt;0.05. Results: Out of total, 30 patients (30%) were in 9-12 years age group, with slight male preponderance (1.1:1). Total 72 cases (72%) were from rural area. Common clinical features were fever, altered sensorium, seizures, irritability, abnormal movement, pallor, papilloedema, and lethargy. Abnormal laboratory parameters included leucocytosis (62%), anaemia (27%), hyponatremia (35%), and hypoglycaemia (16%) and elevated liver enzymes (15%). IgM serology was positive for JEV (19%), scrub typhus (6%), herpes simplex virus (2%), dengue (2%), measles (1%), and enterovirus (1%). Magnetic resonance imaging brain was normal in 37% of the cases. About 54% of the cases recovered completely, 20% of the cases died and remaining 26% survived with sequelae. Conclusion: AES is common among older male children from the rural area. Serologically JEV is most common cause. Total 54% cases recovered completely. Proportion of death and residual sequelae were higher in the JEV category. The observations of the study indicate need of extensive studies and scaling up of JE vaccination.

Satisfaction of the clients attending integrated counseling and testing center in a teaching hospital of North-Eastern India: An observational study

Background: Integrated Counseling and Testing Centers (ICTC) provide counseling and testing for HIV to the clients. Satisfaction of the clients attending an ICTC determines its acceptance among people, and it is crucial for preventing this disease. Objectives: To estimate the level of satisfaction and to determine its association with sociodemographic parameters of the clients attending ICTC in a teaching hospital. Methodology: This hospital-based cross-sectional study was conducted in October 2019 among 213 clients attending ICTC of Agartala Government Medical College, chosen by census technique. An interview schedule containing information regarding age, sex, marital status, education, socioeconomic class, along with a component for evaluating HIV counseling and testing services initially used by UNAIDS, was used for data collection. Results: Among the clients, 54.5% (116) were male, 45.5% were aged between 35 and 80 years, 79.3% were from rural areas, 87.8% were Hindu by religion, 33.8% belonged to scheduled caste community, 63.4% were primary educated, 35.2% belonged to BG Prasad's Class II socioeconomic status, 83.6% were married, and 10.3% attended ICTC by self-initiated approach. Only 39% of the clients were found to be satisfied with the services of this ICTC. Waiting time in queue was found to be significantly associated with client's satisfaction. Conclusion: The client's satisfaction level was found to be low. Reduction in queuing time, caring attitude, and use of the client's own language might improve the scenario.

Accuracy of Two-dimensional Ultrasound and Magnetic Resonance Imaging in Diagnosis of Foetal Congenital Anomalies in a Tertiary Care Hospital- A Cross-sectional Study

Introduction: Ultrasound screening for foetus congenital malformations is the mainstay in diagnosis and is commonly performed at 19-22 weeks gestation. Magnetic Resonance Imaging (MRI) is known as a problem solving tool which is used for answering a specific question. Both ultrasound and foetus MRI are highly sensitive and specific in diagnosis of congenital anomalies of the foetus with high agreement between both modalities. Aim: To determine the accuracy of Ultrasound Sonography (USG) and High Field 3 tesla MRI in diagnosis of different types of foetal Central Nervous System (CNS) and non CNS congenital abnormalities. Materials and Methods: A cross-sectional study was conducted in the Department of Radiodiagnosis at Agartala Government Medical College and GB Pant Hospital from June 2017 to May 2019. A total of 65 cases with ultrasound diagnosis of foetus abnormalities were examined by 3 Tesla MRI. MRI were performed within 15 days after USG detected anomalies. Statistical analysis was done using Chi-square test. Results: In cases with foetus anomalies high field MRI provided detailed findings leading to a more refined diagnosis. CNS anomalies were more as compared to other anomalies. Some of the antenatal findings were confirmed in some cases following termination of pregnancy and some were by postnatal examination. Among them chest anomalies was least common i.e., 1.5%. sensitivity of MRI was 88.13%, specificity was 66.66%, Positive Pressure Ventilation (PPV) was 96.29%, Negative Predictive Value (NPV) was 36.36% and USG sensitivity was 82.43%, specificity and 77.77%, PPV was 95.83%and NPV was 41.17%. Conclusion: High field MRI should be used as a second line of investigation in patients with foetus abnormalities diagnosed by ultrasound for confirmation of diagnosis and selecting the treatment protocol. In cases of fatal abnormalities, a confirmed diagnosis made before 20 weeks of pregnancy may help by terminating the pregnancy.

Validity of Computed Tomography in Evaluation of Acute Ischaemic Stroke in Comparison to Magnetic Resonance Imaging: A Cross-sectional study

Introduction: Cerebrovascular disease represents a major reason for mortality and morbidity worldwide. Imaging plays a pivotal role in the management of stroke patients. Haemorrhagic stroke diagnosis is straightforward using a Computed Tomography (CT) scan whereas early ischaemic strokes are sometimes difficult to diagnose by imaging. The use of Magnetic Resonance Imaging (MRI) may diagnose ischaemic stroke more convincingly; however MRI remains less available, time consuming and complicated. Unenhanced CT can be performed quickly; can help to identify early signs of stroke. Aim: To determine the validity of CT in the evaluation of acute ischaemic stroke compared to MRI for early diagnosis. Materials and Methods: The study was a cross-sectional study conducted in the Department of Radiodiagnosis, Agartala Government Medical College and GB Pant Hospital, Agartala, Tripura, India. The study period was from December 2018 to December 2020 and included 70 patients. The instruments used were SIEMENS 128 slice CT-SOMATOM model definition AS and SIEMENS 3.0 Tesla MRI-SKYRA model. Statistical Package for Social Sciences (SPSS) for Windows, version 25.0 (SPSS Inc, Chicago, USA) was used for data analysis. Results: Out of all patients (n=70) 63 patients were ultimately found to have infarction. Out of these 63 cases of infarction 69.84%(n=44) were male and 30.16% (n=19) were female. Sensitivity of CT scan was 87.3%, specificity was 71.4%, positive predictive value was 96.4%, negative predictive value was 38.4% and accuracy was 85.7%. The p-value was 0.002. In all patients who presented before six hours (n=15) showed decreased creatinine value during Magnetic Resonance Spectroscopy (MRS) in the lesion area compared to the normal side of brain. None of the patients showed variation in the lactate value. Those presenting after 6 hours (n=48), creatinine was reduced in all the cases (100%), Choline was increased in 89.6%. Conclusion: Sensitivity and specificity of CT scan is lower than MRI. Diffusion-Weighted Imaging (DWI) has 100% sensitivity in diagnosing acute infarction.

Rural spine surgery practice: Challenges in optimal management of traumatic spinal cord injury

Study design: Prospective observational study. Objectives: To highlight the challenges in the management of traumatic Spinal Cord Injury in rural spine surgery practice. Setting: Agartala Government Medical College, Agartala Tripura India. Methodology: Consecutive spinal cord injury cases were admitted from September 2018 to September 2019 in the department of orthopaedics and surgical stabilization with pedicular screws system with or without decompression was carried out. Results: 44 patients with SCI were treated with 34 males (77.27%) and 10 females (22.72%) majority of the patients were between the age group of 31-40 years (40.9%). Fall from height being the common cause of SCI the patient were brought to the hospital emergency at 1 day to 7 day in 61.36% and in 45.5% of the cases SCI patients were transported to the hospital on relative arrangement in 45.45% of cases CT evaluation was carried out at 1day to 7 days and MRI evaluation at one week to one month in 59.09% of the cases. Time to surgery was between one week to one month in 61.6% of our cases and 40.45% of our patients belonged to low economic families. Conclusion: Comprehensive management of SCI is a big challenge in a resource-challenged rural area needs a collaborative effort by the government for improving the practice of spine surgery in rural settings. Imbalance still exists in the availability of the specialized spine care between urban and rural areas. Families with low socio-economic status had a major financial, social and psychological impact as majority of the patients were the primary bread earning members of the family and hence emphasis should be on proper utilization of the available Government health schemes for addressing the financial constrain families in rural set ups.

Cataract and Associated Factors Among OPD Attendees in a Teaching Institute of North East India: A Baseline Observation.

Background:In India 66% of blindness among individuals aged 50 yrs and above is attributable to cataract. Cataract has multiple etiologies and many of them are modifiable. But data regarding burden and correlates of cataract among OPD attendees in Northeast India are insufficient.Objectives:To estimate the proportion of cataract among the attendees of ophthalmology OPD of a teaching hospital of Northeast India and to study the factors associated with it.Methods:This hospital based cross-sectional study was conducted during 7th February to 6th March 2020, using a pre-tested structured interview schedule, among 330 adults attending ophthalmology OPD of Agartala Government Medical College, chosen by consecutive sampling.Result:Proportion of cataract among the attendees was 36.7% and it was 51.5% among the subjects aged ≥50 years. Age, family type, literacy, diabetes mellitus and hypertension had significant associations with cataract (P < 0.05). Logistic regression model has identified age ≥ 50 yrs (OR: 5.57, 95% CI: 2.98-10.43) and illiteracy (OR: 2.67, 95% CI: 1.55-4.59) as the significant predictors for developing cataract (P < 0.05) in the study population.Conclusion:Proportion of cataract among OPD attendees is 36.7%, which is higher than the community prevalence of cataract in Tripura. Promoting literacy, reducing family size, blood sugar and blood pressure may bring down the proportion of cataract in this population.

English

BACKGROUND Lancefield Group-B Streptococcus (GBS) emerged as a significant neonatal pathogen with mortality rates of 15 - 50 % in western countries during 1970s. In India, incidence of invasive neonatal GBS diseases is around 0.17 per 1000 live birth and probably is underestimated. Hence, the study was undertaken to evaluate the vaginal GBS colonization in pregnant women along with the neonatal outcome. METHODS The study was single centered, hospital based observational cross-sectional study done in the dept. of Obstetrics &amp; Gynaecology at Agartala Government Medical College (AGMC), and GBP Hospital for one &amp; half years (Jan’ 16 - June’ 17). 250 Pregnant mothers with 31 to 40 weeks of gestation with singleton pregnancy, delivering either by Caesarean section &amp; Vaginal delivery, were included in this study. They were recruited from obstetrics OPD and casualty of AGMC &amp; GBP Hospital. During 1 st pelvic examination, two low vaginal swabs were taken for Gram Staining, and for determination of ß-hemolytic colony in blood agar. After identification of GBS from genitalia, outcome of neonates in these positive cases were evaluated for up to 28 days after delivery. RESULTS GBS was found in 8.8 % of total women recruited and was more common in multi-gravida. GBS vaginal colonization was significantly associated with low birth weight, and preterm delivery (p value 0.01) which is significant. CONCLUSIONS Prevalence of vaginal GBS colonization is more in pregnant mothers, more in multigravidas &amp; is associated with low-birth-weight neonates and preterm delivery. So, there is a need to formulate guidelines for incorporation of detection of vaginal colonization in multi gravidas to determine its prevalence. KEYWORDS Group-B Streptococcus (GBS), Multigravidas, Colonization, Neonates, Pregnant Women

Hypovitaminosis D, Dyslipidaemia and Thyroid Dysfunction Among Adolescents and Their Associations With Raised Blood Pressure in a North Eastern City of India

Background: Raised blood pressure (BP) has been found to be associated with serum levels of vitamin D3, lipid profile and thyroid hormones among adults. But limited information is available regarding such associations in adolescents. Objectives To estimate the prevalence vitamin D3 deficiency, dyslipidaemia and thyroid dysfunction among secondary school students of Agartala municipal corporation area and to study their associations with raised BP. Methods: This school based cross-sectional study was conducted during April 2018 to December 2018 among 1000 students studying in different secondary level schools located in Agartala municipal corporation area chosen by multi stage sampling technique ensuring proportionate representation in the sample. Result: Prevalence of vitamin D3 deficiency, thyroid dysfunction and dyslipidaemia were found to be 79.4%, 62.8% and 37.5% respectively. Out of total, 58.1% of the study subjects had raised BP, 34.1% were fatty, 16.7% were overweight, 5.3% were obese and 48.3% had high waist hip ratio (WHR). Among all, 82.27% subjects with high BMI, 70.97% fatty subjects and 69.05% subjects with either low or normal WHR had significantly elevated BP (p 0.05). Binary logistic regression has identified higher BMI, higher body fat content, high WHR, habit of consuming extra salt and fast food on regular basis as the significant determinants of raised BP in this population (p<0.05). Conclusion: Though vitamin D deficiency, thyroid dysfunction and dyslipidaemia are prevalent among adolescents of Northeast India, they did not emerge as significant determinants of blood pressure in them. Funding Statement: Department of Health Research (DHR), Ministry of Health & Family Welfare, Govt. of India, New Delhi through Multidisciplinary Research Unit, AGMC. Declaration of Interests: There is no conflict of interest. Ethics Approval Statement: Informed written consent document for participation in this study was handed over to participating students for obtaining consent from their guardians. This study was approved by the institutional ethics committee of Agartala Government Medical College.

Facility based retrospective infant death study in a tertiary care hospital of Tripura

Background: Infant and neonatal mortality are important indicators of the overall physical health of a community. An increase is generally indicative of unmet human needs in healthcare, sanitation, nutrition and education. Objective: To estimate the different causes of death along with the geographic distribution of the reported death cases during the study period.Methods: Analysis of the retrospective mortality data of infant and neonates in the Pediatric Department of Agartala Government Medical College and Hospital, from 2014-2018, was conducted.Results: A total of 1525 infant deaths were recorded in the study facility, of which 878 (57.57%) were early-neonates, 120 (7.87%) late neonates and 527 (34.56%) post-neonatal infants. The most reported causes of neonatal mortality in Tripura were found to be preterm/low birth weight and perinatal asphyxia with OR of 1.45 (CI=1.137-1.857) and 1.41 (CI=1.10-1.81) respectively.Conclusions: The increasing burden of preterm births and neonatal sepsis needs attention towards ante-natal care along with holistic healthcare services. The need for intensive actions from both administration and healthcare facility to promote identification of red-flags at primary level, followed by proper referral from the periphery to tertiary care facility has been reiterated in this study.

Study of outcome of Intrauterine Contraceptive device (CuT-380A) insertion immediately after vaginal delivery

Introduction Closely spaced pregnancies are associated with adverse outcomes both for mother and foetus. The recommendations based on the results of technical consultants for healthy timing & spacing of pregnancies (HTSP) are that after a live birth, a woman should wait at least 24 months but not more than 5 years before attempting the next pregnancy to reduce the health risks and better outcome for the mother & baby. Here, our study was to see the effects of IUCD (CuT-380A) insertion immediately after vaginal delivery for spacing. Methods This study was done at Agartala Government Medical College (AGMC) and GBP Hospital for one & half years (Jan'16–June'17). Antenatal mother of term pregnancy were counselled. They were recruited from Gynae OPD & emergency and evaluated for different outcomes at 6th, 12th& 18th months in terms of different complications. Results Total of 200 women of term period of gestation (POG) where counselled and 55 women participated in this study. Common complications were expulsion of IUCD 5 (9.1%) at 6th month & bleeding per vagina 3 (5.5%) at one year. Expulsion of IUCD at one & half year was 5 (9.1%) and infection 1 (1.8%). 23 (42.6%) subjects continued with IUCD. Conclusion Major complications are low here, but still outcomes in terms of different parameters are not encouraging. Health workers at different levels can overcome this gap to improve the outcome. All our efforts should be made to enhance the field activities in making people aware about PPIUCD.