Tripura Medical College Research Articles

A Study on Blood Group Distribution, Bleeding Time, and Clotting Time Variation among First-year Undergraduate Medical Students

Abstract Background: ABO blood group status of an individual is an important test that helps in blood grouping, cross-matching, solving medicolegal aspects, etc. Furthermore, bleeding time (BT) and clotting time (CT) are important tests to plan surgery, check response to anticoagulants, etc. BT is affected by platelet function while CT is affected by clotting factors. BT is prolonged in congenital or acquired platelet abnormalities. Defect or absence of one or more factors can cause prolonged CT. Aims and Objectives: To determine the blood group, of the students and to determine their BT and CT. Materials and Methods: Institution-based cross-sectional observational study done in the Department of Physiology, Tripura Medical College and Dr. BRAM Teaching Hospital. BT and CT were done by Duke’s Method and Capillary glass tube method respectively. Blood groups were determined based on the presence or absence of agglutination. Qualitative data were expressed in percentage and quantitative data in frequency, mean, and standard deviations. Results: Sixty-one (58%) females and 44 (42%) males participated. Blood group O and blood groups B (33.3%) were equally most predominant. BT is >4 min (total) in 13% of students (n = 14) with slightly more in males (16% males). In addition, CT is >6 min in 37% of students (n = 39) with slightly more in females (39% females). Conclusion: In our study, blood group O and blood group B were equally the most predominant. CT toward upper normal ranges (>6 min) slightly more in females than males.

A Study on SARS-CoV-2 Infection and Its Association with Co-morbidities: A Retrospective Cohort Study

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a novel coronavirus (nCoV) that causes viral pneumonia known as Coronavirus Disease 2019 (COVID- 19). It can infect people of all age groups, and various clinical conditions are strong indicators of co-morbidities in COVID- 19. The presence of co-morbidities is crucial in determining the clinical outcome of coronavirus infections. Therefore, it is crucial to understand the demographic profile and associated risk factors of COVID-19 in this geographical region. Aim: To assess the association between SARS-CoV-2 infection and demographic characteristics and co-morbidities. Materials and Methods: A retrospective cohort study was conducted at the National Accreditation Board for Testing and Calibration Laboratories (NABL)-accredited Virology Service Laboratory (VSL) of Tripura Medical College and Dr. BR Ambedkar Memorial Teaching Hospital, Agartala, Tripura, India. All the required data was collected between May 2021 and October 2022, and data analysis was carried out from February to March 2023. After obtaining Indian Council of Medical Research (ICMR) approval, real-time Reverse Transcriptase-Polymerase Chain Reaction (rRT-PCR) was used for the detection of SARS-CoV-2 RNA. A total of 10,263 samples were included in the study. RNA extraction was performed using the viral Ribonucleic Acid (RNA) extraction Miniprep Kit protocol manufactured by MDI Membrane Technologies, and RT-PCR was conducted according to the Indian Council of Medical Research (ICMR)-approved DiAGSureTM nCoV-19 Detection Assay (Multiplex, TaqMan based) protocol developed by GCC BIOTECH. The findings were based on demographic parameters such as age group and gender distribution. Results were expressed as proportions and percentages, and statistical analysis was done by Chi-square test in Statistical Package for Social Sciences (SPSS) version 20.0. Results: Out of the 10,263 registered patients, 1471 (14.33%) were confirmed to have SARS-CoV-2 infection. The most affected age group was found to be between 21 and 40 years, with 524 (35.62%) cases. Males, 927 (63.02%) were more frequently infected than females, 544 (36.98%). Among all the SARS-CoV-2 infected patients, co-morbidities were found in 254 (17.26%) cases, and the association between co-morbidities and the rRT- PCR test results was found to be statistically significant, with a p-value=0.01. Conclusion: The highest number of SARS-CoV-2 patients were found in the age group of 21 to 40 years, predominantly among males. Patients with co-morbidities showed a significant association with SARS-CoV-2 infection. Diabetes was found to be the most prevalent risk factor among all the patients.

Successful management of Gastroschisis baby at Tripura medical college and Dr. BRAM teaching hospital: a rare case report

Gastroschisis is a congenital defect of the anterior abdominal wall in which the intestines and other abdominal organs, protrude from the abdomen through a small hole. In recent years rates of Gastroschisis have been increasing. Most of cases it is an isolated defect or associated with other anomalies. Ultrasonography can detect it within 14 weeks after physiological herniation. Gastroschisis and omphalocele are two defect that closely resemble each other. In this case, we discuss a newborn baby with gastroschisis being successfully managed and was discharged in healthy condition 21days later.

A case of omphalocele associated with teratoma in a new born baby: a very rare case report

An omphalocele is a congenital midline abdominal wall defect at the level of the umbilical cord insertion into the fetal abdomen that results in herniation of intra-abdominal contents into a sac comprising of an outer layer of amnion and an inner layer of peritoneum. The most common eviscerated contents are liver and small intestine though virtually any organ can be seen within the omphalocele sac including colon, pancreas, spleen, omentum, stomach, heart or genitalia. We report an unusual case of omphalocele associated with mature teratoma in Tripura medical college and DR. BRAM teaching hospital. Only five cases of teratoma arising in a case of omphalocele are reported in the literature reviewed.

Successful management of neonatal gastric perforation in Tripura medical college and Dr. BRAM teaching hospital-a rare case report

Gastric perforation in the newborn is a rare surgical emergency in our practice area; nevertheless, since the earlier it is diagnosed, the better the prognosis, it is a possibility that we must be aware of. Perforation would be suspected in an infant with severe abdominal distension and diagnosis is confirmed with simple abdominal X-rays, including anteroposterior and lateral projections with horizontal ray, on which pneumoperitoneum will be shown. We report the case of a neonate diagnosed with gastric perforation at 72 hours of age who underwent a successful surgical intervention and was able to go home clinically healthy 14 days later.

A STUDY ON EFFECTS OF HYPOMAGNESEMIA AMONG CRITICALLY III PATIENTS ADMITTED TO INTENSIVE CARE UNIT

BACKGROUND: Hypomagnesemia is one of the common electrolyte disorders found in critically ill patients, but mostly remains under diagnosed . Our aim is to study prevalence and effects of hypomagnesemia among critically ill patients admitted to intensive care unit and to correlate with patient outcome and other parameters like length of stay in ICU, ventilator support and duration, mortality. This cross- METHODS: sectional study was conducted at Tripura Medical College and DR. BRAM Teaching hospital, over a period of 6 months duration from 1st June 2022 to 30th November 2022. 102 Critically ill patients of age more than 18 years admitted to ICU fullling the criteria were included in the study. Demographic data , medical history, length of ICU stay, requirement of ventilatory support and mortality was recorded for each patient. The severity scoring system used was Acute Physiology and Chronic Health Evaluation-II (APACHE-II). Serum magnesium levels along with other relevant investigations were done within rst 24 h of hospital admission. Among RESULTS: 102 patients, the mean age was 52.5 ± 13.7 years. 66 (64.7%) were male and 36 (35.3%) were females. The mean APACHE-II score was 21.9 ± 1.8. Prevalence of hypomagnesaemia in the present study was 36.3 % , whereas 63.7% had normomagnesemia. Majority of patients with hypomagnesemia had sepsis (51%). When hypomagnesemia was compared with normomagnesemia group, patients with hypomagnesemia had higher APACHE II score (23.1 ± 1.7 vs 21.2 ± 1.5), more frequently had sepsis (51% vs 20%), higher ICU stay (10.3 ± 2.5 vs 8.7 ± 2.1), more frequent need for ventilatory support (54% vs 27%), higher mortality (41% vs 12%), and the association was statistically signicant. However, no signicant difference was found in the duration of ventilation between the two groups. This study has found high prevalence of hypomagnesemi CONCLUSION: a in critically ill patients. Hypomagnesemia was associated with higher APACHE II score on admission, increased duration of ICU stays, increased need of ventilator support and higher mortality. Hence, monitoring of magnesium levels should be recommended in critically ill patients as it has several prognostic and therapeutic implications

Cardiometabolic and Hematological Consequences of Subclinical Hypothyroidism – A Hospital-based Study

Introduction: Cardiometabolic syndrome is a major public health problem that effects various groups of population world over. Overt hypothyroidism is reported to be associated with both adverse cardiometabolic events as well as hematological picture. However, cardiometabolic and hematological consequences of subclinical hypothyroidism (SCH) are yet to be evaluated in different population. In the present study, we evaluated cardiometabolic and hematological consequences of SCH in a middle aged population from Agartala, Tripura, India. Methodology: The study was conducted on 193 patients attending the ENT OPD of Tripura Medical College and Dr. B.R. Ambedkar Memorial Teaching Hospital, Hapania, Agartala. Subjects having diabetes mellitus, hypertension, patients having thyroxin, antithyroid drugs and antilipidemic drug users, established cancer patients, pregnant woman, and women receiving oral contraceptive pills were excluded from inclusion in the study. Results: The mean age of the subjects was 40.13 years, and females constituted around 65 % of total subjects. The analyses showed a significant difference the RBC count, HB concentration, and a non-significant difference in WBC count between euthyroid and hypothyroid subjects, while platelets showed no significant difference between the groups. There was a significant increase in total cholesterol level and level of LDL cholesterol as well as blood pressure, blood sugar level, and waist circumference in hypothyroid subjects in comparison to euthyroid subjects. Conclusion: The study concluded that the subjects with hypothyroidism have worse cardiometabolic parameters with alteration in lipid profile. Thyroid dysfunction affects all blood parameters except platelets. The follow-up of patients with hypothyroidism should include the complete blood count and evaluation of lipid profile and other cardiometabolic parameters.

A Study on FibroScan and Endoscopic Finding in Patients of Chronic Liver Disease attending Tripura Medical College and Dr. B.R. Ambedkar Memorial Teaching Hospital.

Chronic liver disease (CLD) represents different liver disorders of varying severity and etiology in which hepatic inflammation and fibrosis continue at least for 6 months. Portal hypertension is one of the important complications of CLD and its early recognition is of paramount importance. Though liver biopsy remains the gold standard for diagnosing liver fibrosis and upper gastrointestinal (GI) endoscopy plays an important role in diagnosing different findings of portal hypertension, various noninvasive methods like FibroScan are being increasingly used to diagnose liver fibrosis. Study the FibroScan and endoscopic findings in patients of CLDs and the objectives are to find the prevalence of portal hypertension and to find various grades of esophageal varix and portal hypertensive gastropathy (PHG) and its relationship with liver fibrosis by FibroScan. A total of 114 patients of CLD and compensated cirrhosis having childturcotte- pugh (CTP) stages A and B were included in the study fulfilling inclusion and exclusion criteria, after calculating the sample size of 100. All the patients underwent detailed history, physical and gastrointestinal examination. Complete blood count (CBC), liver function test (LFT), kidney function test (KFT), viral markers were done. Aspartate aminotransferase (AST) to platelet ratio index (APRI) score was calculated, liver fibrosis was estimated by FibroScan and evidence of portal hypertension was documented by upper GI endoscopy. Cutoff value of FibroScan, APRI score, and model for end-stage liver disease (MELD) score for portal hypertension was decided by receiver operating characteristic (ROC) curve. Alcoholic liver disease (ALD) was the most common cause (43%) of CLD closely followed by nonalcoholic fatty liver disease (NAFLD) in 42% cases followed by chronic viral hepatitis, 75% patients had evidence of portal hypertension with PHG being the most common followed by esophageal varix. F4 fibrosis was found in 73% of cases followed by F3, F2, and F1 fibrosis. FibroScan value of 12.2 kPa was predictive of presence of portal hypertension and value of 26.6 mm predicted the presence of large esophageal varices.

Estimation of Proinflammatory Cytokines and Mediator CD40 Ligand Levels in Young Tribal Subjects of Tripura- An Observational Study

Introduction: Obesity is the established risk factor for the development of cardiovascular diseases like hypertension, diabetes mellitus, chronic heart diseases and atrial fibrillation. Cytokines such as Interleukin-6 and Interleukin-12 (IL-6,IL12) play a significant role in the development of obesity related disorders. Cluster of differentiation 40 (CD40) Ligand, a trimetric protein structurally related to Tumor Necrosis Factor alpha (TNF-α) family contributes to atherothrombosis by being a link between platelets, inflammation, thrombosis and atherogenesis. The present study was undertaken to explore the interplay between inflammatory cytokines and CD40 Ligand (CD40L) in young obese tribal subjects. Aim: To estimate the level of proinflammatory cytokines like IL-6, IL-12 and CD40 Ligand in obese subjects and compare with non obese tribal subjects of Tripura, India. Materials and Methods: In this observational study, 60 non obese and 60 young obese tribal subjects within age group of 18-36 years were enrolled, over a period of 2 years from March 2014 to March 2016 at Tripura Medical College (TMC) and Dr. BRAM Teaching Hospital. Serum levels of IL-6, IL-12 and CRP were estimated by Enzyme-Linked Immunoassay (ELISA). Plasma level of fibrinogen activity was measured by coagulation assay. The Homeostasis Model Assessment (HOMA) of insulin resistance was calculated as insulin (micro unit per milliliter) x glucose (milimoles/Ltr)/22.5. Soluble Cluster of differentiation 40 Ligand (sCD40L) in serum was determined by ELISA. Statistical analysis was performed using Mann-Whitney test, Chi-square test and regression analysis. Results: Cohort consisted of 19 (31%) males and 41 (68.3%) females whereas the control non obese group comprised of 16 (26.6%) males, and 44 (73.3%) females. In the present study, the authors had observed that the biochemical parameters like fasting blood glucose, cholesterol, triglycerides and HighDensity Lipoprotein (HDL) cholesterol were significantly higher in obese subjects compared to non obese subjects. Further, the authors observed that C-reactive Protein (CRP), IL-6, IL-12 and Fibrinogen level were statistically higher in obese subjects. A statistical significant difference was found in fasting insulin level and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) between obese and the non obese group. Finally, there was positive relationship between CD40 Ligand and cytokines with obesity. Conclusion: The present study has demonstrated that the circulating levels of IL-6 and IL-12 have a strong relationship with obesity and other parameters of metabolic risk. It was also observed that there is a clear positive relationship between CD40L and cytokine families.

A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge and Attitude Regarding Childhood Behaviour Disorder Autism Among Mothers of Selected Developmental Centres of Agartala, Tripura, India

Background of the study: Autism is a Global burden including in our country India. Autism in the developmentaldisorder included under the umbrella of the pervasive development disorder. Childhood developmental disorderAutism characterized by deficits in social interaction, communication with unusual repetitive behaviour. Usuallythey live in their won world. Event they may show no interest what is happening around their. They remain usuallyin their won world. Socialization, education are big challenge for mothers whose has the child with Autism. Becausein the way of development of such children needed specialised knowledge and attitude of mothers includingcaregivers, parents and teachers. Keeping mind the concurrent, the present study aims to progression of awarenessand development of childhood behaviour disorder Autism in Tripura, Agartala as well as in our country India.Materials and methods: Present study is a quasi-experimental research design.500 mothers of Vidya WelfareSociety and Tripura Medical College & Dr.B.R.A.M Teaching Hospital, Agartala with child with Autismwere selected by purposive sampling technique. Dr. Nola Pender theory was implied in this study. 40 Semistructured questionnaire of knowledge and 12 Attitude were administered after structured teaching programme.The estimated reliability of the tool is 0.90. Data were analysed by inferential quantitative method.Results: The results of post-test knowledge showed the increase in knowledge regarding childhood behaviourdisorder autism. The reliability of the tool structure knowledge questionnaire was 0.82 and the tool forattitude was 0.90. The enhancement of knowledge regarding meaning and characteristics of autism was 38.7%,enhancement of knowledge regarding causes of autism was 41.2% and enhancement of knowledge regardingmanagement was 39.6% and the over all aspects of knowledge was 39.4%. The increase or enhancement ofattitude regarding childhood behavioural disorder autism was 19.1%. The paired t-test was carried out and itwas found to be remain significant for knowledge and attitude at p<0.001 level. Results implied that increase inknowledge and the increase in attitude regarding childhood behavioural disorder autism among mothers childwith autism in this present study.Conclusion: Mothers with more education and financial empowerment will make easier path to managechildhood behaviour disorder Autism. This study also suggest for more family support, Intra-natal care ,toprovide child joint family environment, access of others institutional health care and counselling centres facilityfor behaviour disorder autism of child also need for proper knowledge and attitude of mothers’ child with autism.

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BACKGROUND Most common osseous destructive lesions effecting the jawbone are odontogenic cystic lesions, which are lined by epithelium, has been involved in the formation of teeth as the epithelial cell rest are present in jawbone after teeth formation. The three most common odontogenic cysts (OCs) are radicular cyst (RC), dentigerous cyst (DC) and the odontogenic keratocyst (OKC). Less common variety is the residual cyst. Odontogenic cysts are mainly developmental and inflammatory in origin. The objective of the present study was to find clinico-radiographic characteristics of odontogenic cysts in the mandible. METHODS This was a case series (descriptive) study on OCs of mandible conducted at Tripura Medical College and Dr BRAM Teaching Hospital, Hapania, Agartala, Tripura (W), India, over a period of 6 months from August 2019 to January 2020. Subjects showing clinico-radiographic features of OCs in mandible were included, subsequently confirmed by histopathological examinations. Usually orthopantomograms (OPGs) and intra oral peri apical radiograph (IOPAs) were done for radiological findings, computed tomography (CT) scan was required for examination of the size of lesion. Data were analysed using windows excel. RESULTS Diagnosis of OCs was confirmed in 20 patients, among them, males were (60 %) and female were (40 %). The age range of the patients was 17 - 65 years. Most common type of cyst diagnosed in the study was radicular cyst in 50 % cases followed by dentigerous cysts which were in 30 % cases, odontogenic keratocysts were in 15 % patients and others were 5 %. RCs were represented in higher percentage (50 %). Right side of mandible was the most effected side (60 %) than left side (40 %). Main finding of the study was, in every type of cystic lesions, males were recorded as predominant, and it occurred in early age group. CONCLUSIONS Main finding of the study was radicular cyst which was in higher percentage (50 %) and was being most common with association of carious tooth. KEYWORDS Odontogenic Cysts, Mandible, Finding

THYROID SWELLING AND IT’S ASSOCIATION WITH THYROID HORMONE STATUS AND BLOOD LIPID PROFILE: A CROSS-SECTIONAL STUDY

Disease of thyroid gland are among the most abundant endocrine disorder in the world second only to diabetes mellitus . Thyroid diseases namely hypothyroidism and hyperthyroidism,constitutes the most common endocrine abnormality in recent years,diagnosed either in subclinical or clinical form.One observational cross sectional study was conducted in the department of ENT, Tripura Medical College & DR.BRAM Teaching hospital involving 75 nos of subjects having thyroid swellings. Mean value of T3,T4 and TSH was different in cases of euthyroid, hypothyroid , hyperthyroid and subclinical hypothyroid subject. It was of statistically significant. Here P value of T3, T4 & TSH according to thyroid hormone status were less than 0.05(α%) level of significance.There was statistically difference in average value of T3,T4 & TSH with different thyroid hormone status at 5% level of significance.We found that 9.3% of the study subjects were having altered lipid profile.We found that 62.5% of hypothyroid subjects were having altered lipid profile . Amongst them,all subclinical hypothyroid subjects were having altered lipid profile.Whereas hyperthyroid subjects were having normal lipid profile.Two (3.07%) euthyroid cases were having altered lipid profile.We found that mean values of total cholesterol, triglyceride, HDL, LDL and VLDL was different in cases of euthyroid , hypothyroid , hyperthyroid and subclinical hypothyroid subject.It was of statistically significant.Here P value of total cholesterol,triglyceride,HDL,LDL and VLDL according to thyroid hormone status were less than 0.05(α%) level of significance. There was statistically difference in average value of total cholesterol,triglyceride,HDL,LDL and VLDL with thyroid hormone status at 5% level of significance.

Evaluation of functional outcome of distal tibial fractures managed with locking compression plate using minimally invasive plate osteosynthesis (MIPPO) technique

Background: Treatment of distal tibial fracture is challenging, because of precarious blood supply leading to poor healing. Various modality of surgical treatment such as closed intramedullary nailing, Open Reduction and internal fixation with conventional plate osteosynthesis and external fixation has been tried so far. But this modalities doesnot give better functional outcome and had high complication rate. The newer technique of distal tibia fractures fixation using MIPPO (minimally invasive percutaneous plate osteosynthesis), involves less soft tissue handling and minimal periosteal stripping resulting in low infection rate and faster healing. Aim of the Study: To evaluate clinical, functional and radiological outcomes after minimally invasive plate osteosynthesis using distal tibial locking compression plates. Materials and Methods: In this study, 30 patients with distal third tibial extra articular Metaphyseo diaphyseal fractures with or without associated fibula fractures were treated with MIPPO. The present prospective study was conducted in the department of Orthopaedics at Tripura Medical College, between August 2020 to July 2021. Results: All fractures had a good clinical and radiological union. The fractures were stabilized with MIPPO, at an average of 6.27 days post- trauma, with an average operative time of 66.25 minutes. Functional outcome evaluation was done using Olerud-Molander ankle score, at the end of 1 year. Average radiological union time of 17.6 weeks and there were one delayed union and one nonunion. None of the cases had implant failure or any significant deformity with good to excellent results in 86.66% cases. Conclusion: It is concluded that locking plate fixation by minimally invasive percutaneous plate osteosynthesis technique (MIPPO), is the most effective procedure for closed extra-atricular distal tibial Dia-metaphyseal fractures.

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BACKGROUND Hematological malignancies are a major health problem in our society due to their high mortality and morbidity. It includes diverse and biologically distinct subgroups and can be defined as clonal neoplasm of hematopoietic stem cells characterized by uncontrolled proliferation of immature cells in bone marrow and spilling into peripheral blood. The patterns of subtypes of hematological malignancies vary in different populations and geographic areas because of genetic, environmental, dietary and social factors. Research of epidemiological features of leukemia are poorly reported in Tripura. The objective of the study was to get an idea about the pattern of hematological malignancies in our institute which will help to get an idea of the disease in our state and find out the incidence of hematological malignancies in Tripura Medical College, a tertiary care hospital in Tripura. METHODS This is a one-year prospective study, conducted in the Department of Pathology, Tripura Medical College & DR BRAM teaching hospital from July 2017 to June 2018. Medical records of all patients admitted to our hospital and diagnosed as a case of hematological malignancy were reviewed for demographic and clinical characteristics at diagnosis. Data analysis was performed by using statistical package for social sciences (SPSS) version 16. RESULTS Our study included 19 diagnosed cases of hematological malignancies, of which 15 were of acute leukemia and 3 cases were of chronic leukemia. Amongst the cases of acute leukemia, 9 were diagnosed as acute myeloid leukemia (AML) whereas 6 were diagnosed as acute lymphoblastic leukemia (ALL). Out of chronic leukemic cases, all were diagnosed as CML. We reported a solitary case of multiple myeloma in a elderly male patient. Present study showed male predominance, invariably affecting the adults. Commonest form of leukemia in adults were AML followed by chronic myeloid leukemia (CML) whereas all cases of ALL were found in children.The most common peripheral blood finding in hematological malignancy was pancytopenia followed by bicytopenia. CONCLUSIONS In our study, acute leukemia was the most common subtype of leukemia in all age groups. Of all leukemia cases, majority were of AML. Demographic characteristics were almost the same as other regional reports. Our observation is mostly comparable with other studies from India and the neighborhood countries. The differences observed in few demographic parameters may be due to geographic variation and genetic difference of study population. KEY WORDS Hematological Malignancies, Acute Leukemia, Chronic Myeloid Leukemia

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BACKGROUND Upper gastrointestinal bleeding (UGIB) is one of the common medical emergencies throughout the world that may require hospital admission and results in high patient morbidity and mortality. The presentation of UGI bleeding depends on the amount and location of haemorrhage. Upper gastrointestinal endoscopy (UGIE) is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions. The present study has been carried out to evaluate the different aetiological causes of UGIB in a tertiary care centre in the North Eastern part of India and compare the same with other studies done globally. METHODS This was a hospital based observational study with cross sectional design carried out in the Department of Medicine at Tripura Medical College & DR BRAM Teaching Hospital, Agartala. Total 376 patients were selected for this study for over a period of 2 years from January 2017 to December 2018. Upper GI endoscopy was performed in all patients after hemodynamic stabilisation. Rockall scoring system was used in non-variceal cases to predict the mortality in patients with upper GI bleeding. RESULTS A total of 376 patients had endoscopy for UGIB which included 260 (69.1 %) males and 116 (30.9 %) females, and the mean age was 47.9 (± 17.0) years. The most common cause of UGIB was peptic ulcer disease (duodenal ulcer and gastric ulcer) consisting of 31.38 %, followed by erosive gastritis (23.94 %), oesophageal varix (11.17 %), portal hypertensive gastropathy (10.64 %), duodenitis (8.51 %). Gastrointestinal malignancy (gastric and oesophageal cancers) was reported in 3.98 % and rare causes of UGIB were Mallory-Weiss syndrome (1.86 %), and esophagitis (1.60 %). Among them 4.26 % of the patients had normal endoscopy findings. CONCLUSIONS In the present study, peptic ulcer disease was the most common cause of upper gastrointestinal bleeding, followed by erosive gastritis. Rockall score of more than 4 was numerically associated with increased incidence of mortality. KEYWORDS Upper Gastrointestinal Bleeding (UGIB), Upper Gastrointestinal Endoscopy (UGIE

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BACKGROUND Most commonly occurring impacted teeth encountered in dental surgery are mandibular 3rd molars. Reasons of impactions may be due to evolution and modern dietary habits, lack of space, decreased skeletal growth, and disproportionate crown size. Impacted tooth may cause various complications, if left untreated distal caries is commonly seen in mandibular 2nd molars. The aim of the current study was to determine the prevalence of distal caries of mandibular 2nd molars due to impacted mandibular 3rd molars. Symptoms like distal caries of 2rd molars is one of the major factors affecting the oral health next to periodontal disease and periodontal abscess. METHODS The study included 103 patients, reported to the dental department of Tripura Medical College and BRAM &Teaching Hospital, Agartala. The study was done from July 2019 – December 2019, age ranged from 18 to 50 years. Panoramic radiographic examinations were carried out in each patient. Angulations of impaction and incidence of caries of the adjacent mandibular 2nd molars were recorded. All data were collected and analysed using percentage analysis. RESULTS 103 patients panoramic radiographs were studied, out of 103, 63 (61 %) were male, 40 (39 %) were female. 31 patients (30.1 %) out of 103 patients were found to have distal caries of mandibular 2nd molars adjacent to mandibular 3nd molars. 85 % of caries was associated with mesioangular impaction. CONCLUSIONS Careful monitoring to detect the caries lesions in early stage is necessary, as the distal caries on the mandibular 2nd molars was found to be high. Subsequently proper measures should be taken for restoration of mandibular 2nd molars and removal of impacted mandibular 3rd molars, if necessary. KEYWORDS Distal Surface Caries, Mandibular 2nd Molars, Impacted Mandibular 3rd Molars, Angulation

Clinical profile of patients with acute pancreatitis in a tertiary care centre in Tripura: A retrospective study

Background: Acute Pancreatitis is a common disease with wide clinical variation and its incidence is increasing. Acute pancreatitis is an inflammatory process leading to abdominal pain, progressive destruction of exocrine tissue and in some patients a loss of endocrine tissue as well, with multiple organ failure and high mortality. Severity of acute pancreatitis is linked to the presence of systemic organ dysfunction and/or necrotizing pancreatitis.
 Aims and Objective: The present study was aimed to study the clinical profile of acute pancreatitis, the etiology and complications of acute pancreatitis received treatment in the Department of Surgery, Tripura Medical College & Dr. BRAM Teaching Hospital, Agartala, Tripura.
 Materials and Methods: This was a hospital based retrospective study which was conducted from January 2019 to December 2019. All patients with a diagnosis of acute pancreatitis were included in this study in order to find out the clinical presentations from the available clinical, laboratory and radiological data.
 Result: Of the 100 patients in this study, 96 were male and 4 were female. Minimum age in our study was 10 years and maximum were 70 years. Maximum numbers of patients were below 45 years of age. Alcohol was identified as the most important etiological factor associated with acute pancreatitis. Among the known etiological factors 90% of the cases were related to alcoholism and 4% were due to gall stone disease. Abdominal pain and vomiting were the most common symptoms in our study. Epigastric tenderness was present in 90% of the cases and guarding/rigidity in 50% of cases. 14% patients showed jaundice as a sign of acute pancreatitis. There was no major difference between the CT grading system and clinical grading system. Most of the patients recovered with conservative treatment. Adverse outcome was noted in one patient with acute necrotizing pancreatitis.
 Conclusion: Acute pancreatitis is one of the leading causes of increase in morbidity and mortality to society. Clinical assessment along with radiological findings correlated well with the morbidity and mortality. Our study identifies alcoholism as one of the most important etiological factors.

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Self-medication practices among medical and nursing students in Tripura, India: a mixed-method study

Background: In developing countries like India, self-medication is a common practice because of costly clinical services and easy availability of medicine from pharmacies. There is an increase trend of self-medication among different health professional students apart from general people. This study aims to assess self-medication practice among medical and nursing students in Tripura, India.Methods: This cross-sectional study was conducted among undergraduate medical and nursing students of Tripura Medical College and Tripura College of Nursing, of Tripura for two months (January- February 2018). A pre-tested, semi-structured schedule was used to collect the required information. The collected data was entered in SPSS version 16.0, represented in proportions and p <0.05 was considered as statistically significant.Results: Overall 353 (88.3%) students of both courses practiced self-medication; prevalence was more among medical (91.5%) than nursing students (85%). Main source of information among medical students were books (90.2%) while 56.5% nursing students replied friends and/or seniors as primary source. Majority (53%) respondents took self-medication for headache (79.2% medical vs 72.4% nursing students) followed by fever (77.6% medical vs 52.4% nursing). Less than half of the respondents (48.5% medical vs 46.5% nursing students) believed that self-medication was harmful; maximum nursing students (71.5%) believed that self-medication is self-care as compare to medical students (56.5%).Conclusions: The study found wide practice of self-medication among students, inappropriate use of which may cause serious health hazards. Promoting education regarding self-medication and making healthcare system available can reduce self-medication practices substantially.

Sleep disturbance and its effect on work performance of staffs following shifting duties: A cross-sectional study in a medical college and hospital of Tripura

Introduction: Sleep disturbance among night-shift workers results in serious adverse effects on their health affecting almost all the systems of the body. Recently, the World Health Organization has also identified night-shift work as being carcinogenic to human. Objective: The main objective is to study the prevalence of sleep disturbance and its effect on work performance of health-care staff working in shifts in a Medical College Hospital of Tripura. Materials and Methods: An institution-based cross-sectional study was conducted in February 2018, among 135 staffs working in shifts, including resident doctors, intern doctors, nursing staffs, security guards, technicians, ward boys, and ward girls of the Tripura Medical College and DR. BRAM Teaching Hospital. Systematic random sampling was used to collect the required samples with a predesigned and pretested interview schedule designed based on the Pittsburgh Sleep Quality Index. Data entry and analysis were done in the Statistical Package for the Social Sciences software version 16.0 (SPSS Inc. SPSS for Windows, Chicago, Illinois, USA). Data were represented in percentages in tables and charts, and the Chi-square test was applied to find out the statistical association. Results: Of the total 135 participants, the majority (28.9%) were interns and nursing staffs and paramedical students (26.7%). The prevalence of sleep disturbance was 54% among the participants, and it was significantly higher among those residing in hostel and quarter as compared to their own home (P = 0.003). Sleep disturbance was also found to be significantly decreasing their performance at work (P