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Upper gastrointestinal bleeding is one of the most commonly encountered emergencies in day-to-day practice. In the present retrospective study, the various causes of acute nonvariceal upper gastrointestinal bleeding (NVUGIB), its management modalities, and the final outcome of patients were studied.Methods:A retrospective study of etiology of upper gastrointestinal (UGI) bleeding for a period of 13 months, January 2015 to February 2016 in Department of Gastroenterology, Central Referral Hospital, Gangtok, was conducted. There were a total of 127 upper gastrointestinal bleeding patients, out of which 70 patients were excluded due to endoscopically proven variceal bleeding. Of the 57 patients, the various causes were determined by investigations and were treated accordingly.Conclusion:Hematemesis was the most common presentation and duodenal ulcers the most common etiology among the acute nonvariceal upper gastrointestinal bleed. The cause of bleeding was not identified in one patient. Majority (34 patients, 59.64%) of the patients was treated conservatively, some needed endoscopic interventions (23 patients, 40.35%) and there was no any mortality.

Marriage is the blending together of two lives, two personalities of the opposite sex for as long as two shall live in this world. It is the building law of God and protects the mankind. But early and late marriage may have an adverse health consequence. A study was conducted to assess the knowledge on health consequences of early and late marriage among students at selected college of Sikkim. Investigators adopted the quantitative approach using the descriptive survey research design through convenient sampling technique. Structured knowledge questionnaire on health consequences of early and late marriage were developed and sent for validation to experts before collecting the data. Result shows that majority 84% and 49% has moderate knowledge, 12% and 47% has poor knowledge and 4% each has good knowledge on health consequences of early and late marriage respectively. The study reveals that there was no significant association of knowledge on health consequences of early and late marriage.

significant impact on patients' health-related quality of life and are common in chronic hemodialysis patients. The purpose of this study was to see how effective intradialytic leg ergometry and stretching exercises were at reducing fatigue and muscle cramps in hemodialysis patients at tertiary care hospitals.A quasi-experimental study conducted among 58 patients undergoing hemodialysis, randomly selected experimental and control group. Experimental group received intradialytic leg ergometry and stretching exercises during the first 2 hrs of dialysis session for a total duration of 4 weeks. Data on fatigue and muscle cramps were assessed using Multidimensional Assessment of Fatigue Scale (MAF) and PENN Spasm Frequency Scale (PSFS) respectively, at the beginning prior to implementation of intervention and re assessed during the 4th week. The study finding showed that the mean posttest score of fatigue in the experimental group was 26.86±8.228 was lesser than mean posttest score in control group 32.40±8.726, where the differences between the two groups was statistically significant at p<0.05 level. Similarly with regard to muscle cramps the mean posttest score in experimental group was 1.21±0.491 was lesser than mean posttest score in control group 2.07±0.884 where the differences between the two groups was statistically significant at p<0.05 level. The findings concluded that intradialytic leg ergometry and stretching exercises were beneficial in reducing fatigue and muscle cramps in hemodialysis patient. Keywords: [Hemodialysis, Fatigue, Muscle Cramps, Intradialytic ergometry]

Background: Dengue viruses, single-stranded positive polarity ribonucleic acid (RNA) viruses of the family Flaviviridae, are the most common cause of arboviral disease in the world and has turned this disease into a serious public health problem. Aims: To study retrospectively the incidence of laboratory confirmed dengue cases among the clinically suspected patients, the clinical profile of dengue-positive cases, and to co-relate with the environmental conditions. Materials and Methods: Five hundred and eighty blood sample was collected in the microbiology laboratory of district hospital Singtam, from clinically suspected cases of dengue infection, from 22 nd August 2013 till 30 th November 2013 for rapid dengue kit test initially followed by confirmation test by Immunoglobulin M (IgM) capture ELISA test. Conclusions: Fever with myalgia should be evaluated for Dengue fever (DF) in Sikkim, northeastern part of India. We also report the first outbreak of dengue fever in the east district (Singtam) of Sikkim.

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The outbreak of Dengue was reported from South Sikkim (Jorethang) and East Sikkim (Rangpo) in September 2017. Objective:To confirm the dengue outbreak by ELISA to find the serotype of Dengue virus responsible for the outbreak in Sikkim. Materials and Methods:Serum samples from the two districts (outbreak areas) were tested by NS1Ag ELISA and IgM ELISA. The NS1Ag positive samples were sent to ICMR unit, NICED (National Institute of Cholera and Enteric disease), Kolkata for serotyping. Results:The most common age group affected was 16-30 years. Males were more affected than females. The outbreak occurred in the month of September 2017. The predominant serotype was DEN2 few cases of DENV 1, DENV3 and DENV4 were also found. Conclusion:Recent outbreak has established Dengue as an important disease of concern in Sikkim. Young age groups were more affected. Serotype 2 was the major circulatory serotype.

With the advent of free flaps, pedicled flaps have taken somewhat of a backseat in reconstruction of post-surgical defects of the lower limb. However neither are all candidates suitable for free flaps nor is the procedure an easy one to perform in all centres provided the constrains of available facilities and operation theatre dates. In this retrospective and prospective study carried out in a tertiary care oncology centre in the north eastern part of india we review the outcome and feasibility of pedicled flaps for reconstruction after surgeries of lower limb malignant tumors.