Education Intervention on 'Hearing Impairment - Its Assessment and Management' among Medical Practitioners in Sikkim, India

BACKGROUND

Health care providers must be aware of the choices in aural rehabilitation methods and assessment procedures available presently to those with hearing impairment in order to facilitate early identification and intervention and ensure quality of care to those hearing impaired individuals. The referrals from the medical fraternities for the audiological services are not uniform across India. Part of reason may be that awareness about the roles of and responsibilities of audiologist's is poor among medical practitioners. In some regions of India medical practitioners may be only grossly be aware of audiologists per se. They may not know enough to refer all individuals with hearing or balance disorders for the required audiological services.

AIM

To evaluate changes in pre survey and post survey after education intervention specifically planned for medical practitioners in the state of Sikkim, India. Education intervention included awareness about hearing impairment and its assessment and management by audiologists.

METHOD

A pre and post survey comparison research design with purposive convenient sampling technique was applied. Participants were medical practitioners working in geographical area of Sikkim at the time of the study. Inspection of demographic data of respondents showed that they were in their age range of 24 and 60 years and with work experience ranging 1-40 years. Participants were invited for an awareness talk which included, information about hearing loss, early identification and early intervention, tests and management of hearing loss in different age groups, need for hearing aids/cochlear implants, auditory training, and the role of an audiologist in the management of hearing loss and ways to prevent hearing loss. A pre and post awareness program responses were collected from all the participants using a customized questionnaire tool.

RESULTS

Respondents exhibited, in the pre-survey questionnaire, lack of awareness in many aspects of audiology, including assessing hearing impairment, diagnosing hearing loss, and the role of an audiologist. There was an overall, statistically significant difference in the level of performance on the pre-awareness and post-awareness responses.

CONCLUSION

Following an awareness campaign among the medical professionals in Sikkim, there was a considerable change in their level of awareness of hearing impairment, its assessment, and management by audiologists. The reach of the awareness campaign was significant as around 70% of subjects showed significant change in their knowledge and attitude towards hearing impairment, its management.

Baseline metagenome-assembled genome (MAG) data of Sikkim hot springs from Indian Himalayan geothermal belt (IHGB) showcasing its potential CAZymes, and sulfur-nitrogen metabolic activity

Here we present the construction and characterization of metagenome assembled genomes (MAGs) from two hot springs residing in the vicinity of Indian Himalayan Geothermal Belt (IHGB). A total of 78 and 7 taxonomic bins were obtained for Old Yume Samdong (OYS) and New Yume Samdong (NYS) hot springs respectively. After passing all the criteria only 21 and 4 MAGs were further studied based on the successful prediction of their 16 S rRNA. Various databases were used such as GTDB, Kaiju, EzTaxon, BLAST XY Plot and NCBI BLAST to get the taxonomic classification of various 16 S rRNA predicted MAGs. The bacterial genomes found were from both thermophilic and mesophilic bacteria among which Proteobacteria, Chloroflexi, Bacteroidetes and Firmicutes were the abundant phyla. However, in case of OYS, two genomes belonged to archaeal Methanobacterium and Methanocaldococcus. Functional characterization revealed the richness of CAZymes such as Glycosyl Transferase (GT) (56.7%), Glycoside Hydrolase (GH) (37.4%), Carbohydrate Esterase family (CE) (8.2%), and Polysaccharide Lyase (PL) (1.9%). There were negligible antibiotic resistance genes in the MAGs however, a significant heavy metal tolerance gene was found in the MAGs. Thus, it may be assumed that there is no coexistence of antibiotic and heavy metal resistance genes in these hot spring microbiomes. Since the selected hot springs possess good sulfur content thus, we also checked the presence of genes for sulfur and nitrogen metabolism. It was found that MAGs from both the hot springs possess significant number of genes related to sulfur and nitrogen metabolism.

Human papillomavirus (HPV) vaccine introduction in Sikkim state: Best practices from the first statewide multiple-age cohort HPV vaccine introduction in India-2018-2019

BACKGROUND

Cervical cancer is a leading cause of cancer-associated mortality among women in India, with 96,922 new cases and 60,078 deaths each year, almost one-fifth of the global burden. In 2018, Sikkim state in India introduced human papillomavirus (HPV) vaccine for 9-13-year-old girls, primarily through school-based vaccination, targeting approximately 25,000 girls. We documented the program's decision-making and implementation processes.

METHODS

We conducted a post-introduction evaluation in 2019, concurrent with the second dose campaign, by interviewing key stakeholders (state, district, and local level), reviewing planning documents, and observing cold chain sites in two purposefully-sampled community areas in each of the four districts of Sikkim. Using standard questionnaires, we interviewed health and education officials, school personnel, health workers, community leaders, and age-eligible girls on program decision-making, planning, training, vaccine delivery, logistics, and communication.

RESULTS

We conducted 279 interviews and 29 observations in eight community areas across four districts of Sikkim. Based on reported administrative data, Sikkim achieved >95% HPV vaccination coverage among targeted girls for both doses via two campaigns; no severe adverse events were reported. HPV vaccination was well accepted by all stakeholders; minimal refusal was reported. Factors identified for successful vaccine introduction included strong political commitment, statewide mandatory school enrollment, collaboration between health and education departments at all levels, and robust social mobilization strategies.

CONCLUSIONS

Sikkim successfully introduced the HPV vaccine to multiple-age cohorts of girls via school-based vaccination, demonstrating a model that could be replicated in other regions in India or similar low- and middle-income country settings.

Isolation, Characterization, and Evaluation of Native Rhizobacterial Consortia Developed From the Rhizosphere of Rice Grown in Organic State Sikkim, India, and Their Effect on Plant Growth

Eight rhizospheric bacteria were isolated from the organic paddy fields of Sikkim, India, and identified as Pseudomonas kribbensis KSB, Burkholderia cenocepacia SRD, Kosakonia oryzendophytica YMA7, Pseudomonas rhodesiae SRB, Bacillus sp. ARA, Paenibacillus polymyxa COW3, Bacillus aryabhattai PSB2, and Bacillus megaterium PSB1. They showed plant growth-promoting attributes in rice and have bio-control potential against phytopathogen Colletotrichum gloeosporioides of large cardamom (Amomum subulatum). Burkholderia cenocepacia SRD showed production of indole acetic acid and ammonia and solubilization of phosphate and potassium and also possessed nitrogen fixation potential. It showed antagonistic activity against two other plant pathogens of large cardamom, viz., Curvularia eragrostidis and Pestalotiopsis sp., under in vitro conditions. The liquid bacterial consortium was prepared using the bacterial strains SRB, PSB1, and COW3 (Consortia-1); PSB2, SRD, and COW3 (Consortia-2); and COW3, KSB, and YMA7 (Consortia-3) to increase the growth and yield of rice plants under organic farming conditions. Greenhouse and field studies showed that the Consortia-3 had the highest plant growth-promoting activity. Consortia-3 demonstrated better agronomic performance in terms of root length (9.5 cm),number of leaflets per plant (5.3), grains per panicle (110.6), test grain weight (27.4 g), dry root weight per plant (0.73 g), and total dry biomass per plant (8.26 g).

Sleep Quality and Daytime Sleepiness among the Clinicians Working in a Tertiary Care Center in Sikkim, India

BACKGROUND

Doctors in India have increased workload and are at risk for poor sleep and excessive daytime sleepiness which have not been explored much.

METHODS

One hundred doctors selected by convenience sampling from different departments of the hospital were assessed cross-sectionally. Physical parameters which were assessed included height, weight, blood pressure, and diabetes status. Other variables assessed included durations of duty hours and social media usage. Sleep quality and daytime sleepiness were assessed with the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), respectively.

RESULTS

Mean age of the participants was 35.3 years with a SD of 6.21. In all, 42% were female. The overall prevalence of poor quality of sleep was 28.3%. Among the participants, junior and senior residents were the most affected; 45% of the junior residents were having a poor quality of sleep. Daytime sleepiness was significantly more common among the junior residents as compared with doctors of other designations (P =0.02). The mean duration of duty hours was highest for the junior residents. Male participants were more likely to be obese and to have systemic hypertension. No significant difference was found for social media usage among different designations or gender.

CONCLUSION

Poor sleep quality and excessive daytime sleepiness are highly prevalent among the doctors, especially those who are lower in the hierarchy. Interventions for physical and psychological morbidity among the doctors and strict implementation of guidelines governing duty hours and call schedule of junior physicians are recommended.

Rich yet undocumented ethnozoological practices of socio-culturally diverse indigenous communities of Sikkim Himalaya, India

AIM OF THE STUDY

The indigenous people of Sikkim Himalaya possess indispensable traditional knowledge including the use of flora and fauna due to their close association with nature. The present study aims to explore the rich and undocumented ethnozoological practices of different indigenous communities of the Sikkim Himalaya.

MATERIALS AND METHODS

Data was collected using semi-structured questionnaire interviews among the traditional healers and indigenous communities of Sikkim. A total of 91 respondents covering all four districts of Sikkim were interviewed from September 2017-April 2018.

RESULTS

This study recorded a total of 59 species belonging to nine taxonomic groups used for traditional ethnozoological practices by the indigenous communities of Sikkim. Mammals represented 58% of the total animals followed by birds (22%). Among the total, 71% of animal species were used for zootherapy whereas 29% were used for religious customs or shamanistic practices. Almost 64% species were used for treatment of more than one disease and the chief mode of preparation was by boiling the body parts. Among different parts used in traditional medicine, meat was most preferred while horns and hairs were mostly used for religious purposes.

CONCLUSION

Present findings suggest that traditional medicine including zootherapy still serves as a source of primary healthcare in rural areas of Sikkim and provides an identity to the culture of a region. We recommend documentation of more such traditional medicinal systems along with scientific validation of traditional practices with modern tools. Biodiversity Management Committees (BMCs), the legally formed bodies at local level, may be entrusted in documentation of such practices which might contribute significantly in the conservation of traditional practices and also preserves the associated traditional knowledge as per the provision of Biological Diversity Act of India.

Talaromyces marneffei Outside Endemic Areas in India: an Emerging Infection with Atypical Clinical Presentations and Review of Published Reports from India

Talaromycosis is a disseminated disease caused by Talaromyces (Penicillium) marneffei, mainly seen in acquired immunodeficiency syndrome (AIDS) patients. Its distribution is restricted to southeast Asian countries; a small pocket of endemicity exists in the northeast Indian state of Manipur. Here, we present a series of five cases presenting to our tertiary care hospital, originating from non-endemic states neighboring Manipur. In addition to the geographical distinction, a variety of unique features were noted in our cases, including human immunodeficiency virus (HIV)-negative hosts, the absence of typical skin lesions, presentation as pneumonia and generalized lymphadenopathy. Our series highlights the importance of distinguishing this disease from histoplasmosis and tuberculosis, both endemic in India.

Study of sociodemographic correlates, anxiety, and depression among opioid dependents admitted in treatment centres in Sikkim, India

BACKGROUND

People with opioid use disorder have significant anxiety and depression which can be because of neuroplastic changes due to use of opioid or because of use as a self-medication to relieve depression and anxiety. During the last one decade, opioid use has reached an alarming proportion in Sikkim, India; but, any research related to anxiety and depression among opioid users has not been done.

AIMS

To assess for depression and anxiety disorders among the opioid dependence syndrome (ODS) participants and its severity, and to find the association with the sociodemographic characteristics.

METHOD

One hundred participants from three different drug detoxification and rehabilitation centres who were diagnosed with ODS as per the ICD-10, Diagnostic Criteria for Research were assessed cross-sectionally with the Addiction Severity Index to find out the substances abused and psychiatric morbidity. Anxiety, depression, and mania were graded with the Hamilton rating scales for anxiety and depression, and the Young Mania Rating Scale.

RESULTS

Mean age of participants was 29.6 (±6.24) years. Ninety six per cent were males. Most of the participants were using multiple opioid preparations. Thirty four per cent were using dextropropoxyphene containing pain killer followed by six per cent using codeine containing cough syrup. Eighty two per cent had depression; however, only 13% were found to have severe depression. Fifty six per cent had anxiety and six per cent were found to have mania. Most of the participants with ODS were single, attended at least secondary education, from urban locality, and were from high socioeconomic status.

CONCLUSION

anxiety and depression are highly prevalent among ODS people. Treatment should not be limited to management of ODS but also the comorbid psychiatric illness.

Analyzing Social Networks to Examine the Changing Governance Structure of Springsheds: A Case Study of Sikkim in the Indian Himalayas

The governance of natural resources now attracts greater participation of different stakeholders, ushering in a shift from conventional governance by the state to that by a network of stakeholders-a form of governance marked by a growing role of non-state and local actors. These changing dynamics are highlighted through a study of the governance network for springsheds in the Indian Himalayas by empirically mapping the changes in the Dhara Vikas Yojna, a plan or scheme (yojana) by the state for the development (vikas) of springs (dhara) in Sikkim, India, from policy planning to policy implementation. The study highlights the diverse existing and emerging roles of different stakeholders, the complex relationships between them, and the power dynamics that influence the management of springsheds. The study (1) identified some new but missing actors/actor groups that were critical to managing springs; (2) showed that although state governments continue to play a dominant role, decision making is shifting to non-state and local actors; and (3) highlighted the importance of exchanging knowledge and information in implementing a policy more effectively. Understanding the characteristics of the governance network helped in drawing lessons to make the plan more sustainable and replicable, which include considering the policy in the wider context of policies for other sectors such as sanitation and hydropower development, incentivising the emerging actors, and building a stronger interdisciplinary and inclusive knowledge network. Such an integrated approach to policymaking can also be adopted to analyze governance networks related to natural resources other than water.

Gliophorusglutinosus sp. nov. (Hygrophoraceae, Agaricales) from Eastern Himalayan region of India

An interesting species of the genus Gliophorus (sect.Glutinosae), collected from Sikkim Himalaya in India, is described here as G.glutinosus sp. nov. after thorough morphological examination and phylogenetic analysis. The species is mainly characterised by its strongly glutinous basidiomata throughout, particularly on the twisted stipe, decurrent lamellae with glutinous edge, gelatinised cheilocystidia, presence of pleuropseudocystidia and absence of clamps in hyphae of the pileipellis. This communication includes detailed morphological description, illustrations, comparison with the allied taxa, nrITS based phylogeny of this novel taxon and a key to the species under Gliophorussect.Glutinosae.

Non-response to first-line anti-tuberculosis treatment in Sikkim, India: a risk-factor analysis study

Setting: Sikkim, India, has the highest proportion of tuberculosis (TB) patients on first-line anti-tuberculosis regimens with the outcome 'failure' or 'shifted to regimen for multidrug-resistant TB (MDR-TB)'. Objective: To assess the factors associated with non-response to treatment, i.e., 'failure' or 'shifted to MDR-TB regimen'. Methods: We conducted a retrospective cohort study using Revised National Tuberculosis Control Programme data of all TB patients registered in 2015 for first-line TB treatment. In addition, we interviewed 42 patients who had not responded to treatment to ascertain their current status. Results: Of 1508 patients enrolled for treatment, about 9% were classified as non-response to treatment. Patient factors associated with non-response were urban setting (adjusted odds ratio [aOR] 2.39, 95%CI 1.22-4.67), ethnicity (being an Indian tribal, aOR 1.73, 95%CI 1.17-2.57, Indian [other] aOR 1.83, 95%CI 1.29-2.60 compared to patients of Nepali origin) and those on retreatment (aOR 2.40, 95%CI 1.99-2.91). Of the patients interviewed, 28 (67%) had received treatment for drug-resistant TB. Conclusion: In Sikkim, one in 11 patients had not responded to first-line anti-tuberculosis treatment. Host-pathogen genetics and socio-behavioural studies may be required to understand the reasons for the differences in non-response, particularly among ethnic groups.

Geobacillus yumthangensis sp. nov., a thermophilic bacterium isolated from a north-east Indian hot spring

A thermophilic, spore-forming, rod-shaped bacterium isolated from the Yumthang hot spring in North Sikkim, India was subjected to taxonomic studies. The thermophilic bacterial isolate was designated as strain AYN2^T. Cells were Gram-stain-positive, aerobic, motile, rod-shaped, catalase-positive and methyl red-negative. Strain AYN2^T was able to grow in the pH range from 6 to 10 (optimum, pH 7.5-8.0), at 40-70 °C (60 °C) and in NaCl concentrations of 0-4 % (1 %). The major cellular fatty acids were iso-C15 : 0 (12.8 %), iso-C16 : 0 (13.9 %) and iso-C17 : 0 (13.8 %). No matches were found in the rtsba6 Sherlock libraries. The G+C content of the genomic DNA was 42.11 mol%. Based on phylogenetic analysis of the 16S rRNA gene sequences, strain AYN^T showed highest sequence similarity to the type strain of Geobacillus toebii (96 %). However, the phenotypic properties of strain AYN2^T were clearly distinct from those of G. toebii and related species. On the basis of polyphasic analysis, strain AYN2^T represents a novel species in the genus Geobacillus, for which the name Geobacillus yumthangensis sp. nov. is proposed. The type strain is AYN2^T(MTCC=12749=KCTC=33950= JCM 32596).

Two new species and one new record of the genus Tylopilus (Boletaceae) from Indian Himalaya with morphological details and phylogenetic estimations

Tylopilus himalayanus and T. pseudoballoui are described as new species from two Himalayan states (Sikkim and Uttarakhand) in India. Tylopilus himalayanus is characterised by a unique combination of features: reddish- or brownish-grey to purplish-grey then brown to reddish-brown or darker pileus, absence of olive or violet tinges on stipe surface, angular pores, stipe without reticulum or rarely with a faint reticulum restricted to the very apex, bitter taste of the context and positive macrochemical colour reaction of the stipe context with KOH (dark orange) and FeSO₄ (dark green), medium sized (10.9-14.4 × 3.9-4.9 µm) basidiospores and occurrence under coniferous trees; T. pseudoballoui is distinguished by orange-yellow to brown-yellow sticky pileus, pale yellow pore surface with pinkish hues that turns pale to greyish-orange on bruising; angular pores, stipe concolorous to pileus with pruinose but never reticulate surface, ixocutis pattern of pileipellis and occurrence under broadleaf trees. Another species, T. neofelleus, which was reported earlier from China and Japan, was also collected from Sikkim and reported for the first time from India. All three species are described with morphological details and two-locus based (nrLSU and nrITS) phylogenetic data.

Altitudinal variation and bio-climatic variables influencing the potential distribution of Culicoides orientalis Macfie, 1932, suspected vector of Bluetongue virus across the North Eastern Himalayan belt of Sikkim

Culicoides orientalis was first recorded from Sikkim, in the year 1963, but no evidence based disease outbreak were available. In the last 50 years, 260 Bluetongue disease outbreaks caused by Culicoides species have been evidenced from India. Moreover, in recent years with increase of average temperature worldwide and increase in longevity of arthropod vectors like Culicoides along with a geographical range shift to new suitable warmer regions has increased the potentiality of vector borne disease outbreak throughout the world. The Himalayan range of Sikkim in India is a biodiversity hotspot and is extremely sensitive to such global climate changes. An attempt has been made to evaluate the altitude, climate and environmental data on selected study sites of Sikkim for a period of two years (2014-2015) for discerning potential distribution of C.orientalis in this region. The altitude, temperature, precipitation and potential distribution range maps of C. orientalis showed the areas of highest species abundance within the altitudinal range of 550-1830m, with some species extending its range up to 3750m, with average precipitation of 2010-2590mm and mean temperature of 11-18°C. The Maximum Entropy Modelling (MaxEnt) and the Jackknife test of the MaxEnt model further revealed that the major contributing factors governing C. orientalis distribution are annual precipitation (78.8%), followed by precipitation of driest quarter (8.3%) and mean temperature of the warmest quarter (3.3%). Accuracy of the study was evaluated by the area under the curve (AUC=0.860). The Biplot on F₁-F₂ axes (N=16, α=0.05) in the PCA showed the linear depiction of all the variables considered in our study, major contributors were annual precipitation, precipitation of driest quarter and mean temperature of warmest quarter being the primary factors governing species distribution, as analogous to results of the MaxEnt model. This study would help in developing strategies for monitoring and managing surveillance programmes to control the chances of disease spread to livestock animals and also validate the predictions on the eventual spread of the vector midges to higher altitudes of Sikkim.

Integrating ethnobiological knowledge into biodiversity conservation in the Eastern Himalayas

Biocultural knowledge provides valuable insight into ecological processes, and can guide conservation practitioners in local contexts. In many regions, however, such knowledge is underutilized due to its often-fragmented record in disparate sources. In this article, we review and apply ethnobiological knowledge to biodiversity conservation in the Eastern Himalayas. Using Sikkim, India as a case study, we: (i) traced the history and trends of ethnobiological documentation; (ii) identified priority species and habitat types; and, (iii) analyzed within and among community differences pertaining to species use and management. Our results revealed that Sikkim is a biocultural hotspot, where six ethnic communities and 1128 species engage in biocultural relationships. Since the mid-1800s, the number of ethnobiological publications from Sikkim has exponentially increased; however, our results also indicate that much of this knowledge is both unwritten and partitioned within an aging, gendered, and caste or ethnic group-specific stratum of society. Reviewed species were primarily wild or wild cultivated, native to subtropical and temperate forests, and pend IUCN Red List of Threatened Species assessment. Our results demonstrate the value of engaging local knowledge holders as active participants in conservation, and suggest the need for further ethnobiological research in the Eastern Himalayas. Our interdisciplinary approach, which included rank indices and geospatial modelling, can help integrate diverse datasets into evidence-based policy.

"Metabolic Syndrome and Its Risk Determinants in Sikkim": A Glimpse from a Hospital Study

Sikkim has been reported to have the highest percentage of Diabetes Mellitus and Hypertension in the country. The study aimed to focus its precursor termed 'Metabolic Syndrome' (MetS) with special attention to its risk determinants as a measure to promote awareness in preventing the rise in number of these non communicable diseases in the state with only 6,10,577 inhabitants. Of 361 participants, 33.5% were diagnosed MetS as per the harmonized MetS criteria, 64.5% deemed non-MetS comprised of participants with "2 Risk", "1 Risk" and "0 Risk" for MetS, however not enough (3 or more) to be categorized as MetS. A "large WC + elevated BP + raised FBS"; "large WC + elevated BP" and "large WC" were the different types of risk combinations found frequently in the "3 Risk", "2 Risk" and "1 Risk" category respectively. MetS was most common among the females and highly found in 51-60 years of age. Ethnically "Bhutia/Lepcha/Tamang/Sherpa" were diagnosed with highest percentage of MetS followed by "Nepalese" and "Others". The chief contributing factor to compose MetS in the female population was a large WC. We conclude, Diabetes and Hypertension are indeed prevailing in Sikkim and that the presence of either an increased waist circumference or an elevated blood pressure mandates a check for the remaining four risk factors for MetS, rendering worthwhile to keep an account of MetS risk types by stratification to comprehend the influence of socio-cultural and ethno-geographical factors in causing MetS.

A 10-year retrospective study of suicide in Sikkim, India: Sociodemographic profile and risk assessment

OBJECTIVE

The present study had been undertaken to investigate the sociodemographic profile of individuals who had committed suicide in Sikkim which may throw light on the vulnerable groups.

MATERIALS AND METHODS

Ten-year suicide data (2006-2015) obtained from Police Headquarters, Crime Branch, Gangtok, have been statistically evaluated to study the sociodemographic profile.

RESULTS

The results showed that out of 1604 suicide cases recorded for the past 10 years, 1051 were males (65.5%) and 553 (34.5%) were females. Suicide was found to be common among the age group of 21-30 years (24.4%), Rai community (15.8%), population of rural areas (82.6%), and among the population of eastern districts (50.6%). Hanging (94.8%) was found to be the most common method adopted for suicide.

CONCLUSION

The study provides preliminary information about the vulnerable groups for suicide in the state which may be vital for taking necessary steps for its prevention shortly.

Genetics, morphology and ecology reveal a cryptic pika lineage in the Sikkim Himalaya

Asian pika species are morphologically ∼similar and have overlapping ranges. This leads to uncertainty and species misidentification in the field. Phylogenetic analyses of such misidentified samples leads to taxonomic ambiguity. The ecology of many pika species remains understudied, particularly in the Himalaya, where sympatric species could be separated by elevation and/or substrate. We sampled, measured, and acquired genetic data from pikas in the Sikkim Himalaya. Our analyses revealed a cryptic lineage, Ochotona sikimaria, previously reported as a subspecies of O. thibetana. The results support the elevation of this lineage to the species level, as it is genetically divergent from O. thibetana, as well as sister species, O. cansus (endemic to central China) and O. curzoniae (endemic to the Tibetan plateau). The Sikkim lineage diverged from its sister species' about 1.7-0.8myrago, coincident with uplift events in the Himalaya. Our results add to the recent spate of cryptic diversity identified from the eastern Himalaya and highlight the need for further study within the Ochotonidae.

Himalayan Aromatic Medicinal Plants: A Review of their Ethnopharmacology, Volatile Phytochemistry, and Biological Activities

Aromatic plants have played key roles in the lives of tribal peoples living in the Himalaya by providing products for both food and medicine. This review presents a summary of aromatic medicinal plants from the Indian Himalaya, Nepal, and Bhutan, focusing on plant species for which volatile compositions have been described. The review summarizes 116 aromatic plant species distributed over 26 families.

Weight concerns and food habits of adolescent girls in two contrasting ecological regions: A comparative study in India

OBJECTIVE

To compare the incidence of weight concerns and food habits between two ethnically different groups of adolescent girls residing in two distinct ecological settings: the plains of Kolkata and the mountains of Sikkim.

METHODS

Two separate cross-sectional studies were conducted within a period of five years in urban hilly areas of Sikkim and the city of Kolkata, India. A total of 506 girls aged 14-19 years were selected from the study areas of Sikkim (n=224) and Kolkata (n=282). Girls were interviewed for weight concerns and food habits along with socio-demographic characteristics. Weight concerns were assessed with four variables such as, perceptions about own body weight, felt dissatisfied with own body weight, urge for dieting and use of weight reduction diet. Food habits included consumption of major foods during the past one week.

RESULTS

Bivariate analyses showed that Kolkata girls perceived themselves as overweight, remained dissatisfied with body weight, expressed perceived need for dieting and followed weight reduction diet more compared to the girls of Sikkim. Food habits indicated that all Sikkimese girls preferred to consume cereals regularly, while Kolkata girls consumed vegetables, pulses, fish, fruits, bread and butter and fried foods more than Sikkimese girls. Multivariate analyses showed that place of residence was significantly (p<0.05) associated with both weight concerns and food habits of girls.

CONCLUSION

Diversity in culture, ethnicity and socio-economic standard perhaps develop the disparity in food habits and weight concerns between girls of urban hilly areas of Sikkim and the city of Kolkata.

Descriptive epidemiology and high risk behavior of male prescription opioid abusers: Cross-sectional study from Sikkim, North East India

BACKGROUND

Sikkim is emerging as an important area for prescription opioid abuse with frequent news of seizures and arrests due to possession of prescription opioids. However, till date there is a little information on descriptive epidemiology and high risk behavior of prescription opioid abusers from Sikkim.

AIMS

The aim was to describe demographic (age, sex, religion, marital status, community, occupation, etc.); socioeconomic (income, education, family information etc.); and high risk behavior (e.g., injection sharing, visit to commercial sex workers [CSWs], homosexuality etc.) among treatment-seeking prescription opioid abusers in Sikkim.

MATERIALS AND METHODS

Epidemiological data were collected by administering predevised questionnaires from n = 223 prescription opioid abusers (main problem prescription opioids) reporting for treatment at five different drug abuse treatment centers across Sikkim.

RESULTS

The mean age of prescription opioid abusers in Sikkim was 27 years; all were male, of Nepalese ethnicity and single/never married, school dropout and/or illiterate, earning < Rs. 10,000/month with most spending almost Rs. 5000 a month on prescription opioids. Most (57.4%) prescription opioid abusers belonged to the urban community. Commonly abused prescription opioids were dextropropoxyphene and codeine. Injection sharing was more in urban areas whereas syringe exchange was observed equally among rural and urban prescription opioid abusers. Among urban injectors visits to CSWs, and multiple sex partners were also common in spite of knowledge about AIDS. Limited condom use was observed among rural respondents. Incidences of arrests, public intoxication, and violence under the influence of prescription opioids were also reported.

CONCLUSION

Both the rural and urban areas of Sikkim show increasing rates of prescription opioid abuse among males. It is more prevalent among school dropouts and unemployed youth. Trends of injection drug use, unsafe injection, high risk behavior have also been observed.

Socioeconomic characteristics of alcohol and other substance users, seeking treatment in Sikkim, North East India

Objectives:

The present study was conducted to generate information for better understanding of socioeconomic and CAGE characteristics of alcohol and other substance users who were undergoing treatment in Sikkim.

Subjects and Methods:

Socioeconomic and CAGE questionnaire was administered to alcohol and other substance abusers of Sikkim (n = 241) who were undergoing treatment in different treatment centers of Sikkim. Information was collected on printed instrument after taking participant's consent and data was statistically analyzed.

Results:

Male participants (93.8%) outnumbered female (6.2%). Majority of the sample were either in the school dropout group or school completed (36.1%) group. Most of the samples were occupationally unemployed, urban residents, Nepali by ethnicity, single, and Hindu (48.5%) by religion. Minimum age for starting of alcohol and drug was 5 years and 7 years respectively. Knowledge about AIDS and its transmission was satisfactory. All the four CAGE characteristics were present in majority of samples.

Conclusions:

Climate, geographical location, wide and easy availability of alcohol in Sikkim make this state vulnerable for alcohol abuse. Alcohol drinking among parents, sibling and friends found to be important risk factor. Outreach to the community for better acceptability of treatment is an important area to fill the gap of treatment demand and treatment supply.

Further karyosystematic studies of the Boreonectesgriseostriatus (De Geer) group of sibling species (Coleoptera, Dytiscidae)-characterisation of B.emmerichi (Falkenström, 1936) and additional European data

A lectotype is designated for the Tibetan species Deronectesemmerichi Falkenström, 1936 (Currently Boreonectesemmerichi (Falkenström)), and its habitus, as well as the median lobe and parameres of its aedeagus, are figured along with additional comparative material. Material of Boreonectesemmerichi from Sikkim (BMNH) represents the first record of a Boreonectes Angus, 2010 species from India. The karyotype of Boreonectesemmerichi is described as having 26 pairs of autosomes plus sex chromosomes which are X0 (♂), XX (♀). The karyotype is most like that of Boreonectesmacedonicus (Géuorguiev, 1959), but with slight differences. Additional chromosomal information is given for Boreonectesgriseostriatusgriseostriatus (De Geer, 1774) in the French Alps, Boreonectesgriseostriatusstrandi (Brinck, 1943) on the Kola Peninsula, Boreonectesmultilineatus (Falkenström, 1922) in the Pyrenees and Boreonectesibericus (Dutton & Angus, 2007) in the Spanish Picos de Europa.

Further karyosystematic studies of the Boreonectesgriseostriatus (De Geer) group of sibling species (Coleoptera, Dytiscidae)-characterisation of B.emmerichi (Falkenström, 1936) and additional European data

A lectotype is designated for the Tibetan species Deronectesemmerichi Falkenström, 1936 (Currently Boreonectesemmerichi (Falkenström)), and its habitus, as well as the median lobe and parameres of its aedeagus, are figured along with additional comparative material. Material of Boreonectesemmerichi from Sikkim (BMNH) represents the first record of a Boreonectes Angus, 2010 species from India. The karyotype of Boreonectesemmerichi is described as having 26 pairs of autosomes plus sex chromosomes which are X0 (♂), XX (♀). The karyotype is most like that of Boreonectesmacedonicus (Géuorguiev, 1959), but with slight differences. Additional chromosomal information is given for Boreonectesgriseostriatusgriseostriatus (De Geer, 1774) in the French Alps, Boreonectesgriseostriatusstrandi (Brinck, 1943) on the Kola Peninsula, Boreonectesmultilineatus (Falkenström, 1922) in the Pyrenees and Boreonectesibericus (Dutton & Angus, 2007) in the Spanish Picos de Europa.

Two new species of hydnoid-fungi from India

Two taxa, Hericium yumthangense (Russulales, Agaricomycotina) and Mycoleptodonoides sharmae (Polyporales, Agaricomycotina) are described as new to science from the Shingba Rhododendron sanctuary located in the northern district of Sikkim, India. Macro- and micromorphological characters are described and illustrated for both species, which are compared with allied taxa. ITS rDNA sequences supported H. yumthangense as a rather isolated species within Hericium, the species complexes of which were not resolved due to low interspecific sequence divergence. In the case of M. sharmae, 28S rDNA (D1/D2) data rendered this poorly known genus among well-known taxa of the core-polyporoid clade.

Cryptococcus gatti serotype B isolated in Sikkim (North-East India)-A new geographical niche

Cryptococcus neoformans and Cryptococcus gatti both cause infection in immunocompromised patients. We report a case of meningitis with C. gatti in an AIDS patient. This case to our knowledge is the first case of C. gatti being reported from Sikkim (North East India).

Literature based species occurrence data of birds of northeast India

The northeast region of India is one of the world's most significant biodiversity hotspots. One of the richest bird areas in India, it is an important route for migratory birds and home to many endemic bird species. This paper describes a literature-based dataset of species occurrences of birds of northeast India. The occurrence records documented in the dataset are distributed across eleven states of India, viz.: Arunachal Pradesh, Assam, Bihar, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura, Uttar Pradesh and West Bengal. The geospatial scope of the dataset represents 24 to 29 degree North latitude and 78 to 94 degree East longitude, and it comprises over 2400 occurrence records. These records have been collated from scholarly literature published between1915 and 2008, especially from the Journal of the Bombay Natural History Society (JBNHS). The temporal scale of the dataset represents bird observations recorded between 1909 and 2007. The dataset has been developed by employing MS Excel. The key elements in the database are scientific name, taxonomic classification, temporal and geospatial details including geo-coordinate precision, data collector, basis of record and primary source of the data record. The temporal and geospatial quality of more than 50% of the data records has been enhanced retrospectively. Where possible, data records are annotated with geospatial coordinate precision to the nearest minute. This dataset is being constantly updated with the addition of new data records, and quality enhancement of documented occurrences. The dataset can be used in species distribution and niche modeling studies. It is planned to expand the scope of the dataset to collate bird species occurrences across the Indian peninsula.

Methicillin-resistant Staphylococcus aureus: prevalence and current susceptibility pattern in sikkim

Background:

Prevalence of methicillin-resistant Staphylococcus Aureus (MRSA) strains is reported to be increasing globally.

Objectives:

The study was conducted to find the magnitude and antibiotic susceptibility pattern of MRSA infection in a referral tertiary care teaching hospital of Sikkim, India.

Materials and Methods:

In this cross sectional study, 827 clinical specimens were collected from different departments of Central Referral Hospital. One hundred and ninety-six carrier screening nasal swabs were obtained from health care workers of the hospital. Subsequently, the antimicrobial susceptibility test was performed for the confirmed MRSA isolates as per Clinical and Laboratory Standards Institute (CLSI).

Results:

Methicillin resistance was seen in 152 isolates of S. aureus – 111 from clinical specimens and 41 from carrier screening samples. MRSA positivity among males was significantly higher than females. Extremely significant MRSA-positive cases were observed from ages less than 30 years, in-patient cases, particularly with a stay of more than 15 days and with a previous history of intake of broad spectrum antibiotics. Incidentally, there was no significant difference of MRSA positivity with a previous history of hospitalization. The extent of MRSA and drug resistance pattern was significantly different among various samples of S. aureus-positive isolates. The strains tested exhibited decreased susceptibility to vancomycin and imipenem. Most vulnerable of the carrier were the cleaners, that was a significant observation. Incidentally, there was no resistance in the carriers to both vancomycin and imipenem.

Conclusion:

MRSA is prevalent in our hospital and strains resistant to methicillin and vancomycin were quite high.

A profile of substance abusers using the emergency services in a tertiary care hospital in Sikkim

BACKGROUND

Sikkim, a state in Northeast India with a population of more than 500,000 and inhabited by indigenous population of Lepchas, Bhutias and Nepalis, lies in the foothills of the Himalayas sharing borders with Tibet, Nepal and Bhutan. Northeast India is a major source of injection drug users (IDUs) and associated HIV/AIDS. Alcohol use is traditionally prevalent in Sikkim and recently, IDU behaviour has also been reported, although systematic information on epidemiology and treatment availability of substance abuse in Sikkim is not available.

AIM

To study the sociodemographic and drug use profile of substance abusers using the emergency services in a tertiary care hospital.

METHODS

A retrospective chart review was used. Patients with history of current drug use seeking emergency services for any medical or surgical consequence incident to substance abuse from July 2000 to June 2005 (60 months) were included in the study. Data were generated from emergency case register, hospital records and case sheets. SPSS 10.0 was used for data analysis.

RESULTS

Out of 54 patients seeking emergency services with substance abuse (1.16% of all psychiatric consultations), alcohol abusers were 77.8% and other opioid abusers 14.8%. Prevalence of IDU was 16.66%. Common opioids abused were dextrpropoxyphene and pentazocine, both analgesics. A significant number of patients (46.3%) had a history of >20 days/month frequency of abuse. Median of duration of abuse with all drugs was 12 years, while that with IDU population was 3 years. Alcohol withdrawal was the commonest cause (57.4%) of reporting to the emergency. Psychiatric comorbidity was found among 7.4%. Commonest medications used were chlordiazepoxide and clonidine, for withdrawal and naltrexone, for substitution. No standardized treatment protocol for substitution treatment was available.

CONCLUSIONS

This is an initial attempt to study the sociodemographic and drug use profile of substance abusers in Sikkim. Demographic and socioeconomic characteristics of substance abusers seeking emergency services are not significantly different from treatment-seeking substance abusers in other parts of India. IDU behaviour has been detected and low median duration of use suggests an emerging problem and need for urgent harm reduction. Alcohol withdrawal was the commonest cause of seeking emergency services, which is related to high prevalence of alcohol abuse in Sikkim. No standardized substitution treatment is available for substance abusers, which may lead to higher rates of relapse.