Anxiety and depression among medical undergraduate students and their sociodemographic correlates in Sikkim: A cross-sectional study

Background: Psychological morbidity in medical undergraduate students has always been reported from various countries across the globe. Studies which document this burden among medical students in India are very few. Aims and Objectives: The presence of depression and anxiety among medical undergraduate students was assessed using a previously validated and standardized instrument, hospital anxiety and depression scale (HADS) and the associations with their sociodemographic and comorbidities were identified. Materials and Methods: In a cross-sectional survey, a self-administered, pre-designed, pre-tested HADS was used to collect information on basic sociodemographic (age, gender, semester, and socioeconomic status) and comorbidities through a Google Forms. Informed written consent was obtained from all participants. Scores for each of the respondents over each of the subscales (depression and anxiety) were calculated as per the severity rating index. Results: The study showed that majority (77.4%) of the students did not feel that they were depressed which was found to be similar in both male and female students. However, about 50% of both male and female students were found to be suffering from either mild or moderate anxiety. The present study showed that there was no significant association between HADS score and socioeconomic and sociodemographic characteristics among medical undergraduate students. Conclusion: A substantial proportion of medical undergraduate students was found to be anxious and quite a lot of them were found to be suffering from mild to moderate depression, revealing a neglected area of the students’ psychology requiring urgent attention. Student counseling services need to be made available and accessible to curb this morbidity.

Curvularia eragrostidis, a new threat to large cardamom (Amomum subulatum Roxb.) causing leaf blight in Sikkim

Large cardamom (Amomum subulatum Roxb.) is now affected by several diseases caused by both viruses andfungi. At present, leaf blight is considered a major threat to cardamom cultivation in Sikkim. During the pasttwo decades, cultivation of the crop in this region has dropped by almost 60%. Hence, to quantify the severityof leaf blight damage and identification of the causal organism for the disease, a survey was conducted fromMay to August 2017 in different large cardamom growing regions of Sikkim. During this survey, a typicalsymptom of leaf blight was observed on cardamom leaves in many locations. The leaves with blights werecollected, surface sterilized, and inoculated on potato dextrose agar (PDA). The pathogen was isolated as pureculture, and on the basis of morphological and microscopic characteristics, the fungus was identified species ofCurvularia. Molecular characterization of the fungal isolate with ITS-rDNA partial gene amplification usinguniversal primers (ITS4 and ITS5), showed 100% similarity with Curvularia eragrostidis (family: Pleosporaceae). The fungal isolate and nucleotide sequence was deposited in National Fungal Culture Collection ofIndia (NFCCI), Pune and NCBI with accession numbers NFCCI 4541 and MN710527, respectively. This is thefirst report on the occurrence of C. eragrostidis pathogen causing leaf blight of large cardamom grown inSikkim.

Hailey Hailey Disease: Case Report of a rare disease

Hailey–Hailey disease also known as Familial benign chronic pemphigus is a relatively uncommon disease characterized by painful erosions, vesicles, pustules and scaly erythematous plaques on the neck, axillae, groins and perineum. A case of 27 years old male with history of recurrent, itchy, erythematous, papules and vesicles over the groins presented to the dermatology OPD. A clinical diagnosis of Hailey – Hailey disease was made which was confirmed later by histopathological examination. He was treated with tacrolimus ointment and showed a remarkable improvement.

Pattern of Dermatoses in a tertiary care hospital in East Sikkim

The authors had attempted to understand the pattern of Dermatosis coming to the skin OPD of Central referral Hospital, SMIMS, Gangtok. Out of 8630 Patients included in our study, 51.8% were female patients with female male ratio of 1.07:1. Majority of the patients (29.24%) was from the age group 21-30 years followed by age group of 31-40 years (18.96%). Eczema and allergic disorder constituted the maximum number of the cases (21.14%), followed by Fungal Infections (16.5%). The skin infections of viral and bacterial aetiology constituted 11.76% and 4.45% respectively. The pigmentary disorders comprised of 8.7%. Other pattern of skin diseases in a decreasing order as observed were Acne (6.62%), Alopecia (5.9%), Parasitic infestations (5.09%) Photodermatoses (4.6%), papulosquamous disorder (4.27%), vesiculobullous disorders (0.6%), Autoimmune diseases (0.35%) and malignancy (0.04%).

Phenotyping of Salmonella serotypes isolated from natural sources of water in rural areas of East Sikkim.

The objective of the study was to conduct bacteriological analysis of water with special reference to Salmonella spp from natural sources of rural habitations of East Sikkim. A total of 28 Salmonella serovars isolated were biotyped, phage typed and tested for their anti-microbial susceptibility. All the isolates of Salmonella enterica serovar Typhi belonged to Biotype I. Four isolates of S. typhi belonged to phage type A. All S. paratyphi A isolates belong to phage 2. All the isolates were sensitive to chloramphenicol, cefi xime and amikacin. Untreated natural water sources are unsafe for human consumption.

Current analgesic use predicts low emotional quality of life in youth: A cross-sectional survey among university students in Sikkim, North East India.

Background & objectives: Occurrence of chronic physical pain is increasingly identified among youth, and medically unsupervised analgesic use is a possible risk factor for opioid dependence and other mental diseases in later life. Therefore, the present study was carried out in young student population in Sikkim, India, to explore predictors (including current chronic pain and current analgesic use) of low QoL in youth to identify a subset of population vulnerable to substance use and mental diseases in later life. Methods: The study was conducted in a health university setting in Sikkim, North East India. In this cross-sectional study, 156 participants were enrolled with almost equal number of males and females. Generic instruments for demographics and current analgesic use and SF - 36, for assessment of quality of life (QoL), were used. QoL was measured in general, physical and emotional domains. Presence of chronic physical pain during past four weeks was captured using SF - 36. Results: Almost two-third participants reported presence of current physical pain (69%, n=108); and (14%, n=22) reported current analgesic use for pain. In logistic regression model controlled for age, ethnicity, gender and residence, higher body mass index (BMI) (β=-0.16, P=0.02) and current analgesic use (β=1.6, P=0.006) predicted low QoL in emotional domain (less accomplishment due to emotional problem). Current analgesic use also predicted low QoL in another measure of emotional domain (depressed β=2.0, P=0.001). Interpretation & conclusions: This study identified a subset of participants in their youth with low QoL in emotional domain predicted by current analgesic use and possible overweight problem. Low QoL in more than one emotional domain also identifies possibility of later psychiatric impairment. However, chronic pain did not emerge as a significant predictor of low QoL in emotional domain.

Outbreak of scrub typhus in the North East Himalayan region-Sikkim: An emerging threat.

Scrub typhus is an acute febrile illness that is known to be endemic in the South East Asian countries and the Western Pacific region. We here report an outbreak in the tiny Himalayan state of Sikkim. Patients with pyrexia of unknown origin were evaluated. They were screened by Weil-Felix test and the rapid immunochromatographic method. Samples that were positive by either Weil-Felix agglutination test or by rapid immunochromatography were confirmed by IgM enzyme-linked immunosorbent assay (ELISA). A total 204 samples were screened. Sixty-three patients were confirmed positive among which 42 were male and 21 were female. Effective management and early administration of antibiotics will help prevent the complications and mortality associated with scrub typhus.

Economic evaluation of iodine deficiency disorder control program in Sikkim: A cost-benefit analysis.

Background: Iodine deficiency disorders (IDDs) are the most common cause of preventable brain damage globally. The strategy of prevention and control of iodine deficiency is based on iodine supplementation. Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. The objective of the study was to conduct a cost-benefit analysis of the two programs of iodine supplementation, i.e., iodized salt program (ISP) and iodized oil program (IOP) against no preventive program (NPP) option. Materials and Methods: The study was conducted in 1990 in the state of Sikkim in India. The costs were calculated on the assumption of universal coverage of ISP and coverage of IOP among all children aged 0-14 years and women in the age group of 15-44 years. Direct and indirect cost of ISP and direct cost of IOP was computed based on the costs of year 1991. The discount rate taken was 10% and all the costs were converted to the year 2010 using wholesale price index (WPI) data. Consequences in terms of health effects, Social/emotional effects, and resource use were included. Results: The discounted cost of ISP and IOP was Rs. 59,225,964 and Rs. 46,145,491, respectively. In ISP, 64.1% of the total cost was required for salt iodization, 17.6% for monitoring, and 18.3% for communication. In IOP, 50.9% of the costs were required for iodized oil; rest was for syringes and needles, manpower expenses, travel, and communication. Total resource saving was Rs. 95,566,220 for ISP and Rs. 92,177,548 for IOP. Incremental benefit for ISP was Rs. 36,340,256 and Rs. 46,032,057 for IOP. The cost-benefit ratio for ISP was 1.61 and 2.00 for IOP. Conclusion: IOP has a higher cost-benefit ratio for prevention of IDDs than ISP in the state of Sikkim, India.

Pediatric Scrub Typhus in South Sikkim.

We present five cases of paediatric Scrub typhus from Community Health Centre, Namchi, South Sikkim emphasize timely diagnosis of scrub typhus for appropriate management. Response to doxycycline was good, with fever subsiding within 48-72 hrs of starting the treatment. Four out of five cases completely recovered once appropriate medication was given.

Novel Biochemical Abnormalities and Genotype in Farber Disease.

We present five cases of paediatric Scrub typhus from Community Health Centre, Namchi, South Sikkim emphasize timely diagnosis of scrub typhus for appropriate management. Response to doxycycline was good, with fever subsiding within 48-72 hrs of starting the treatment. Four out of five cases completely recovered once appropriate medication was given.

Economic evaluation of iodine deficiency disorder control program in Sikkim: A cost effectiveness study.

Background: Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. In year 1989, the state government of Sikkim was planning to implement Iodine Deficiency Disorder control program in state and had following two options to choose from, based on existing knowledge; a) a salt iodization program, b) an iodized oil injection program. No information was available at that point of time on comparative advantages of the above stated two approaches. Objectives: To identify the most cost-effective alternative for IDD elimination in Sikkim, amongst the following 3 alternatives: a) Iodized salt program (ISP), b) Iodized oil injection program (IOP) to high risk group, c) no preventive program. Materials and Methods: Study population was the general population of state of Sikkim, India in year 1990. Cost- effective analysis was undertaken comparing 3 alternative programs, targeted towards IDD elimination in state of Sikkim. Identification, measurement and valuation of the costs of ISP and IOP and identification and measurement of the consequences of IDD were done to carry out the cost-effective analysis. Visible goiter person years (VGPY), endemic cretinism, IDD attributable death were used to assess the health consequences/disease burden of IDD. Results: The cost per VGPY, endemic cretinism and IDD attributable death were Rs 76.67, Rs 24,469 and Rs 9,720, respectively for ISP. The cost per VGPY, endemic cretinism and IDD attributable death were Rs 75.82, Rs 19,106 and Rs 7,709, respectively for IOP. Conclusion: The results of the analysis showed that iodized oil program is more cost-effective for prevention of irreversible IDDs than the iodated salt program in state of Sikkim, India.

Traditional uses and medicinal potential of Cordyceps sinensis of Sikkim.

Cordyceps sinensis has been described as a medicine in old Chinese medical books and Tibetan medicine. It is a rare combination of a caterpillar and a fungus and found at altitudes above 4500m in Sikkim. Traditional healers and local people of North Sikkim recommend the mushroom, i.e., Yarsa gumba, Keera jhar (C. sinensis) for all diseases either as a single drug or combined with other herbs. The present study was undertaken to collect information regarding the traditional uses of cordyceps in Sikkim. It was found that most local folk healers/traditional healers use cordyceps for the treatment of 21 ailments. A modern literature search was carried out to assess whether the curative effects are valid or just blind faith of local people. Chemical constituents of cordyceps are given and pharmacological and biological studies reviewed. More mechanism-based and disease-oriented clinical studies are recommended.