Epidemiological study of snakebite cases in Sikkim: Risk modeling with regard to the habitat suitability of common venomous snakes.

BACKGROUND: Snakebite envenoming is listed as category 'A' Neglected Tropical Disease. To achieve the target of WHO (World Health Organization) 2019, it becomes necessary to understand various attributes associated with snakebite including community awareness, improvisation of medical facilities and to map the potential distribution of venomous snakes responsible for the bite. Hence this study is conducted in Sikkim, India to understand the epidemiology of snakebite in Sikkim. The potential distribution and risk mapping of five common venomous snakes are done for effective management of snakebite cases. METHODS AND FINDINGS: The snakebite cases registered in six district hospitals and four PHCs (Primary Health Centers) of Sikkim were collected from the year 2011 to 2018. Community survey was also conducted to supplement the data. Ecological Niche Modeling (ENM) was performed to predict the potential habitat of five common venomous snakes of Sikkim. The risk modeling of snakebite cases was done at the level of Gram Panchayat Unit (GPU) using Geographically Weighted Regression (GWR) and Ordinary Linear Square (OLS) model. We found higher number of male victims inflicted with snakebite envenomation. The potential distribution of the five venomous snakes showed satisfactory mean AUC (Area under Curve) value. Both the models showed significant positive association of snakebite cases with habitat suitability of the venomous snakes. Hospital data revealed no death cases whereas community data reported 24 deaths. CONCLUSIONS: Death from snakebite reflected in community data but not in hospital data strongly indicates the people's belief in traditional medicine. Though people of Sikkim have rich traditional knowledge, in case of snakebite traditional practices may be ineffective leading to loss of life. Sensitizing people and improving medical facilities along with proper transport facilities in rural areas might significantly reduce the snakebite casualties in the state.

Prevalence of Leptospira serogroup-specific antibodies in cattle associated with reproductive problems in endemic states of India.

In this study, the seroprevalence and distribution of Leptospira in dairy cattle in endemic states of India were investigated in association with reproductive problems of the cattle. A total of 373 cattle serum samples from 45 farms in Maharashtra, Gujarat, Andhra Pradesh, Telangana, Karnataka, Tamil Nadu, Punjab, Haryana, Chhattisgarh, Sikkim and Uttarakhand states were collected from animals with a history of reproductive disorders like abortion, repeat breeding, anoestrus and endometritis, and also from apparently healthy animals. These samples were screened for Leptospira serogroup-specific antibodies by microscopic agglutination test (MAT) using a panel of 18 live reference serovar antigens. The seropositivity of 70.51% (263/373, 95% CI 0.65 to 0.75) was associated with reproductive problems (χ2 = 55.71, p < 0.01) and sampled states (χ2 = 32.99, p < 0.01) and independent of apparently healthy animals (χ2 = 15.6, p > 0.10) and age groups of cattle (χ2 = 0.91, p > 0.10). Further, the odds (risk-relation) of reproductive disorders was 5.29 compared to apparently healthy animals (0.25 odds). The frequency distribution of predominant serogroup-specific Leptospira antibodies were determined against the serovars: Hardjo (27.76%), Pyrogenes (18.63%), Canicola and Javanica (17.49%), Hebdomadis (17.11%), Shermani and Panama (16.73%), Djasiman (16.35%), Tarassovi, Grippotyphosa and Pomona (15.97%), Icterohaemorrhagiae (15.59%), Copenhageni (14.83%), Australis (13.69%), Kaup and Hurstbridge (10.65%), Bankinang (10.27%) and Bataviae (9.51%). In conclusion, dairy cattle have a role in maintaining important several serovars besides well-known Hardjo serovar in endemic states of India and warrant mitigating measures to reduce the incidence of cattle leptospirosis including need for an intensive surveillance programme, preventive vaccination and control strategies.

Survey of musculoskeletal abnormalities in school-going children of hilly and foothill regions of Eastern Himalayas using the pediatric Gait, Arms, Legs, Spine screening method.

OBJECTIVE: To study the prevalence and pattern of musculosketetal abnormalities in school-going children living in the hilly and foothill regions of the Eastern Himalayas using the pediatric Gait, Arms, Legs, Spine (pGALS) screening tool. METHODS: Total of 3608 children, aged 3-12 years were enrolled from 16 schools (5 in the hills) in the eastern Himalayan region. After the three screening questions, the pGALS maneuvers were administered. Subjects were shown a video on pGALS before the actual testing. Those detected to have abnormality were probed in greater detail and referred for treatment as necessary. RESULTS: The pGALS examination was completed in 3463 children with a median time of 3 min (range 1.9-5.4 min). The abnormality pattern was in the order: growing pains (38.86%), hypermobility (25.54%), mechanical pains (24.46%) and others (11.14%). Among mechanical pain, back and neck problems occurred with a similar overall frequency of 7.61%. Similar order was observed considering only children from the pains. However, in hill children, the proportion of mechanical problems (32.28%) exceeded proportion of hypermobility (23.62%). Asymptomatic hypermobility was more common than symptomatic hypermobility. Maximum prevalence of hypermobility was in 6-9 year age group. Of the 94 children with hypermobility, 55.32% had some kind of joint pain. CONCLUSIONS: Pediatric Gait, Arms, Legs, Spine is an acceptable screening tool for musculoskeletal abnormalities in apparently healthy children. Growing pain is the commonest musculoskeletal complaint while hypermobility is the commonest physical abnormality in school-going children in the Eastern Himalayas. Asymptomatic hypermobility is more common than symptomatic hypermobility.

Estimating the intra-cluster correlation coefficient for evaluating an educational intervention program to improve rabies awareness and dog bite prevention among children in Sikkim, India: A pilot study.

BACKGROUND: Educational initiatives targeting at-risk populations have long been recognized as a mainstay of ongoing rabies control efforts. Cluster-based studies are often utilized to assess levels of knowledge, attitudes and practices of a population in response to education campaigns. The design of cluster-based studies requires estimates of intra-cluster correlation coefficients obtained from previous studies. This study estimates the school-level intra-cluster correlation coefficient (ICC) for rabies knowledge change following an educational intervention program. METHODS: A cross-sectional survey was conducted with 226 students from 7 schools in Sikkim, India, using cluster sampling. In order to assess knowledge uptake, rabies education sessions with pre- and post-session questionnaires were administered. Paired differences of proportions were estimated for questions answered correctly. A mixed effects logistic regression model was developed to estimate school-level and student-level ICCs and to test for associations between gender, age, school location and educational level. RESULTS: The school- and student-level ICCs for rabies knowledge and awareness were 0.04 (95% CI: 0.01, 0.19) and 0.05 (95% CI: 0.2, 0.09), respectively. These ICCs suggest design effect multipliers of 5.45 schools and 1.05 students per school, will be required when estimating sample sizes and designing future cluster randomized trials. There was a good baseline level of rabies knowledge (mean pre-session score 71%), however, key knowledge gaps were identified in understanding appropriate behavior around scared dogs, potential sources of rabies and how to correctly order post rabies exposure precaution steps. After adjusting for the effect of gender, age, school location and education level, school and individual post-session test scores improved by 19%, with similar performance amongst boys and girls attending schools in urban and rural regions. The proportion of participants that were able to correctly order post-exposure precautionary steps following educational intervention increased by 87%. CONCLUSION: The ICC estimates presented in this study will aid in designing cluster-based studies evaluating educational interventions as part of disease control programs. This study demonstrates the likely benefits of educational intervention incorporating bite prevention and rabies education.

Recurrent dermatophytosis: A rising problem in Sikkim, a Himalayan state of India.

Changing pattern of dermatophytic infection among people of Sikkim over the past few years and its recurrence rate has brought a need to do a study on clinical pattern and its recurrence from this part of the country. The objectives of this study are to discern the clinical patterns of dermatophytosis, identification of the isolated fungi to its species level and to see the pattern of its recurrence. The study was carried out from January 2015 to May 2016. A total of 192 samples were collected from the patients with clinical findings of dermatophytic infection. Required history of the patients was taken, followed by clinical examination of the lesions and sample collection. The samples were processed for mycological study till species identification and a follow up of patients were done to assess its recurrence pattern. The age distribution of the patients was from 2 to 80 years. The mean and median age was 30.33 and 33 years respectively. The male female ratio was 1.8:1. Dermatophytosis was noted more commonly in students (n = 64, 33.33%) and jawans (n = 44, 22.92%). Maximum occurrence was noted from April to July (n = 106, 55.20%) and was seen mainly in young Hindu males. Tinea corporis (n = 104, 54.16%) was the most common clinical manifestation followed by tinea unguium (n = 30, 15.63%). T. mentagrophyte (40%) was the most common species followed by T. schoenleinii (33.3%), T. tonsurans (16.6%) and T. rubrum (6.6%). The recurrence rate was seen most commonly in clinical cases of tinea faciei 100%, followed by tinea pedis 80% and tinea unguium 46.6%. Overall clinical cure rate was 58.3% and recurrence rate was 34.3%. In the isolated species of dermatophytes, the recurrence rate was 73.68% and that of non-dermatophytes it was 28.07%. Dermatophytosis is an important health problem with high recurrence in Sikkim with difference in the etiological agent from other parts of India.

Ethnic Variations in Gastric cancer in a tertiary care centre of Sikkim in North-East India.

Inroduction: The etiology of gastric cancer is multifactorial. Marked differences in the incidence of gastric cancer among different ethnic groups living in the same geographical area have been observed. Aim and methods: This study looked at ethnic and dietary factors in patients with gastric cancer diagnosed at a tertiary referral centre in Sikkim over a period of one year. Patients of 60 years and above were included in the study and divided into four ethnic groups : Bhutias, Lepchas, Rais and other groups. Results: 211 cases underwent upper GI endoscopy and 32 were diagnosed to have gastric cancer. Gastric cancer incidence was highest in Bhutia ethnic group. A trend towards higher intake of smoked meats, fermented vegetables, salt tea, and H.pylori positivity in the Bhutia ethnic group was associated with higher incidence of gastric cancer as compared to other ethnic groups. Conclusion: The study with a referral centre bias showed that Bhutia ethnic group had a higher incidence of gastric cancer as compared to other ethnic groups.

Study of acute transfusion reactions in a teaching hospital of Sikkim: A hemovigilance initiative.

OBJECTIVE: Blood transfusions are inherently associated with risks ranging in severity from minor to life-threatening. Continuous monitoring of transfusion related complications can promote understanding of factors contributing to transfusion reactions and help to formulate necessary remedial measures. This study was designed to analyze the frequency and nature of transfusion reactions reported to the blood bank of a remote North East Indian teaching hospital. MATERIALS AND METHODS: All acute transfusion reactions (ATRs) reported to the blood bank over a period of 20 months (May 2013 to January 2015) were reviewed and analyzed. The risk of transfusion reactions associated with each individual component was assessed. RESULTS: A total of 3455 units of whole blood and component transfusions were carried out of which a total of 32 (0.92%) ATRs were encountered. Packed red blood cells (PRBCs) (n = 15, P = 0.06) and whole blood (WB) (n = 13, P = 0.83) were most commonly implicated. Allergic reaction was the most frequent transfusion reaction encountered (65.6%), seen most commonly with PRBC (risk of 0.76%, P = 0.42), and WB (risk of 0.68%, P = 0.63) transfusions. This was followed by febrile reactions (28.1%), which were seen more commonly with PRBCs (risk of 0.57%, P = 0.016). No reactions were observed with platelet transfusions. CONCLUSION: The overall incidence of transfusion reactions in this hospital is slightly higher than those having more advanced transfusion facilities in India. The lack of leukoreduction facilities in our hospital could be a likely cause for the same. The use of leukoreduced WB and PRBCs could possibly reduce the overall incidence of ATRs in general and febrile nonhemolytic transfusion reactions in particular.

Determinants of respiratory diseases in East Sikkim.

BACKGROUND: Due to the difficult geographic terrain with lack of roads and transport, the Sikkim State in India finds difficulties in contending the respiratory diseases especially during the rainy seasons. FINDINGS: A case-control study was conducted for two months at the Central Referral Hospital of East Sikkim involving 110 individuals in the age group of 10 years and above. Due to feasibility constraints, 55 cases and 55 controls were selected by applying the non-probability sampling method with age and sex matching. The collected data were tabulated and analyzed by using the SPSS (Statistical Package for Social Sciences) version 10.0 for windows. Findings were expressed in terms of proportion, Chi Square Test and Multiple Logistic Regression Analysis. Here, p-value <0.05 was considered as statistically significant. This study revealed that the presence of overcrowding, chronic exposure to allergens, smoking habits, chronic respiratory illnesses within last 5 years, family history of chronic respiratory illnesses and mental illnesses were independently associated with respiratory diseases. CONCLUSION: This study should be replicated in other parts of Sikkim to obtain more confirmatory evidence on determinants of respiratory diseases.

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) (ß=-0.16, P=0.02) and current analgesic use (ß=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 ß=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.

Characterization of smallholder pig production system: productive and reproductive performances of local and crossbred pigs in Sikkim Himalayan region.

The present study was conducted to know the smallholder pig production system in tribal areas of Sikkim State, India. Two hundred tribal farmers were selected randomly from the North and East District of the state. Information on socio-economic characteristics of farmers (gender, occupation, educational status, and farming experience), management practices, disease prevalence, and economics in pig production was collected. The study recorded the mean land holding as 1.2 ± 0.8 ha, and the number of pigs per farm was 5.0 ± 0.28. Pigs were mainly kept as a source of income, and 70 % of farmers reared crossbreed pigs. Ninety percent (90 %) of respondents practiced the intensive system of management whereby kitchen wastes along with cooked mixture comprising maize bhusa, mustard oil cake, pseudostem of banana, tuber, stem, and plant leaves were used to feed their animals. About 40.5 % of farmers procured their breeding stock from government farms that had good records and utilized veterinary services like timely vaccination and deworming. The diseases prevalent in the study area were swine fever, diarrhea, helminthoses, sarcoptic mange, pneumonia, etc. The litter sizes at birth (local, 4.3 ± 0.45; crossbreed, 7.2 ± 0.33), at weaning (local, 2.79 ± 0.24; crossbreed, 6.1 ± 0.21), and age at first farrowing (local, 365.39 ± 7.96 days; crossbreed, 337.24 ± 8.79 days) were recorded. Production costs of meat extracted from local and crossbred pigs were 1.08 $/kg and 0.86 $/kg, respectively.

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.

Prevalence and risk factors associated with sexually transmitted diseases (STDs) in Sikkim.

The population of Sikkim is a unique blend of multi-tribal and metropolitan culture. However, till date, no data regarding prevalence of sexually transmitted diseases (henceforth abbreviated as STDs) among this population is available and hence requires attention. Hence the objective is to determine the prevalence of STDs in Sikkim and to describe associated risk factors. A cross-sectional study involving 'Questionnaire-based anonymous feedback system' was followed to collect data from 2,000 individuals across the society. The four most common STDs, gonorrhea, syphilis, chlamydia and HIV, were considered for the study. Total 69 (3.6%) cases of STDs were found in 1,918 individuals was affected by at least one of the STDs, out of which 43 were males and 26 were females. Cases of gonorrhea, syphilis, chlamydiasis and HIV were 25, 22, 4 and 18 respectively. Out of total 69 cases of STDs, 20 individuals were also suffering from some kind of hepatitis. Addictions like alcoholism, smoking and drugs were also found in significant number, with 1,019 (>50%) individuals with at least one of these addictions. Relative risk analysis indicates that gender-wise females are more vulnerable to STDs than males. The number of partners, addictions, especially alcohol and drug abuse, also contribute to STD cases. STDs act as a significant risk factor in transmitting some of the types of hepatitis. In such cases, females are more vulnerable than males. The results suggest that new community health programs are essential for both, HIV and non-HIV STDs in Sikkim.

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.

Population-based cancer incidence in Sikkim, India: report on ethnic variation.

BACKGROUND: A Population-Based Cancer Registry (PBCR) was set up in Sikkim (a state in the North Eastern India) in 2003. We examined incidence rates by ethnic groups from 2003-2008. METHODS: Age-adjusted incidence rates (AARs) per 100,000 person-years were calculated by direct method using the world standard population, and analysed by ethnic group (Bhutia, Rai and other). RESULT: There were a total of 1148 male and 1063 female cases of cancer between 2003 and 2008 on the Sikkim PBCR. The overall AARs were 89.4 and 99.4 per 100,000 person-years in males and females, respectively. Incidence rates were highest amongst the Bhutia group (AAR=172.4 and 147.4 per 100,000 person-years in males and females, respectively), and the largest difference in rates were observed for stomach cancers with AARs being 12.6 and 4.7 times higher in the Bhutia group compared with other ethnic groups in males and females, respectively. CONCLUSION: These observations call for further epidemiological investigations and the introduction of screening programmes.

Socioeconomic correlates of reproductive morbidity among adolescent girls in Sikkim, India.

UNLABELLED: The present study investigates the prevalence of reproductive health morbidities, treatment-seeking behavior, and its association with sociodemographic correlates among unmarried and married adolescent girls of Sikkim. The study sample includes 1250 adolescent girls randomly selected from both urban and rural blocks of the State. Information on socioeconomic and demographic characteristics, prevalence of reproductive health morbidities, and treatment-seeking behavior was collected using standard pretested questionnaires. RESULTS: of the study indicate that the prevalence of reproductive health morbidities among both married and unmarried girls is quite high. Age, media exposure, and economic status emerged as significant correlates of treatment-seeking practices among both married and unmarried girls. High prevalence of reproductive health morbidity in this vulnerable group, particularly in rural settings, requires urgent intervention of health planners. This study reinforces an indirect and mediatory role of socioeconomic and demographic factors in the prevalence of reproductive health morbidities and associated treatment-seeking behaviors.

A case series and review of sporotrichosis in Sikkim.

Sporotrichosis caused by the fungus Sporothrix schenckii has been widely reported from the northern Himalayan belt and the north eastern region of India. Three autochthonous cases of lymphocutaneous sporotrichosis from east and south districts of Sikkim are reported. Fluid aspirate from the nodulo-ulcerative lesions were sent for cytology and fungal culture. S. schenckii was isolated on culture and cytological examination in all three cases showed granulomatous reaction. Thermal dimorphism was demonstrated and animal pathogenicity testing was performed. Saturated solution of potassium iodide was used for treatment and the last case was treated with itraconazole and potassium iodide. Awareness of this disease and an extensive environmental study is required to understand the actual burden of this disease.

Nasopharyngeal carcinoma in the Northeastern states of India.

Nasopharyngeal cancer (NPC) is a rare disease in most parts of the world, except for Southeast Asia, some parts of North Africa and the Arctic. It is mostly seen in people of Chinese origin. In India, NPC is also rare, except for the Hill States of Northeast India, particularly Nagaland, Manipur, and Mizoram. The striking feature of NPC in Northeast India is that the incidence ranges over the complete spectrum from the lowest (as 0.5/100 000 to 2.0/100 000 among Caucasoid) to the highest (as about 20/100 000 among Cantonese/Zhongshan dialect Chinese). The age-adjusted rate of NPC in Kohima district of Nagaland State is 19.4/100 000, which is among the highest recorded rates. By contrast, in Assam, one of the so-called Hill States but not itself a hilly state, NPC is much less common. The Northeastern region is distinguished by a preponderance of the Tibeto-Burman languages and by variable mongoloid features among peoples of the region. The nature of the migratory populations who are presumed to be bearers of the mongoloid risk is unknown, but these NPC occurrence features provide an outstanding opportunity for NPC risk investigation, such as that of the hypothesis of Wee et al. for westward displacement of Chinese aborigines following the last glacial maximum.

Determinants for the retreatment groups of pulmonary tuberculosis patients treated in a DOTS programme in Sikkim, India.

OBJECTIVE: To assess knowledge, attitude and different health-seeking behaviours among 250 cured and 250 category-II tuberculosis patients. METHODS: A case-control study was conducted in different health settings in Sikkim, a part of the Indian continent. A questionnaire was filled for the purpose. RESULTS: Results showed significant differences in overcrowding, smoking and alcohol intake. There was a general unawareness with the disease and its treatment between the two groups. 45% of the respondents reported that tuberculosis is caused by germs. 81.4% stated that tuberculosis presents only as cough. 94.8% of the case group and 90.8% of the control group stated that it is a transmissible disease. Sharing food with tuberculosis patients (64% of case group, 55% of the control group; p < 0.05), inadequate diet (16.4% of case group, 9.6% of the control group; p < 0.03) were mentioned as modes of transmission. Sixty six per cent of the case group and 56.8% of the control group mentioned the use of DOTS for prevention and control (p < 0.05). Sixty three per cent of the control group regarded tuberculosis as a life threatening condition (p < 0.00) [(adjusted OR = 2.04, (95% CI: 1.43, 2.93)]. Tuberculosis was considered as a completely curable disease by 96.4% of the case group (p < 0.05). 40.6% of the respondents agreed to be in contact with a tuberculosis infected person. 64% of the retreatment group discontinued their treatment due to frequent travelling for work. CONCLUSION: The study revealed lack of knowledge, positive attitude and inappropriate health seeking behaviours among of the tuberculosis patients, irrespective of their categorization.

Lymphatic filariasis in East District, Sikkim.

East district of Sikkim has been considered as non-endemic for lymphatic filariasis (LF). However, a LF survey conducted during 2008 revealed microfilaria rate (mf rate) of 1.2%. The LF survey was carried out in 15 randomly selected villages and urban localities of East Sikkim. Out of 3,428 night blood smears collected and examined, 42 were found positive for Wuchereria bancrofti. Microfilaria (mf) carriers were detected from 5 surveyed villages and 5 urban localities of Singtam and Rangpoo with mf rate ranging from 0.5% to 4.2%. The mean mf density was 5.4 per 20cmm3 blood. All mf carriers were residents of east district, Sikkim except two persons who were from Bihar. The detection of microfilaria in young children who had never moved from the area indicates probable indigenous transmission. Out of 15 surveyed areas LF disease was found in 11 areas with prevalence ranging from 0.4% to 7.0%.(Disease rate was 1.6%) (1.7% for Males & 1.4% for females). One local individual was found with lymphoedema and also mf positive. Vector density ranged from 70 to 435 per ten-man-hours, sufficient for transmission of LF. 712 female Cx. quinquefasciatus were dissected to detect the filarial infection and none was found positive. The present survey findings indicate endemicity of filariasis in East district of Sikkim.

Clinico-etiologic correlates of onychomycosis in Sikkim.

AIMS AND OBJECTIVES: The etiological spectrum of any superficial mycosis is largely dependent on the flora in the immediate environment of the individual. It is influenced by the geographic, climatic and occupational factors. The study is basically to formulate baseline data for the species prevalence of various dermatophytes in patients with onychomycosis attending the Central Referral Hospital, Gangtok, Sikkim. MATERIALS AND METHODS: Thirty-four clinically suspected cases of onychomycosis were subjected to mycological studies. RESULTS: Thirty-two (94.12%) cases were positive for fungal elements by direct microscopy and 28 (82.35%) by culture. Young adults in the age group of 21-30 years were mainly affected. The male:female ratio was 1.125:1. Dermatophytes were isolated in 18 cases (64.29%). Trichophyton tonsurans (44.44%) was the most common isolate followed by T. mentagrophytes (22.22%), T. rubrum (11.11%), T. verrucosum (11.11%) and Microsporum audouinii (11.11%). Apart from dermatophytes, Aspergillus niger (21.43%) and Penicillium marneffei (14.28%) were also isolated. CONCLUSION: Dermatophytes, mainly T. tonsurans, as well as moulds other than dermatophytes were isolated from onychomycosis patients in Gangtok, Sikkim.