Evaluation of biomedical waste generation in Himachal Pradesh before and during the Covid 19 pandemic

Himachal Pradesh dealt with the same crisis as other states in India due to the extensive dissemination of the COVID-19 coronavirus infection. Biomedical waste management is crucial for public health and environmental safety, and the pandemic's impact on waste generation is an understudied area. This study specifically utilizes data from the Himachal Pradesh Pollution Control Board as well as information from other governmental and non-governmental organizations, which are analysed and compared for the pre-pandemic and pandemic periods. This research offers a thorough analysis of waste generation of Himachal Pradesh both before and during the COVID-19 outbreak. Kangra (671 kg/day), Shimla (526 kg/day), are found to be high Bio medical waste generation (BMWG) districts whereas Kinnour (22 kg/day), Lahul Spiti (6 kg/day) are observed as lowest BMW generating districts in Himachal Pradesh on average basis in the year 2018 to 2020. The unexpected COVID-19 viral pandemic has caused a huge increase in Bio-medical waste (584 kg/day) in the year 2021 in comparison to that in the year 2020 (139 kg/day). The gaps analysis of Himachal Pradesh implementation of the Biomedical waste regulations was also assessed in this study. Deep burials have been severely prohibited by the Himachal Pradesh government; yet, two districts continue to dispose of BMWs using deep burial techniques. The findings reveal important insights into the changing patterns of BMW generation, shedding light on the challenges and requirements for effective waste management strategies during health crises. The insights obtained from this study can contribute in development of resilient waste management system that can effectively respond to future pandemics or health crises, ensuring the safety of healthcare workers, the public, and the environment.

Life cycle assessment of municipal solid waste generated from hilly cities in India - A case study

Improper disposal of waste poses a grave environmental threat, contributing to pollution of air, water, and soil. It is necessary to address this issue in order to mitigate the adverse effects of solid waste on both the environment and public health. In many developing nations, municipal authorities of bigger cities are enduring significant challenges in proper management of waste. The present study evaluates the impacts of various waste management alternative scenarios for environmental impacts for the selected study locations using Life Cycle Assessment (LCA) methodology. The methodology comprised of five different scenarios of waste management including an existing baseline scenario. In this context, the environmental impact categories analyzed were Global Warming potential (GWP), Acidification potential (AP), Eutrophication potential (EP) and Human Toxicity potential (HTP). The results indicated that amongst all the proposed scenarios, Scenario 1 and 4 exhibited the maximum and minimum environmental impacts respectively. The study revealed that least greenhouse gas emissions, acidification potential, eutrophication potential and human toxicity potential were comparatively lesser for scenario 4 varying from 5.65 to 11.36 kg CO2eq t-1; 1.24-3.345 kg SO2eq t-1, EP 0.19-0.68 kg PO4eq t-1, and 0.35-4.22 kg 1,4-DBeq t-1 respectively. Further, a sensitivity analysis was also performed to evaluate the influence of recycling rate of valuable resources in all the considered scenarios. The sensitivity analysis indicated an inversely proportional relation between change in recycling rate and total environmental burdens.

Recent public health concerns of the high-altitude tribal population of Lahaul and Spiti, Himachal Pradesh

Objective

India has a tribal population of 8.6%. Health concerns of the high-altitude tribal population in India play a vital role in overall socio-economic development and health transformation of the country. Therefore, the aim of this study was to determine the current health problems among the tribal population of Lahaul and Spiti district of Himachal Pradesh.

Material and Methods

The study area encompasses one regional hospital (RH) in Keylong (the district headquarters), three community health centers (CHCs), and 16 primary health care centers (PHCs). In addition, the district has 37 sub-centers (SCs) and 21 Ayurveda dispensaries to serve the district. The data for this study were gathered over a 4-year period from records of daily out-patient department registration from the various health centers (RH, CHCs, and PHCs) from 2017 to 2020.

Results

In terms of communicable diseases, the population in the concerned region was more likely to have acute respiratory infection, enteric fever, tuberculosis, and typhoid. Hypertension, asthma, bronchitis, and diabetes mellitus type II were determined to be the most common non-communicable diseases.

Conclusion

Acute respiratory disease, hypertension, diarrhea, accidental injuries, and eye problems were shown to be prevalent in the study area. The population's position in relation to these five diseases indicates the community's sensitivity to a variety of common conditions. There is a need to review the needs and priorities of the concerned population and create goals and targets to meet those needs using validated public health measures.

Governing the soil: natural farming and bionationalism in India

This article examines India's response to the global soil health crisis. A longstanding centre of agricultural production and innovation, India has recently launched an ambitious soil health programme. The country's Soil Health Card (SHC) Scheme intervenes in farm-scale decisions about efficient fertiliser use, envisioning farmers as managers and soil as a substrate for production. India is also home to one of the world's largest alternative agriculture movements: natural farming. This puts farmer expertise at the centre of soil fertility and attends to the wider ecological health of soils. Despite emerging as a mode of resistance to dominant agricultural systems, natural farming is now being delivered in increasingly bureaucratic ways by India's state governments. This article offers Himachal Pradesh as a case study in how the soil is governed, drawing on 38 semi-structured interviews with scientists, agricultural officers, non-governmental organisation leaders, and activists. Rather than assess approaches to soil health according to their ecological bottom line, we examine the differing forms of knowledge, expertise and 'truth' in the SHC and Natural Farming approaches. Our analysis reveals discontinuities in how farmers are imagined, as well as continuities in how quasi-spiritual language combines in a bionationalist project, positing assumptions about the correct arrangement of life in nationalist terms. We point to a shift toward hybrid and pick-and-mix approaches to soil health, as farmers and their organisers are increasingly invested with the capacities to combine multiple options. We see a fracturing of expertise and the opening up of epistemic pluralism in responses to the soil fertility crisis.

Insecticide susceptibility status of malaria vectors in Himachal Pradesh, India

BACKGROUND & OBJECTIVES

The state of Himachal Pradesh is one of the hilly forested states of India. Warming of climate has been evidenced in the state due to the ongoing climate change which may cause the upsurge/introduction of mosquito-borne diseases. To curb disease transmission, an effective vector control strategy will be required.

METHODS

Insecticide susceptibility status of available malaria vectors was determined using the standard WHO method in six districts Kangra, Una, Mandi, Bilaspur, Solan and Mandi of the state. An. culicifacies and An. fluviatilis were tested against DDT (4%), malathion (5%) and deltamethrin (0.05%) using WHO insecticide susceptibility kits.

RESULTS

Overall, An. culicifacies was found resistant to DDT in all the six districts, susceptible to malathion in all districts except Bilaspur and Solan where it showed possible resistance. It was susceptible to deltamethrin in all the study districts. An. fluviatilis was resistant to DDT and susceptible to malathion and deltamethrin in Kangra and Una districts.

INTERPRETATION & CONCLUSION

At present, indoor residual spraying (IRS) is not being undertaken in Himachal Pradesh. However, with the information generated through the present study, the state government can plan evidence-based IRS at least for focal spray in limited foci reporting malaria incidence.

Detection of Leishmania donovani in Wild-Caught Phlebotomine Sand Flies in Endemic Focus of Leishmaniasis in Himachal Pradesh, India

An endemic focus of cutaneous leishmaniasis (CL) is located in the Sutlej River Valley in Himachal Pradesh (India) in the north-western Himalaya where CL co-exists with visceral leishmaniasis (VL). In areas of the Indian subcontinent such as Rajasthan, cutaneous leishmaniasis is transmitted by Phlebotomus papatasi (Scopoli) and Phlebotomus salehi. In Himachal Pradesh, Phlebotomus longiductus (Parrot) is suspected to be the vector for CL. In the current study, sand flies were collected and tested for Leishmania infection and to confirm the vector species causing CL. Sand flies were collected during April and September of 2017-2019 from CL endemic villages of Rampur (Shimla), Nirmand (Kullu) and Nichar (Kinnaur) districts of Himachal Pradesh. The sand flies were identified as Phlebotomus (adlerius) longiductus (Parrot) and Phlebotomus (larrousisus) major (Annandale). The density of P. longiductus was found highest. The elevation of villages ranged from 947 m to 2,130 m and were far from the presence of subsoil water. Field collected sand flies tested positive (7.69%) for Leishmania donovani by PCR-RFLP. The L. donovani sequences detected from P. longiductus were 97% similar to L. donovani sequences reported from the cases of CL in Himachal Pradesh.The Leishmania positive sand flies were morphologically identified as Phlebotomus adlerious longiductus providing one step further evidence towards the vector status of CL in Himachal Pradesh. The findings of the study are of epidemiological significance for strategic planning of vector control for leishmaniasis in India.

Modelling the reference crop evapotranspiration in the Beas-Sutlej basin (India): an artificial neural network approach based on different combinations of meteorological data

Accurate prediction of the reference evapotranspiration (ET₀) is vital for estimating the crop water requirements precisely. In this study, we developed multi-layer perceptron artificial neural network (MLP-ANN) models considering different combinations of the meteorological data for predicting the ET₀ in the Beas-Sutlej basin of Himachal Pradesh (India). Four climatic locations in the basin namely, Kullu, Mandi, Bilaspur, and Chaba were selected. The meteorological dataset comprised air temperature (maximum, minimum and mean), relative humidity, solar radiation, and wind speed, recorded daily for a period of 35 years (1984-2019). The datasets from 1984 to 2012 and 2013 to 2019 were utilized for training and testing the models, respectively. The performance of the developed models was evaluated using several statistical indices. For each location, the best performed MLP-ANN model was the one with the complete combination of the meteorological data. The architecture of the best performing model for Kullu, Mandi, Bilaspur, and Chaba was (6-2-4-1), (6-5-4-1), (6-5-4-1), and (6-4-6-1), respectively. It was observed, however, that the performance of other models was also relatively good, given the limited meteorological data utilized in those models. Further, to appreciate the relative predictive ability of the developed models, a comparison was performed with four existing established empirical models. The approach adopted in this study can be effectively utilized by water users and field researchers for modelling and predicting ET₀ in data-scarce locations.

Seroprevalence and immunological characterization of Trypanosoma evansi infection in livestock of four agro-climatic zones of Himachal Pradesh, India

Trypanosoma evansi, a hemoflagellate protozoan parasite, causes wasting disease called surra in wide range of animals. Although the organism has been reported from various parts of India, data generated from organized epidemiological study is still in infancy in majority states of India. In the present study, livestock of Himachal Pradesh, India, was targeted for epidemiological investigation of T. evansi infections. A total of 440 equines and 444 cattle serum samples were collected from four agro-climatic zones. Furthermore, serum samples of 280 buffaloes from three different agro-climatic zones of Himachal Pradesh were also collected and evaluated for the presence of T. evansi infection by indirect ELISA. Data generated showed higher prevalence in buffalo (23.57%) followed by cattle (22.52%) and equines (1.82%). Disease was found to be more prevalent (P < 0.01) in cattle of lower altitude as compared to those of higher altitudes. No significant variation was seen in prevalence of disease on the basis of age and sex of the animals. Serum biochemical analysis revealed increased levels of BUN in T. evansi-infected equines. Levels of liver function enzymes such as ALT/GGT and AST were found to be significantly elevated (P < 0.01) in seropositive animals whereas glucose levels were significantly lower in surra-seropositive animals as compared to seronegative animals. Immunoblot analysis of whole cell lysate (WCL) antigen of T. evansi using surra-seropositive samples of equines showed immunodominant bands in the range of 100-25 kDa. Bovine-seropositive samples recognized polypeptide bands in the range of 85-32 kDa, including protein clusters of 52-55 and 48-46 kDa. Polypeptide cluster of 62-66 kDa was found common in seropositive samples of bovines and equines from all agro-climatic zones. T. evansi was found to be highly prevalent in livestock of Himachal Pradesh, and thus, there is dire need for designing of proper control strategies against surra.

An Insight Into Systemic Immune Response in Leishmania donovani Mediated Atypical Cutaneous Leishmaniasis in the New Endemic State of Himachal Pradesh, India

Leishmaniasis continues to afflict known and newer endemic sites despite global efforts towards its control and elimination. In this regard, the emergence of newer endemic sites with unusual disease formats is recognized wherein Leishmania donovani complex classically known to cause visceral disease is demonstrated to cause cutaneous manifestation. In this context, atypical cutaneous leishmaniasis (CL) cases caused by L. donovani genetic variants from the newer endemic state of Himachal Pradesh (HP) in India are beginning to be understood in terms of parasite determinants. The atypical CL manifestation further needs to be explored to define host immune correlates with a possible role in driving the unusual disease progression. In the given study, we performed comprehensive systemic-immune profiling of the atypical CL patients from the study area in HP, India, in comparison with the classical visceral leishmaniasis (VL) patients from the northeast region of India. The systemic immune response was studied using ELISA-based assessment of Th1, Th2, Th17, Treg, and Th22 specific plasma cytokine expression pattern and parasite-specific total serum IgG/IgG subclasses. The specified immune correlates are known to exhibit heterogeneous association with the different infecting parasite species, infection load, and co-lateral host immunopathology in classical CL and VL. In the atypical CL patient group, altered expression of IL-10 emerged as the key finding that could potentially fine-tune the Th1/Th17/Th22 effector cytokine axis towards a localized cutaneous manifestation. A reduced expression of IL-10 along with a high IFN-γ/IL-10 ratio as a readout of effective parasite killing defined atypical cutaneous outcome. In contrast, high circulatory IL-10 levels and a depressed IFN-γ/IL-10 ratio were seen in classical VL patients in line with an ineffective parasite-killing cytokine response. Overall, the study highlights new knowledge on host immune correlates in terms of cytokine expression pattern and IgG subclasses that underline atypical disease manifestation such that L. donovani, a generally visceralizing parasite species cause skin localized cutaneous lesions.

Prevalence of sibling-species of Anopheles (Cellia) fluviatilis complex in Himachal Pradesh, India

BACKGROUND & OBJECTIVES

Malaria is one of the most infectious and life-threatening vector borne disease in the tropics. Climate change can significantly influence malaria epidemiology and expansion of malaria vectors to hilly regions of Himachal Pradesh in India, hitherto considered areas of low transmission. Entomological surveillance in Kangra district of Himachal Pradesh revealed high density of a proven efficient vector of malaria, Anopheles fluviatilis, but transmission intensity of malaria was found very low. It was therefore considered prudent to investigate the sibling-species composition of An. fluviatilis complex in Kangra valley to ascertain their role in transmission of malaria.

METHODS

The study was undertaken in six villages in Kangra district of Himachal Pradesh, India. A total of 4446 mosquitoes were collected during the one-year study period (2018) and processed in pools of ten for molecular characterization. DNA extraction and multiplex PCR was performed on 900 An. fluviatilis mosquitoes for differentiation of sibling-species. ELISA was used to detect Plasmodium falciparum and Plasmodium vivax circumsporozoite proteins in 3790 An. fluviatilis samples.

RESULTS

Among prevalent mosquito species, An. fluviatilis was the predominant species constituting 69.5% of total mosquito collection. Sibling-species U was found in 92.22% and species T in 7.78% samples assayed. ELISA confirmed the absence of evidence of malaria parasite in any of the An. fluviatilis mosquitoes screened. Based on the difference in the sequences of conserved regions of the 28SrDNA, sibling-species U was confirmed as prevalent in the study villages.

INTERPRETATION & CONCLUSION

Study revealed that in Kangra district, An. fluviatilis sibling-species U is predominant followed by species T, and both are non-vectors. The absence of malaria parasite and zoophagic nature of An. fluviatilis established through blood meal analysis, confirmed that both U and T are non-vector sibling-species.

Molecular characterization and forensic relevance of the autosomal STRs for the population of North Indian geographical province Himachal Pradesh, India

Keeping in view the diverse demography of India, present study was undertaken to explore the molecular characterization and forensic relevance of 20 autosomal STRs for the highly diverse population of north Indian state Himachal Pradesh. 724 unrelated individuals from the admixed population of Himachal Pradesh were undertaken for present study and 20 autosomal STRs used to explore genomic diversity of studied population. A total of 270 different alleles along with 13.5 alleles per locus were observed. The allele 8 of the locus TPOX was observed as the most frequent allele. Observed heterozygosity ranged from 0.677 to 0.898, which supported wide range of selection of the unrelated individuals for this study. Combined power of discrimination, power of exclusion, matching probability and paternity index were observed as 1, 0.9999999958, 3.9 × 10^-26 and 2.3 × 10⁸ respectively, across the studied loci. In the population differentiation test, studied population showed genetic relatedness with Indian population rather than the populations of West, North and North east countries. Present study deciphered the novel autosomal STR data, which could be useful for the forensic application and population genetic studies.

Assessment of liver and renal functions in human immunodeficiency virus-infected persons on highly active antiretroviral therapy: A mixed cohort study

Background

Indian data on potential hepatorenal toxic effects of highly active antiretroviral therapy (HAART) in HIV/AIDS-affected persons is lacking.

Objectives

To assess hepatorenal abnormalities in HIV-infected persons on HAART in a hospital-based mixed cohort study using concurrent and nonconcurrent data analysis.

Methods

Hepatorenal function tests, urinalysis and ultrasonogaphy for liver/kidneys (when applicable) were assessed in 400 (men 185; women 215) persons aged 2-84 (mean 47.8) years on HAART. Acute liver toxicity, acute kidney injury and chronic kidney disease were defined depending upon abnormal serum alanine aminotransferase, urea and creatinine levels/clearance as per standard guidelines.

Results

The duration of HAART was 1 month to 9 years (mean 3.7 years) with 284 (71%) individuals being on treatment for ≤5years. The major HAART regimens included zidovudine + lamivudine + nevirapine in 175 (43.8%), tenofovir + lamivudine + efavirenz in 174 (43.5%) and zidovudine + lamivudine + efavirenz in 20 (5%) individuals and were associated with grade-1 hepatic dysfunction in 57 (14.3%) individuals, with men aged between 31 and 45 years on antiretroviral therapy for >5 years being mainly affected. Forty two (17.1%) of 246 individuals with anemia and 15 (9.7%) of 154 individuals without anemia showed hepatic dysfunction. None had acute kidney injury, chronic kidney disease or abnormal urinalysis or ultrasonography. In contrast, the pretreatment elevated serum alanine amiotranerase in 99 (22.3%) and blood urea and/or creatinine levels in 16 (4%) individuals decreased significantly post highly active antiretroviral therapy.

Conclusions

The study reflects the low frequency of regimen based highly active antiretroviral therapy-associated hepatic or nephrotoxicity despite prolonged use, especially in the absence of other risk factors. Preexisting anemia appears an important risk factor for highly active antiretroviral therapy-induced hepatotoxicity (OR 1.90, Cl 95% CI 1.02-3.57, P = 0.04). Highly active antiretroviral therapy-associated nephrotoxicity was not a significant problem. Study of viral load or other risk factors and potential of each drug for hepatorenal toxicity/dysfunction in HIV affected were not part of the study. A small number of subjects and retrospective analysis of biochemical parameters were other important limitations.

Leishmania donovani Infection with Atypical Cutaneous Manifestations, Himachal Pradesh, India, 2014-2018

We conducted a molecular study of parasite sequences from a cohort of cutaneous leishmaniasis patients in Himachal Pradesh, India. Results revealed atypical cutaneous disease caused by Leishmania donovani parasites. L. donovani variants causing cutaneous manifestations in this region are different from those causing visceral leishmaniasis in northeastern India.

Typical and atypical cutaneous leishmaniasis in Himachal Pradesh (India)

BACKGROUND

Visceral leishmaniasis (VL) is in elimination phase in India while cutaneous leishmaniasis (CL) is being reported from new foci. In Himachal Pradesh (HP), a foci of CL had been reported along Satluj River, but the causative agent poses a dilemma, hence the present study was undertaken in Shimla, Kullu and Kinnaur districts.

METHODS

A total of 28 CL patients from Indira Gandhi Medical College and Hospital Shimla (IGMC) in 2018, were tested by rK39., Twelve fresh cases were subjected to microscopic detection of Leishmania parasite, PCR and sequencing. Skin biopsies of 3-4 mm diameter were cultured, as well as imprints were prepared for the detection of Leishmania amastigotes. Biopsy samples were inoculated into different culture media (M199, RPMI 1640, NNN) and were incubated at 22-24 °C. Polymerase chain reaction (PCR) was performed to characterize Leishmania parasite species.

RESULTS

Of 28 patients, one was positive by rK39 dipstick test and one imprint was found positive for Leishmania amstigotes. Twelve biopsy DNA samples subjected to PCR for Leishmania kDNA, were found Lesihmania positive. Identification of Leishmania species was confirmed by PCR-RFLP and sequencing method. Of 12 Leishmania positive samples, six were identified as L. donovani, three L. tropica, two L.major and one remained unidentified.

CONCLUSIONS

This study revealed the existence of three species of parasites i.e., L. donovani, L. tropica and L. major indicating the existence of typical and atypical leishmaniasis in Himachal Pradesh. The occurrence of CL cases in HP, Kerala or elsewhere should not be ignored considering them just cases of CL alone. Further studies are warranted to confirm the existence of L.donovani zymodeme MON37 from cases of CL in HP or L.donovani zymodeme MON2 strain causing VL in Bihar. Elimination of CL should also be considered along with goal of Kala -Azar elimination.

Theileria orientalis outbreak in an organized cattle breeding farm

Theileriosis is an important tick borne disease of cattle caused by a haemoprotozoan of genus Theileria. Clinical bovine theileriosis is mainly caused by T. annulata or T. parva but the clinical disease due to T. orientalis is rare. T. orientalis mainly infect RBCs and causes "Oriental theileriosis" or Theileria-associated bovine anaemia in cattle and other livestock species. Two genotypes of T. orientalis (Chitose and Ikeda) are reported to cause severe disease in some countries. In this report, a spontaneous outbreak of Oriental theileriosis was studied in an organized Holstein-Friesian cattle breeding farm situated in the south-eastern Himalayan ranges of Himachal Pradesh State of India. Animal blood and tick samples were tested using cytological and PCR techniques. The disease episode occurred in a protracted manner spanning over 10 to 12 months and association of T. orientalis was confirmed in 93.3% of the blood and 21.7% of Rhipicephalus microplus (tick) samples. No other tick borne pathogen was detected except Anaplasma marginale in two blood samples. Haematological profiling of infected cattle showed characteristic indicators of anaemia like haemoblobin, RBC count, haematocrit value and mean corpuscular volume at either lower than normal or near the lower normal range. The prevailing persistent anaemic changes led to more severe clinical manifestations like abortion and joint inflammation. The detected T. orientalis strains and ticks species were further confirmed by nucleotide sequence analysis of 18S rRNA and 16S rRNA genes. Phylogenetically, T. orientalis strains showed clustering with other reported strains of T. orientalis from the surrounding regions. This first report of clinical Oriental theileriosis from India emphasises the importance of T. orientalis as an emerging tick borne pathogen and role of widely prevalent ticks species in disease transmission and their impact on livestock production.

Genetic evidence of shared ancestry among diverse ethno-linguistic human populations of Himachal Pradesh

In Indian montane system, human populations often exhibit an unparallel social organization where inter-caste marriages are still not common. This attribute affects the demography and population genetic structure of the resident populations. Further, human populations residing in the mountains in India are poorly studied for their genetic make-up and allele distribution patterns. In the present study, we genotyped 594 unrelated individuals using PowerPlex® 21 System (Promega, USA) from eight different populations belonging to 12 districts of Himachal Pradesh which differed in ethnicity, language, geography and social organization. Altogether, we obtained 1415 alleles with a mean of 8.84 ± 0.26 alleles per locus and 0.80 mean observed heterozygosity. Locus Penta E showed the highest combined power of discrimination and was found most informative for forensic purposes. Interestingly, phylogenetic analysis grouped the populations of Rajputs, Scheduled castes and Brahmins into one cluster, which indicated a deep genetic admixture in the ancestral populations. This study documents the first-ever report on the population genetic assignment of various castes in Himachal Pradesh and unveils the facts of cryptic gene flow among the diverse castes in the northern hilly state of India. Our results showed a genetic relationship among the various ethno-linguistically diverse populations of India.

Richness of non-timber forest products in Himalayan communities-diversity, distribution, use pattern and conservation status

BACKGROUND

Non-timber forest products (NTFPs) are important resources for sustenance of rural communities; a systematic planning to manage diverse NTFPs may immensely contribute to food and livelihood security of forest dwellers. Considering this, the present study has been undertaken in the Himachal Pradesh state in north India. It aims to provide detailed information on diversity, distribution, use pattern, and conservation status of selected NTFPs that have market potential, and suggest a possible way for their sustained management and possible role in livelihood upgradation of dependent communities.

METHODOLOGY

An inventory of NTFP species was prepared by collecting secondary information from published scientific studies in journals, books, and other periodicals as well as species being traded as per Forest department records. Search on various online databases were also used (Scopus, Google Scholar, PubMed, ISI Web of Science) using specific search terms such as "non-timber forest products," "NTFPs," "medicinal plants," "wild edible plants," and "Himachal Pradesh," "Western Himalaya," and "Northwest Himalaya." A list of potential NTFPs was prepared having market value. To evaluate the relative usefulness of different species, a quantitative valuation was also used by calculating various indices, such as use value (UV), relative frequency of citation (RFC), relative importance index (RI), cultural importance index (CI), and cultural value (CV).

RESULTS

A total of 811 species have been screened that has significant potential for the State, and categorized in 18 groups as per their use. The family use value was highest for Asteraceae (FUV = 76.75). Among plant parts used, whole plants, roots (including rhizomes and tubers), leaves, flowers, fruits, seeds, stems, and barks were used by the forest dwellers. Maximum NTFPs were collected from the warm temperate zone, followed by the temperate, sub-alpine, sub-tropical, and alpine zones. Sixty-one percent of species had medicinal importance, followed by species used for food and fodder purposes. Although species richness of medicinal plants decreased with altitude, however, most plants extracted from high altitudes were high-value species fetching better income. As many as 125 NTFPs were identified under the diverse level of threats according to IUCN criteria and as per the local stakeholders' perceptions.

CONCLUSION

High dependence on NTFPs by poor and marginal communities for domestic needs as well as market demand of selected species leads to create excessive pressure on them. Unfortunately, the state agencies are not having any robust conservation plan for NTFPs. For long-term management of NTFPs sector, a species-specific conservation strategy, proper harvesting protocol, cultivation practices, the supply of quality planting material, product development and diversification, value chain development, and ensured market is greatly desired. This will not only lead to conserving NTFPs resources in their natural habitats but also lead a sustainable livelihood generation for forest dwellers.

Leptomonas seymouri Co-infection in Cutaneous Leishmaniasis Cases Caused by Leishmania donovani From Himachal Pradesh, India

Himachal Pradesh in India is a newer endemic state with co-existence of cutaneous and visceral leishmaniasis. The cutaneous leishmaniasis cases are on an increase in the region and reported to be unusually caused by Leishmania donovani with limited molecular validation. In order to molecularly characterize the causative parasite of the cutaneous disease, parasite specific Internal-Transcribed Spacer 1 (ITS1) PCR RFLP and sequence analysis was performed on skin lesional biopsies from cutaneous leishmaniasis patients. Interestingly, we found the presence of Leptomonas seymouri in 38.5% (22/57) of the patients along with L. donovani detected in all the samples. L. seymouri is a monoxenous insect trypanosomatid, generally incapable of infecting humans. In recent years, the parasite is also reported to co-infect humans with L. donovani in visceral and post kala-azar dermal leishmaniasis (PKDL) cases prevalent in northeastern India. The finding of L. seymouri-L. donovani co-infection in unusual cutaneous cases from Himachal Pradesh is the first ever to our knowledge and imply a newer disease paradigm. There is an urgent need to understand the biology of Leptomonas co-infection with L. donovani and its possible role in visceral and/or dermotropic disease outcome. Importantly, L. seymouri co-infection in cutaneous cases and previously reported visceral and PKDL cases needs to be recognized as a newer phenomenon by the leishmaniasis surveillance program in India.

Pyrexia of unknown origin in HIV-negative adults from Himachal Pradesh (India): will you suspect disseminated histoplasmosis?

Histoplasmosis is usually clinically suspected only in people who reside in, are migrants from or are travelling to endemic areas such as North America. Immunocompetent patients with a low level of exposure typically have either subclinical or mild and self-limiting infection. The most common risk for the development of progressive disseminated form is HIV infection. We recently managed two patients with disseminated histoplasmosis, presenting with prolonged fever, significant weight loss, pallor and hepatosplenomegaly. Both were HIV-negative and lived in Himachal Pradesh (India), a region that was considered "Histoplasma-free" until recently.

Assessment of genetic polymorphism at 20 autosomal STR loci in scheduled caste population of Himachal Pradesh

In this study, we evaluated the genetic diversity indices and forensic parameters of scheduled caste population of Himachal Pradesh, India, at 20 autosomal STR loci. Altogether, 233 alleles were observed with an average of 11.65 ± 0.88 alleles per locus. In exception of locus D13S317, no loci deviated from Hardy Weinberg equilibrium. Locus Penta E was found to be the most polymorphic and discriminative loci. The combined power of discrimination and the combined power of exclusion were 1 and 0.999. Further, we established the phylogenetic relationship between the scheduled caste population of Himachal Pradesh and 14 other populations of India. We found 20 autosomal STR loci used in the present study were polymorphic and can be used in population genetic studies and forensic related case works.

Evaluation of genetic polymorphism at 20 autosomal STR loci in Rajput population of Himachal Pradesh, India

In the present study, genetic diversity indices and forensic parameters of Rajput population of Himachal Pradesh, India, were obtained at 20 autosomal short tandem repeat (STR) loci included in the PowerPlex^® 21 System (Promega, USA). With 227 alleles and 11.35 ± 0.89 alleles per locus, none of the locus deviated from the Hardy-Weinberg equilibrium (HWE). The most polymorphic and discriminative locus was Penta E. Phylogenetic tree showed high genetic affinity of Rajput population of Himachal Pradesh with Rajputs of Madhya Pradesh and Yadav of Bihar. Overall, the tested 20 autosomal STRs were polymorphic in Rajput population and found suitable in forensic casework and population genetic studies.

Neuropsychiatric Manifestations of Scrub Typhus

Scrub typhus is caused by Orientia tsutsugamushi characterized by focal or disseminated vasculitis and perivasculitis which may involve the lungs, heart, liver, spleen and central nervous system. It was thought to have been eradicated from India. Recently it is being reported from many areas of India. The clinical picture and severity of the symptoms varies widely. The neurological manifestations of scrub typhus are not uncommon but are diverse. Meningoencephalitis is classical manifestation of scrub typhus but cerebellitis, cranial nerve palsies, plexopathy, transverse myelitis, neuroleptic malignant syndrome and Guillan-Barré syndrome are other manifestations reported in literature. The availability of literature on the neurological manifestations of scrub typhus is limited to case reports mainly. This article reviews various neurological manifestations of scrub typhus reported in literature.

High prevalence of rifampin-resistant tuberculosis in mountainous districts of India

BACKGROUND

India accounts for quarter of global rifampin-resistant/multi-drug resistant-tuberculosis (RR/MDR-TB). Knowledge on risk-factors and distribution of MDR-TB at district level is limited.

OBJECTIVE

Study prevalence and risk factors of MDR-TB in tuberculosis patients in hilly districts of Himachal Pradesh, India.

METHODS

Between July 2012-June 2013, TB patients registered under the Revised National Tuberculosis Control Program in Kangra and Una districts suspected of MDR-TB were referred for Xpert® MTB/RIF testing at the Delek Hospital, Dharamsala by the district TB Office.

RESULTS

Of 378 patients enrolled (median age: 45 years; 85% males), 18% (n = 68) were rifampin-resistant. Among Xpert positives (n = 305), distributions of RR-TB were: 10% (n = 9/89) for recurrent cases who had received TB treatment for <2-months, 15% each for new (n = 9/59) or recurrent cases (n = 5/34) remaining smear positive between 2 and 4 months of treatment, 36% (n = 41/113) for treatment failures, and 40% (n = 2/5) for loss to follow-ups. Of the sputum-smear positives, 15% (n = 51/338) were Xpert negative. Seeking care in the private sector was associated with higher risk of RR-TB (OR:1.85; 95% CI:0.87-3.9).

CONCLUSION

Prevalence of RR-TB is generally high in patients suspected of MDR-TB in the hilly districts of Himachal Pradesh. High prevalence during early phase of treatment can suggest primary transmission of DR-TB. Universal drug susceptibility testing and innovative case finding strategies will benefit patients living in mountain districts with inadequate access to healthcare. The high proportion of sputum-smear positive but Xpert negative cases may be due to non-tubercular mycobacterial disease.

Epidemiology and genetic diversity of group A rotavirus in acute diarrhea patients in pre-vaccination era in Himachal Pradesh, India

Acute gastroenteritis due to Group A rotaviruses remains the leading cause of mortality and morbidity in children in developing countries. India introduced its indigenous rotavirus vaccine Rotavac® in 2016 and Himachal Pradesh (HP) the first state to launch it. The present study aimed to evaluate rotavirus strain diversity associated with AGE prior to vaccine introduction in HP. A total of 331 fecal specimens collected from diarrheic children hospitalized at RPGMC Tanda, HP between July-2014 and June-2016 were screened for RVA by EIA. Rotavirus RNA was extracted by TRIZOL method and analyzed by RNA-PAGE. G/P typing was performed using semi-nested multiplex reverse transcriptase PCR. Rotavirus was detected in 45% (n = 149/331) of diarrheic children, with highest rate observed in the 6-11 months age group (47%). Vomiting was found more frequently associated with RV-infection. Among G-types, G12 was found most prevalent (33.1%) followed by G1 (28.4%), G9 (12.2%), G2 (9.5%), G3 (3.4%) and G10 (2.7%). G4 (0.7%) strains were rarely detected. Among P-types, P[6] was the most prevalent (40.5%) followed by P[8] (29.1%) and P[4] (14.2%). Of note, genotypes G3 and P[11] were detected for the first time in HP. Among G/P combinations, G12P[6] was most prevalent (30.4%) followed by G1P[8] (20.3%), G2P[4] (4.7%), G1P[6] (3.4%) and G3P[8] (2.7%). Interestingly, our study observed high percentage of unusual strains (14.2%) namely G9P[4], G2P[6], G2P[8], G12P[4] and G1P[11]. The regionally common strains G3P[6], G4P[6], G9P[6], G9P[8], G10P[6], G10P[8] and G12P[8] strains were very rarely detected. Of interest, RNA migration pattern of G1P[8] was DS-1 like and genomic heterogeneity was observed within G12P[4] strains with both long and short electropherotypes. Our study highlights rich genetic diversity with emergence of rare rotavirus strains circulating in HP and provides baseline data prior to Rotavac® introduction that will help to gauge the impact of the Rotavac® vaccine in HP.

Drivers of land use/cover change and its impact on Pong Dam wetland

Population growth, urbanization, and changing land use/cover practices are responsible for the loss of ecosystem services of wetlands around the world. The present study investigated wetland degradation that occurred in the Western Himalaya, Himachal Pradesh, India. The land use/cover change maps between 2001 and 2016 derived from remotely sensed imagery showed that the Pong Dam wetland is severely affected due to anthropogenic pressure posing risks of habitat destruction within its catchment area. The agriculture area increased by 159% and barren land decreased by 53% between 2001 and 2016. It indicates the rapid conversion of unused or scrub land for agriculture purpose in the area. The rate of sedimentation in the wetland is around 24.4 M.cum/year, and the survival age of the wetland is about 100 years. This rate is likely to increase in the near future due to large-scale unregulated development in the area. To reduce further destruction in this wetland, agricultural practices should be minimized in the area, and agroforestry practices should be encouraged to maintain the health and ecology of the wetland.

Coinfections as an aetiology of acute undifferentiated febrile illness among adult patients in the sub-Himalayan region of north India

Background & objectives

In India, certain geographic regions witness simultaneous outbreaks of two or more diseases like scrub typhus, dengue fever, malaria, leptospirosis and chikungunya during monsoon and post-monsoon period, sharing common indication of acute febrile illness. The objective of the present study was to assess the prevalence of coinfections among patients with acute undifferentiated fevers (AUF) admitted in a tertiary care hospital in the northern hilly state of Himachal Pradesh, India.

Methods

This was a hospital based open cohort study conducted over a period of two months (September and October) in 2016. All the patients above the age of 18 yr admitted in medical wards and fulfilling the definition of AUF were included. The patients diagnosed with dual infections were the subjects of the study. Standard guidelines were used for case definitions of scrub typhus, dengue, chikungunya, malaria and leptospirosis.

Results

Dual infections were noted in 16 patients admitted with AUF. The most common coinfection was scrub typhus and dengue, reported in 10 patients. Scrub typhus and leptospirosis coinfection was observed in three patients. Dengue and chikungunya was observed in one patient. Scrub typhus, dengue and vivax malaria was detected in one patient. Scrub typhus and vivax malaria was detected in one patient. Out of the 10 cases positive for both scrub and dengue, four had no history of travel outside Himachal Pradesh. All three cases positive for both scrub and leptospirosis were indigenous without any history of travel outside Kangra, Himachal Pradesh. The outcome of all the patients was with full recovery.

Interpretation & conclusion

The study established the presence of coinfections (mainly dengue fever and leptospirosis) as a cause of AUF in the study area, which is a nonendemic region. The role of easily available and widely performed serological tests in the aetiological diagnosis of AUF is significant. Studies are required to determine the normal titres in the local population before using the imported commercially available serological tests in the diagnosis of AUF.

Occupational Health Hazard Exposure among municipal solid waste workers in Himachal Pradesh, India

The net volume of Municipal Solid Waste (MSW) generated in Himachal Pradesh is 350 tons per day (TPD) with an annual growth rate varying between 1 and 1.33%. This leads to serious considerations regarding potential occupational health hazards of workers associated with MSW. The study generated from non-engineered landfill sites was carried out at three locations- Shimla, Solan, and Mandi in Himachal Pradesh, India. . The main aim of this study was to determine existing occupational hazards in relation to MSW management at these locations, to coordinate with the different municipalities and suggest suitable remedial measures for our study locations. In particular, the exposure assessment to the work force comprising of street sweeping, waste collection, waste processing, and rag picking were assessed using an interview scheduling technique. A questionnaire survey was carried out on these workers with the questions asked related to their work culture, socio-economic conditions, general awareness of occupational health risks and related occupational health hazards associated with the work being performed by them. The results showed that the workforce mainly comprised of males with a low percentage of literacy rates. The age distribution showed that majority of waste collectors and street sweepers were above 30 years of age (67%) and that the rag pickers in Mandi town were below 20 years of age. Income variation between casual and regular workers was highly significant with regular workers (INR 600-1200; USD 9-18) getting almost six times the payment of the casual workers (INR 100-200; USD 3-7.5). From the studies conducted the study deduced that about 64% of waste collectors, 80% of street sweepers and 10% of rag pickers in Solan and about 6.67% street sweepers, 57.47% waste collectors and 100% of rag pickers in Mandi were not provided with any protective equipment. Interestingly, in the capital city of Shimla a small fraction of the street sweepers (28%) and waste collector (6%) confirmed that they were given protective equipment twice in a year. The lack of provisions of protective equipment along with the ignorance of the workers results in occupational health hazards due to different types of external injuries. The major occupational health issues reported by various categories of waste workers were muscle and ligament sprain, cuts and lacerations and different allergies varying between 1.97 and 66.67% [ for e.g. in Solan it varies from 32.47-66.67%; Shimla 1.97-10.16% and in Mandi 9.52-16.67%], 6.36-67.95% and 5.77-42.86%, respectively. From this study, it was observed that such workers are ill-protected against such occupational health hazards new laws and policies are needed to be introduced for their protection.

Prevalence of Pediatric Metabolic Syndrome and Associated Risk Factors among School-Age Children of 10-16 Years Living in District Shimla, Himachal Pradesh, India

INTRODUCTION

Recently, an increasing trend in the prevalence of pediatric metabolic syndrome (PMS) among school-age children has been documented in different parts of India. There is lack of data on the prevalence of PMS and its associated risk factors among school-age children living in district Shimla, Himachal Pradesh. Hence, to fill in the gap in the existing knowledge, the present study was conducted.

METHODOLOGY

A cross-sectional study was conducted during 2015-2016. Thirty clusters (schools) were identified from a list of all schools using population proportionate to size sampling methodology. From each school, 70 children in the age group of 10-16 years were selected. Data was collected on the sociodemographic characteristics, anthropometry, waist circumference, blood pressure, and physical activity. Fasting venous blood samples were collected for estimation of blood glucose, triglycerides, and high-density lipoprotein levels.

RESULTS

The prevalence of PMS using International Diabetes Federation classification was 3.3% and using modified-adult treatment panel classification criteria was 3.5%. Risk factors identified to be associated with PMS among school-age children were (i) male gender, (ii) high family monthly income, (iii) sedentary lifestyle, (iv) consumption of evening snack, (v) television/computer viewing, and (vi) motorized transportation for commuting to school.

CONCLUSION

The PMS prevalence was 3.3% in school-age children residing in District Shimla. There is a need to formulate interventions to prevent and correct metabolic syndrome among them for reducing early onset of cardiovascular disease during adulthood.

Validity of Madras Diabetes Research Foundation: Indian Diabetes Risk Score for Screening of Diabetes Mellitus among Adult Population of Urban Field Practice Area, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

INTRODUCTION

IDRS is based on four simple parameters derived from known risk factors for diabetes; two modifiable risk factors (waist circumference and physical inactivity) and two non-modifiable risk factors (age and family history of diabetes), which may be amenable to intervention. The present study has been planned as the region specific validation is important before it can be used for screening in this part of the country.

AIMS

The aim of the present study was to validate MDRF-IDRS for screening of diabetes mellitus among adult population of urban field practice area, IGMC, Shimla, Himachal Pradesh, India.

METHODS

The present community based cross sectional study was conducted among 417 adults fulfilling the eligibility criteria using a two stage sampling design.

RESULTS

In the present study IDRS value ≥70 had an optimum sensitivity of 61.33% and specificity of 56.14% for detecting undiagnosed type 2 diabetes in the community. At an IDRS score of ≥70, the PPV was 23.47%, NPV as 86.88%, the diagnostic accuracy as 57.07%, LR for positive test as 1.398, LR for negative test as 0.69 and Youden's index as 0.17. However Youden's index was 0.19 at a cut of ≥60 i.e. higher than what was at ≥70. Higher IDRS scores increased the specificity but the sensitivity dramatically decreased. Conversely, lower IDRS values increased the sensitivity but the specificity drastically decreased. Area under the curve = 0.630 and a P value < 0.001.

CONCLUSIONS

MDRF IDRS is user friendly screening tool but the criteria of including the parameter of physical activity for the calculation of the risk score needs to be clearly defined. In the present study the maximum sensitivity of 100% was seen at a cut off of ≥30. Hence we would recommend that all those in the medium and high risk group should be screened for type 2 Diabetes.

Data in support of poisoning related mortalities from southern Himachal Pradesh

Poisoning has always been pointed as one of the leading causes of human death throughout the world. Despite the best efforts made by many research institutes, the worldwide true figure on mortalities with poisoning could never be achieved due to many reasons. One of the main reasons is the unavailability of complete database from the rural and catchment areas of the world where these types of incidents are usual. People can be made aware about this problem by presenting data articles on regular basis, therefore to mark a resource document these data should be regularly up-dated. The current data report is a briefing of types and trends of chemical poisoning amongst human in southern hilly region of Himachal Pradesh (HP), India. This research database is an outcome of five year retrospective study based on assessment of records pertaining human deaths associated with poisoning occurred in southern Himachal Pradesh, and reported at State Forensic Science Laboratory (SFSL), Junga during 2010-14. Cases where ethyl alcohol was detected have been put under exclusion criterion. All the cases were reviewed and summarized in terms of yearly and monthly frequency of reports wrapping important information portraying the involvement of gender, age, locality, types of poison, and mode of death in the poisoning incidents. Review of these scientific reports showed some notable figures having a direct concern with public and legal domains to promote risk reduction and prevention of chemical poisonings.

Isolation and characterization of lactic acid bacteria from traditional pickles of Himachal Pradesh, India

A total of 15 isolates of lactic acid bacteria (LAB) were isolated from traditional pickles of rural and urban areas of Himachal Pradesh. These isolates were identified as Enterococcus faecalis (7), Lactobacillus plantarum (3), Pediococcus pentosaceus (2), Leuconostoc mesenteroides (1), Lactococcus lactis (1) and Enterococcus sp. (1) on the basis of morphological, biochemical and 16S rDNA sequence analysis. All the LABs produced exopolysaccharides, have antibiotic susceptibility, and possess activity of β-galactosidase, β-glucosidase, protease and amylase, while none of the isolates showed haemolytic activity. Out of 15 isolates tested, only 6 isolates showed the phytase activity. These LAB exhibited antimicrobial activity against food borne pathogenic bacteria i.e. Bacillus cereus, Escherichia coli, Staphylococcus aureus and Shigella dysenteriae. These results suggested that LAB isolates from traditional pickles of Himachal Pradesh have very good potential to be used as probiotics.

Prevalence of Vitamin D deficiency and associated risk factors among children residing at high altitude in Shimla district, Himachal Pradesh, India

INTRODUCTION

Vitamin D is important for bone development in children. A high prevalence of Vitamin D deficiency (VDD) has been documented from different parts of India. However, limited data are available on VDD among children residing at high altitude region of country.

OBJECTIVES

To assess the prevalence of VDD and associated risk factors among children in the age group of 6-18 years in Shimla, Himachal Pradesh.

METHODS

A community-based cross-sectional study was conducted in the year 2014-2015. A total of 626 children in the age group of 6-18 years were enrolled from 30 clusters which were identified using population proportionate to size sampling method. A minimum of 20 children in the age group of 6-18 years per cluster were selected using random number tables. The data on socioeconomic status, physical activity, sunlight exposure, and biochemical parameters of bone and mineral metabolism were assessed.

RESULTS

Ninety-three percent of school-age children were found Vitamin D deficient as per serum 25(OH) D levels of <20 ng/ml. The prevalence was significantly higher among females.

CONCLUSION

A high prevalence of VDD was found in children residing in high altitude region.

In vitro study of probiotic properties of Lactobacillus plantarum F22 isolated from chhang - A traditional fermented beverage of Himachal Pradesh, India

Present study was carried out to evaluate a new bacterial strain, Lactobacillus plantarum F22 as probiotic strain. L. plantarum F22 was isolated from a traditional inoculum called ‘Phab’ which is used for the preparation of a traditional beverage chhang of Lahaul and Spiti of Himachal Pradesh. The isolate was identified by conventional and molecular techniques and tested for different probiotic properties. The 16S rRNA sequence of the isolate was registered in National Centre for Biotechnology Information (NCBI) under accession number KT865223. Further, L. plantarum F22 was evaluated for its probiotic potential viz., autoaggregation capacity, hydrophobicity, acidity tolerance, antibiotic susceptibility and cumulative probiotic potential and was found to possess good probiotic potential with a cumulative probiotic score of 91.7%. L. plantarum F22 has been proved to be highly effective, therefore can be recommended for the development of new pharmaceuticals and functional food preparations.

Neurological manifestations of scrub typhus in adults

In order to study the neurological manifestations in adult patients suffering from scrub typhus, 323 patients aged over 18 years, admitted with a positive diagnosis, were screened for neurological dysfunction; 37 patients with symptoms and/or signs suggestive of neurological dysfunction were included in the study. Of these, 31 (84%) patients had altered sensorium, four (11%) had cerebellitis, one (2%) patient had acute transverse myelitis and one (2%) had bilateral papilloedema without focal neurological deficit. Of the 31 patients with altered sensorium, 15 (40%) had meningoencephalitis, three (8%) had seizures, two (5%) had cerebral haemorrhages, one (2%) had a presentation likened to neuroleptic malignant syndrome (NMS) and one (2%) had a 6th nerve palsy with inflammation of the right cavernous sinus. Cerebrospinal fluid (CSF) analysis was abnormal in 23 patients (raised lymphocytes in 68%, raised protein in 80%). All patients improved with anti-rickettsial therapy.

Utilization of Services Under Janani Shishu Suraksha Karyakram for Institutional Deliveries in the Public Sector Facilities, Sirmaur District, Himachal Pradesh, India

Background:

Janani Shishu Suraksha Karyakram (JSSK) was initiated in 2011 to reduce the out of pocket expenditure for pregnant women. We estimated the proportion of mothers who received JSSK benefits and out of pocket expenditure (OOP) if any in Sirmaur, Himachal Pradesh.

Materials and Methods:

We did cross sectional survey in public sector facilities among 156 consecutive mothers using structured questionnaire. We computed the proportion of mother who received the benefits and the median OOP expenditure.

Results:

Among 156 mothers surveyed, 93 (60%) received the full benefits during hospital stay and 29 (19%) received full transport benefits. Free diagnostics and drugs were given to 149 (96%) and 134 (86%) respectively. Overall, 63 (40%) had median OOP Rs 210 during hospitalization and 127 (81%) had median OOP of Rs 420 during transport.

Conclusion:

JSSK benefitted the mothers utilizing the public sector facilities however drugs, consumables and transport contributed to the OOP expenditure.

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.

Knowledge, attitude, and perception of disease among persons living with human immunodeficiency virus/acquired immuno deficiency syndrome: A study from a tertiary care center in North India

Background:

Although modification of behavioral practices among human immunodeficiency virus (HIV)-affected patients is important in decreasing HIV disease transmission, the knowledge, attitude, and perception studies about HIV infection rarely include persons living with HIV/acquired immuno deficiency syndrome (AIDS).

Aims:

To assess knowledge, attitude, and perceptions of persons living with HIV/AIDS for the disease and other epidemiological aspects.

Materials and Methods:

One-hundred and fifty consecutive persons living with HIV/AIDS were enrolled for this questionnaire-based cross-sectional, descriptive study.

Results:

These 150 patients comprised 93 men and 57 women, aged between 14 and 78 (mean 37.13) years. The majority, 112 (74.67%) patients were between 20 and 50 years of age and 116 (77.3%) patients were either illiterate or high-school dropouts. Drivers, laborers, and self-employed comprised 69 (74.2%) patients among affected males. Only 129 (86%) respondents had heard about HIV/AIDS and knew about its heterosexual transmission. Ninety-eight (65.3%) respondents were aware of disease transmission from infected blood or needle pricks. Interestingly, 106 (70.7%) respondents were aware of the importance of using condom in preventing disease transmission. Television/radio was the most common sources of information for 135 (90%) patients. Nearly, 69% respondents disfavored disclosing their disease to friends/colleagues fearing stigmatization.

Conclusions:

Information, education, and communication activities are imperative to educate persons living with HIV/AIDS about life-long nature of the disease, modes of its transmission, and significance of preventive measures to bridge the gaps in their knowledge. While improvement in individual economic status, education, and health services remains highly desirable, mass media can play a pivotal role in creating awareness among masses.

Knowledge, attitude, and perception of disease among persons living with human immunodeficiency virus/acquired immuno deficiency syndrome: A study from a tertiary care center in North India

BACKGROUND

Although modification of behavioral practices among human immunodeficiency virus (HIV)-affected patients is important in decreasing HIV disease transmission, the knowledge, attitude, and perception studies about HIV infection rarely include persons living with HIV/acquired immuno deficiency syndrome (AIDS).

AIMS

To assess knowledge, attitude, and perceptions of persons living with HIV/AIDS for the disease and other epidemiological aspects.

MATERIALS AND METHODS

One-hundred and fifty consecutive persons living with HIV/AIDS were enrolled for this questionnaire-based cross-sectional, descriptive study.

RESULTS

These 150 patients comprised 93 men and 57 women, aged between 14 and 78 (mean 37.13) years. The majority, 112 (74.67%) patients were between 20 and 50 years of age and 116 (77.3%) patients were either illiterate or high-school dropouts. Drivers, laborers, and self-employed comprised 69 (74.2%) patients among affected males. Only 129 (86%) respondents had heard about HIV/AIDS and knew about its heterosexual transmission. Ninety-eight (65.3%) respondents were aware of disease transmission from infected blood or needle pricks. Interestingly, 106 (70.7%) respondents were aware of the importance of using condom in preventing disease transmission. Television/radio was the most common sources of information for 135 (90%) patients. Nearly, 69% respondents disfavored disclosing their disease to friends/colleagues fearing stigmatization.

CONCLUSIONS

Information, education, and communication activities are imperative to educate persons living with HIV/AIDS about life-long nature of the disease, modes of its transmission, and significance of preventive measures to bridge the gaps in their knowledge. While improvement in individual economic status, education, and health services remains highly desirable, mass media can play a pivotal role in creating awareness among masses.

Iodine nutritional status in Himachal Pradesh state, India

INTRODUCTION

Iodine deficiency (ID) is the preventable causes of mental retardation worldwide. Himachal Pradesh (HP) state is a known endemic region to ID.

OBJECTIVE

the objective was to assess the current status of iodine nutrition in a population of HP, India.

METHODOLOGY

There are three regions in HP namely: Kangra, Mandi, and Shimla. In each region, one district was selected namely: Kangra, Kullu, and Solan. In each district, 30 clusters were identified by utilizing population proportional-to-size cluster sampling methodology. A total of 5748 school-age children (SAC) (Kangra; 1864, Kullu; 1986, Solan: 1898), 1711 pregnant mothers (PMs) (Kangra; 647, Kullu; 551, Solan: 513), and 1934 neonates (Kangra; 613, Kullu; 638, Solan: 683), were included in study. Clinical examination of thyroid of each child and PM was conducted. Casual urine samples were collected from children and PMs. Cord blood samples were collected for estimation of thyroid stimulating hormone (TSH) among neonates.

RESULTS

In SAC, total goiter rate (TGR) was 15.8% (Kangra), 23.4% (Kullu), and 15.4% (Solan). Median urinary iodine concentration (UIC) level was 200 μg/l (Kangra), 175 μg/l (Kullu), and 62.5 μg/l (Solan). In PMs, TGR was 42.2% (Kangra), 42.0% (Kullu), and 19.9% (Solan). Median UIC level was 200 μg/l (Kangra), 149 μg/l (Kullu), and 130 μg/l (Solan). In Neonates, TSH levels of > 5 mIU/L were found in 73.4 (Kangra), 79.8 (Kullu), and 63.2 (Solan) percent of neonates.

CONCLUSION

As per, UIC level (<100 μg/l) in SAC, ID was found in district Solan. In Kullu and Solan districts, there were ID (UIC level < 150 μg/l) among PMs. TSH levels indicated ID in all districts surveyed.

Scrub typhus with visual hallucinations

The occurrence of psychiatric symptoms in scrub typhus is not commonly reported in literature. We present a case of scrub typhus with visual hallucinations.

Iodine nutrition status amongst neonates in Kangra district, Himachal Pradesh

Iodine deficiency (ID) is an endemic health problem in Kangra district, Himachal Pradesh (HP) state. ID leads to mental retardation, deaf mutism, squint, dwarfism, spastic diplegia, neurological defects and congenital anomalies. Iodine nutrition status amongst neonates can be assessed by estimating thyroid stimulating hormone (TSH). The present study was conducted with an objective to assess the iodine nutrition status amongst Neonates in Kangra district, HP. All of the hospitals in the district which provide obstetric services were enlisted, of which three were selected for this survey. A total of 613 umbilical cord blood samples of neonates were collected on filter paper and analyzed for TSH. WHO (2007) reported that that a <3% frequency of TSH concentrations above 5 mIU/L in samples collected 3-4 days after birth indicates iodine sufficiency in a population. In our study we found that 73.4% of the neonates had TSH levels of more than 5 mlU/l, thus indicating ID in the population studied. Iodine deficiency continues to be a public health problem in Kangra district, Himachal Pradesh.

"Freezing" parasites in pre-Himalayan region, Himachal Pradesh: Experience with mini-FLOTAC

BACKGROUND

Helminths and protozoa infections pose a great burden especially in developing, countries, due to morbidity caused both by acute and chronic infections. Data on distribution of intestinal parasitic infections among the native and expatriates populations in Himachal Pradesh are scarce. The aim of our survey was to analyze the intestinal parasitic burden in communities from Dharamsala, Kangra district, in clinical and public health settings. We also field-tested the mini- FLOTAC, an innovative diagnostic device.

METHODS

Subjects referring to the Tibetan Delek Hospital for abdominal discomfort and all children of the Tibetan Primary School in Dharamsala were screened for intestinal parasitic infections with direct smear, formol-ether concentration (FEC) method and mini-FLOTAC, their clinical history was recorded, and correlations between clinical symptoms and infections analyzed.

RESULTS

152 subjects were screened for intestinal parasites, of which 72 subjects in the outpatients department (OPD) (36 expatriates and 36 natives) and 80 in the school. 60% of schoolchildren and 57% of OPD patients were found positive for any infection, the most represented were protozoa infections (50%), whereas helminthic infections accounted only for 13% and 20% in OPD patients and schoolchildren, respectively. The most prevalent among helminths was Ascaris lumbricoides (11%). Giardia intestinalis was more present among schoolchildren than the OPD patients (20% vs 6%) and E. histolytica/dispar was more prevalent among the OPD patients (42%) than the school children (23%). Correlations were found between nausea and loose or watery stools and parasitic infections, particularly in expatriates, whereas schoolchildren, despite being as infected as adults, were completely asymptomatic. Mini-FLOTAC detected higher number of helminth infections whereas FEC method was more accurate for the diagnosis of protozoa.

CONCLUSIONS

This study presents an accurate snapshot of intestinal parasitic infections in Dharamsala, and their high prevalence calls for more awareness and control measures. Mini-FLOTAC is a promising and simple technique for the diagnosis of helminth infections.

Slowly rising hilly young population of himachal: a step towards stabilization

BACKGROUND

Socioeconomic development is the best contraceptive. Himachal Pradesh has made developments in all the fields, especially reducing the size of the family via family planning program.

AIM

The objectives of this analysis are to describe the various methods of family planning used from 2003 to 2010 and their impact in averting the births in the state and in stabilizing the population.

MATERIALS AND METHODS

We collected secondary data of the family planning program and the various methods employed from the total population (Census 2011) covered under family planning program (FPP) of the state. We analyzed and compared the results with India. We measured the impact of the program due to FP methods adopted. We employed the standardized program indicators- total fertility rate, birth rate, death rate, growth rate and census trend towards population growth; fertility rate (in %), birth rate and death rate (per thousand of the population per year) from 3.8, 31.5 and 11.1 in 1981 to 1.9, 17.2 and 7.2 in 2009. We entered dataset by double data entry technique and analyzed descriptively using Epi info version 3.3.2 and stat calc software.

RESULTS

The state has the population of 6,856,509, sex ratio in age 0-6 years is 906/1000 males. The unmet need for family planning services is 15%. The impact of family planning program has resulted in averting of 3,387,744 of pregnancies from 2003 to 2010. The total fertility rate (TFR) has come down to 1.9 in 2008 from 3.8 children per woman in 1981. The death rate has declined from 11.1 per 1000 live births in 1981 to 7.2 per 1000 live births in 2009. The trend in decadal growth rate of the state is observable as 23.0% in 1971 while in 2011, it is 12.8%; more towards young population and for geriatric one as well but not exploding like India.

CONCLUSION

Total population is on the increase with reference to the population of reproductive age bracket (15-49 years) and also geriatric population above 60 steadily despite good social and health indicators. Bulging reproductive age group with mild upward shift of the geriatric population is the root cause for increasing population in hills of Himachal Pradesh.

Characterization of bhatooru, a traditional fermented food of Himachal Pradesh: microbiological and biochemical aspects

A number of traditional fermented products are prepared and consumed in Himachal and the types of traditional fermented products of Himachal are unique and different from other areas. Bhatooru is an indigenous leavened bread or roti and constitutes the staple diet of rural population of Himachal. The microbiological analysis of the inoculums (malera) revealed that it composed of a consortium of microorganisms. Population of Lactobacillus, Leuconostoc and Saccharomyces cerevisiae increased from 4.77 to 8.0 log cfu/g of dry matter in 10 h of fermentation. The amount of total proteins increased from 13.6 to 18.4 % (w/w). The total sugars during fermentation decreased from 74.1 to 50.1 % (w/w) on dry weight basis. However, the reducing sugar level of the fermenting samples increased significantly from 7.8 to 16.5 mg/g dry matter in the first 4 h and thereafter, it gradually decreased to 10.0 mg/g dry matter. Similarly starch content decreased from 70.2 to 48.3 % (w/w) on dry weight basis by 10 h of fermentation. In fermented samples protease activity increased from 0.48 U/g dry matter to 11.5 U/g in 6 h and then decreased to 3.21 U/g on dry weight basis at 10 h. Amylase activity initially increased from 65.0 to 79.4 U to 6 h and then declined to 69.9 U/g of dry matter. Fermentation in bhatooru significantly enhanced the B vitamin levels especially thiamine, riboflavin and nicotinic acid and essential amino acids viz methionine, phenylalanine, threonine, lysine and leucine.

New geochronological constraints on the thermal and exhumation history of the Lesser and Higher Himalayan Crystalline Units in the Kullu-Kinnaur area of Himachal Pradesh (India)

New geochronological, petrological and structural data from the Beas-Sutlej area of Himachal Pradesh (India) are used to reconstruct the tectonothermal and exhumation history of this part of the Himalayan orogen. Sm-Nd garnet ages at 40.5 ± 1.3 Ma obtained on a pegmatoid from the inverse metamorphic High Himalayan Crystalline (HHC) in the Malana-Parbati area probably mark local melting during initial decompression. Ongoing exhumation in ductilely deformed leuco-gneiss is constrained by Sm-Nd garnet ages at 29 ± 1 Ma and white mica Rb-Sr ages around 24-20 Ma, while Bt Rb-Sr ages indicate a drop of regional metamorphic temperatures below 300 °C between 15 and 12 Ma. The deep Sutlej gorge exposes medium-grade paragneisses and Proterozoic orthogneisses of the Lesser Himalayan Crystalline (LHC), overthrust by the HHC along the Main Central Thrust (MCT). Mica cooling ages in the HHC are in the range of 14-11 Ma. Above the extruded wedge of the HHC, the Leo Pargil leucogranite and associated dykes intrude the Haimanta Unit (HU) below the weakly metamorphic Palaeo-Mesozoic sediments of the Tethyan Himalayas (TH). The Leo Pargil leucogranite yielded a mean Sm-Nd garnet age of 19 ± 1 Ma and Rb-Sr muscovite and biotite cooling ages between 16.4 and 11.6 Ma. Marked young extrusion of LHC units resulted in differentiated exhumation/cooling of more frontal parts of the orogen. Very young ductile deformation of LHC gneisses near Wangtu is constrained by late-kinematic pegmatite intrusions crosscutting the main mylonitic foliation. Sm-Nd garnet and Rb-Sr muscovite ages of these pegmatites range between 7.9 ± 0.9 and 5.5 ± 0.1 Ma. Published apatite FT ages down to 0.6 Ma also document accelerated diachronous sub-recent exhumation of different parts of the orogen. Together with geochronological data from the literature, the new results demonstrate that the HHC and the HU were deformed by shortening and crustal thickening during the Eohimalayan phase (Late Eocene-Oligocene), followed by a strong thermal overprint and intrusions of granitoids during the Neohimalayan Phase (Early to Middle Miocene). The LHC experienced amphibolite facies metamorphic conditions in the Late Miocene prior to extrusion between the HHC and the very low-grade Lesser Himalayan sediments. In conjunction with climate changes, young tectonic activity in this central part of the Himalayan orogen may have strongly influenced fluvial incision and erosion, and therefore, contributed to the accelerated uplift, as indicated by extensive accumulation of Late Miocene to Early Pleistocene fluviatile-lacustrine sediments in the Zanda basin, the Transhimalayan headwaters of the Sutlej, in Western Tibet.

The pattern of hydatid disease-a retrospective study from himachal pradesh, India

Hydatid disease is a common but little studied disease in Himachal Pradesh, India. This is a retrospective study from the Lady Willingdon Hospital, Manali. 115 patients presenting from April 1996 to March 2007 were included. Outcome measures were mortality and morbidity. 70 patients were female and 46 were male. (One female patient was operated on twice). 78% (n = 90) of the occurrences were hepatic. There were other varied sites. There were fourteen pulmonary hydatids. All patients underwent surgical cystectomy. An "AIR Technique" (Aspiration, Injection, Reaspiration) is described for scolicidal deactivation after March 2003 utilized in thirty two patients. There was no mortality. There were five documented recurrences in our series all of which occurred in cystectomy done without the AIR (Aspiration, Injection, Reaspiration) technique. Hydatid disease is a common disease in Himachal Pradesh warranting a high index of suspicion leading to an early diagnosis. A simple technique called the "AIR TECHNIQUE" (Aspiration, Injection, Reaspiration) is described.

Outbreak of gastroenteritis in tibetan transit school, dharamshala, himachal pradesh, India, 2006

Background:

On 28^th June, 2006, 55 cases of the gastroenteritis were reported among the hostellers of the Tibetan Transit School, Dharamshala. We investigated the outbreak to identify the source, propose control and preventive measures.

Materials and Methods:

We defined a case of the gastroenteritis as the occurrence of more than three smelly loose motions between 28^th June to 2^nd July, 2006 among some sections of the resident hostellers. We determined age and sex specific attack rate. We hypothesized it as a food borne beef meat outbreak. We conducted the case control study and collected the information about the food items consumed inside and outside the hostel at dinner using the standardized questionnaire. We calculated floor wise incidences of four hostels, odds ratios and attributable fractions. We interviewed food handlers. We lifted the seven rectal stool, four water and three samples from floor, kitchen and meat chopper room for culture and sensitivity.

Results:

116 cases patients of 802 hostellers met the case definition. The maximum attack rate (16%) was in the youngest group (15-20yrs) and nil in staff and 31-40 years age group with 5 overall attack rate as 14%. Sex specific attack rate was more (18%) in females. The floor wise incidences of the case patients were the highest in 2nd and 3rd floors, occupied by the youngest group. The median age was 20 yrs (Range 17-40 yrs). The most common symptoms were watery diarrhea (71/116, 61%) and bloody diarrhea-(45/116, 39%); abdominal pains-(87/116, 75%). Of the six food/water items examined, the food specific attack rate was highly statistically significant in the beef meat eaters (82% with PAF 71%), and Odds Ratio 19.19 (95% C.I. as 9.3-140). The food handlers & their cooking conditions in the kitchen were unhygienic. The food was not available for testing. Escherichia coli were detected in the samples from rectal stools, kitchen and meat chopper room. No fatality was reported.

Conclusion/Recommendation:

The beef meat purchased from outside was implicated for the explosive common source outbreak. The school authorities were counseled for hygienic food handling.