Clinicomycological and Histopathological Profile of Onychomycosis: A Cross-sectional Study from South India.

BACKGROUND: Onychomycosis (OM) is a fungal infection of the finger or toenails caused by dermatophytes, yeasts, or nondermatophyte molds (NDMs) and can involve any component of the nail unit. OM, apart from being asymptomatic, is a chronic disease and warrants long-term treatment. AIMS: The aim was to study the clinicoepidemiological features of OM and to evaluate the mycological and histopathological features among patients attending the dermatology outpatient department. SUBJECTS AND METHODS: A cross-sectional hospital-based study was performed in 500 patients with symptoms related to the nails and nail folds. OM was confirmed in 284 patients by potassium hydroxide (KOH) mount, fungal culture, or biopsy. Descriptive analysis of the data was undertaken. RESULTS: The study included 284 confirmed cases of OM of which 117 (41.1%) were positive for fungal elements by KOH mount, 168 (59.1%) samples showed positivity in fungal culture, and 62 (21.8%) samples had positive nail biopsy results. Distolateral subungual OM was the most common clinical type (47.6%). Among the fungal isolates, a predominance of dermatophytes was observed followed by yeasts and NDMs. The most common dermatophytic fungal isolate in the culture was Trichophyton rubrum (45%). CONCLUSION: Our study implies the importance of laboratory diagnosis of OM as it can mimic diverse nail disorders. As the role of NDMs and yeasts is on the rise for etiology of OM, investigations such as KOH examination, culture, or nail biopsy becomes essential for correct diagnosis and management.

Onychoscopic evaluation of onychomycosis in a tertiary care teaching hospital: a cross-sectional study from South India.

BACKGROUND: Onychoscopy is the dermoscopic evaluation of nail and associated structures. It is useful in identifying the various onychoscopic patterns which act as a link between naked eye examination and nail histopathology and may help in avoiding nail biopsy in unnecessary cases. OBJECTIVES: To evaluate the onychoscopic patterns in confirmed cases of onychomycosis. METHODS: An observational, prospective, cross-sectional study was performed in 500 patients with symptoms related to the nails and nail folds. Onychomycosis was confirmed in 234 patients by KOH mount/fungal culture/biopsy. These patients underwent dermoscopy with a handheld 20× polarized contact dermoscope (Heine's delta 20 T). The dermoscopic patterns were identified, and their correlation with the clinical subtype of onychomycosis was analyzed. RESULTS: The study included 234 confirmed cases of onychomycosis. The common dermoscopic patterns observed were spikes (43.16%), jagged (29.9%), longitudinal striae (49.1%), linear edge (3.4%), and distal irregular termination (34.6%). The statistically significant findings of distal and lateral subungual onychomycosis (DLSO) were longitudinal striae, spikes, and jagged patterns. The new patterns observed in our study are bluish streaks and globules (8.9%) and bluish gray globules (7.6%) in cases of DLSO which were not statistically significant. CONCLUSION: Onychoscopy, being handy, inexpensive, and noninvasive, has the potential to reduce the invasive procedures. Statistically significant patterns in DLSO and total dystrophic onychomycosis (TDO) are described in our study. Few new patterns have been described whose significance has to be tested by conducting larger sample size studies.

Itolizumab - a humanized anti-CD6 monoclonal antibody with a better side effects profile for the treatment of psoriasis.

Management of psoriasis is a challenge to the treating physician. The chronic inflammatory state of psoriasis with exacerbations and remissions necessitate "on-and-off" treatment schedules. The safety profiles of drugs and tolerability issues for patients are important factors to be considered during treatment. Various biological agents targeting T-cells and the inflammatory cytokines are available for systemic treatment of psoriasis. However, major causes of concern while using these drugs are risk of susceptibility to infection and development of anti-drug antibodies, which will affect the pharmacokinetic properties, efficacy, and safety profile of the drug. Itolizumab, a humanized anti-CD6 monoclonal antibody, is a new molecule that acts by immunomodulating the CD6 molecule. CD6 is a co-stimulatory molecule required for optimal T-cell stimulation by the antigen-presenting cells. This step is crucial in T-cell proliferation to form Th1 and Th17 cells, which play a major role in the pathogenesis of psoriasis. This article deals with the properties of Itolizumab and its role in the treatment of psoriasis. Based on the available published data, Itolizumab seems to have a better adverse effects profile and at the same time comparatively less efficacy when compared to other biological agents available for treating psoriasis. Larger studies with longer duration are required to clearly depict the long-term side effects profile.

Fine needle aspiration cytology as an aid to diagnosis, categorization and treatment when pure neuritic leprosy presents as nerve abscess.

BACKGROUND: Pure neuritic leprosy (PNL) usually presents with neurological symptoms without skin involvement. Fine needle aspiration can play an important role in the management of PNL cases presenting as nerve abscesses. AIM: To assess the role of fine needle aspiration cytology (FNAC) in diagnosing and categorizing PNL cases presenting as nerve abscesses in the absence of neurological symptoms. MATERIALS AND METHODS: Five patients with subcutaneous nerve related swellings without clinically evident neurological deficits were subjected to FNAC. As the cytological features were suggestive of nerve abscesses due to leprosy, Fite stain was performed in all cases. As none of the patients had any leprosy skin lesions, they were diagnosed as cases of PNL. Features like cellularity, caseous necrosis, presence or absence of lymphocytes, macrophages, epithelioid cells, granulomas, Langhans giant cells and nerve elements were analyzed with the bacteriological index, to categorize PNL according to the Ridley-Jopling classification. RESULTS: Based on the cytological features and bacteriological indices, 3 cases were cytologically categorized into tuberculoid (TT)/borderline tuberculoid (BT) leprosy and the other two, as BT/borderline lepromatous (BL) and BL leprosy respectively in spite of having similar clinical presentation. Based on the cytological diagnoses, category-specific treatment could be instituted with clinical improvement. CONCLUSIONS: The simple and minimally invasive FNAC procedure allows diagnosis and a reasonably accurate categorization of PNL presenting as nerve abscess and therefore, highly useful in its clinical management.

Concomitant presentation of alopecia areata in siblings: a rare occurrence.

Alopecia areata (AA) is one among the many causes of non-scarring alopecia in children. Family history has been noted in 10-20% of cases, but concomitant presentation in siblings is extremely rare. The patterns and associations of childhood AA are similar to adults; however, there are some differences which are being highlighted in this article.

The creation and verification of cranial models using three-dimensional rapid prototyping technology in field of transnasal sphenoid endoscopy.

BACKGROUND: Surgical navigation systems have been used increasingly in guiding complex ear, nose, and throat surgery. Although these are helpful, they are only beneficial intraoperatively; thus, the novice surgeon will not have the preoperative training or exposure that can be vital in complex procedures. In addition, there is a lack of reliable models to give surgeons hands-on training in performing such procedures. METHODS: A technique using an industrial rapid prototyping process by three-dimensional (3D) printing was developed, from which accurate spatial models of the nasal cavity, paranasal sinuses (sphenoid sinus in particular), and intrasellar/pituitary pathology were produced, according to the parameters of an individual patient. Image-guided surgical (IGS) techniques on two different platforms were used during endoscopic transsphenoidal surgery to test and validate the anatomical accuracy of the sinus models by comparing the models with radiological images of the patient on IGS. RESULTS: It was possible to register, validate, and navigate accurately on these models using commonly available navigation stations, matching accurately the anatomy of the model to the IGS images. CONCLUSION: These 3D models can be reliably used for teaching/training and preoperative planning purposes.

The creation and verification of cranial models using three-dimensional rapid prototyping technology in field of transnasal sphenoid endoscopy.

BACKGROUND: Surgical navigation systems have been used increasingly in guiding complex ear, nose, and throat surgery. Although these are helpful, they are only beneficial intraoperatively; thus, the novice surgeon will not have the preoperative training or exposure that can be vital in complex procedures. In addition, there is a lack of reliable models to give surgeons hands-on training in performing such procedures. METHODS: A technique using an industrial rapid prototyping process by three-dimensional (3D) printing was developed, from which accurate spatial models of the nasal cavity, paranasal sinuses (sphenoid sinus in particular), and intrasellar/pituitary pathology were produced, according to the parameters of an individual patient. Image-guided surgical (IGS) techniques on two different platforms were used during endoscopic transsphenoidal surgery to test and validate the anatomical accuracy of the sinus models by comparing the models with radiological images of the patient on IGS. RESULTS: It was possible to register, validate, and navigate accurately on these models using commonly available navigation stations, matching accurately the anatomy of the model to the IGS images. CONCLUSION: These 3D models can be reliably used for teaching/training and preoperative planning purposes.

Improving learning during pediatric lectures with multiple choice questions.

OBJECTIVE: To evaluate the role of multiple choice questions (MCQs) administered at the conclusion of the lecture in improving medical student learning. METHODS: This prospective interventional study was conducted in a Medical College. In ten randomly chosen pediatric lectures delivered to prefinal year medical students, MCQs were administered at the conclusion of the lecture and the answers were discussed with the students. After the series of lectures, students were evaluated by hundred 'single best response' MCQs with half from the lectures with MCQs self-assessment (MSA group) and the rest were from the other set of lectures (WMSA group). Scores from both groups were compared using paired 't' test. RESULTS: When the scores from MSA and WMSA groups were compared for the study population, no significant difference was noted. A significant difference (p = 0.003) was found between the groups, when the mean (± SD) scores of the men (25.2 ± 4.8 in the MSA group and 28.6 ± 7.3 in the WMSA group) were compared. No difference was seen among women, whose mean (± SD) scores in the MSA and the WMSA group were 26.6 ± 6.9 and 26.3 ± 6.9 respectively. When the scores of the first half of the session was analyzed, there was significant difference between the two groups among men (p = 0.0001) implying that lectures with MCQs self-assessment improved the long-term retention. CONCLUSIONS: MCQs' based self-assessment at the conclusion of the lecture does not improve the learning among prefinal year medical students. However, this study has shown the usefulness of MCQs based self-assessment among male medical students.