A descriptive study of onychoscopic features in various subtypes of onychomycosis.

Background: The diagnosis of onychomycosis is usually clinical and is confirmed by 40% KOH examination. A diagnostic dilemma occurs when KOH examination is negative despite strong clinical suspicion. Dermoscopic evaluation of the nail is referred to as onychoscopy. We attempted to assess the dermoscopic findings in Onychomycosis positive with KOH examination. Methods: A cross sectional study was conducted in a tertiary care center including 122 patients with clinical suspicion of onychomycosis with KOH positivity. After assessment of risk factors and gross nail examination, onychoscopic examination was done to identify the presence of the specific features. Results: Primary findings of onychoscopic examination were 'spiked pattern' in 80.3% subjects, of which 95 were distal lateral subungual onychomycosis (DLSO), 8 of total dystrophic onychomycosis (TDO). True leukonychia was seen in the single patient of proximal subungual onychomycosis (PSO) and pseudoleukonychia in the single patient of white superficial onychomycosis (WSO). Distal irregular termination was observed in 23% of subjects - 8 from DLSO and in all 20 patients of TDO. 'Ruin appearance' was observed in all 20 patients of TDO, 56 patients with DLSO and not seen in other types of onychomycosis (OM). Presence of spiked pattern, Longitudinal striae, Distal irregular termination and Ruin appearance were found to be statistically significant (p < 0.001). Conclusion: In suspected onychomycosis, specific onychoscopic findings such as Spiked pattern, Longitudinal striae, Ruin appearance and Distal irregular termination can be used as supporting evidence for diagnosing onychomycosis clinically and initiating antifungal therapy if mycological testing is unavailable or negative.

Randomised trial to evaluate the effectiveness and safety of varying doses of linezolid with bedaquiline and pretomanid in adults with pre-extensively drug-resistant or treatment intolerant/non-responsive multidrug-resistant pulmonary tuberculosis: study protocol.

INTRODUCTION: Drug-resistant tuberculosis (DR-TB) is a global public health problem. Patients suffer for months if undiagnosed or treated inadequately, transmitting DR-TB in the community before succumbing to the disease. Early diagnosis, prompt treatment initiation and completion play a significant role in treatment success. However, extended regimens with injectable result in poor treatment adherence and outcomes. Our objective is to evaluate the effectiveness, safety and tolerability of various doses and duration of linezolid (LZD) in combination with bedaquiline (BDQ) and pretomanid (Pa) after 26 weeks of treatment in adults with pre-extensively drug-resistant or treatment intolerant/non-responsive multidrug-resistant pulmonary TB. METHODS AND ANALYSIS: A multicentric, randomised pragmatic clinical trial in India will enrol participants in one of the three arms-control arm (arm 1): BDQ, Pa and LZD 600 mg daily for 26 weeks or intervention arms (arm 2): BDQ, Pa and LZD 600 mg for 9 weeks followed by 300 mg for 17 weeks or arm 3: BDQ, Pa and LZD 600 mg for 13 weeks followed by 300 mg for 13 weeks. The primary endpoint is the proportion of patients with favourable outcomes as sustained cure and treatment completion. The secondary endpoint is unfavourable outcomes, including deaths, treatment failure, toxicity/adverse events and lost to follow-up till 48 weeks post-treatment. ETHICS AND DISSEMINATION: The study has been approved by the ethics committees of participating institutes and the National Institute for Research in TB. The trial results will help establish evidence towards a safe and effective dose of LZD that can be used in a fully, all-oral short course regimen for highly DR-TB patients. The results of this study will be shared with the National TB Elimination Programme of the country and the WHO guidelines development group through publications and dissemination meetings. TRIAL REGISTRATION NUMBER: NCT05040126.

Factors associated and knowledge on road traffic accidents, rules among private university students in Chengalpattu district, Tamil Nadu, India - A cross-sectional study.

BACKGROUND: Road traffic accidents (RTAs) are an emerging public health issue of global concern causing 1.35 million deaths per year. They are the leading cause of death among 5-29 years who contribute to the future and current productive population of the country. The outcome of mortality and permanent disability are public health concerns. We determined the factors associated with RTAs among medical undergraduates and assessed their knowledge of road traffic rules. MATERIALS AND METHODS: This study had 500 medical undergraduates from a tertiary hospital located in Chengalpattu district, Tamil Nadu. Data were collected using questions from "Road safety question bank" issued by Ministry of Road Transport and Highways, Government of India, sent as Google forms to students. Descriptive statistics were used and multivariate analysis was performed to identify risk factors associated with RTAs. RESULTS: The mean age of the students was 21.4 (standard deviation = 1.7) years. About 30.4% of students suffered from RTAs in the past 2 years. Practice of drunken driving and mobile phone usage showed significant association with RTA occurrence (P < 0.001). Multiple logistic regression revealed that students crossing speed limits and jumping signals had 3.19 and 2.04 times more risk of sustaining RTAs. Seventy-five percent of students had good knowledge on road traffic rules. CONCLUSION: Nearly half the subjects have suffered RTA in the past 2 years. Students who over speed, jumped signals and used mobile phones while driving sustained more RTAs. Overall, road traffic rules knowledge was satisfactory. Students need education on risky driving behaviors and aftermath of crashes.

Extent of knowledge and attitudes on plagiarism among undergraduate medical students in South India - a multicentre, cross-sectional study to determine the need for incorporating research ethics in medical undergraduate curriculum.

BACKGROUND: Undergraduate medical students in India participate in various research activities However, plagiarism is rampant, and we hypothesize that it is the lack of knowledge on how to avoid plagiarism. This study's objective was to measure the extent of knowledge and attitudes towards plagiarism among undergraduate medical students in India. METHODS: It was a multicentre, cross-sectional study conducted over a two-year period (January 2018 - December 2019). Undergraduate medical students were given a pre-tested semi-structured questionnaire which contained: (a) Demographic details; (b) A quiz developed by Indiana University, USA to assess knowledge; and (c) Attitudes towards Plagiarism (ATP) questionnaire. RESULTS: Eleven medical colleges (n = 4 government medical colleges [GMCs] and n = 7 private medical colleges [PMCs]) participated. A total of N = 4183 students consented. The mean (SD) knowledge score was 4.54 (1.78) out of 10. The factors (adjusted odds ratio [aOR]; 95% Confidence interval [CI]; p value) that emerged as significant predictors of poor knowledge score were early years of medical education (0.110; 0.063, 0.156; < 0.001) and being enrolled in a GMC (0.348; 0.233, 0.463; < 0.001).The overall mean (SD) scores of the three attitude components namely permissive, critical and submissive norms were 37.56 (5.25), 20.35 (4.20) and 31.20 (4.28) respectively, corresponding to the moderate category. CONCLUSION: The overall knowledge score was poor. A vast majority of study participants fell in the moderate category of attitude score. These findings warrant the need for incorporating formal training in the medical education curriculum.

Extent of awareness and attitudes on plagiarism among post-graduate resident doctors and junior medical faculty in India: a cross-sectional, multicentric study.

OBJECTIVES: Though dissertation is mandatory for postgraduates (PG), it is unknown if adequate knowledge on plagiarism exists at that level. Thus, we intended to study the knowledge and attitude towards plagiarism among junior doctors in India. DESIGN: Cross-sectional study SETTING: PG medical residents and Junior faculty from various teaching institutions across south India. PARTICIPANTS: A total of N=786 doctors filled the questionnaires of which approximately 42.7% were from government medical colleges (GMCs) and the rest from private institutions. METHODS: Participants were given a pretested semistructured questionnaire which contained: (1) demographic details; (2) a quiz developed by Indiana University, USA to assess knowledge and (3) Attitudes towards Plagiarism Questionnaire (ATPQ). OUTCOME MEASURES: The Primary outcome measure was knowledge about plagiarism. The secondary outcome measure was ATPQ scores. RESULTS: A total of N=786 resident doctors and junior faculty from across 11 institutions participated in this study. Of this, 42.7% were from GMCs and 60.6% were women. The mean (SD) knowledge score was 4.43 (1.99) out of 10. The factors (adjusted OR; 95% CI; p value) that emerged as significant predictors of knowledge were number of years in profession (-0.181; -0.299 to -0.062; 0.003), no previous publication (0.298; 0.099 to 0.498; 0.003) and working in a GMC (0.400; 0.106 to 0.694; 0.008). The overall mean (SD) scores of the three attitude components were: Permissive attitudes-37.33 (5.33), critical attitudes -20.32 (4.82) and subjective norms-31.05 (4.58), all of which corresponded to the moderate category. CONCLUSION: Participants lacked adequate knowledge on how to avoid plagiarism suggesting a need for a revamp in medical education curriculum in India by incorporating research and publication ethics.

Knowledge, awareness, and attitude among the employees in emergency ambulance services towards traumatic dental injuries.

INTRODUCTION: Traumatic dental injuries are the most frequently encountered dental emergencies. Psychologically a missing tooth in the front tooth region can be a cause of social embarassment for the child and may elevate the anxiety level in the parents. The prognosis of any road traffic accident (RTA) mainly depends on the employees in emergency ambulance services to prompt correct emergency measures. AIM OF THE STUDY: The purpose of this study was to evaluate the knowledge and the awareness level of the employees in emergency ambulance services regarding the management of dental trauma in patients who have sustained RTAs. MATERIALS AND METHODS: In total, 100 healthcare workers in 108 emergency ambulance services were randomly evaluated using a self-structured questionnaire in and around Kancheepuram district of Tamil Nadu. RESULTS: The overall knowledge of the personnel in 108 emergency ambulance services regarding management of traumatic injuries to the teeth was not satisfactory. Approximately, 86% of employees reported that no dental first aid is given for the patient who has sustained RTA. CONCLUSION: Dental trauma awareness program and first aid training will help in rebuilding the awareness and knowledge regarding the importance of management in a dental emergency.

Prevalence of Nicotine Dependence among Men Aged 21-60 Years in the Rural Field Practice Area of a Tertiary Care Hospital in Tamil Nadu, India.

BACKGROUND: The World Health Organization (WHO) estimated that about 4 million deaths worldwide annually are attributable to tobacco use. Tobacco use is an important risk factor for numerous chronic diseases like cancer, diseases of the lungs, and cardiovascular diseases. Despite this, tobacco use is common throughout the world. Almost 150 million young people are known to use tobacco out of which a majority worldwide began this when they were adolescents. The complex mechanism of nicotine dependency makes it challenging to evaluate dependence or progress towards dependence. The objectives of the study were: (1) To assess the prevalence of nicotine dependence among tobacco users. (2) To study the correlates of nicotine dependence among rural population. METHODS: A cross sectional study was conducted using a predesigned and pretested structured proforma. The study was conducted among men of 21-60 years in field visit area of SRM medical college. Karl fagerstrom nicotine dependence questionnaire was used to assess dependence on nicotine. RESULTS: The overall proportion of smokers was 35%. The mean age of initiation of smoking was 20.09 years and the reason was peer pressure, duration of smoking was 11.98 years. 46% of smokers had intention to quit smoking, others gave a reason as addiction (51.6%) for not quitting. Significant association was found between tobacco use and socio-economic parameters such as age group, marital and socio economic status. CONCLUSION: The proportion of smokers was 35%. Significant determinants of smoking were those aged more than 40 years, those of lower socio economic status.

Epidemic Varicella Zoster Virus among University Students, India.

We investigated a yearlong varicella zoster virus outbreak in a highly susceptible young adult population at a large university in India. Outbreaks of varicella infection among adults are not well described in the literature. Infection control measures and vaccination policy for this age group and setting are needed.

Correlation of Adiposity Indices with Electrocardiographic Ventricular Variables and Vascular Stiffness in Young Adults.

INTRODUCTION: Excess adiposity constitute an important public health problem because of the associated increased risk of hypertension, coronary heart disease, type 2 diabetes and other disorders. Not only the contribution of general measures of adiposity but also central measures of adiposity have been observed. AIM: To compare and correlate the central and general adiposity indices with ventricular electrocardiographic variables and vascular stiffness indices in normal, overweight and obese young adults. MATERIALS AND METHODS: This was a cross-sectional study. Nearly ninety subjects were enrolled and were divided into 30 normal weight, 30 overweight and 30 obese group based on the BMI classification of WHO for Asian population with their age ranging from 18-25 years. Waist and hip circumferences were measured using stretchable tape. Two novel indices-conicity index and abdominal volume index were calculated using standard formula. ECG and pulse wave were recorded using the Physiopac - Medicaid systems. Statistical analysis was done using SPSS version 19.0 software. ANOVA test was done to compare the variables among three groups. Pearson's correlation coefficients were applied to establish the correlations between variables. RESULTS: In our study Body Mass Index (BMI) and Conicity Index (CI) was significantly and strongly correlated with the ventricular electrocardiographic variables especially with QRS duration, QTc interval and with vascular stiffness indices. These indices can be used to assess the electrocardiographic abnormalities and vascular stiffness status. CONCLUSION: Excess adipose tissue in young adults was closely linked to ventricular depolarization and repolarization abnormalities and also to increased vascular stiffness. Adiposity indices in particular (BMI, CI) provide a simple and non invasive approach to assess these abnormalities at the earliest in order to prevent future complications.

Does Iron Deficiency Anaemia and its Severity Influence HbA1C Level in Non Diabetics? An Analysis of 150 Cases.

INTRODUCTION: Anaemia has a high prevalence having great impact worldwide and potentially contributing to the pathogenesis of various chronic diseases. Approximately 1/3rd of patients with anaemia have iron deficiency. American Diabetes Association (ADA) has affirmed Glycated Haemoglobin (HbA1C) ≥ 6.5% as a diagnostic criterion for Diabetes Mellitus (DM). Variation of HbA1C in Iron Deficiency Anaemia (IDA) has clashing results. AIM: To decide the impact of IDA on HbA1C levels among non diabetics. To assess and analyse the variation of HbA1C according to the degree of anaemia (mild, moderate and severe). MATERIALS AND METHODS: This cross-sectional study was carried out in SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu from February 2016 to October 2016 and approved by our Institutional Ethical Committee. Totally 150 non diabetics (75 with IDA and 75 without IDA) were included in this study. Medical history was recorded and HbA1C, Haemoglobin (Hb), Haematocrit (Hct), red cell indices, serum iron, ferritin and Fasting Plasma Glucose (FPG) were tested. RESULTS: The IDA patients in this study had a mean HbA1C (6.84±0.07%) which was higher than the non anaemic group (5.12±0.04%) and this difference was statistically significant (p< 0.05). HbA1C level was increased when severity of anaemia worsened. Also, noteworthy statistical significance was observed between no anaemia, mild, moderate and severe anaemia (p< 0.05). CONCLUSION: In this study, we observed a positive correlation between IDA and elevated HbA1C level in non-diabetic population.

Value of pentraxin-3 and galectin-3 in acute coronary syndrome: a short-term prospective cohort study.

BACKGROUND: Acute coronary syndrome (ACS) continues to be a leading cause of morbidity and mortality worldwide. Galectin-3 and pentraxin-3 are two prognostic biomarkers that have been studied in heart failure (HF). However, there are limited data on these biomarkers in the ACS population. The objective of the study was to determine the variables that are most affected by high concentrations of pentraxin-3 and galectin-3, and the influence they have on outcomes of all-cause mortality in patients with ACS. METHODS: We included a total of 160 patients [ST elevation myocardial infarction (STEMI),n = 64; non STEMI/unstable angina (NSTEMI/UA), n = 38; and control subjects with chronic stable angina (CSA)/microvascular angina (MVA) n = 58]. Plasma pentraxin-3 and galectin-3 levels were assessed from these patients at the time of hospital admission. Major adverse cardiovascular events including all-cause mortality, rehospitalizations and coronary artery bypass graft surgery (CABG) were assessed at 6 months. RESULTS: The median concentration of pentraxin-3 and galectin-3 were significantly higher in STEMI than in NSTEMI patients (p < 0.005) or controls (p < 0.005). Greater numbers of deaths (4 versus 0) were observed in STEMI patients with higher levels of these biomarkers. In addition, ACS patients with high levels of pentraxin-3 and galectin-3 had lower left ventricular ejection fraction (LVEF) (p < 0.005), and a moderate correlation was observed between LVEF and pentraxin-3 levels (r = -0.45, p < 0.005). Patients with higher galectin-3 levels were also observed to have a lower estimated glomerular fraction rate (eGFR), and a moderate correlation was observed between them (r = -0.34, p < 0.005). CONCLUSION: Pentraxin-3 and galectin-3 hold much promise in the ACS population as prognostic biomarkers.