Onychomycosis in eastern Nepal.

Onychomycosis, a fungal infection of the nail is responsible for up to 50.0% of all nail diseases. Though, dermatophytes are most frequently implicated as the causative agents in onychomycosis, yeast and molds are increasingly recognized as causative pathogens. This study was aimed to know the clinical and mycological pattern of onychomycosis in eastern Nepal. Eighty-two clinically diagnosed patients of onychomycosis attending the Dermatology Outpatient department of a tertiary hospital over a period of one year were enrolled in this study. Clipping from the severely affected nail and skin scrapping from active border of the skin lesions if associated were collected from each patient and subjected to microscopy and culture for identification of fungi. The commonest affected age group was 21-40 years. The male: female ratio was 2.7:1. Fifty-one patients had isolated fingernail involvement, while involvement of toenails was seen in 15 patients. Distolateral subungual onychomycosis (67%) was the commonest clinical type followed in decreasing order by superficial white onychomycosis (14.6%), proximal subungual onychomycosis (9.8%), candidal onychomycosis (7.4%) and total dystrophic onychomycosis (1.2%). Trichophyton mentagrophytes (28.8%) was the most common pathogen isolated followed by Trichophyton rubrum (21.2%), Trichophyton tonsurans (11.5%), Candida albicans (11.5%), Trichospron beigelii, (9.6%), Epidermophyton floccosum (7.7%), Trichophyton violaceum (5.8%), and Aspergillus flavus (3.9%). Distolateral subungual onychomycosis was the most common clinical presentation and T. mentagrophytes and T. rubruni were the most frequently isolated fungi for onychomycosis in eastern Nepal.

Atypical varicella zoster as SJS-TEN overlap syndrome with involvement of palm and sole.

A 14-month-old boy presented with generalised vesicular eruption involving the face, trunk and extremities accompanied by high grade fever. He had associated redness and purulent discharge from both eyes. Examination revealed erosions on the tongue, soft palate and genitalia with haemorrhagic crusts on the lips and nasal orifices. All laboratory investigations were within normal limits except leucocytosis. Chest x-ray showed left middle zone pneumonitis. Treatment was by paracetamol, antibiotics and oral acyclovir. Desquamation started from the eighth day. Our purpose in reporting this case is to highlight the fact that varicella can be atypical with distal involvement and can present as SJS-TEN overlap syndrome.

Perception of final-year medical students about skills attainment in a new medical school of Nepal.

The competence of clinical and procedural skills possessed by medical students on graduation have received considerable importance in recent years. This questionnaire-based study was conducted at B.P. Koirala Institute of Health Sciences, Dharan, Nepal with an aim to assess the perception about clinical and procedural skills attainment by final-year medical students in a new medical school of Nepal. Fifty-nine final year MBBS students were interviewed using a set of questionnaire related to the experience gained by the students in relations eight clinical and twenty procedural skills. The perception about the level of attainment was good for most of the clinical skills and for few procedural skills, for example, using an auroscope and ophthalmoscope. The level of attainment was very poor in inserting the flatus tube, aspirating pleural and ascitic fluids, performing lumbar puncture, administering enema and giving subcutaneous injection. The perceived confidence in giving intravenous injection, inserting venflons, catheterizing urinary bladder, performing ambu bag and mask ventilation, proctoscopy and suturing of superficial wound was greater than the level of practical experience. The practical experience was more in doing venesection but the perceived confidence was poor in it. The final year medical students had mastered most of the clinical skills but not all procedural skills equally. Those skills in which they are not competent must be acquired during internship. Training in these skills needs to be reinforced by establishing a skill laboratory.