An Atypical Case of Acrokeratosis Verruciformis of Hopf Responding to Combined Acitretin and Cryotherapy.

Acrokeratosis verruciformis of Hopf (AKVH) is a rare genetic skin condition associated with an ATP2A2 gene mutation, thus affecting keratinization. Classically, AKVH appears in childhood over acral sites as symmetrical, flat, verruca plana-like lesions with an autosomal dominant inheritance, while sporadic cases affect atypical sites in adulthood. As this entity can closely mimic other verrucous skin conditions, identifying characteristic histopathological changes is essential to make a diagnosis in the absence of genetic studies, especially in resource-poor countries. This is the first reported case of AKVH from North-East India clinically mimicking extensive verruca vulgaris in an adult with a possible sporadic occurrence. AKVH is usually difficult to treat and superficial ablation is the treatment of choice. However, this case highlights the role of cryotherapy with acitretin in the management of AKVH with a rapid response.

Evaluation of Serological Tests for the Diagnosis of Syphilis.

Background Syphilis remains a significant public health concern in India. Ensuring the accuracy of diagnostic tests is crucial for effectively managing this disease. Objectives This study aims to assess the detectability of syphilis using commercially available non-treponemal and treponemal tests due to observed discrepancies in test results, which can lead to confusion and anxiety among healthcare providers and patients. Materials and methods We analyzed 2312 serum samples using the rapid plasma reagin (RPR), Treponema pallidum hemagglutination assay (TPHA), enzyme-linked immunosorbent assay (ELISA), and modified TPHA rapid test, interpreting the results according to the manufacturers' instructions. We evaluated the diagnostic accuracy of all four tests. Concordance between the traditional and reverse algorithms was determined by calculating the percentage of agreement and the kappa (κ) coefficient. Results Of the 2312 samples tested, 34 (1.5%) were positive, and 2098 (90.7%) were negative across all four tests. Comparing the test results with clinical diagnosis, TPHA and TP-ELISA showed the highest sensitivity at 96.08%, while RPR demonstrated the highest specificity at 100%. The agreement between the traditional and reverse algorithms was moderate, with a 97.3% agreement and a κ value of 0.53. Conclusion Reliance on a single serological test for syphilis screening presents limitations. A combined approach using both RPR and TPHA tests can more accurately diagnose and confirm syphilis. This combination strategy is cost-effective and relatively simple to implement.

Malignant syphilis in an immunocompromised female: A case report from Northeast India.

Malignant syphilis (lues maligna) is a rare form of secondary syphilis, first described by Bazin in 1859, frequently associated with HIV infection. The resurgence of syphilis in the recent times has been attributed to rise in HIV infection. Malignant syphilis is characterized by the presence of pleomorphic multiple round-to-oval papules, papulopustules, or nodules with ulceration, without central clearing, and occasionally exhibit a lamellate brown to black rupioid crust with prodromal symptoms. We herein report a case of early malignant syphilis in a young immunocompromised patient who was HIV positive and noncompliant to antiretroviral therapy, from Northeast India. The HIV/AIDS epidemic is rising at an alarming rate in this part of the country which has thus led to an increase in the number of other sexually transmitted infections.

Substance Use Disorders and Role of Complementary and Integrative Medicine/Functional Medicine.

Substance use disorders are a growing concern for all ages, including adolescents. Even though there is an increase in recreational substance use and a wider variety of drugs is available to this young population, treatment options remain scarce. Most medications have limited evidence in this population. Few specialists treat individuals struggling with addiction along with mental health disorders. As the evidence grows, these treatments are usually included in complementary and integrative medicine. This article discusses available evidence for many complementary and integrative treatment approaches while briefly describing existing psychotherapeutic and psychotropic medications.

A Retrospective Study of Frontal Fibrosing Alopecia from North-East India.

Background: Frontal fibrosing alopecia (FFA) is an important cause of scarring alopecia seen mostly in post-menopausal women but sometimes in pre-menopausal women and men. Although considered a variant of lichen planopilaris due to its histopathological characteristics, it has distinct clinical features and associations, which make it a unique entity. We hereby report a series of patients with FFA from North-East India. Aims and Objective: This study aimed to analyse the clinical and histopathological characteristics of FFA. Materials and Methods: We retrospectively analysed clinical records and histopathological features of FFA cases diagnosed in the Dermatology Outpatient Department from April 2013 to February 2023. Results: A total of 21 patients, who were diagnosed with FFA from April 2013 to February 2023, were analysed. Of these, 19 patients were female, with a male-to-female ratio of 9.5:1. The mean age of study population was 48.33 years. The majority of the patients were from the post-menopausal age group (15/19 females, 78.94%). Lichen planus pigmentosus (6, 28.57%) was the most commonly associated disease, followed by androgenetic alopecia and lichen planopilaris (2 each, 9.52%). The main histological features noted were perifollicular lymphocytic infiltrate in 18 (85.71%), followed by hydropic degeneration of basal follicular keratinocytes in 15 (71.42%) and melanin incontinence in 14 (66.66%) patients. Conclusion: Our study is the first study from North-East India focusing on the clinical presentation and histopathological characteristics of FFA. Furthermore, with respect to the recent development in FFA, our study attempted to determine the clinical significance of the proposed criteria for the diagnosis of FFA patients by Tolkachjov et al. (2018), viz. International FFA Cooperative Group Criteria (2021).

Method of approximations for the convection-dominated anomalous diffusion equation in a rectangular plate using high-resolution compact discretization.

The present method describes the high-resolution compact discretization method for the numerical solution of the nonlinear fractal convection-diffusion model on a rectangular plate by employing the Hausdorff distance metric. Estimation of anomalous diffusion is formulated by averaging forward and backward mesh stencils. The higher-order fractional derivatives are appropriately approximated on a minimum mesh stencil and subsequently considered for designing a numerical method that falls in the scope of expanded accuracy. Compact discretization is an efficient technique for partial differential equations; however, studies that apply high-resolution scheme for fractional-order systems are still uninvestigated. A second and fourth-order numerical method for the fractional-order convection-dominated anomalous diffusion equation in two dimensions is constructed for practical applications. Convergence of high-order method is obtained for the nonlinear partial differential equations employing Hausdorff fractal distance metric. The numerical simulations with fractal Graetz-Nusselt equation, fractal Poisson equation, fractal Schrödinger equation, and anomalous diffusion equations with variable and constant coefficients are considered to illustrate the utility of the numerical method in the context of local fractional partial differential equations.•The paper demonstrates a computational method for the fractal convection-diffusion model on a rectangular plate.•Two numerical methods of order two and four for the mildly nonlinear fractional-order convection-dominated anomalous diffusion equations are proposed.•The high-resolution scheme is computationally efficient and makes use of minimal data storage.Method name: High-order method for 2D convection-dominated anomalous diffusion equation, Graetz-Nusselt equation, Poisson equation, and Schrödinger equation in fractal media.

Association of Maternal Serum Ischemia Modified Albumin (IMA) with Placental Histopathological Changes and Fetomaternal Outcome: A Prospective Case Control Study in Normotensive and Pre-eclamptic Women.

Introduction: Ischemia and oxidative stress leads to generation of hydroxyl free radicals and modification of 'N-terminus' of human serum albumin. This modified albumin molecule, known as Ischemia Modified Albumin (IMA), is elevated in early stages of ischemia. It has recently been approved by US Food and Drug Administration (US FDA) for its clinical use, as early marker of myocardial ischemia in cardiology. IMA is a novel marker of ischemia and is elevated in other clinical conditions associated with ischemia like pulmonary embolism, uncontrolled type II diabetes mellitus, acute decompensated heart failure, preeclampsia, recurrent pregnancy losses and IUGR. Role of IMA in birth asphyxia in perinatology is of current interest and needs further research. Methodology: A prospective case control study was conducted in a tertiary center in North India for one year. Total 80 pregnant women between 34 and 40 weeks were recruited and allocated in two groups. Case group comprised of 40 pre-eclamptic pregnant women and control group comprised of 40 normotensive pregnant women. Comparison and association of maternal serum IMA levels with fetomaternal outcome and number and types of placental histopathological changes was done in two groups. Results: In preeclampsia group mean serum IMA (115.23 ± 49.51) was significantly higher as compared to the normotensive group (79.21 ± 14.35). The optimum cut off value of IMA to detect a case was 94.5 IU/ml (sensitivity 65%, specificity 87.5%, PPV 83.9%, NPV 71.4% and diagnostic accuracy of 76.3). Pre-eclamptic women, had significantly higher incidence of PTVD, lower fetal birth weight and placental histopathological changes as compared to normotensive group. 83.8% of the women with raised IMA levels were pre-eclamptic. Raised IMA levels were significantly associated with higher incidence of PTVD, birth weight ≤ 2 kg and hypoxic histopathological lesions of chorangiosis, intervillous fibrin and hyalinization. Conclusion: Determination of maternal serum IMA levels early in pregnancy can predict preeclampsia and avoid future severe preeclampsia related complications. It might be useful to optimize both maternal and fetal/neonatal outcomes.

MEUF for removal and recovery of valuable organic components present in effluents: A process intensified technology.

In recent years, the domain of the research space in novel separation process has been led by membrane systems as a panacea providing multifarious benefits of high separation efficiency, elimination of extreme process conditions, sustainability, and environment friendliness coupled with high operational flexibility. In this niche area, often, ultrafiltration is touted as a robust separation technique due to its high separation efficiency, membrane stability, and lower operating costs. The only drawback of relatively large pore size can be overcome by combining surfactant addition, leading to development of integrated processes termed as Micellar Enhanced Ultrafiltration. MEUF processes isolate and selectively separate valuable organics present in effluent streams. The process characteristics fit the bill as a typified example for process intensification Technology interventions for recycling of surfactants can enhance the cost-competitiveness of the process. This has the potential to develop into a broad-spectrum effluent treatment option with a change of surfactants for target contaminants. Here, in this review, we attempt to critically examine the unique features of this technology, development of spin-offs with wide-ranging applications. Specifically applications in removal of hazardous, and persistent components like dissolved organics have been critically studied. The focus was to highlight the crux of the novel technologies highlighting the efficacy and the underlying concept of process intensification. PRACTITIONER POINTS: Role of MEUF as a sustainable process intensifying separation technique for removal and recovery of organics. Novel process development using MEUF. Comparative performance analysis to assess efficacy. Discussions on future integrative process development. Sustainability aspect of MEUF with possibility of byproduct recovery.

Root system architecture in rice: impacts of genes, phytohormones and root microbiota.

To feed the continuously expanding world's population, new crop varieties have been generated, which significantly contribute to the world's food security. However, the growth of these improved plant varieties relies primarily on synthetic fertilizers, which negatively affect the environment and human health; therefore, continuous improvement is needed for sustainable agriculture. Several plants, including cereal crops, have the adaptive capability to combat adverse environmental changes by altering physiological and molecular mechanisms and modifying their root system to improve nutrient uptake efficiency. These plants operate distinct pathways at various developmental stages to optimally establish their root system. These processes include changes in the expression profile of genes, changes in phytohormone level, and microbiome-induced root system architecture (RSA) modification. Several studies have been performed to understand microbial colonization and their involvement in RSA improvement through changes in phytohormone and transcriptomic levels. This review highlights the impact of genes, phytohormones, and particularly root microbiota in influencing RSA and provides new insights resulting from recent studies on rice root as a model system and summarizes the current knowledge about biochemical and central molecular mechanisms.

Oral Tegafur-Uracil Combination plus Leucovorin versus Other Fluoropyrimidine Agents in Colorectal Cancer: A Systematic Review and Meta-Analysis.

Shikha VermaBackground Systemic fluoropyrimidines, both oral and intravenous, are an integral part of colorectal cancer (CRC) management. They can be administered either with curative or palliative intent. Objectives This article examines the literature to analyze the efficacy and safety of the oral fixed-dose combination of uracil and tegafur (UFT)/leucovorin (LV) compared with other fluoropyrimidine agents, with an intention to implement the findings into the current treatment algorithms for CRC. Methods An exhaustive systematic literature search was performed for prospective studies using PUBMED, Cochrane Library, and EMBASE database. Studies which met eligibility criteria were shortlisted and grouped into chemotherapy given for curative or palliative intent. Results Eight trials were shortlisted involving 4,486 patients for the analysis. There was no difference between UFT/LV and other fluoropyrimidines in the primary endpoints-disease-free survival (hazard ratio [HR] 1.01; 95% confidence interval [CI] 0.90-.15; p = 0.81) and progression-free survival (HR 0.87; 95% CI 0.66-.66; p = 0.35) for curative and palliative intent CRC patients, respectively. In secondary analyses, there was no significant difference observed between UFT and other fluoropyrimidines in overall survival in CRC patients with curative intent (HR 1.04; 95% CI 0.88-1.23; p = 0.63) and palliative intent (HR 1.02; 95% CI 0.97-1.06; p = 0.42) . In the safety analysis, we found significantly lesser patients on UFT/LV had stomatitis/mucositis (odds ratio [OR] 0.20; 95% CI 0.05-0.85; p = 0.03), fever (OR 0.46; 95% CI 0.29-0.71; p < 0.001), infection (OR 0.42; 95% CI 0.24-0.74; p < 0.01), leukopenia (OR 0.04; 95% CI 0.00-0.95; p = 0.05), febrile neutropenia (OR 0.03; 95% CI 0.00-0.24; p = 0.001), and thrombocytopenia (OR 0.14; 95% CI 0.02-0.79; p = 0.03) compared with other fluoropyrimidines. Conclusion Oral UFT/LV is equally efficacious to other fluoropyrimidines, especially intravenous 5-fluorouracil, in the management of early as well as advanced CRC patients. Importantly, UFT/LV has a superior safety profile compared with other fluoropyrimidines in terms of both hematological and nonhematological adverse events.

Incorporation of Telepsychiatry for Patients with Developmental Disorders into Routine Clinical Practice-A Survey of Specialty Clinics Adapting to Telepsychiatry During the COVID-19 Pandemic.

In 2020, a nationwide shift to telepsychiatry occurred in the wake of the Coronavirus Disease 2019 (COVID-19) pandemic and lockdowns. To assess the rates of telepsychiatry appointment attendance pre- and post-lockdown, we conducted a national, multi-site survey of appointments in 2020 compared to a similar time period in 2019, at outpatient child psychiatry clinics that specialize in the treatment of patients with Autism Spectrum Disorder (ASD) and/or Developmental Disabilities (DD). ASD/DD clinics rapidly shifted to telepsychiatry, returning to pre-pandemic appointment numbers and completion rates within months. We advocate for the continued funding of this care model, discuss the substantial benefits physicians, patients and families have found in using telepsychiatry, and suggest ways to improve future access for ASD/DD telepsychiatry.

Psychotropic Medication Adherence in Children and Adolescents.

Researchers believe that almost 20% of children and adolescents struggle with chronic and persistent mental health concerns. Mental health is the leading cause of disability in the United States. Youth can struggle with several impairing mental health disorders, such as attention-deficit/hyperactivity disorder, mood disorders, psychotic disorders, and autism spectrum disorder. Inadequately treated chronic mental illnesses can adversely affect the growing brain profoundly, including academic decline, early school dropout, cognitive deficits, interpersonal relationship concerns, aggression, suicide attempts or completion, substance use disorders, frequent hospital admissions, and inability to maintain employment. Even if diagnosed early in their course of illness, many of these individuals struggle to continue medications as prescribed. The factors predicting adherence to medications are underresearched in children and adolescents. Psychotropic medication compliance is a complicated issue that is tied to various aspects of caring for a minor individual. Hence, it is relevant to discuss factors that are predicted to contribute to noncompliance in this age group. The purpose of this review is to carefully consider the gaps in knowledge, suggesting interventions by using established instruments and clinical strategies to resolve the identified barriers for improving medication adherence. Compliance should be targeted at various levels, including the entire family tree and the treatment team.

The utility of multiplex polymerase chain reaction for diagnosis of infectious diarrhoea in a tropical country.

PURPOSE: The etiology of infective diarrheaoften remains undiagnosed. We studied the role of multiplex polymerase chain reaction (PCR) for detection of etiological agents of diarrhoea. METHODS: Fast track diagnostics (FTD)gastroenteritis panel for bacterial and viral pathogens was used to test stool samples from patients with diarrhoea. RESULTS: Stool samples from 276 patients (138 immunocompetent and 138 immunocompromised) with diarrhoea and 138 healthy controls were tested. Bacterial culture was positive in 5 samples. Following agents were isolated: Shigella sonnei(2), Shigella dysentriae(1), SalmonellaParatyphi B(1) and Vibrio cholerae (1). Multiplex PCR panel did not include Vibrio cholerae in its panel. A total of 65 target pathogens were identified in 60/276 (21.7%) patients by multiplex PCR. 28/65(41.1%) and 37/65 (56.9%) were bacterial and viral agents respectively. Identified bacteria were Shigella(20), Salmonella(3), Campylobacter(4) and Clostridium difficile(1). Viral targets identified were Norovirus GII (28), Adenovirus(4), Astrovirus(3) and Sapovirus(2). All the controls were negative for enteropathogens by conventional methods and multiplex PCR. CONCLUSIONS: Our detection rates increased from 1.8% (5/276)by conventional methods to 21.7% (60/276)by multiplex PCR, which included both bacterial as well as viral targets.

60 years of fertilization and liming impacts on soil organic carbon stabilization in a sub-tropical Alfisol.

Limited information is available on the C stabilization mechanism of tropical soils under different management practices including long-term organic manuring, mineral fertilization alone, or in combination with lime. Hence, to understand the effect of continuous application (for 60 years) of organic manure, fertilizer, and lime alone or in combination on an acidic Alfisol, stabilization of soil organic carbon (SOC) was evaluated under maize (Zea mays L.) wheat (Triticum aestivum L.) cropping. There were eight treatments that included farmyard manure (FYM) and nitrogen (N) applied in terms of FYM, additional dose of phosphorus (P) and potassium (K) applied in terms of inorganic fertilizer (FYM + P'K'), FYM + P'K' with liming (FYM + P'K' + L) and NPK alone. These treatments were laid in a randomized block design with three replications. Results indicated that FYM + P'K' plots had maximum amount of SOC inside large macroaggregates. The value was 33 and 92% greater than only minerally fertilized (NPK) and unfertilized control plots, respectively, whereas microaggregate-associated C was highest in plots with FYM + P'K' and lime (FYM + P'K' + L), which was 48 and 183% more than unfertilized control and NPK plots, respectively. Inside soil microaggregates, plots under FYM + P'K' had highest labile C, while NPK + L plots had highest recalcitrant C. Plots with organic amendments contained higher glomalin in large macroaggregates. Plots treated with FYM + P'K' had maximum intra-aggregate particulate organic matter within microaggregates inside macroaggregates (iPOM_mM), which was 28 and 74% higher than NPK and unfertilized control plots, respectively. Total C stock inside the protected microaggregates within macroaggregates was maximum for FYM + P'K' plots. It had 38, 67, and 171% higher C stock than NPK, FYM, and unfertilized control plots, respectively. Interestingly, despite estimated C input in FYM-treated plots was much higher than NPK plots, FYM-treated plots had less C stabilization within microaggregates and within microaggregates inside macroaggregates. Microaggregates within macroaggregates accounted for ~54% of the recalcitrant C content. Thus, macroaggregates stabilization through occlusion of microaggregates was accountable for sequestration of SOC and only FYM application did not promote that mechanism compared to NPK. Carbon stabilization within macroaggregates under FYM plots was mainly governed by amorphous iron oxide.

Dilemma of Treating Psychosis Secondary to Stroke.

Post-stroke psychosis is prevalent and disabling with increased mortality risk. Treatment for post-stroke psychosis is limited in this staggering medical concern. The most commonly used medications are antipsychotics, however, the risk for stroke increases further with the use of antipsychotics. Furthermore, interventional clinical studies have not been carried out to test the efficacy and safety of antipsychotics in the management of post-stroke psychosis. We present a case of post-stroke psychosis to highlight the risks faced by these patients in terms of daily function and safety concerns and the challenges encountered in treatment due to poor response to the conventional antipsychotics; and so calling attention to early diagnosis and improved treatment options. More clinical investigations are needed to address the pathology associated with the clinical presentation and exploring the pharmacotherapies to improve efficacy and safety of treatment for post-stroke psychosis.

CC-type glutaredoxin, OsGrx_C7 plays a crucial role in enhancing protection against salt stress in rice.

Soil salinity is one of the critical issue worldwide that adversely affect soil fertility. Salt stress significantly limits crop yield and grain quality; therefore, there is an urgent need to develop a strategy to improve salt stress tolerance. In present study, we reported that rice glutaredoxin (OsGrx_C7) plays a positive response in salt induced stress. Gene expression analysis, silencing, and overexpression of OsGrx_C7 gene were used to discover the role of OsGrx_C7 in response to salt stress. Gene expression analysis suggested that OsGrx_C7 expression was induced under salt stress and ubiquitously expressed in rice including root and shoot. The silencing of osgrx_c7 gene leads to increased sensitivity to salt stress, indicating its importance in salt stress tolerance. A gain-of-function approach showed that OsGrx_C7 may act as an important determinant in salt stress, compared with WT, and revealed higher biomass accumulation, improved root and plant growth under salt stress. Under salt stress condition, OsGrx_C7 overexpressing rice plants showed lower level of lipid peroxidation and Na+/K+ ratio, while proline accumulation, soluble sugar content and GSH/GSSG ratio was higher compared to WT. Furthermore, expression analysis suggested that OsGrx_C7 acted as positive regulator of salt tolerance by reinforcing the expression of transporters (OsHKT2;1, OsHKT1;5 and OsSOS1) engaged in Na+ homeostasis in overexpressing plants. Overall our study revealed that OsGrx_C7 emerged as a key mediator in response to salt stress in rice and could be used for engineering tolerance against salt stress in rice and other crops.

Measuring the Effectiveness of Benzodiazepine Prescriptions Control in Community Setting Using Prescription Drug Monitoring Program (PDMP).

Benzodiazepines have been widely prescribed for several years for the treatment of anxiety, insomnia, and post-traumatic stress disorder (PTSD). Benzodiazepines were meant to be for short term use but in clinical settings long term use has been the "norm" for the treatment. Benzodiazepines are known for addiction potential and have been involved in accidental overdose deaths. According to the National Institute on Drug Abuse (NIDA), there has been a tenfold increase in the number of deaths due to overdose from 1999 to 2017. Benzodiazepines contributed to staggering high figures of 11,537 deaths in 2017 alone. Kentucky was ranked 4th in overdose related deaths in 2015 by CDC. Seeing this rise in overdose deaths, our community mental health clinics (CMHC) took the initiative to protect the community by removing benzodiazepines from the approved formulary in all adult outpatient community mental health clinics (total six clinics) in 2016. This project was initiated to protect the community from overdose deaths. In order to see the decrease in the benzodiazepine prescriptions, we did a quarterly Kentucky All Schedule Prescription Electronic Reporting (KASPER) prescriber's reports to see the trend. The goal of this project was to monitor the trend of benzodiazepine prescription control in CMHC. Our hypothesis was implementation of CMHC "No Benzodiazepine" policy would decrease in the number of prescriptions. To implement this change, we made a committee to educate staff including physicians, APRN's and therapists. Patients were also educated and informed regarding benzodiazepine free policy. Education materials were posted in the clinics and handed over to patients. Patients were offered individual and group therapy sessions to learn coping skills to cope with their anxiety. Patients had the option of inpatient detoxification, if clinically indicated. No new patients were started on benzodiazepines and patients who were already on benzodiazepines were slowly titrated off. Slow titration over the course of a few months was done as needed and tolerated. Quarterly, prescriber's prescription reports were generated with the help of KASPER (KASPER is PDMP in the state of Kentucky). After analyzing quarterly reports over the span of 2 years, we concluded that there was a total of 89% decrease in benzodiazepine prescriptions. We are hoping to reach close to 100% in the next few years. We conduct a Mental Health Statistics Improvement Program (MHSIP) which is a general patient satisfaction survey done annually. We used this data to monitor the change with this new policy. Open patients report was run to monitor any change in case load before and after the implementation of the policy. After compilation of the KASPER/ PDMP data of all the prescribers- MD's and APRN's, we found an 89% decrease in the number of benzodiazepines prescriptions over the span of 2 years. We did the open patients report and did not find any decrease in case load. In 2016, there were 10,359 open patients and in 2018 there were 12,266 open patients. We reviewed the MHSIP general patient satisfaction survey that is done annually, and we did not find any major difference in overall satisfaction as compared to previous years. These practice- based interventions implementing harm reduction strategies suggest that, although it was a difficult task, with strict adherence to no benzodiazepine policy, we were able to achieve a stark drop in the number of benzodiazepine prescriptions, in the span of 2 years, and have been able to continue to maintain the low numbers of benzodiazepine prescriptions.

Dermatoscopic Features of Onychomycosis and its Correlation with Nail Plate Potassium Hydroxide Mount (KOH), Culture, and Periodic Acid Schiff Stain (PAS) in North East India.

Context: Dermatoscopy has been used recently for identifying the specific features of onychomycosis. Very few studies have used it as a diagnostic tool. Our study highlights the specific patterns in different clinical types of onychomycosis and the novel features that have never been reported previously. Aims: To study the dermatoscopic patterns in patients with onychomycosis and determine the sensitivity, specificity, positive, and negative predictive values of the different features. Study Design: A cross-sectional study. Materials and Method: Dermatoscopic picture using dinolite video dermatoscope was taken in patients diagnosed with onychomycosis either with a positive KOH, culture, and/or PAS. Result: A total of 80 patients were included. Onychomycosis was identified in 68 individuals. Clinically, 73.52% presented with distal lateral subungual onychomycosis (DLSO) and 26.47% had total dystrophic (TD). PAS was positive in 85.29% of patients, KOH in 75%, and culture in 66.17%. Trichophyton species were isolated in 53.33%, whereas Candida species in 40% of patients. Dermatoscopic features were seen in all 68 patients (100%). The most common finding in decreasing order includes spike pattern, ruin appearance, distal irregular terminations (DIT), longitudinal striations, chromonychia, focal homogeneous opacities, microsplitting, and uniform homogeneous pattern. Three novel patterns were observed: homogeneous opacity with a-z pattern border, microsplitting in a Christmas tree pattern, and focal homogeneous opacities. Conclusion: To our knowledge, this is the first study conducted in northeast India where dermatoscopy was used as a diagnostic tool and it was found to have the highest sensitivity. New features that have not been described before have been identified.