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Porokeratosis is a keratinization disorder with unclear etiopathogenesis, varied clinical presentation and characteristic histopathology, and is usually unresponsive to current therapeutic options. Until now, it was considered to be a clonal disorder with immunity, ultra violet radiation and other factors playing important roles in etiopathogenesis. It is now known that abnormalities in the mevalonate pathway are responsible for this clonal keratinization abnormality. New variants of porokeratosis like eruptive bullous, pruriginous, lichen planus like, follicular variants and porokeratoma have been described. While the cornoid lamella is the classical histopathologic feature, dermoscopy and reflectance confocal microscopy make the diagnosis clearer. Development of malignancy in a few variants is a concern. Linear, disseminated superficial actinic and giant lesions are most prone to developing malignancies. Bowen’s disease, squamous cell carcinoma, basal cell carcinoma and even melanoma have been reported in cases of long-standing porokeratosis. Newer modalities of therapy such as photodynamic therapy, ingenol mebutate and HMGCoA inhibitors may play a role in the future.

BACKGROUND There has been an alarming increase in the prevalence of chronic, recurrent and steroid modified dermatophytosis of the glabrous skin in the recent years in India. There is paucity of literature on the magnitude of this major public health problem. OBJECTIVE To estimate the prevalence of dermatophytosis and clinico-epidemiological features of chronic and recurrent dermatophytosis (CRD) across India and to evaluate the associated risk factors. METHODS This is a multicentric descriptive cross-sectional study conducted in 13 centres situated across India in two phases during dry and rainy seasons. All consecutive patients presenting with dermatophytosis were screened during the study period of 14 consecutive working days. Patients with CRD of the glabrous skin as per the case definition were included after exclusion of isolated hair and nail infections. Demography, clinical findings and results of potassium hydroxide wet mount were recorded. RESULTS AND CONCLUSION A total of 41,421 patients were screened, out of which 7174 (17.31%) patients had glabrous dermatophytosis. CRD was observed in 1999 (27.86%) patients with 78.08% and 21.95% of chronic and recurrent dermatophytosis, respectively. Family history was present in 50.03% of patients. History of sharing of fomites was present in 50.37% of them. Synthetic tight clothes were worn by 43.47%, while 50.9% gave history of misuse of topical corticosteroid creams. Multiple site involvement was common (69.58%) with tinea cruris (79.99%) and tinea corporis (75.69%) being the most common clinical types. CRD is associated with sharing of fomites, topical corticosteroid misuse and involvement of multiple sites.

In this case report, we describe the first case of Phialemonium obovatum infection involving the renal allograft in a recipient beyond 1 year after living renal transplant. The patient presented with a locally invasive mycetoma caused by this melanized fungus in the anterior abdominal wall, which extended during the hospital stay to involve the allograft. The fungus was identified by its characteristic micromorphological features present on potato dextrose agar and Sabourad dextrose agar and on subsequent slide cultures. The patient did not survive despite repeated surgical procedures, including partial allograft nephrectomy and broad-spectrum antifungal medications. Other cases of Phialemonium infections involving renal and stem cell transplant recipients are reviewed.

BACKGROUND Linear lesions are fairly common in our daily practice. However, the appearance of these lesions can vary, thus complicating the diagnosis. AIMS To study the various clinical presentations, the demographic profile of patients and the clinicopathological correlations of dermatoses presenting with a linear distribution. METHODS We conducted an institution-based, cross-sectional, descriptive study of 281 consecutive patients with linear lesions attending dermatology clinics. MedCalc software (V11.6) was used for statistical analysis. RESULTS Patients were divided into eight groups: lesions along the lines of Blaschko (n = 136), lesions along blood vessels (n = 3), lesions along lymphatics (n = 3), Koebner phenomenon (n = 24), autoinoculation (n = 24), external factors (n = 45), infestations (n = 2) and 'other' (n = 44). The mean age at presentation was 24.50 ± 18.82 years and the male/female ratio was 1.32 : 1. The commonest symptom was itching/burning (56.94% of patients), while the commonest site was the arm (44.48%); followed by the leg (30.60%), trunk and abdomen (22.42%), head and neck (19.20%), and genitalia (0.35%). Apart from the common cases, there was a wide gamut of rare conditions (e.g. angiokeratoma circumscriptum naeviforme, porokeratotic eccrine ostial and dermal duct naevus, Blaschko-linear syringocystadenoma papilliferum, progressive cribriform and zosteriform hyperpigmentation, unilateral naevoid acanthosis nigricans, fixed drug eruption, discoid lupus erythematosus). CONCLUSION Linear lesions act as diagnostic clues to many dermatological conditions, therefore, the importance of meticulous examination in clinical dermatology cannot be overemphasized.

Background Recurrent coronavirus disease 2019 (COVID-19) infection is an emerging problem and may prove to be one of the greatest problems in controlling the pandemic in the future. Recurrent infections can be due to reactivation of dormant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or reinfection with similar or different strains of SARS-CoV-2. Case presentation Here we present an interesting case of a health care worker working as a laboratory assistant at a COVID-19 laboratory who developed recurrent COVID-19 infection. He did not develop an immune response after the first episode of COVID-19; however, immunoglobulin G (IgG) antibodies were detected after the second episode. Conclusions Through this case, we discuss the concept of reactivation and reinfection in the post-COVID period. We suggest that standard guidelines should be established to check for viral shedding and immune response among cured cases of COVID-19 after discharge via serial real-time polymerase chain reaction (RT-PCR) testing and IgG antibody detection. Further, strict hygiene practices should be stressed to these patients with possibility of COVID-19 recurrence.

Aims and Objectives: Aim of this study was to know the prevalence of Coagulase Negative Staphylococci (CoNS) in Blood Stream Infection (BSI) among patients attending a Superspeciality hospital in North India. Objective of this study was to compare incidence of CoNS in ICU and ward patients suffering from BSI and their antimicrobial susceptibility pattern. Materials and Methods: This retrospective hospital based study was conducted in the Microbiology Department, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow for a period of two years (January, 2017 -December, 2018). Blood samples from a total of 6498 patients from Out-Patient, In-Patient and Intensive care unit departments were subjected to aerobic and anaerobic bacterial culture. Culture positive broth was subcultured on Blood Agar and MacConkey Agar to isolate pathogens in pure culture. Pure cultured isolates were tested for antimicrobial susceptibility pattern by Kirby Bauer Disk Diffusion method as per CLSI 2018. Results: During the study period, out of total 3284 samples in 2017 and 3214 in 2018, 663 and 595 were found to be culture positive respectively. Staphylococci were isolated from 636 (9.78%) patients (10.2% in 2017 and 9.2% in 2018). Staphylococcus aureus was isolated from 18.8% and CoNS from 81.2% of total Staphylococcal isolates. Among CoNS isolates 70.7% were found to be Methicillin Resistant CoNS (MRCoNS). Discussion and Conclusion: This study observed CoNS as a major cause of BSI as compared to Staphylococcus aureus. The significance of CONS bacteremia should be evaluated better in light of clinical profile of the patient. Better screening and infection control practices in the future can decrease the rate of methicillin resistant CoNS in our centre. Keywords: Coagulase Negative Staphylococcus, Commensal, Blood stream infection, Antimicrobial resistance.

Background Increasing antimicrobial resistance (AMR) among common bacteria combined with the slow development of new antibiotics has posed a challenge to clinicians. Aim and objective To demonstrate whether antimicrobial and diagnostic stewardship program (ASP and DSP)-related interventions improve antibiotic susceptibilities among common bacteria causing bloodstream infections (BSI) in patients admitted to the intensive care unit (ICU) and whether these resulted in changes in the volume of antimicrobial consumption. Materials and methods We compared the susceptibility patterns of gram-negative bacteria (GNB) and gram-positive cocci (GPC) causing BSI and changes in the volume of antibiotics prescribed for the same before and after 2017 by a retrospective analysis. Results Postintervention, there was increased susceptibility of all GNBs to aminoglycosides; Escherichia coli and Klebsiella spp. to beta-lactambeta-lactamase inhibitors (BLBLI) combinations; and Klebsiella spp. and Pseudomonas spp. to carbapenems. Acinetobacter spp., Klebsiella spp., and Pseudomonas spp. showed improved susceptibility to doxycycline, whereas E. coli and Klebsiella spp. showed significantly improved susceptibility to fluoroquinolones. Among GPCs, there was increased susceptibility of Staphylococcus aureus (levofloxacin, clindamycin, and aminoglycoside), coagulase-negative S. aureus (CoNS) (chloramphenicol, levofloxacin, clindamycin, and aminoglycoside), and enterococci (chloramphenicol, levofloxacin, and clindamycin). There was a significant reduction in usage of antimicrobials for the treatment of GPCs (linezolid, doxycycline, chloramphenicol, levofloxacin, BLBLI, macrolide, and cephalosporin) and GNBs (levofloxacin, cephalosporin, carbapenem, and colistin), which caused BSI. Conclusion The present study illustrated that combined ASP and DSP interventions successfully reversed the resistance pattern of organisms causing BSI and resulted in a reduction in antibiotic utilization. How to cite this article Agarwal J, Singh V, Das A, Nath SS, Kumar R, Sen M. Reversing the Trend of Antimicrobial Resistance in ICU: Role of Antimicrobial and Diagnostic Stewardship. Indian J Crit Care Med 2021;25(6):635-641.

Background: Given the all-encompassing foothold of COVID-19, it is plausible that the pandemic would have a long-lasting impact on medical training programs, including dermatology. We conducted a survey amongst the residents of dermatology (across India) to assess the impact of COVID-19 pandemic on their teaching and education programs. Materials and Methods: An online semi-structured English questionnaire was prepared on the Google-forms platform and the link was circulated among the residents. The questionnaire comprised of five sections (demographic details, impact on clinical training, procedural training, academic curriculum, and research activities). Appropriate statistical tests were carried out to analyze the data obtained. Results: Three-hundred and seventy-eight responses were taken into consideration. A majority of the respondents (63.5%) were engaged in both COVID-19-related duties and departmental work (out-patient and in-patient duty). Around two-thirds of the trainees (65.1%) claimed a reduction in patient footfall (greater than 50% compared to pre-COVID times). Sixty-nine percent reported a decline of more than 50% in in-patient admission; 47.6% felt that the discontinuity in patient care had severely affected their residency training; 50.8% highlighted that no procedures were being performed in their department; 54.5% opined that academic activities were relatively unhampered as regular seminars were being conducted through online web-based applications; and 65.1% of the trainees were not able to devote any time to their thesis-related work. Conclusion: Since the after-effects of this pandemic will last long, it is advisable that residents and faculties adapt themselves to web-based learning programs in the academic curriculum so that the training of the future consultants does not get jeopardized. Our survey, being the first of its kind in dermatology, will throw some light on the perspective of residents and the way forward to combat the untoward consequences on their training programs.

PurposeThe purpose of this paper is to examine the impact of remittance inflows (remittances) on electricity consumption and electric power losses in Jamaica.Design/methodology/approachThe authors use annual data from 1976 to 2014 and apply vector error correction modelling, Granger causality testing and impulse response analysis.FindingsFirst, the authors find that there is co-integration between remittances and the energy variables, namely electricity consumption and electric power losses. Second, short-run Granger causality exists between the energy variables and remittances. This causality is bidirectional between the energy variables and positive changes in remittances, but it is unidirectional running from the energy variables to negative movements in remittances. Third, the authors find that in the long-run remittances have a negative relationship with electric power losses and a positive relationship with the consumption of electricity.Practical implicationsFindings from this paper will help to elucidate the relationship between electricity consumption, and electric power losses, and remittances.Social implicationsThe problem of electric power losses is acute in Jamaica and it is mostly due to theft. At the same time, Jamaica receives significant remittances. Social policy could have a role to encourage the use of remittances to help stem the theft of electricity.Originality/valueThis is the first study that examines the relationships between remittances, electricity consumption and electric power losses.

Trichophyton(T.)mentagrophytesnow accounts for an overwhelming majority of clinical cases in India, a new “Indian genotype” (T. mentagrophytes ITS genotype VIII)having been isolated from skin samples obtained from cases across a wide geographical distribution in this country. The conventional diagnostic methods, like fungal culture, are, however, inadequate for diagnosing this agent. Thus, molecular methods of diagnosis are necessary for proper characterization of the causative agent. The shift in the predominant agent of dermatophytosis fromT. rubrumtoT. mentagrophytes, within a relatively short span of time, is without historic parallel. The apparent ease of transmission of a zoophilic fungus among human hosts can also be explained by means of mycological phenomena, like anthropization.

Dermatophytosis has attained unprecedented dimensions in recent years in India. Its clinical presentation is now multifarious, often with atypical morphology, severe forms and unusually extensive disease in all age groups. We hesitate to call it an epidemic owing to the lack of population-based prevalence surveys. In this part of the review, we discuss the epidemiology and clinical features of this contemporary problem. While the epidemiology is marked by a stark increase in the number of chronic, relapsing and recurrent cases, the clinical distribution is marked by a disproportionate rise in the number of cases with tinea corporis and cruris, cases presenting with the involvement of extensive areas, and tinea faciei.

Cameras are everywhere, and are increasingly coupled with video analytics software that can identify our face, track our mood, recognize what we are doing, and more. We present the results of a 10-day in-situ study designed to understand how people feel about these capabilities, looking both at the extent to which they expect to encounter them as part of their everyday activities and at how comfortable they are with the presence of such technologies across a range of realistic scenarios. Results indicate that while some widespread deployments are expected by many (e.g., surveillance in public spaces), others are not, with some making people feel particularly uncomfortable. Our results further show that individuals’ privacy preferences and expectations are complicated and vary with a number of factors such as the purpose for which footage is captured and analyzed, the particular venue where it is captured, and whom it is shared with. Finally, we discuss the implications of people’s rich and diverse preferences on opt-in or opt-out rights for the collection and use (including sharing) of data associated with these video analytics scenarios as mandated by regulations. Because of the user burden associated with the large number of privacy decisions people could be faced with, we discuss how new types of privacy assistants could possibly be configured to help people manage these decisions.

In recent years, a surge of remittances to Bangladesh has enabled rural households to adopt modern renewable energy sources. However, researchers have yet to examine any statistical association between remittances and renewable energy. In this study, we determined the causal relationships between per capita remittance inflows and renewable energy consumption in Bangladesh using annual data for the period 1980–2017. This is the first such study. This determination was made while controlling for changes in GDP, and employing causality and cointegration testing. We arrived at three key results. First, a unidirectional causality running from the level of remittances per capita to a level of renewable energy consumption was determined. Second, we observed a unique cointegrating relationship between the variables. Third, a short-run bidirectional causality between remittances per capita and renewable energy consumption was clarified. Important policy implications indicate that the government should create incentives for remittance-recipient households to invest remittance funds in modern renewable technologies such as solar home energy systems.

Background: Frontline doctors engaged in COVID-19 duties have to adopt enhanced protective measures to minimize their risk of exposure. However, these measures may lead to several skin problems, thereby affecting their performance. Objectives: To analyze skin changes induced by enhanced protective measures and explore possible risk factors. Materials and Methods: A web-based descriptive study was conducted among 212 frontline COVID-19 doctors. Data were collected regarding their demography, duty, use of enhanced protective measures including prophylactic hydroxychloroquine, recent skin changes with affected sites, and possible risk factors. Results: Skin changes were reported by 41.5% of respondents (mean age 34.8 ± 5.6 years) across 210 sites. Hands were involved most commonly in 77.3% of doctors, followed by nasal bridge, cheeks, and retroauricular area. Dryness (84.1%) and skin peeling (79.5%) were the commonest clinical features. Regression model showed prolonged PPE wear (>6 h) adjusted odd's ratio (AOR) 2.9, P = 0.005], heavy sweating [AOR 12.8, P = 0.001] and frequent hand hygiene (>10 times/day) [AOR 3.1, P = 0.0006] to be significant risk factors. Hydroxychloroquine prophylaxis was deemed safe as treatment-emergent adverse events were uncommon (17.4%). Conclusion: Frontline doctors have an increased risk of developing skin damage due to enhanced protective measures. Appropriate steps should be taken to address the risk factors and minimize skin damage. Persistent cases mandate dermatology referral for optimum management.

Mentoring albeit is a recently described and popular phenomenon in medicine, is not a new one. All medical specialties have a complex, intertwined relationship between their physicians and trainees who are in different stages of their careers. How a specialty evolves depends on the thread woven by these relationships. This article outlines the concept of mentorship and introduces its various aspects in dermatology. This article attempts to answer what, why, how, when, and where related to mentoring in dermatology, including e-mentorship. The article also includes personal reflections of the authors who are involved in this process.

Skin serves as the mirror of underlying systemic problems. The early diagnosis of subtle cutaneous clinical pointers often helps in identifying renal disorders, obviating the delay in diagnosis and treatment. Cutaneous changes can be observed from the beginning of renal impairment until the evolution to terminal stage, in uremia, hemodialysis, and after kidney transplantation. In the review, we have discussed the cutaneous changes, its implicated etiopathogenesis, and their treatment options, as encountered in chronic kidney disease, hemodialysis and post-renal transplantation.

The characteristic ring with ring appearance in patients with dermatophytosis should raise the suspicion of application of topical corticosteroids (alone or in combination with topical antifungals). Such patients be counselled about the harmful effects applying such inappropriate combinaiton.

Irritable Bowel Syndrome (IBS) is a functional disorder characterized by a set of gastrointestinal symptoms often associated with extra-digestive symptoms with unknown organic basis. It is a prototypic functional bowel disorder in terms of its heterogeneous nature with multifactor pathogenesis. Invariably it is co-morbid with psychiatric disorders. This study was done to determine the frequency and types of psychiatric disorders with irritable bowel syndrome and to find out association of socio-demographic and relevant variables. It was cross-sectional study carried out in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2014 to December 2014. Total 250 sample were included by convenient sampling technique in this study diagnosed as IBS. Diagnosis was done according to Rome III criteria and SCID-CV was used for psychiatric assessment. Respondents were above 18 years of age of either sex. Data was analyzed using SPSS 20. Results showed 86.4% patients have psychiatric disorders. The most common disorder was generalized anxiety disorder (44.9%) followed by major depressive disorder (37.5%). Maximum (35.2%) were IBS-D type followed by 32.8% IBS-C type and 32% IBS-M type. So, it is seen that significant proportion of psychiatric disorders was found in patients with irritable bowel syndrome. Among them, generalized anxiety disorder was leading psychiatric disorder. Bang J Psychiatry 2018;32(2): 32-36

Objective of this study is to know the incidence of biofilm formation by isolates of Candida spp among the patients attending Tertiary health care Superspeciality centre in Lucknow. Material and Methods: A prospective study conducted among patients attending Out-patient department and admitted to In-patient department, and Intensive care unit during the period between January 1st and December 31st 2017. Different samples like endotracheal secretion, urine, blood and pus were collected under sterile conditions and standard fungal tests were performed for identification and appropriate statistical methods were employed to look for association between biofilm and Candida species. Results: Out of the 216 samples included in the study from various departments, 80 samples showed evidence of Candida infections yielding an infection rate of 37%. Among the 99 isolates (32 Candida albicans and 67 Non albicans Candida) subjected for biofilm production, 52 (52.5%) were positive. Conclusion: Non albicans Candida infection has drastically increased in healthcare centres. Biofilms have significant role in the perpetuation of these infections and antifungal resistance primarily with respect to their ability to adhere to various medical devices. Regular monitoring on the sensitivity and biofilm formation will be helpful in optimising therapy and outcome. Keywords: Candida Spp, Biofilms, Microtitre Plate Method.

Introduction: Superficial mycoses refer to the disease of skin, hair and nail caused by fungi, are a serious problem due to deficient sanitation and education. This group includes dermatophytoses, non dermatophytic molds and Candida spp. Microscopic detection of fungal elements using wet mount preparation of 10% and 40% potassium hydroxide (KOH) is a rapid and precise tool for laboratory diagnosis. Objectives: This retrospective study was conducted to evaluate the sensitivity of wet preparation direct microscopy using potassium hydroxide for early detection of fungal elements from various clinical specimens and thereby helping the clinicians in initiating the appropriate antifungal treatments. Materials and Methods: All clinical specimen like skin and nail scrapping from patients suspected of superficial mycoses were subjected to KOH examination for screening and detection and positive samples were cultured on SDA (Sabouraud’s Dextrose Agar) medium for identification. Results: A total of 5734 samples of clinically suspected patients of superficial mycoses attended the tertiary care teaching hospital between September 2013 and August 2017 were included. 3165 patients (55%) were found to be positive by KOH examination. In the present study the most common clinical type was tinea cruris (74.3%) followed by tinea corporis (22.6%) in the patients attending tertiary health care centre. Conclusion: Clinical finding and wet mount with KOH can be believed upon as the single most important rapid and sensitive tool for early diagnosis of superficial mycoses. Since there is a high incidence of superficial mycoses in rural people coming to the tertiary heath care facilities therefore preventive and early screening measures are need of hours. Keywords: Potassium hydroxide preparation, Superficial mycoses, Tinea spp.

In the last two decades, intensive research has been carried out to improve the survival rates of cancer patients. However, the development of chemoresistance that ultimately leads to tumor relapse poses a critical challenge for the successful treatment of cancer patients. Many cancer patients experience tumor relapse and ultimately die because of treatment failure associated with acquired drug resistance. Cancer cells utilize multiple lines of self-defense mechanisms to bypass chemotherapy and radiotherapy. One such mechanism employed by cancer cells is translesion DNA synthesis (TLS), in which specialized TLS polymerases bypass the DNA lesion with the help of monoubiquitinated proliferating cell nuclear antigen. Among all TLS polymerases (Pol η, Pol ι, Pol κ, REV1, Pol ζ, Pol μ, Pol λ, Pol ν, and Pol θ), DNA polymerase eta (Pol η) is well studied and majorly responsible for the bypass of cisplatin and UV-induced DNA damage. TLS polymerases contribute to chemotherapeutic drug-induced mutations as well as therapy resistance. Therefore, targeting these polymerases presents a novel therapeutic strategy to combat chemoresistance. Mounting evidence suggests that inhibition of Pol η may have multiple impacts on cancer therapy such as sensitizing cancer cells to chemotherapeutics, suppressing drug-induced mutagenesis, and inhibiting the development of secondary tumors. Herein, we provide a general introduction of Pol η and its clinical implications in blocking acquired drug resistance. In addition; this review addresses the existing gaps and challenges of Pol η mediated TLS mechanisms in human cells. A better understanding of the Pol η mediated TLS mechanism will not merely establish it as a potential pharmacological target but also open possibilities to identify novel drug targets for future therapy.

The COVID-19 pandemic emerged when India was already facing an epidemic-like situation of superficial dermatophytosis (tinea). The prevalence of tinea in India is currently 27.6%, with tinea faciei accounting for 1.8% cases.1 The use of face masks although necessary, has the potential to aggravate a worrisome situation in India.

BACKGROUND AND OBJECTIVES: Although about 80% of coronavirus disease-2019 (COVID-19) cases are reported to be mild, the remaining 20% of cases often result in severe disease with the potential of crushing already overstrained health care services. There has been sustainable growth of COVID-19 cases worldwide since mid-May 2020. To keep tabs on community transmission of COVID-19 infection screening of the samples from a large population is needed which includes asymptomatic/symptomatic individuals along with the migrant population. This requires extra resources, man power, and time for detection of severe acute respiratory syndrome coronavirus 2 by real-time polymerase chain reaction (RT-PCR). In the current scenario, the pooled sample testing strategy advocated by the Indian Council of Medical Research, New Delhi is a new approach that is very promising in resource-limited settings. In this study, we have evaluated the pooled strategy in terms of accurate testing results, utilization of consumables, and identification of borderline positive cases. MATERIALS AND METHODS: Between April and June 2020, we performed COVID-19 testing by RT-PCR from areas with varying prevalence of population referred to COVID laboratory, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow. In the first step, the samples are collated into pools of 5 or 10. These pools are tested by RT-PCR. Negative pools were reported as negative whereas positive pools of 5 and 10 are then deconvoluted and each sample is tested individually. RESULTS: In the present study, we tested 4620 samples in 462 pools of 10 and 14 940 samples in 2990 pools of 5. Among 10 samples pool, 61 (13%) pools flagged positive in the first step. In the second step, among 61 pools (610 samples) deconvoluted strategy was followed in which 72 individual samples came positive. The pooled-sample testing strategy helps saves substantial resources and time during surge testing and enhanced pandemic surveillance. This approach requires around 76% to 93% fewer tests done in low to moderate prevalence settings and group sizes up to 5-10 in a population, compared to individual testing. CONCLUSIONS: Pooled-sample PCR analysis strategies can save substantial resources and time for COVID-19 mass testing in comparison with individual testing without compromising the resulting outcome of the test. In particular, the pooled-sample approach can facilitate mass screening in the early coming stages of COVID-19 outbreaks, especially in low- and middle-income settings, and control the spread by meticulous testing of all risk groups.

Introduction: The bacterial profile of pus samples in many studies remain the same, but the antibiotic resistance pattern of these isolates has shown a lot of variations. Objective: Comparative study of bacteriological profile and antimicrobial susceptibility of Staphylococcus aureus isolated from pus and wound swab of patients at secondary and tertiary care level centres. Material and Methods: This observational retrospective study was conducted at the department of Microbiology in a super specialty Post Graduate institute. Antibiotic sensitivity testing of Staphylococcal isolates was performed by modified Kirby Bauer’s disc diffusion method as per CLSI 2017 and EUCAST guidelines. Automated susceptibility testing was performed by Vitek-2 Compact system. Conclusions: This study provides a comparative All medical pus specimens from both institution as well as from SRCLI (State Referral Centre for Clinical Lab Investigation) were included of Staphylococcus aureus isolated from pus and wound swab of patients to formulate the local antibiotic policy to initiate the appropriate empirical antibiotic treatment at secondary and tertiary care level centres. Results: Out of 997(59.38%) samples showing single growth, Gram positive organisms were 216 (35.23%) for institutional and 195 (50.78%) for SRCLI (State Referral Centre for Clinical Lab Investigation). 85% and 91% isolates of Staphylococcus aureus were resistant to penicillin followed by erythromyc in (53.5% and 49%) and cefoperazone-sulbactum (28.5% and 14%), while 31 (55%) and 36 (34.61%) isolates were MRSA respectively for institutional and SRCLI. Even the higher antibiotic like linezolid showed 2.5% resistance (P = 0.5054) in MRSA isolates of SRCLI compared to 0% in institutional samples, which was, though not statistically significant, but is of great concern. Vancomycin showed no resistance in both areas. Keywords: Pyogenic Infections, Secondary and Tertiary Health Care, Level Centre, Antimicrobial Resistance

This essay examines the role of disinformation in the Indian general election of 2019. The findings are presented against the background of previous work on the role of digital media in Indian politics. The essay uses 25 in-depth interviews among ordinary Indians to probe their level of awareness about so-called ‘fake news’. It also examines their behavior in seeking news and sharing political information and their views about the digital campaign strategies of leaders and parties. The interviewees were concerned about the increasing role of religious extremism online. Yet they were also strongly aware of the role of disinformation campaigns and had strategies for working around being misled by information shared on social media. The essay concludes by assessing how disinformation and online extremism are likely to have affected the 2019 election, and makes comparisons with Modi's election in 2014 and with other leaders.

This study investigates the effects of a submerged cylinder on the sloshing responses in a partially filled U-shaped container. The movable cylinder is placed at the horizontal portion of a...

Dermatophytoses are infections of the skin, hair and nails, caused by dermatophytes, namely Trichophyton spp, Microsporum spp and Epidermophyton floccosum. Trichophyton soudanense is an anthropophilic fungus, a frequent cause of tinea capitis in Africa though some imported cases are now been reported from Europe, Brazil, Australia and USA. Untill now, 3 cases of T.soudanense causing tinea capitis, tinea unguium, tinea corporis from North India and 2 cases causing tinea corporis and tinea cruris from south India have been reported, but this is probably the first case report of onychomycosis caused by T.soudanense in India. Keywords: Onychomycosis, Trichophyton soudanense, Epidemiology.

The function of the thyroid gland is to secrete sufficient amount of thyroid hormones for regulation of cellular metabolism throughout the body. Patients need medical care for hyper functioning (hyperthyroidism) or hypo functioning (hypothyroidism) of the thyroid gland. Hypothyroidism is a very common disease affecting 0.5% to 0.8% of the adult population in the world. Primary hypothyroidism results in a decreased production of thyroid hormones despite adequate or increased levels of TSH and accounts for 95% of all cases of hypothyroidism. Secondary hypothyroidism results due to hypothalamic or pituitary disease that accounts for 5% of cases of hypothyroidism [1]. Hypothyroidism can cause decreased myocardial contractility, baroreceptor dysfunction, weight gain, non-pitting edema, hyponatremia, decreased ventilatory response to hypoxia and hypercarbia, diminished gastrointestinal function and impaired drug metabolism. Feeding jejunostomy is a surgical procedure by which a tube is inserted in the lumen of the proximal jejunum, primarily to provide enteral nutrition or administer medications. This procedure becomes a vital path for providing nutrition and medication when a person becomes unable to swallow due to obstruction of the food pipe [2]. Carcinoma larynx is a disease in which malignant cells originate from larynx mostly squamous-cell carcinomas which can invade the surrounding structures. Here, we report on the anaesthetic management of a patient of carcinoma larynx with overt hypothyroidism for feeding jejunostomy.

Voice assistants have been shown to be vulnerable to replay attacks, impersonation attacks and inaudible voice commands. Existing defenses do not provide a practical solution as they either rely on external hardware or work under very constrained settings. We introduce a hand gesture-based authentication system for smart home voice assistants called HandLock, which uses built-in microphones and speakers to generate and sense inaudible acoustic signals to detect the presence of a known hand gesture. Our proposed approach can act as a second-factor authentication (2-FA) for performing specific sensitive operations like confirming online purchases through voice assistants. The experiments involving 45 participants show that HandLock can achieve on average 96.51% true-positive-rate at the expense of 0.82% false-acceptance-rate.

Ilio-caval arteriovenous fistula is a rare sequel of lumbar disc surgery or penetrating injury. We report a case of 40-year gentleman presenting with symptoms of congestive heart failure and continuous murmur heard over right iliac fossa. His past history was significant for lumbar disc surgery done twice 1 year back. Computed tomography angiogram confirmed a large fistulous communication between right common iliac artery and inferior vena cava. Open surgical repair was performed as the fistula was not well suited for endovascular repair. We successfully managed this case by open surgical ligation of right common iliac artery proximal and distal to fistula and continuity restored with interposition Dacron graft. He was relieved of symptoms and performing well on follow-up.

The use of voice-control technology has become mainstream and is growing worldwide. While voice assistants provide convenience through automation and control of home appliances, the open nature of the voice channel makes voice assistants difficult to secure. As a result voice assistants have been shown to be vulnerable to replay attacks, impersonation attacks and inaudible voice commands. Existing defenses do not provide a practical solution as they either rely on external hardware (e.g., motion sensors) or work under very constrained settings (e.g., holding the device close to a user’s mouth). We introduce the concept of using a gesture-based authentication system for smart home voice assistants called HandLock, which uses built-in microphones and speakers to generate and sense inaudible acoustic signals to detect the presence of a known (i.e., authorized) hand gesture. Our proposed approach can act as a second-factor authentication (2-FA) for performing specific sensitive operations like confirming online purchases through voice assistants. Through extensive experiments involving 45 participants, we show that HandLock can achieve on average 96.51% true-positive-rate (TPR) at the expense of 0.82% false-acceptance-rate (FAR). We perform a comprehensive analysis of HandLock under various settings to showcase its accuracy, stability, resilience to attacks, and usability. Our analysis shows that HandLock can not only successfully thwart impersonation attacks, but can do so while incurring very low overheads and is compatible with modern voice assistants.

Although the relationship between diet and chronic spontaneous urticaria (CSU) remains elusive, several patients seek dietary modifications as they are easy and cost-effective. Adequate patient education and counseling are crucial as modified diets may be beneficial for a subset of antihistamine refractory CSU patients, and no modality currently exists to identify these patients. Elimination of food items based exclusively on patient history may lead to unnecessary restrictions in most cases resulting in nutritional deficiencies and impaired quality of life. Several dietary strategies have been tried till date with varying rates of success and evidence. This review highlights the various dietary strategies along with their levels of evidence, which may help the treating dermatologists and physicians to counsel CSU patients and make evidence-based treatment decisions. There is grade A recommendation for the elimination of food additives (artificial pseudoallergens), personalized diets, vitamin D supplementation, Diamine oxidase supplementation and probiotics (in children), grade B recommendation for dietary elimination of red meat, fish and their products, natural pseudoallergens (fruits, vegetables, and spices), and low-histamine diet, while dietary elimination of gluten (with concomitant celiac disease) has grade C recommendation. Notably, elimination diets should be continued for at least 3 consecutive weeks to assess their effectiveness.

The available literature on dermatological manifestations of COVID-19 indicates a variation in prevalence and characteristics of muco-cutaneous findings among different population groups.1 An early descriptive Chinese study reported a prevalence of 0.2%, however, a recent Spanish study reported a prevalence of 45.7%.2,3.

Tracheostomy is the primary surgical procedure to overcome acute respiratory distress due to upper airway obstruction. The design of tracheostomy tubes are for management of obstruction usually above the level of the glottis or cricoid cartilage. Infrequently, we come across patients who present with respiratory difficulty due to obstruction at lower levels of the trachea. In such patients, tracheostomy may not alleviate the obstructive symptoms as the limited length of the tube may not bypass the obstruction. There is a dearth of long tracheostomy tubes commercially. They are usually not readily available and costly. We present a method to combine and modify an endotracheal tube and a tracheostomy tube to fashion them into a Long Tracheostomy Tube. We also present two cases where we used the long tracheostomy tubes in an otherwise difficult to manage scenarios.

Azygos or hemizygous continuation of inferior vena cava (IVC) is diagnosed in the presence of intrahepatic interruption of IVC. We report a case of a 4-year-old, male child presenting with a history of poor weight gain. A detailed evaluation of the child revealed a diagnosis of hemizygous continuation of uninterrupted, but severely obstructed, IVC. This incidental finding has rarely been reported in the literature.

Introduction Bicuspid Aortic Valve related aortopathy is known to be associated with ascending aortic aneurysm and coarctation of aorta. Surgical correction of the combined entity as a double stage procedure has its own set of challenges. Single stage repair for the same has been tried since 1980 with variable success rates. Placement of extra anatomic bypass graft for coarctation repair in different orientations have been discussed in the literature but whether the procedure is feasible without any undue risks when combined with the surgical correction of the aortic root and ascending aorta pathology is a subject of debate. Surgical technique Under routine cardiopulmonary bypass, a combined procedure was performed in three patients with ascending aortic aneurysm and coarctation of aorta. The procedure involved the combination of Bentall or supracoronary ascending aorta replacement and a ventral aorta repair. Discussion We, here, examined the feasibility of such a single stage repair done in three patients and discuss the challenges faced by the surgical team with respect to the procedure and the post-operative care.

Background Though melasma is a common skin condition in India, epidemiological studies are few and geographically confined. The present study was designed to gain insights into factors involved in causation and aggravation of melasma, demographic distribution, clinical presentations, and treatment patterns. Methods A cross-sectional multicentric study was conducted in 10 centers distributed across the four regions of India. Data including demographics, personal and family medical history, triggering and aggravating factors, clinical patterns, and details of past treatment regimens were recorded, and severity was estimated using the modified Melasma Area and Severity Index (MASI) score. Data collected by site dermatologists were collated and analyzed. Results The study evaluated 1,001 patients with melasma from 10 centers. Mean age was 38.02 years. Females dominated (85%). Proportion of males was highest in the east (22.2%) and lowest in the south (10.8%). Majority of patients belonged to intermediate skin phototypes. There was a significant difference (P = 0.000) between duration of sun exposure and duration of cooking fire/occupational heat exposure across the four regions. There was a significant association (P = 0.003, Mann-Whitney U test) and a positive correlation between duration of cooking heat/occupational heat exposure and severity of melasma. Sunscreens were used by only one-fifth of the study population (19.6%) whereas use of steroids and triple combinations was more common (28%). Conclusion One of the largest studies on melasma from the subcontinent, this study describes the epidemiological determinants of melasma. Data suggests that the duration of cooking fire/occupational heat exposure may be linked to severity of melasma. Sunscreen use seems inadequate in Indian patients; use of steroid-containing medications is more common.

In this case, we focus on two innovations in the design of competitive discussions for a high stakes learning context. The designer created the intervention to provide learners first-hand discussion experiences despite large class sizes. It was a business communication course, and the large class sizes and group dynamics previously had inhibited constructive feedback and limited learner participation; however, the combination of a (1) time-constrained asynchronous CMC activity, along with (2) strategically selected smaller groups, created an interactive space that matched the designer’s values of equity and inclusion that he wanted to bring to the design. The case chronicles a number of unforeseen consequences of logical design moves, and presents a multimodal re-conception of what it means to discuss in the context of modern business school.

Background and Purpose: Fungal renal abscesses are rare entities associated with significant morbidity and mortality. Affected kidneys can have microabscess, pyelonephritis, pyonephrosis, or papillary necrosis. Case report: Herein, we reported an unusual case of a large renal abscess cause by Candida tropicalis in a diabetic patient. The entity presented as a lump in the abdomen and later was diagnosed to be an abscess on computed tomography scan. Candida tropicalis was confirmed on the culture of the aspirate. The abscess was successfully treated by percutaneous drainage and administration of amphotericin B deoxycholate. Conclusion: Candida tropicalis is now a global concern because of its rising prevalence and high virulence. The growing resistance of this Candida species to azoles, as in our case, calls for a more judicious usage of antifungal agents. Empirical therapy with either amphotericin or echinocandins is an option in case of high azole resistance. This case highlights the importance of timely diagnosis and implementation of aggressive management in cases suffering from fungal abscesses.

A large number of mobile phone applications have been built and deployed to combat COVID-19, offering various services to users, including virus information, contact tracing, and symptom monitoring among others. At the same time, the privacy and security vulnerabilities of user data over these apps have become a big concern in many places. To examine this issue, we conducted a mixed-method study with a combined approach of app analysis and an online survey to understand the privacy vulnerabilities of such apps and get an overview of user perceptions around this issue. In addition, we considered the notion of privacy in two different socio-economic contexts (Global North and Global South) to specify similarities and differences in app-specific privacy functionalities (data practices, functional requirements, regulations, etc.) and identify factors that impacted users’ decision to use such apps (such as trust, preferences, concerns, motivations, etc.). Thus, this paper presents two diverse sets of opinions from these two geographic regions (including 27 countries), which provide a broader understanding of how the privacy concerns around COVID-19 are connected to various economic, political, and social factors. Furthermore, our analysis of 39 apps provides a deep insight into what many COVID-19 apps are lacking to ensure proper privacy practices and how those issues are entangled with various contextual challenges.

Targeted advertisement is prevalent on the Web. Many privacy-enhancing tools have been developed to thwart targeted advertisement. Adblock Plus is one such popular tool, used by millions of users on a daily basis, to block unwanted ads and trackers. Adblock Plus uses EasyList and EasyPrivacy, the most prominent and widely used open-source filters, to block unwanted web contents. However, Adblock Plus, by default, also enables an exception list to unblock web requests that comply with specific guidelines defined by the Acceptable Ads Committee. Any publisher can enroll into the Acceptable Ads initiative to request the unblocking of web contents. Adblock Plus in return charges a licensing fee from large entities, who gain a significant amount of ad impressions per month due to participation in the Acceptable Ads initiative. However, the privacy implications of the default inclusion of the exception list has not been well studied, especially as it can unblock not only ads, but also trackers (e.g., unblocking contents otherwise blocked by EasyPrivacy). In this paper, we take a data-driven approach, where we collect historical updates made to Adblock Plus's exception list and real-world web traffic by visiting the top 10k websites listed by Tranco. Using such data we analyze not only how the exception list has evolved over the years in terms of both contents unblocked and partners/entities enrolled into the Acceptable Ads initiative, but also the privacy implications of enabling the exception list by default. We found that Google not only unblocks the most number of unique domains, but is also unblocked by the most number of unique partners. From our traffic analysis, we see that of the 42,210 Google bound web requests, originally blocked by EasyPrivacy, around 80% of such requests are unblocked by the exception list. More worryingly, many of the requests enable 1-by-1 tracking pixel images. We, therefore, question exception rules that negate EasyPrivacy filtering rules by default and advocate for a better vetting process.

The proliferation of the Internet of Things (IoT) has started transforming our lifestyle through automation of home appliances. However, there are users who are hesitant to adopt IoT devices due to various privacy and security concerns. In this paper, we elicit peoples’ attitude and concerns towards adopting IoT devices. We conduct an online survey and collect responses from 232 participants from three different geographic regions (United States, Europe, and India); the participants consist of both adopters and non-adopters of IoT devices. Through data analysis, we determine that there are both similarities and differences in perceptions and concerns between adopters and non-adopters. For example, even though IoT and non-IoT users share similar security and privacy concerns, IoT users are more comfortable using IoT devices in private settings compared to non-IoT users. Furthermore, when comparing users’ attitude and concerns across different geographic regions, we found similarities between participants from the US and Europe, yet participants from India showcased contrasting behavior. For instance, we found that participants from India were more trusting in their government to properly protect consumer data and were more comfortable using IoT devices in a variety of public settings, compared to participants from the US and Europe. Based on our findings, we provide recommendations to reduce users’ concerns in adopting IoT devices, and thereby enhance user trust towards adopting IoT devices.