Background: Dermatophytosis—superficial fungal infection caused by dermatophyte genera Trichophyton, Microsporum, and Epidermophyton—is among the most prevalent infectious dermatoses worldwide, with a markedly increasing burden in South Asia over the past decade. A concurrent epidemic of treatment-refractory, recurrent tinea infections has been attributed to the emergence of antifungal resistance, particularly terbinafine resistance mediated by mutations in the squalene epoxidase gene (SQLE). The drivers, epidemiology, and clinical correlates of resistance in Indian populations remain incompletely characterized. Objective: To determine the clinico-epidemiological patterns of dermatophytosis, identify prevalent causative species, characterize antifungal susceptibility profiles, detect SQLE resistance mutations, and identify risk factors associated with antifungal resistance in patients attending a tertiary dermatology center in Telangana, India. Methods: This prospective clinico-mycological study enrolled 210 consecutive patients with culture-confirmed dermatophytosis at Shadan Institute of Medical Sciences, Teaching Hospital & Research Centre, Hyderabad between February 2013 and January 2014. Dermatophyte species were identified by morphological and molecular methods. Minimum inhibitory concentrations (MICs) were determined by broth microdilution (EUCAST EDef 9.3). SQLE gene sequencing was performed for terbinafine-resistant isolates (MIC >0.5 µg/mL). Clinical outcomes were assessed at 4 weeks and 3 months. Multivariate logistic regression identified independent predictors of antifungal resistance. Results: Trichophyton mentagrophytes complex (39.0%) and T. rubrum (32.4%) were the predominant species. Terbinafine resistance was detected in 31.7% of T. mentagrophytes and 16.2% of T. rubrum isolates. Fluconazole demonstrated the lowest in vitro activity across all species. SQLE mutations (F397L, L393F, H440Y, A448T) were identified in 86.4% of high-level terbinafine-resistant isolates. Prior terbinafine exposure (adjusted OR 4.24), topical corticosteroid misuse (OR 3.12), and recurrent disease (OR 2.47) were the strongest independent predictors of resistance. Voriconazole demonstrated superior in vitro activity against resistant isolates. Conclusion: Antifungal resistance, particularly terbinafine resistance driven by SQLE mutations in T. mentagrophytes, is a major and growing therapeutic challenge in India. Topical steroid misuse and irrational antifungal prescribing are modifiable drivers that demand urgent regulatory and educational interventions. Routine susceptibility testing should be incorporated into the management of recurrent or treatment-refractory dermatophytosis.

Chest radiographs are one of the most common radiological procedures performed in medical practice. The chest radiograph should ideally include views of the heart, lungs, trachea, mediastinum, bones of the chest and upper part of the abdomen. Chest radiographs are normally taken in the posterior-anterior (PA) view with the patient in upright / standing position but for patients admitted in the intensive care unit (ICU) or other emergency situations, this is not possible and so they are taken in the supine (anterior-posterior views) or semi-erect position. Chest radiographs are done not only for diagnostic reasons to look for abnormalities in the lungs, soft tissues and bones but also to check the position of various invasive lines and tubes. In this article, we aim to discuss and compare the normal and abnormal positions of both the endotracheal tube (ETT) and nasogastric tube (NG) on chest radiographs.

For generations the mind has been mystifying physicians all around the world. It is the powerhouse behind everything we do, and everything that we are – therefore there is no wonder that reams of time, research, money and effort has been poured into this1. The Association of British Neurologist, through various publications in the last 10years, has stated that there are too few neurologist consultants, and that provisions need to be made to ensure that there is comprehensive care to patients in hospitals2. In light of this there has been a recent drive into increasing the number of clinical consultant posts in local hospitals. This drive has led to more innovative measures being implemented in this field, including new research on pharmaceuticals as well as introduction of new technologies.

Staff often feel as though they are being manipulated by patients or describe their behaviour as "manipulative" and yet this term probably adds little to the management of patients other than the expression of dislike because a wide variety of disapproved of behaviours tends to be grouped under this term. An insight into its meaning and use can be gained by noting that patients with psychosis or melancholic depression do not often attract the appellation. Instead, people who are drug and alcohol dependent, people with personality disorders and some depressed patients with atypical symptoms. The key is a sense on the part of the staff that the individual has some voluntary control over their behaviour and that they could change it if they so desired. Another feature is the sense that something is being extracted or demanded in an underhand way. Another feature of situations in which patients are described as manipulative is one where resources are scarce and, for reasons of rationing staff are under pressure not to accede to requests that have resource implications.

Indian medical education system has seen rapid growth in the last two decades. From a miniscule number, private medical colleges have grown to account for more than half of the 270 medical colleges in 2008 and consequently, India has the highest number of medical educators in the world. This unregulated unequal growth brings two issues to focus: the failing quality of medical education and implementing effective solutions to address an artificial faulty shortage due to doctor mal-distribution. The menace posed by the growing mechanization of medical education has to be warded off and efforts should be made to ensure maintenance of standards and check the unplanned growth of substandard medical colleges and substandard education norms in universities or their constituent medical colleges. There is a strong case for a review of the entire system of medical education and examinations in the country. Some solutions like increasing retirement ages of MD faculty to 70 years, sharing of faculty, increasing MD seats, allowing clinical MDs to teach paraclinical and preclinical subjects or temporary merger of specialities have been proposed to address the faculty shortage instead of relying on inadequately qualified MSc non-medical faculty.