Onychomycosis is more common in women of 20-40 years of age. Distolateral subungual onychomycosis and candidal onychomycosis are the most common clinical presentations, and Candida and T. rubrum are the major pathogens in Pakistan.

We report a randomized, double-blind study, comparing the relative efficacy and tolerability of oral terbinafine, given for 1, 2 or 4 weeks, in tinea capitis. Of 161 evaluable patients, 53 were treated with terbinafine for 1 week, 51 for 2 weeks and 57 for 4 weeks. Isolated pathogens included Trichophyton violaceum (71.5%), T. tonsurans (14.9%), T. verrucosum (4.3%), Microsporum audouinii (4.3%), M. canis (2.5%), T. schoenleinii (1.9%) and T. mentagrophytes (0.6%). The final evaluation, at 12 weeks, showed cure rates of 73.6, 80.4 and 85.9%, in the respective groups. The adverse effects noted, were not drug related. In our opinion, terbinafine given for 1, 2 or 4 weeks, is equally effective for most cases of tinea capitis.

T. violaceum is the predominant pathogen causing tinea capitis in children and adults in this part of the world and gives rise to a varied clinical picture. Our findings agree with data from other parts of Pakistan and many countries abroad.

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Objective There has been a rise in the magnitude of dermatological diseases in the South East Asian region. This study aimed to determine the pattern of various skin disorders appearing in the Dermatology Department of a tertiary care hospital, which will help people to understand the scale of the rising incidence and possible preventive measures that can be undertaken to curtail it. Methods An observational study was conducted on all the patients who attended the Dermatology Department during a one year span. A thorough medical history with detailed cutaneous examination was carried out on every patient. Investigations and skin biopsies were performed, where required, for confirmation of diagnosis. Results A total of 95,983 patients presented in the outpatient Department of Dermatology, King Edward Medical University Mayo Hospital Pakistan. Out of this sample, 24,302 patients repeatedly came to the hospital for a follow up visit related to their diseases, while 71,681 were enrolled as new cases. This group comprised 58% females and 42% males; most patients were in the 20–40 years age group. Out of 71,681, eczema was diagnosed in 22,275 (31.07%), infections including bacterial, viral, fungal, sexually transmitted infections (STIs) in 20,178 (28.16%), acne 7910 (11.03%), drug reactions 4830 (6.74%), urticaria 2910 (4.06%), and pigmentary disorders such as lichen planus, melasma and vitiligo were reported in 2739 (3.82%) cases. In addition, psoriasis was reported in 2724 (3.80%), bullous disorders in 1187 (1.66%) and connective tissue disorders in 645 (0.90%). The majority of patients presented with advanced eczema and infectious diseases. Conclusion Eczema was the most common skin disease seen in our study, followed by dermatological infections. The emerging challenges for dermatologists are to prevent and reduce these skin diseases that pose a major healthcare burden, as well as affect the quality of patients' lives.

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The BA.1 x AY.4 recombinant variant (Deltacron) continues to inflict chaos globally due to its rapid transmission and infectivity. To decipher the mechanism of pathogenesis by the BA.1 x AY.4 recombinant variant (Deltacron), a protein coupling, protein structural graphs (PSG), residue communication and all atoms simulation protocols were used. We observed that the bonding network is altered by this variant; engaging new residues that helps to robustly bind. The protein structural graphs revealed variations in the hub residues, number of nodes, inter and intra residues communities, and path communication perturbation caused by the acquired mutations in the Deltacron-RBD thus alter the binding approach and infectivity. Moreover, the dynamic behaviour reported a highly flexible structure with enhanced residues flexibility particularly by the loops required for interaction with ACE2. It was observed that these mutations have altered the secondary structure of the RBD mostly transited to the loops thus acquired higher flexible dynamics than the native structure during the simulation. The total binding free energy for each of these complexes i.e. WT-RBD and Deltacron-RBD were reported to be -61.38 kcal/mol and -70.47 kcal/mol. Protein's motion revealed a high trace value in the Deltacron variant that clearly depict more structural flexibility. The broad range of phase space covered by the Deltacron variant along PC1 and PC2 suggests that these mutations are important in contributing conformational heterogeneity or flexibility that consequently help the variant to bind more efficiently than the wild type. The current study provide a basis for structure-based drug designing against SARS-CoV-2.

During a period of 1 year, out of 202 clinically suspected cases of tinea unguium, 53 (26%) were confirmed by mycological cultures for dermatophytes. Trichophyton rubrum was the most common fungus isolated in 46 (87%) patients, followed by T. violaceum in four (7%), T. interdigitale in two (4%) and Epidermophyton floccosum in one (2%). The disease was more common in adult males and fingernails were found to be affected more often than toenails. The distal and lateral variety was seen in 41 (77%) patients, total secondary dystrophic type in 11 (21%) and proximal subungual type in one (2%). Clinical diagnosis alone is not reliable and mycological confirmation is mandatory for this potentially curable disease.