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BACKGROUND The audit evaluates the value of MDT, including neuro-radiologist and neuro-surgeon, review of contouring carried out by a clinical oncologist in stereotactic radiosurgery (SRS). MATERIAL AND METHODS A sequential audit was conducted of all patients receiving intracranial SRS at our local institution for the first 22 months of a new SRS service. Lesions were contoured first by clinical oncologist then reviewed/edited by the MDT. The initial contour was compared with final contour using Jaccard conformity and geographical miss indices. The dosimetric impact of a contouring change was assessed using plan metrics to both original and final contour. The impact of the contouring review on local relapse, overall survival and radio necrosis rate was evaluated with at least 24 months follow up (24–46 months). RESULTS 113 patients and 142 lesions treated over 22 months were identified. Mean JCI was 0.92 (0.32–1.00) and 38% needed significant editing (JCI0.05). Resection cavities showed more changes, with lower JCI and higher GMI (p CONCLUSION This work highlights that a MDT contour review adds significant value to SRS and the approach translates into reduced local recurrence rates at our local institution compared with previously published data. Radio-necrosis rates are below 10%. No improvement in clinical oncologist contouring over time was shown indicating a collaborative approach is needed regardless of experience of clinical oncologist. MDT input is recommended in particular in contouring of resection cavities.

A total of 8123 Armed Forces personnel attended dermatological OPD from Jan 1989 to Dec 1994. On analysing the record it is found that 2953 (36.3%) cases had infective dermatosis and 5170 (63.7%) cases had non-infective dermatosis. Common infective dermatosis included fungal infections (17.2%), viral infections (7.7%), bacterial infections (3.6%) and arthropode infestations (7.8%). Common non-infective dermatosis included papulosquamous disorders (13.5%), pigmentary disorders (13.4%), eczemas (11.1%), acne (8.7%), alopecia (6.1%), urticaria (4.2%) and drug eruptions (1.9%).

Dear Editor, Sexually transmitted diseases (STDs) have remained a major health problem in India. In addition to its morbidity, STD cases in the Armed Forces cause considerable loss of man-hours due to hospitalization, transfer of cases to STD treatment centres and follow up of the cases varying from 3 months to 30 months. STDs are also a major factor in the transmission of the most dreaded disease of modern time i.e. HIV infection [1]. A study was done to review the current pattern of STDs in the Armed Forces, compare it with the earlier studies on the subject and find out their association with HIV infection. The study was conducted at a large referral STD treatment centre. All new cases of STDs admitted from Jan 1993 to Dec 1999 were studied. Besides recording a detailed history each case underwent a thorough general physical, systemic, dermatological and venereological examination. Relevant investigations were done for confirmation of diagnosis. Serological tests for Syphilis and ELISA for HIV antibodies were done in all cases. ELISA positive cases were subjected to Western Blot test for confirmation of HIV infection. A total of 797 cases were diagnosed as STDs. All cases were males. The youngest case was 18 year old and the oldest 50 years. The year-wise incidence varied from 183 (23.17) in 1994 to 73 (9.17)in 1998 and showed a declining trend (Table-1). This decline in overall incidence of STDs over the years has probably been due to greater awareness and concern of the people especially about acquiring HIV infection. However, despite decline in the overall incidence of STDs the incidence of HIV infection in STDs had increased from 4.9% in 1995 to 15% in 1999 (Table-1). Arora et al reported 0.1% incidence of HIV infection in STDs during 1985–90 [2], whereas Gupta et al reported the incidence to be 16.3% in 1990–96 [3]. The increasing incidence of HIV infection in STDs is probably due to increasing HIV positivity in commercial sex workers. The bulk of cases in the present study was formed by Chancroid in 134 (23.1%) followed by Condyloma Acuminata in 126 (15.8%), Syphilis in 103 (12.9%), Lymphogranuloma Venereum (LGV) in 80 (10%), Gonorrhoea in 58(7.3%) and Herpes Genitalis in 51 (6.4%) respectively (Table-2). Comparing with the previous reports published from the Armed Forces [2, 3, 4, 5, 6] it was observed that the incidence of Syphilis, Gonorrhoea, Chancroid and LGV had declined whereas the incidence of Condyloma Acuminata, Herpes Genitalis, Nonspecific urethritis and Molluscum contagiosum had increased (Table-3). TABLE 1 Year wise incidence of STDs and HIV infection cases TABLE 2 Incidence of different types of STDs and their association with HIV infection TABLE 3 Pattern of STDs in Armed Forces To conclude, there had been a decline in the overall incidence of STDs and in particular Syphilis, Gonorrhoea, Chancroid and LGV. However, despite the declining trend, the incidence of HIV infection in STD cases has shown an increasing trend. It is therefore imperative to control STDs and treat them at the earliest in order to reduce risk of transmission of HIV infection. More aggressive approach is required to impart health education to the Armed Forces personnel, general public and commercial sex workers regarding preventive measures, which will go a long way in reducing the incidence of STDs and HIV infection.

Introduction and objectives The ASTER trial demonstrated that the sensitivity of combined endobronchial/endoscopic ultrasound [EBUS/EUS] is similar to that of mediastinoscopy. 1 NICE guidelines now recommend combined EBUS/EUS for initial mediastinal staging as an alternative to surgical staging. 2 Although surgical staging following negative endosonography is recommended, ASTER showed that 11 mediastinoscopies are required to identify one case of mediastinal disease. We aimed to determine the negative predictive value of EBUS/EUS for mediastinal staging in our practice. Method We identified all patients who had undergone primary surgical resection with lymph node sampling for NSCLC between May 2012 and April 2014 previously staged with CT, PET-CT, EBUS+/-EUS and/or mediastinoscopy. Demographic, histological and surgical details were extracted from clinical records. Analysis was conducted on MedCalc software v13.3.1 and reviewed by an independent statistician. Results 42 patients who underwent EBUS+/-EUS for mediastinal staging were found to have no evidence of N2/3 disease. In 3 cases subsequent mediastinoscopy was performed as a high degree of suspicion for mediastinal disease persisted. However, in all cases surgical staging correlated with endosonographic staging. At thoracotomy, 3 (other) patients were upstaged to N2 disease. In two cases, micrometastatic disease was present in a station 7 node and one case had positive station 5/6 not accessible at EBUS/EUS. Overall the NPV of EBUS+/-EUS was 93% (95% CI, 80%–98%). In 22 of 42 patients, the same nodal stations sampled on EBUS/EUS were removed at surgery. In this subset, EBUS/EUS had a NPV of 91% (95% CI, 71% to 99%). Conclusion We have shown that in an experienced centre, mediastinal staging by EBUS+/-EUS can have a high NPV. In these circumstances, surgical staging following negative endosonography is probably not warranted unless a high degree of clinical suspicion remains following MDT discussion. Regular audit of NPV is recommended to ensure performance standards are maintained. References Annema et al . JAMA 2010;304:2245 NICE guidelines, 2011, Lung Cancer , CG121

Serum zinc levels were studied in 75 patients of different cutaneous disorders and 24 healthy controls. It was found to be significantly lower in acne vulgaris (71.5 ± 21.5µgm/100ml), leprosy(85.9 ± 26.9µgm/100ml) and psoriasis (93.3 ± 25.9µgm/100ml) as compared to healthy controls (105.3 ± 30.1µgm/100ml). No significant correlation was found in other cutaneous disorders studied i.e. vitiligo and aphthous ulcers where serum zinc levels were found to be 97.3 ± 26.6 µgm/100ml and 105.2 ± 23.5 µgm/100ml respectively.

Objective. To evaluate the relationship between commonly used final needle-tip positions and subsequent contrast flow and patient-reported pain relief in transforaminal epidural steroid injections (TFESIs). Design. Retrospective cross-sectional study. Methods. Medical records of subjects (N = 83) having undergone a TFESI between January 2008 and January 2009 were reviewed to compare TFESIs using the superior-anterior (SA) vs. the superior-posterior (SP) quadrant. Outcome Measures. Outcome measures included ventral and dorsal epidural contrast flow as well as near-to-complete pain relief as measured by numerical rating scale pain score pre- and post-procedure. Results. SA TFESIs were associated with greater ventral epidural contrast flow as compared with SP TFESIs (100% vs 61.4%, P < 0.001). SA TFESIs with ventral epidural contrast flow were also associated with flow to a greater number of vertebral levels than SP TFESIs with ventral epidural contrast flow (41% vs 14.8%, P < 0.001). SP TFESIs were associated with greater dorsal epidural contrast flow than SA TFESIs (95.5% vs 43.6%, P < 0.05). SA TFESIs were also associated with a larger proportion of patients who achieved near-to-complete pain relief ( P < 0.05) and greater reduction than SP TFESIs in post-procedure pain score relative to pre-procedure (3.3 vs 1.5, P < 0.01). Discussion. The evolution of TFESIs must balance both safety and efficacy. The efficacy of SA TFESIs is demonstrated to be superior to that of SP TFESIs with regards to ventral epidural flow and patient-reported pain relief. Further efforts should focus on demonstrating efficacy while optimizing safety.

Pattern of sexually transmitted diseases (STDs) in 1027 male patients admitted during 1990 to 1996 were analysed. Majority of cases (86%) were in age group of 20 to 40 years. Out of total 1027 STD cases 334 (32%) were having chancroid, 237 (23%) syphilis, 122 (11.9%) lymphogranuloma venereum, 130 (12.6%) gonorrhoea, 34 (3.3%) Herpes genitalis and 170 (16.5%) other STDs. 167 STD cases (163%) were found to have HIV infection. A rising trend in prevalence of HIV infection in STD patients from 2.8% (1990) to 27.8 (1996) was noticed contrary to declining trend of STDs from 213 cases in 1990 to 79 cases in 1996. The prevalence of HIV infection was 303% in LGV, 19.3% in chancroid, 13.5% in syphilis, 17.6% in herpes genitalis, 6.7% in gonorrhoea and 11.2% in other STD cases. Out of total 167 STD cases having HIV infection 65 (40%) cases were of chancroid, 37 (22.2%) of LGV, 32(19.2%) of syphilis, 8 (4.8) of gonorrhoea, and 6(3.6%) of herpes genitalis while 17 (10.2) cases were having other STDs.

Background : Human pathogenic dermatophytes are keratinophilic molds that infect human skin, nails and hairs. Three genera (Trichophyton, Micosporum and Epidermophyton) of these organisms exist: however, their preferred sites for infections vary. Current management often consists of the topical and systemic administration of antifungal agents or a combination of both. However, these approaches may not be successful in every case due to such factors as difficulty with long term application of topical medications. Despite the successful use of systemic medications side effects and drug resistance remains a major obstacle. The treatment of dermatophyte infections represents a significant cost burden. Aims and Objectives : To study the epidemiology, clinical types and mycological features of dermatophytes from various clinical samples from dermatology department, Santosh Hospital. Material and Method : A total of 100 samples were collected including infected skin, hair and nail samples for a period of six months. Before collecting the samples, 70% alcohol was applied to the infected area and ensured that it was totally dried. Skin samples were collected by scraping, nail sample by clipping and hair samples collected by using sterile forcep or scalpel. Identification was done by KOH mount, culture on SDA, pigment production, lactophenol cotton blue staining and biochemical tests and slide culture techniques. Results : Dermatophytosis was manifested clinically more in the age group 21 - 30 years age. Tinea corporis was the predominant clinical presentation followed by Tinea cruris. Tinea capitis was the predominant clinical presentation in children and Tinea manuum was the commonest clinical type found in female patients. In the present study the male to female ratio was found 1.5 : 1. Majority of patients were belonged to the low socio-economic status. Trichophyton rubrum was the predominant pathogen followed by the Trichophyton mentagrophytes. Conclusion : Tinea corporis was found the most common clinical type of dermatophytosis and Trichophyton rubrum was found the most common fungal isolate in this part of Uttar Pradesh.

The pattern of dermatological admissions based on retrospective study of 1578 Armed Forces personnel who were hospitalised during period of Jan 1984 to Dec 1994 at Command Hospital Southern Command, Pune were analysed. Average yearly admission was 144. Eczema was the most common skin disease requiring admission and accounted for 29.5 per cent cases followed by infections and infestations 25.5, papulo-squamous disorders 21.4, urticaria 4.2, connective tissue disorders 4.2, bullous disorders 2.8, and others 12.4 per cent.

Forty nine cases of chronic liver disorders were studied for cutaneous manifestations. More than half of these (57.1%) cases revealed cutaneous changes. Common cutaneous manifestations were prominent dilated veins on abdomen (28.6%), icterus (20.1%), clubbing of nails (16.3%), ichthyosis (12.2%), hyperpigmentation (12.2%), pruritus (8.2%), gynaecomastia (8.2%) and spider naevi (6.1). Less common cutaneous manifestations included palmar erythema, telangiectasia, leuconychia, loss of body hair and acneiform eruptions in 4.1 per cent cases each and striae distense, purpura and pellagra in 2.0 per cent cases each.

Throughout the history of human civilization, excessive hair growth has been a concern to mankind the object of superstition and mystery, as well as of cosmetic and medical interest. Hirsutism is a common disorder affecting 5-10% of women; Although various modalities of treatment like cosmetic procedures,laser are there but each of them has its own demerits.Since data concerning long term safety and efficacy of the systemic drugs are also lacking, so studies have been conducted using topical agent Eflornithine Hydrochloride. The purpose of this study was to compare the efficacy and safety of Cyproterone acetate + Eflornithine (topical) and Eflornithine (topical) alone in the treatment of Facial Hirsutism. In this randomized comparative double-blind study, 45 patients with facial hirsutism consistent clinically were recruited. Patients were divided into two groups. In group- 1 (23) patients were given eflornithine (13.9%) and cyproterone acetate and In group 2 (22) patients were given topical eflornithine (13.9%)alone. The study showed that cyproterone acetate in combination with topical Eflornithine (13.9% is safe, well tolerated, and effective therapy for facial hirsutism.