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To evaluate the value of a multidisciplinary team (MDT), including a neuroradiologist and a neurosurgeon, review of contouring in stereotactic radiosurgery (SRS).A sequential audit of all patients receiving intracranial SRS at local institution was conducted. Lesions were contoured first by a clinical oncologist, then reviewed/edited by the MDT. The initial contour was compared with the final contour using Jaccard conformity (JCI) and geographical miss indices (GMI). The dosimetric impact of a contouring change was assessed using plan metrics to both original and final contours.In total, 113 patients and 142 lesions treated over 22 months were identified. The mean JCI was 0.92 (0.32-1.00) and 38% needed significant editing (JCI0.95). The mean GMI was 0.03 (0.0-0.65) and 17% showed significant miss (GMI0.05). Resection cavities showed more changes, with lower JCI and higher GMI (P0.05). There was no significant improvement on JCI or GMI shown over time. The dosimetric analysis indicated a strong association of conformity metrics with planning target volume dose metrics; a 0.1 change in gross tumour volume conformity metric association with a 6-17% change in dose to 95% of the resulting planning target volume. Greater association was seen in the resection cavity, suggesting the geographical nature of a typical contouring error gives rise to greater potential change in dose. Clinical outcomes compared well with published series. The median survival was 20 months; the local relapse-free rate in the treated areas was 0.89 (0.8-0.94) at 40 months; the radionecrosis-free rate at 40 months was 0.9 (0.83-0.95) with a median of 17 months to developing radionecrosis.This work highlights that MDT contour review adds significant value to SRS and the approach translates into reduced local recurrence rates at the local institution compared with previously published data. No improvement in clinical oncologist contouring over time was shown, indicating that a collaborative approach is needed regardless of the experience of the clinical oncologist. MDT input is recommended in particular for contouring of resection cavities.

This systematic review and meta-analysis explores the effectiveness of teacher interventions supporting children with externalizing behaviors based on teacher and child outcomes. A systematic search was conducted using 5 electronic databases. From 5714 papers, 31 papers that included interventions delivered directly to teachers and aimed to benefit either teachers and/or children with externalizing behaviors were included. The review focused on qualified teachers working with children aged 2–13. The results of the current meta-analysis revealed a positive effect of teacher intervention on teacher and child outcomes, including the increased use of teacher-appropriate strategies, as well as significant and moderate improvements in teacher–child closeness, and small reductions in teacher–child conflict. For child outcomes, the interventions reduced externalizing behavior problems and ADHD symptoms and enhanced prosocial behavior. Only one fully blinded analysis for conduct problems was possible and revealed a moderate but significant reduction in favor of intervention. These findings provide evidence to support the role of teacher interventions for both teachers and children with externalizing behaviors. Future research should include more PBLIND measurements so that MPROX findings can be confirmed. More research should be done to evaluate the influence of teacher interventions on teachers’ well-being.

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%).

We studied beta-2 microglobulin (β-2M) levels in 44 HIV infected subjects belonging to 3 clinical stages as well as in 25 healthy controls. The method used was a competition enzyme immunoassay. In this study, levels of β2-M were measured in two groups of HIV infected individuals, the asymptomatic and those with progressive and advanced disease, in order to affirm its role as a surrogate prognostic marker. It was found that mean β-2M levels were 1.28 mg/L in the controls (normal range 0-2.4 mg/L), 11.41 mg/L in the HIV infected subjects, 2.69 mg/L in the asymptomatic HIV infected, 12.14 mg/L in those with persistent generalized lymphadenopathy (PGL) and 39.29 mg/L in the patients with acquired immunodeficiency syndrome. It was concluded that β-2M levels were significantly higher in the HIV infected as compared to the controls. Further, the levels were much higher in the HIV infected with progressive diseasc/PGL and highest in those who had developed AIDS. β-2M is an important surrogate serological marker useful in prognostication of disease process in the HIV infected. Advantages of measuring β-2M levels over p24 antigen detection and CD4 counts were highlighted.

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.

The discovery and large-scale genotyping of informative gene-based markers is essential for rapid delineation of genes/QTLs governing stress tolerance and yield component traits in order to drive genetic enhancement in chickpea. A genome-wide 119169 and 110491 ISM (intron-spanning markers) from 23129 desi and 20386 kabuli protein-coding genes and 7454 in silico InDel (insertion-deletion) (1–45-bp)-based ILP (intron-length polymorphism) markers from 3283 genes were developed that were structurally and functionally annotated on eight chromosomes and unanchored scaffolds of chickpea. A much higher amplification efficiency (83%) and intra-specific polymorphic potential (86%) detected by these markers than that of other sequence-based genetic markers among desi and kabuli chickpea accessions was apparent even by a cost-effective agarose gel-based assay. The genome-wide physically mapped 1718 ILP markers assayed a wider level of functional genetic diversity (19–81%) and well-defined phylogenetics among domesticated chickpea accessions. The gene-derived 1424 ILP markers were anchored on a high-density (inter-marker distance: 0.65 cM) desi intra-specific genetic linkage map/functional transcript map (ICC 4958 × ICC 2263) of chickpea. This reference genetic map identified six major genomic regions harbouring six robust QTLs mapped on five chromosomes, which explained 11–23% seed weight trait variation (7.6–10.5 LOD) in chickpea. The integration of high-resolution QTL mapping with differential expression profiling detected six including one potential serine carboxypeptidase gene with ILP markers (linked tightly to the major seed weight QTLs) exhibiting seed-specific expression as well as pronounced up-regulation especially in seeds of high (ICC 4958) as compared to low (ICC 2263) seed weight mapping parental accessions. The marker information generated in the present study was made publicly accessible through a user-friendly web-resource, “Chickpea ISM-ILP Marker Database”. The designing of multiple ISM and ILP markers (2–5 markers/gene) from an individual gene (transcription factor) with numerous aforementioned desirable genetic attributes can widen the user-preference to select suitable primer combination for simultaneous large-scale assaying of functional allelic variation, natural allelic diversity, molecular mapping and expression profiling of genes among chickpea accessions. This will essentially accelerate the identification of functionally relevant molecular tags regulating vital agronomic traits for genomics-assisted crop improvement by optimal resource expenses in chickpea.

We developed genome-wide 84634 ISM (intron-spanning marker) and 16510 InDel-fragment length polymorphism-based ILP (intron-length polymorphism) markers from genes physically mapped on 12 rice chromosomes. These genic markers revealed much higher amplification-efficiency (80%) and polymorphic-potential (66%) among rice accessions even by a cost-effective agarose gel-based assay. A wider level of functional molecular diversity (17–79%) and well-defined precise admixed genetic structure was assayed by 3052 genome-wide markers in a structured population of indica, japonica, aromatic and wild rice. Six major grain weight QTLs (11.9–21.6% phenotypic variation explained) were mapped on five rice chromosomes of a high-density (inter-marker distance: 0.98 cM) genetic linkage map (IR 64 x Sonasal) anchored with 2785 known/candidate gene-derived ISM and ILP markers. The designing of multiple ISM and ILP markers (2 to 4 markers/gene) in an individual gene will broaden the user-preference to select suitable primer combination for efficient assaying of functional allelic variation/diversity and realistic estimation of differential gene expression profiles among rice accessions. The genomic information generated in our study is made publicly accessible through a user-friendly web-resource, “Oryza ISM-ILP marker” database. The known/candidate gene-derived ISM and ILP markers can be enormously deployed to identify functionally relevant trait-associated molecular tags by optimal-resource expenses, leading towards genomics-assisted crop improvement in rice.

Attention-deficit hyperactivity disorder (ADHD) and its associated behavioural manifestations develop and progress as the result of complex gene-environment interactions. Parents exert a substantial influence and play a major role in their child's social environment. Despite this, recent evidence has suggested that adapting the child's environment via parenting interventions has minimal effects on child ADHD symptoms when analysing data from informants who are probably blind to treatment allocation. However, adverse parenting and family environments may act as a source of environmental risk for a number of child outcomes beyond ADHD symptoms. This is a narrative review that critically discusses whether parenting interventions are beneficial for alternative functioning outcomes in ADHD including neuropsychological, academic and social functioning and disruptive behaviour and how parenting and familial environments may be associated with these outcomes. In addition, the review explores how parental depression and parenting efficacy impact on capacity for optimal parenting and whether parenting interventions benefit parents too. A review of the evidence suggests that with modification, parenting interventions are beneficial for a number of outcomes other than ADHD symptom reduction. Improving the parent-child relationship may have indirect benefits for disruptive behaviour. Furthermore, parenting behaviours may directly benefit child neuropsychological, academic and social functioning. Parenting interventions can have therapeutic benefits for parents as well as children, which is important as parent and child well-being is likely to have a transactional relationship. Evaluation of the clinical success of parenting interventions should focus on a wider range of outcomes in order to aid understanding of the multifaceted benefits that they may be able to offer. Parenting interventions should not be seen as a redundant adjunct to medication in multi-modal treatment approaches for ADHD; they have the potential to target outcomes that, at present, medication seems less able to improve.

Attention-deficit hyperactivity disorder (ADHD) is a complex disorder that can affect individuals across the lifespan. It is associated with substantial heterogeneity in terms of aetiology, clinical presentation and treatment outcome and is the subject of extensive research. Because of this, it can be difficult for clinicians to stay up to date with the most relevant findings and know how best to respond to parents' questions and concerns about the disorder and interventions. This is a narrative review that aims to summarize key findings from recent research into ADHD and its treatment that clinicians can share with families in order to increase their knowledge about ADHD and intervention options. ADHD develops as a result of complex interplay between interdependent genetic and non-genetic factors. The disorder is associated with substantial impairments in functioning and poor long-term outcomes. Pharmacological and non-pharmacological treatment options are available for symptom management and to improve function, but functioning outcomes often fail to normalize in children with ADHD. Despite extensive advances in understanding this complex disorder, it is clear that there is still a long way to go. In particular, we address the need for future non-pharmacological interventions to be more specifically targeted for ADHD symptoms and its commonly associated functioning deficits in order to ensure the best long-term outcomes for children with ADHD.

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

There is increased awareness that attention deficit hyperactivity disorder (ADHD) continues into adulthood. Thus, health services are faced with a new challenge in providing a 'smooth' transition to adult services appropriate for young people with ADHD. This scoping review sought to identify the literature addressing transition for young people with ADHD to adult mental health services (AMHS). A scoping review, in which the search terms 'ADHD' and 'Transition' or 'Transfer' were entered into eight healthcare publication databases facilitated by NHS Evidence to identify both published and unpublished papers between 2000 and June 2013. Additional informal searches were also undertaken. Twenty-three papers were selected for this review. This review confirms the lack of research explicitly tracking transition from Paediatrics/Child and Adolescent Mental Health Services (CAMHS) to AMHS for young people with ADHD. Only four papers directly studying transition for ADHD patients were identified. Three further studies surveyed clinician perspectives. Taken together, the studies address a number of issues in relation to transition, including the developmental course of ADHD symptoms, appropriate adult care, knowledge and communication, unmet need, comorbidities, environmental demands and medication cessation/dosage during the transition period. While literature surrounding transition exists, the scope of the evidence showing successful and unsuccessful transition activity from Paediatric and CAMHS to AMHS for young people with ADHD is limited. Future quality research in the form of audits, longitudinal tracking studies and service evaluations are required if we are truly to understand and identify what is needed and currently available for successful transition to an appropriate adult service for ADHD patients.

Iron pentacarbonyl reacts with 6-dimethylaminofulvene in refluxing xylene to give three products, 1 , 2 and 3 . Compound 1 is R , S -[Fe 2 η,η-C 5 H 4 CH(NMe 2 )CH(NMe 2 )C 5 H 4 (CO) 2 (μ-C0) 2 ], 2 is its R , R / S , S isomer, and 3 is [Fe 2 η 3 ,η 5 -Me 2 NCHC 5 H 3 CHC 5 H 4 (CO) 5 ]. Compound 3 is favoured by high reactant concentrations and an excess of [Fe(CO) 5 ]. Analogues of 2 and 3 but not 1 may be prepared by using 6-Me(Ph)NCHC 5 H 4 , 6-Et 2 NCHC 5 H 4 and 6- i Pr 2 NCHC 5 H 4 ; the last of these also gives the unlinked dimer [Feη 5 -C 5 H 4 CH 2 N i Pr 2 2 (CO) 2 (μ-CO) 2 ]. This behaviour is attributed to the steric effects of the NR 2 groups on the formation of the ring- linking C-C bond. Dynamic NMR studies show that in 1 , but not 2 , there is a slowable restricted rotation about this bond and, in both 1 and 2 , rotation- inversion about the nitrogen atoms of the NMe 2 groups can be slowed. Compounds 1 and 2 are derivatives of a 1,2-bis-dimethylaminoethane, and as such have an extensive organic chemistry that leaves the Fe 2 (CO) 2 (μ-CO) 2 moieties intact. There are differences between 1 and 2 , due to conventional stereochemical effects, and consequently the Fe 2 (CO) 2 (μ-CO) 2 fragments are involved in some instances; this leads to unexpected and unusual reactions. The structures of 2 and the ketone [Fe 2 (η,η-C 5 H 4 CH 2 C(O)C 5 H 4 (CO) 2 (μ-CO) 2 ] have been confirmed by X-ray diffraction studies and are compared with that previously reported for 1 .

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.

Blood groups in 104 cases of HIV infection and 300 normal persons were determined. A relatively increased incidence of HIV infection was observed in persons with blood group O and relativey lower incidence in blood group B. Incidence of HIV infection was also low in Rh negative subjects. These results suggest a possible relationship between the incidence of blood group and the natural defence mechanism against HIV infection.

Forty six cases of chronic liver disorders with and without cutaneous manifestations were studied for abnormalities of liver function tests. 27 cases were associated with cutaneous manifestations and 19 cases without cutaneous manifestations. A higher serum bilirubin level was seen in all cases with cutaneous manifestations. Serum bilirubin was significantly high (P0.05) in patients of chronic active hepatitis with cutaneous manifestations. Serum alkaline phosphatase and serum glutamic pyruvic transaminase (SGPT) levels were significantly high in chronic active hepatitis and alcoholic liver disease without cutaneous manifestations respectively.

Pyoderma gangrenosum (PG) has previously been reported in very few patients with HIV infection. We describe here a 30-year-old housewife with HIV infection having multiple ulcerations over lower limbs characteristic of PG.

Five hundred twenty seven HIV seropositive male cases were observed for herpes zoster for a period of five years. Overall incidence of herpes zoster in HIV infection was found to be 11.8%. Herpes zoster was presenting symptom in 50% cases. It developed in first year of follow up in 38.8% cases, in second and third year of follow up in 4.8% cases each and in fourth year in 1.6% case. Majority of cases (89%) were in age group of 20 - 40 years. Thoracic dermatome (68%) was commonest to get involved followed by cervical (14.5%), trigeminal (9.7%) and lumbosacral (8%). Among other associations of HIV seropositive herpes zoster cases 24.2% cases had tuberculosis and 4.8% cases had hepatitis B virus infection. The skin lesions of herpes zoster in majority of cases were bullous, haemorrhagic and necrotic.

Four cases of HIV infection in children between one to eight years of age are reported. Three were males and the other one female. One child was horn to known HIV infected mother. The female child was victim of sexual abuse and had disseminated tuberculosis with syphilis and gonorrhoea. Other two children were having systemic as well as dermatological disorders for which HIV test was done and found positive.

The pattern of skin disorders among 11393 civil and 8123 defence service personnel who attended out-patient department (OPD) from January 1989 to December 1994 is presented. Infective dermatoses were more common in civil population (41.2%) as compared to defence service personnel (36.3%). Fungal infection was common in both groups (15.1% and 17.2%) whereas parasitic infestations and pyoderma were more common in civil population (12.8% and 6.1%) as compared to service personnel (7.8% and 3.6%). Among non-infective dermatoses eczemas were more common in civil population (17.3%) as compared to Armed Forces personnel (11.7%), whereas papulosquamous disorders, pigmentary disorders, acne and alopecia were more common in Armed Forces personnel (13.5%, 13.4% 8.7% and 6.2%) as compared to civil population (10.8%, 10.1%, 6.4% and 4.1%). The incidence of other skin disorders did not differ much between the two groups.

A total of 300 patients from first day of life to 17 years of age were analysed for pattern of skin disorders. School going children formed majority (41.3%) of cases followed by preschool children (32%). Infections formed the commonest disorder (31 %) followed by eczemas (24%), papulosquamous disorders (12%), infestation (8.6%) and urticaria (5.3%) while vitiligo, acne vulgaris, alopecia areata and genodermatoses were seen in 2.7% cases each.

A total of 320 patients of more than 60 years of age were studied for dermatological changes with aging. The male female ratio of patients was 3:1. Majority of cases (60.6%) were between 60-65 years of age. Pruritus was present in 37.5% cases, wrinkles in 82.1%, senile lentigenes in 57.8%, seborrhoeic keratosis in 48.8%, cherry angioma in 48.1%, idiopathic guttate hypomelanosis in 43%, skin tags in 37%, xerosis in 28%, comedones in 19%, infection and infestation in 40%, eczematous disorders in 36.9%, papulosquamous disorders in 10%, metabolic disorders in 16%, pigmentary disorders in 8.7%, keratinisation disorders in 4.1%, vesiculobullous disorders in 2.8% and associated systemic disorders in 49.7% cases.

A total of 1027 male patients suffering from sexually transmitted diseases (STD) during 1990 to 1996 were screened for HIV infection. All cases were in the age group 17 years to 48 years. One hundred and sixty-seven STD cases (16.3%) were found to have HIV infection. A rising trend in incidence of HIV infection in STD patients from 1990 (2.8%) to 1996 (27.8%) was noticed countrary to declining trend of STDs from 213 cases in 1990 to 79 cases in 1996. The incidence of HIV infection was 30.3% in lymphogranuloma venereum, 19.5% in chancroid, 13.5% in syphilis, 17.6% in herpes genitatis, 6.7% in gonorrhoea and 11.2% in other STD cases.

The vortex‐settling basin (VSB) is a fluidic device that uses only the vortices of the flow to remove sediment. This is an economical, efficient, and water‐conserving alternative to the other available sediment‐extraction devices. This paper presents guidelines for designing and modeling VSBs. It shows that the circular basin should have diameter equal to five times (as compared with six times stipulated in American practice) the bed width of inlet canal. The distinctive features of the proposed design are formation of free vortex in the outer region and flow in the basin traversing a relatively longer path before reaching the overflow weir. Extraction of sediment smaller than 0.5 mm is optimized when a diaphragm and a deflector are incorporated in the inlet canal and basin, respectively. Diameter of the flushing pipe and the flushing discharge to be adopted for the extraction of different sediment fractions are specified. Formulas suggested for prediction of trapping efficiency are simpler and more relia...

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.

A clinics-bacteriological study of 52 patients with urethritis was carried out. All the patients were evaluated clinically and bacteriologically at the beginning and end of the treatment. Majority of the patients belonged to the age group 21-30 years (58%). Incidence of gonococcal urethritis was 65% and Non gonococcal Urethritis (NGU) 35%. The common organisms causing NGU were chlamydia (28%) ureaplasma (11%) and mycoplasma (11%). Neisseria gonorrhoea was resistant to penicillin in (38%), ciprolloxacin in 67, and to noriloxaein in 6% cases. High incidence of HIV positivity was found in gonorrhoea (21%).

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.

Research on the role of parenting styles in the development of disruptive behaviour problems has focused primarily on how parents handle conflict once it has occurred. This home observational study examined strategies used by 52 mothers to prevent conflict with 3-year-olds. It was predicted that mothers of children with behaviour problems would use fewer "positive" strategies to resolve conflict, and would use reactive rather than pre-emptive strategies. Results showed frequency of positive strategies did not differ between the groups. Mothers of children with behaviour problems were less likely to use pre-emptive, and more likely to use reactive, strategies. Further analysis showed child conduct problems, rather than other characteristics, best discriminated pre-emptive from reactive strategy users. Follow-up of a subsample found that reactive strategies at age 3 predicted age 5 behaviour problems, even after controlling for age 3 behaviour problems.

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.

Three cases of concurrent infection with HIV and leprosy are reported. One had developed borderline lepromatous leprosy one year after identifying HIV infection, while the other two had indeterminate leprosy and both conditions were identified at the same time in these two patients. All three cases showed satisfactory response to standard antileprosy multidrug therapy.

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.

One hundred twenty histologically confirmed cases of leprosy having macular lesions were evaluated clinically and histopathologically according to Ridley-Jopling classification. Of these 120 cases, the majority (91 or 75.8%) were young adults. The main clinical findings were: a single macule in 42 patients (35%), multiple macules 2-5 in numbers in 35 patients (29.1%), 6-10 macules in 17 patients (14.1%) and more than 10 macules in 26 patients (21.6%). Impairment of sensation over the macular lesions was present in 62 cases (51.6%), total loss of sensation was noticed in 31 patients (25.8%) and sensation was intact in 27 patients (22.5%). Acid-fast bacilli were detected in 11 cases (9.1%) by slit-skin smear examination. Clinical examination of the 120 cases revealed features of TT in 16 (13.3%), BT in 41 (34.1%), BB in 11 (9.1%), BL in 13 (10.8%), LL in 7 (5.8%) and indeterminate leprosy (IL) in 32 patients (26.6%). On the contrary, histologically there were 22 cases of TT (18.3%), 38 cases of BT (31.6%), 8 (6.5%) BB, 10 BL (8.3%), 7 LL (5.8%) and 35 cases of IL (29.1%). Histopathological features were consistent with the clinical picture in 84 patients (70%).