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Aims: Intussusception is a common pediatric surgical emergency and an indicator for primary healthcare. We report our experience with childhood intussusception at a tertiary care hospital in the private sector in Central Kerala and add our refinement to the technique of hydrostatic saline reduction which had more desirable outcome. Settings and Design: Children presenting with the diagnosis of intussusception which were managed in our department of pediatric surgery at a private hospital in Kerala, India. Subjects and Methods: Eighty children, up to 15 years of age, (43 boys, 37 girls) confirmed to have intussusception on ultrasound and managed in our institution from October 2016 to July 2020 with hydrostatic saline reduction. Sixty-two (77%) of them were aged 3 months to 3 years (numbers <10 to be written in words); the age of idiopathic intussusception. Statistical Analysis Used: SPSS V25. Association between variables using Chi square test and independent t test. Results: A total of 80 children met the criteria out of that (n = 79) had successful nonoperative reduction. Hydrostatic saline enema 73, One Barium and five air enema. A child presented in shock was taken up for laparotomy and reduced operatively. Six recurred within 24 h (7% early recurrence) and a second attempt at nonoperative reduction succeeded in all six of them. (numbers <10 in words). Eleven children (14%) had a late recurrence, the attempt at saline hydrostatic reduction was successful in only 3 (27%) and 8 went on to have surgery. Six were successfully reduced operatively and 2 had resection anastomosis. Conclusions: After excluding those who need surgery on clinical grounds, we report a 98.7% success with nonoperative reduction for the first instance of intussusception, a 24 h recurrence of 7%, with successful repeat reductions in all. With the refinement in the technique, we could achieve a desirable outcome. At the first presentation, surgery was indicated in 1 of the 80 children. We report a late recurrence rate of 14%, with a 27% success rate for nonoperative reduction. No pathological lead points were identified even in this group. All the children had an uneventful and a faster recovery. In our series, we had 97.5% follow up rate. [ABSTRACT FROM AUTHOR]

Background: A train accident is defined as a "collision, derailment, or any other event involving the operation of on-track equipment." Train accidents can beget ruinous damages and particular injuries including the death of the person. Methods: In the present study,themajority of victims were between 21- 40 years of age. There was a rural preponderance in our study population with 34.13% victims from urban regions and 48.41% victims from rural regions. Students comprised the largest section (33.33%) of railway related deaths followed by self employed people (30.17%). The maximum numbers of railway fatalities in this study were accidental(67.46%) followed by suicides (27.78%). The victims of fatal railway related deaths mainly succumbed to Hemorrhage & shock, injuries to vital organs and head injuries. Conclusion: Public awareness about safety measures and existing laws will also alleviate some of the fatalities. The railway authorities must take steps to prevent the accident by acknowledging the safety engineering, training,awareness among staff and strict law enforcement. [ABSTRACT FROM AUTHOR]

Background: Children with multisystem inflammatory syndrome in children (MIS-C) often develop shock and require vasoactive agents. The vasoactive-inotropic score (VIS) is a potential scoring system to assess the amount of vasoactive agent support required. The study was conducted to correlate VIS at 6 and 12 h with the length of intensive care unit (ICU) stay and with COVID immunoglobulin G (IgG) antibody titers in cases of MIS-C with shock. Subjects and Methods: Demographic and clinical details were collected from patients with the diagnosis of MIS-C with shock requiring vasoactive agents. VIS was calculated at 6 and 12 h following initiation of the first inotropic/vasoactive agent. Results: Twenty-nine children admitted with the diagnosis of MIS-C who presented with shock or developed shock during hospital stay were the study population. On performing Spearman's correlation, a positive correlation was observed between COVID IgG titers and VIS at 6 h. There was no significant association between VIS and length of ICU stay. Conclusions: VIS had limited significance in predicting the length of ICU stay and the need for vasoactive agents required. [ABSTRACT FROM AUTHOR]

Hemodynamic assessment along with continuous monitoring and appropriate therapy forms an integral part of management of critically ill patients with acute circulatory failure. In India, the infrastructure in ICUs varies from very basic facilities in smaller towns and semi-urban areas, to world-class, cutting-edge technology in corporate hospitals, in metropolitan cities. Surveys and studies from India suggest a wide variation in clinical practices due to possible lack of awareness, expertise, high costs, and lack of availability of advanced hemodynamic monitoring devices. We, therefore, on behalf of the Indian Society of Critical Care Medicine (ISCCM), formulated these evidence-based guidelines for optimal use of various hemodynamic monitoring modalities keeping in mind the resource-limited settings and the specific needs of our patients. When enough evidence was not forthcoming, we have made recommendations after achieving consensus amongst members. Careful integration of clinical assessment and critical information obtained from laboratory data and monitoring devices should help in improving outcomes of our patients. [ABSTRACT FROM AUTHOR]

Introduction. Cholera is gastroenteritis caused by Vibrio cholerae. It presents with vomiting, severe secretory diarrhoea, and dehydration. It can cause severe complications with severe electrolyte imbalances and oligoanuric acute kidney injury due to acute tubular necrosis secondary to dehydration or infection itself. However, cholera presenting with significant proteinuria and acute kidney injury has not been reported. Hence, this study was conducted. Aims and Objectives. This aim of this study was to assess clinical features, treatment, and prognosis of AKI in cholera patients; to correlate proteinuria with AKI in cholera patients; and to compare cholera patients with normal kidney function and those with AKI. Material and Methods. It was a retrospective observational study involving patients with cholera. Information regarding cholera patients with acute kidney injury, proteinuria, and prognosis were collected. Results. Most of the patients had significant vomiting, moderate-to-severe diarrhoea, dehydration, and hypovolaemic shock. Cholera caused severe complications such as severe electrolyte imbalances including hyponatraemia and hypokalaemia, acute kidney injury, and proteinuria secondary to dehydration or infection. A surprising finding noted was the lack of significant association between the onset of acute kidney injury and usual risk factors such as hypovolaemic shock and dehydration. It was found that proteinuria had influenced the onset of acute kidney injury, but it did not influence recovery. As there was complete recovery in kidney function, none of the cases required kidney biopsy. There was no mortality noted. Conclusions. This study points towards the rare occurrence of proteinuria and acute kidney injury in Vibrio cholerae infection with spontaneous remission of kidney disease with appropriate therapy. [ABSTRACT FROM AUTHOR]

Objectives: To compare the incidence of healthcare-associated infections (HAI) and their outcomes between patients admitted to the ICU with sepsis and those admitted with non-sepsis diagnoses. Materials and methods: We performed a single-center, prospective, observational study of ICU patients at a tertiary level medical-surgical unit from April 2018 to October 2018. All patients admitted to the ICU with a length of stay (LOS) > 48 hours were included. Baseline data including demographics, co-morbidities, and severity of illness scores were collected. Index occurrence of HAI in all these patients was noted and data regarding organ support and patient outcomes were recorded. The incidence, complications, ICU LOS, and 30-day mortality of HAI were compared between the patients admitted to ICU originally with sepsis and non-sepsis diagnoses. Results: A total of 271 patients were evaluated in our study (N = 106 for the sepsis group and N = 165 for the non-sepsis group). No significant difference between the groups was found in the incidence of HAI (29.2% in sepsis group vs 24.4% in non-sepsis group; p = 0.07). Complications (acute kidney injury (AKI): 71 vs 45%; p = 0.01, shock: 81 vs 55%; p = 0.05, need for mechanical ventilation (MV): 30 vs 15%; p = 0.04) were more common in sepsis group compared to the non-sepsis group. The ICU LOS (12.2 ± 5.2 days vs 8.8 ± 2.05 days; p = 0.01) was significantly longer in the sepsis group. There was no significant difference in 30-day mortality between the groups (45 vs 25%; p = 0.07). Conclusions: The incidence of HAI seems to be similar between patients admitted with sepsis and non-sepsis diagnoses. However, patients admitted with sepsis develop higher rates of organ failure secondary to HAI and have a longer ICU LOS compared to patients admitted with non-sepsis diagnoses. The mortality rate of HAI did not differ between these two groups. [ABSTRACT FROM AUTHOR]

Background: Multisystem inflammatory syndrome (MIS) associated with severe acute respiratory syndrome coronavirus (SARS-CoV-2) (MIS-C) in children is being increasingly reported across the world. Materials and methods: Children fulfilling the World Health Organization criteria of MIS-C needing pediatric intensive care unit between April 15 and July 26, 2020 were studied. Results: There were 21 patients with median age of 7 years [interquartile range (IQR) 1.9-12.1], of which 11 were females. SARS-CoV-2 real-time polymerase chain reaction positive in 8/21 and/or antibody positive 16/21. Fever was present in all patients, and gastrointestinal symptoms being second most frequent (16/21). One child had aplastic anemia, while the rest had no comorbidities. Nearly all presented with shock (n = 20/21) and 90% needed vasoactive drugs with a median Vasoactive Inotropic Score of 40 (IQR 20--95). Thirteen children needed ventilatory support and one needed peritoneal dialysis. Nine children had left ventricular dysfunction and five had dilatation of coronaries on echocardiography. Inflammatory markers C-reactive protein [98 mg/dL (IQR 89-119)], serum ferritin [710 mg/dL (IQR 422-1,609)], and serum interleukin-6 levels [215 ng/L (IQR 43-527)] were uniformly elevated. Eighteen children received pulse methyl-prednisolone, eleven intravenous immunoglobulins, and four tocilizumab. Eighteen children (86%) were discharged home while three died. Conclusion: In our cohort, MIS-C was seen in previously healthy children with fever, gastrointestinal symptoms, and shock. Early and aggressive management of shock and immune modulation with methyl-prednisolone and intravenous immunoglobulin were used. [ABSTRACT FROM AUTHOR]

Background: Purpura fulminans (PF) is a potentially fatal uncommon disorder of intravascular thrombosis and is clinically characterized by rapidly progressive hemorrhagic infarction of the skin. Objective: To describe the clinical feature and outcome of a series of patients with PF. Materials and Methods: A descriptive study based on review of case records was carried out at a tertiary care hospital in Kolkata. Results: Twenty three consecutive cases seen over a period of 8 years were studied. The age range was 4 days to 78 years (mean 35.6 years) with a male to female ratio of 1:2.8. Hemorrhagic rash was the universal presenting symptom. Other major presenting features included pneumonia (26.1%), sudden-onset shock syndrome (21.7%), and urinary tract infection (17.4%). All patients presented with retiform purpura and lesional necrosis and 8 (34.8%) patients had associated peripheral gangrene. Nineteen (82.6%) patients had sepsis and 60.9% patients had vesiculo-bullous lesion. Pneumococcus was the most common (26.1%) pathogenic organism detected. The precise cause of PF could not be detected in two (8.7%) patients. One patient (4.3%) with neonatal PF had protein C deficiency. All patients had evidence of disseminated intravascular coagulation (DIC). One patient had to undergo a below knee surgical amputation and one patient had autoamputation of the digits. Ten (43.5%) patients succumbed to their illness. Seven of the 8 patients who had peripheral gangrene had a fatal outcome. Limitations: Relatively small sample size and a referral bias were a few limitations of the present study. Conclusion: The present study emphasizes that PF is a cutaneous marker of DIC. Association of peripheral gangrene, leukopenia and neutropenia may be the reason for the high mortality rate. [ABSTRACT FROM AUTHOR]

Background: Fatal burns and related injuries are major cause of death and disability. There are certain pathological changes such as lungs shows necrotizing pneumonia, congestion of alveolar walls, capillary proliferation, intra alveolar oedema, giant epithelial cells Objective: To study on the cause of death due to burn cases and histopathological changes in north Indian setting. Method: This was a cross-sectional study. All autopsies with history of burn injury were studied to find out the significant histopathological change in lung. Cases was thoroughly studied using specially designed proforma that included demographic profile of deceased, history from relatives, police & hospital records, autopsy findings. Results: The most common cause of death due to burn injury was found to be Sepsis (48.2%) and neurogenic shock (29.5%). On histopathological examination, Congestion in trachea was present in majority 434 (78.9%) cases while Tracheal soot particles were present in only 40 (7.3%) cases. Specimens of 375 cases were available for histopathology out of which 52 (13.9%) specimens were autolyzed. Changes suggestive of Pneumonia (50.1%), Congestion (83.7%), alveolar and interstitial haemorrhage (63.2%) were present in majority of the cases while changes suggestive of alveolar interstitial edema (64.3%), alveolar wall disruption (66.1%), inflammatory cells (55.5%), hyaline membrane (79.7%) and Fibrin strands (79.7) were absent in majority of cases. Capillary dilatation was present in 39.2%. Conclusion: In the present study, an important observation in burn deaths is the Sepsis and Neurogenic shock. Congestion in trachea was most common on histopathological change. [ABSTRACT FROM AUTHOR]

The objective of the present study was to identify risk factors for mortality at admission in children admitted to the Pediatric Intensive Care Unit (PICU) with acute gastroenteritis (AGE) with severe dehydration and shock. This was a retrospective chart review of all cases of AGE with severe dehydration and shock admitted to the PICU from 2012 to 2017. Children who died during hospital stay were compared with those who survived. A total of 62 children were admitted with AGE to the PICU during this period. Twenty-four children (39%) died. The following variables were found to be significantly associated with death on univariate analysis: clinical pallor (p = 0.01), thrombocytopenia (p = 0.018), elevated leucocyte count (p = 0.02), hypoalbuminemia (p = 0.02) and severe acute malnutrition (SAM) (p = 0.04). On multivariate analysis, only hypoalbuminemia {RR [95% CI: 2.6 (1.27 to 9.21)]; 0.039} and SAM {RR [95% CI: 4.9 (1.12 to 10)]; 0.045} remained statistically significant. Children admitted with severe dehydration and shock had high mortality rates. These children were a sicker subset with probable sepsis. Severe acute malnutrition and hypoalbuminemia were associated with increased risk of death in these patients. [ABSTRACT FROM AUTHOR]

Background: India is combating with a major issue of a high maternal and infant mortality rate and Government of India ensured the availability of quality services through public health institutions, National Health Mission has introduced competency based training and certification programme to be implemented through skills laboratories. Objective: To assess the effectiveness of training in maternal and child health (MCH) care held at National Skills Training Centre (NSTC) -- "Daksh", Jamia Hamdard among participants from the Delhi State, in terms of knowledge retention and expressed practice and to find out the association between the knowledge and expressed practice scores. Method and Materials: A descriptive evaluative study was conducted among 30 participants who had their training on MCH care held at NSTC -- "Daksh", among the Delhi state selected by purposive sampling technique from various institutions where the participants were presently working. Data was collected using structured knowledge questionnaire and practice checklist through paper and pencil method and interview. Data analysis was done through SPSS version 20. Results: The results revealed that out of 30 participants, 24 (80%) participants were having adequate knowledge, while 6 (20%) participants were having inadequate knowledge. There was significant difference between post test knowledge scores on the last day of training (K1) and knowledge scores assessed during the study (K2). Regarding expressed practice, 24 (80%) participants were having good practice while, 6 (20%) participants were having poor practice. In skill -management of postpartum haemorrhage, the participants scored highest rank, whereas in skill -- management of pre-eclampsia/ eclampsia skill, participants scored the least rank. There was positive correlation (0.46) between knowledge and expressed practice scores of training in MCH held at NSTC-"Daksh". Conclusion: The study concluded that the training was effective in improving the knowledge and practice of participants. [ABSTRACT FROM AUTHOR]

Background and aims: Acute kidney injury (AKI) became an important cause of mortality and morbidity in critically ill children, despite advancement in its management. In developing countries etiology of AKI are different from that of developed countries. Materials and methods: This observational study was carried out in pediatric intensive care unit (PICU) in 2 months to18 years of critically ill children. Kidney injury was defined and categorized by the pRIFLE criteria. Results: Out of 361children, 86 children (23.8%) developed AKI at some point during admission, 275 children (age and sex matched) who did not develop kidney injury during hospitalization served as non-AKI children. Maximum cases of AKI were seen in 1-5 years of age. Maximum children of AKI were of viral encephalitis (n = 43, 50.0%) followed by scrub typhus (n = 14, 16.3%). Risk factors for the development of AKI were shock, PRISM score and longer hospital stay. In our study the mortality in AKI children (n = 30, 34.8%) was significantly higher (p = 0.005) as compared to non-AKI children (n = 56, 20.3%)). Duration on mechanical ventilation, PICU stay and hospital stay were also significantly (p = 0.001) higher in AKI children. Conclusion: AKI is common in critically ill children and associated with high mortality and morbidity. [ABSTRACT FROM AUTHOR]

Scrub typhus has reemerged with a different geographical distribution and varied clinical presentation like acute encephalitis syndrome (AES), which is a less known entity in scrub typhus. In this case series, we studied the clinical profile and outcome of eight patients who presented with AES and a positive scrub serology without any other identifiable cause of encephalopathy. All these patients had fever, altered sensorium, and nuchal rigidity, while seizures were present in six (75%) patients and papilledema in two (25%) patients. Complications like shock, pulmonary edema, and gastrointestinal (GI) bleed were observed in three (37%) patients. All patients except for one responded well to the treatment and recovered completely. Scrub typhus should be suspected early in patients presenting with AES. [ABSTRACT FROM AUTHOR]

Injuries to abdomen can be fatal leading to death of victim because of the effect of trauma to vital organs present inside the abdominal cavity. Injury to abdomen involves risk of shock due to hemorrhage as result of rupture of vital organs present inside the abdomen. Trauma to Abdomen is caused either by blunt force or penetrative force. Abdominal injuries are also very commonly seen in case of fall from height especially fall on flat surface from small heights. stabbing of abdomen may lead to opening of large blood vessels present inside the abdomen leading to profuse bleeding. Rupture of bowel can lead to spilling of its contents into peritoneal cavity lead to peritonitis and death due to systemic infection. Abdominal trauma is also frequently encountered in road traffic accidents. Victims with abdominal trauma usually presents with abdominal pain, tenderness, distension, diminished or absent bowel sounds. Abdominal guarding is an important sign seen because of tensing of abdominal wall muscles to guard inflamed organs inside the abdomen. Protrusion of abdominal organs especially bowel, out through the wound may be seen in case of penetrative injury to the abdomen. sports injuries also commonly affect abdomen. [ABSTRACT FROM AUTHOR]

Duodenal ulcer perforations have been known since 1600 AD. It is a common surgical emergency and every surgeon will encounter it. The perforation size of >2 cm has been used as the criteria for defining Giant duodenal ulcers. The management of giant duodenal perforations in hemodynamically unstable patient with comorbid condition is taxing because of high incidence of the postoperative leak and mortality. We have used the simple technique of Triple Tube Ostomy after the primary closure of the defect with encouraging results. It is a retrospective study done at the J. N medical college AMU Aligarh from May 2005 to May 2015. Hemodynamically unstable patients who have presented to the emergency with preoperative diagnoses of giant duodenal ulcer perforation and had undergone triple tube ostomy with primary repair of the perforation were included in the study. There were 34 patients of giant duodenal perforation who presented in shock. All of them underwent triple-tube-ostomy after primary repair of the duodenum. Thirty-two patients recovered with two mortalities (5.8 %). Several definite surgical techniques have been described for the management of giant duodenal ulcer perforation but they are complex, have very high morbidity and mortality rate and require an expert surgeon. A close retrospective scrutiny of the patients suggests that simple triple-tube-ostomy technique which is based on the principle of damage control surgery has good postoperative results Therefore, we recommend it as the procedure of choice in these patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Pediatric index of mortality (PIM) 2 score is one of the severity scoring systems being used for predicting outcome of patients admitted to intensive care units (ICUs). The aim of the present study was to evaluate the usefulness of PIM2 score in predicting mortality in a tertiary care pediatric ICU (PICU) and to assess the associated factors in predicting mortality such as presence of shock, need for assisted ventilation and Glasgow coma scale <8. Materials and Methods: This was a prospective observation study done at tertiary care PICU from May 2011 to July 2011. Consecutive 119 patients admitted to PICU (aged 1 month to 12 years) were enrolled in the study. PIM2 scoring was done for all patients. The outcome was recorded as death or discharge. The associated factors for mortality were analyzed with SPSS 17. Results: PIM2 score discriminated between death and survival at a 99.8 cut-off, with area under receiver operating characteristic curve 0.843 with 95% confidence interval (CI) (0.765, 0.903). Most patients were referred late to this hospital, which explains higher death rate (46.2%), lesser length of hospital stay (mean 2.98 days) in the mortality group, and increased rate of mechanical ventilation (68.1%). Presence of shock was independently associated with mortality, as evidenced by binary logistic regression. Conclusion: PIM2 score discriminated well between survivors and death at PICU. Presence of shock was significantly associated with mortality. [ABSTRACT FROM AUTHOR]

Objective: To develop a simple clinical scoring system for severity of illness to help prioritize care and predict outcome in emergency department. Methods: Prospective hospital based observational study. Out of a total of 874 children who attended emergency department in one year, 777 were included in the study. Data was collected at the time of admission in emergency department. The baseline information like age, gender, etc and variables of 'toprs' score viz temperature, oxygen saturation, pulse rate, respiratory rate, sensorium and seizures were recorded. Variables were categorized as normal (score zero] or abnormal (score 1) based on systemic inflammatory response syndrome (SIRS) criteria and criteria mentioned in advanced pediatric life support (APLS) and the total scores were computed for each child. The outcome (death/discharge) was correlated with the study variables and total score. The predictive ability of score was calculated using receiver operating characteristic (ROC) curve analysis. . Findings: of the six variables, temperature, oxygen saturation and respiratory rate, were found to be significantly associated with mortality. Mortality increased with the increase in the number of abnormal variables. Based on the regression coefficients, maximum possible score was 6.68. The predictive ability of score was 81.7 calculated using ROG curve. Maximum discrimination was observed at a score of 2.5. Conclusion: For triage in emergency, any patient with 2 or more abnormal variables should be closely monitored and evaluated. These patients require admission as they have a potential risk of death. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The purpose of the study was to explore determinants of outcome in adults with dengue hemorrhagic fever or dengue shock syndrome. Methods: We performed a multicenter, retrospective, observational study over a 2-year period in 3 intensive care units (ICUs) in Pune (India). Results: One hundred eighty-four adult patients were admitted to the ICU with a positive dengue immunoglobulin M test result; 43 met the World Health Organization criteria for dengue hemorrhagic fever or dengue shock syndrome. One patient who was transferred to another hospital and whose outcome was unknown was not included in the analysis. Of the 42 patients, 20 (48%) had multiorgan failure on ICU admission. The ICU mortality was 19% (8/42). Nonsurvivors were more likely than survivors to have cardiovascular (100% vs 12%), respiratory (88% vs 12%), or neurological (75% vs 12%) failure (all P < .01). Hematological failure was not associated with a higher risk of death. Cumulative fluid balance at 72 hours was more positive in nonsurvivors than in survivors (6.2 vs 3.5 L, P < .05). Serum albumin concentrations at ICU admission were lower in nonsurvivors than in survivors (2.9 ± 0.3 vs 3.4 ± 0.7 g/dL, P < .05). Conclusions: In our cohort, outcome from severe dengue was primarily related to nonhematological organ failure. Low serum albumin concentration on ICU admission and a more positive fluid balance at 72 hours were also associated with worse outcomes. [Copyright &y& Elsevier]

Japanese encephalitis (JE) and malaria would coexist in the areas where both illnesses are endemic with overlapping clinical pictures, especially in a case of febrile encephalopathy with hepatosplenomegaly. However, there are no published data till date showing concurrent infection of these two agents despite both diseases being coendemic in many areas. We report a case of concurrent infection of JE and mixed plasmodium infection, where the case, initially diagnosed as cerebral malaria did not improve on antimalarials and alternative diagnosis of JEV encephalitis was thought which was confirmed by a serological test. To the best of our knowledge, this is the first case report of concurrent Japanese encephalitis with mixed plasmodium infection. We report a case of 3-year-old male child, who presented with febrile encephalopathy with hepatosplenomegaly. Based on a rapid diagnostic test and peripheral smear examination, a diagnosis of mixed P.Vivax and P.falciparum infection was made and the patient was treated with quinine and doxycycline. However, besides giving antimalarials the patient did not improve and an alternative diagnosis of JE was considered as the patient was from the endemic zone of Japanese encephalitis. Cerebrospinal fluid (CSF) of the patient was sent for a virological study which came out to be positive for JE IgM in CSF, which is confirmatory of JE infection. In a patient with febrile encephalopathy with hepatosplenomegaly especially in areas coendemic for JE and malaria, the possibility of mixed infection should be kept in mind. [ABSTRACT FROM AUTHOR]

An intraperitoneal leech, which entered through vagina and uterus in a 2-year-old girl is reported. The child presented with intraperitoneal hemorrhage and shock. A leech inside the peritoneal cavity has never been reported in the literature. [ABSTRACT FROM AUTHOR]

Introduction: The LML stonebreaker is a portable, non-electrical, contact intra-corporeal lithotripter, intended for use to fragment stones in the urinary tract. It requires no extraneous electrical or pneumatic connections. We report our experience with LML stonebreaker in use with a rigid ureteroscope. Materials and Methods: 26 males and 5 females age ranging from 19 yrs to 54 yrs underwent ureteroscopy and intra-corporeal lithotripsy for ureteric calculi. The number of shocks required, the fragmentation rate and the usage of the CO2 cartridge was noted. Results: The size of the stones ranged from 7 mm to 21 mm in the ureter. The fragmentation rate was 100%. The number of shocks required ranged from 3 to 22. Each cartridge provided adequate power for 3 cases. Conclusions: LML Stonebreaker is an effective, safe, and reliable lithotripter. It is an asset to a mobile urologist. [ABSTRACT FROM AUTHOR]

The article considers some issues when conducting trauma counseling to victims of earthquakes and tsunamis in India. A major distinguishing element of trauma is sudden shock. Instances of injury, violence, humiliation and assault through rape all cause trauma. Reactions to trauma may range from mild and temporary symptoms to severe and long-term disturbances that include psychotic breaks, affective disorders and physiological malfunctions. One therapeutic method recommended by counselors is re-enactments in safe environments.