Combined Rupture of the Diaphragm and Urinary Bladder in Blunt Trauma Abdomen.

The authors examined a 25-year-old man with a combined rupture of the diaphragm and urinary bladder following blunt trauma to the abdomen. The presence of hematuria, suprapubic tenderness, and elevated serum urea and creatinine levels in this patient raised suspicion of urinary bladder rupture. Documentation of bowel gas shadows on the chest x-ray suggested underlying diaphragm injury. A computed tomogram of the thorax and abdomen confirmed the tear in the left hemidiaphragm with intrathoracic herniation of abdominal contents; however, it failed to detect the intraperitoneal urinary bladder rupture. Both the defects were identified and repaired during laparotomy. The sudden increase in intraabdominal pressure in blunt trauma to the abdomen often resulted in full-thickness tears of the diaphragm and the urinary bladder. Although radiological investigations were pivotal for assessing the damage to the internal organs, a methodical and thorough exploratory laparotomy was invaluable for successfully managing patients with blunt abdominal trauma.

Quarantine and COVID-19 pandemic: Multidimensional perception of people in quarantine in North Kerala.

Background: Proper hand hygiene, face masks, social distancing, maintaining appropriate social distancing, and quarantine are the major strategies for the prevention of transmission of coronavirus disease (COVID-19) infection. The aim of the study was to determine and asses the knowledge, perceptions, health practices of quarantine and COVID-19 and to determine the psychosocial profile of people in quarantine. Methods: A descriptive cross-sectional study was done in quarantined individuals in a rural and urban setting in Malappuram district of Kerala from February 2021 to June 2021 by telephonic interview. Mental health status was assessed by Patient Health Questionnaire 9. Results: Only half (49.6%) of the population has satisfactory knowledge about COVID-19 disease. Only 53.9% has satisfactory knowledge on preventive measures and this is significantly more in rural (62.9%) compared to urban (44.4%). Only 45.3% has satisfactory adherence on practice of preventive measures. Also nearly half (44.9%) of the participants were affected by factors such as fear of infection, frustration, inadequate supplies, inadequate communication and financial insecurity. Urban population (53.2%) were more affected compared to rural (37.1%). 31.6% of the participants were having any form of depression with PHQ 9. Pearson's correlation test revealed significant correlations between different factors and outcome variables. Predictors of 'Satisfactory Practice on preventive measures' and 'Any depression' were determined. Conclusion: Only half of the population has satisfactory knowledge and practice on preventive measures. Ensure health intervention programs to improve knowledge and adherence to practices. Strengthening of system to support their needs and psychosocial support should be provided.

Survival and Toxicity Following Chemoradiation for Carcinoma of the Cervix - Impact of Multiple-phase Treatment and Shielding.

AIM: We report on outcomes and significant grade 3-4 late toxicities between January 1999 and October 2006 following introduction of multi-phase treatment and effect of shielding in treatment of cervical cancer with concurrent chemoradiation. PATIENTS AND METHODS: Radiotherapy dose by phase, recurrence, survival and toxicity data was collated by a retrospective review of clinical notes. Shielding information was retrieved from original planning films. RESULTS: 3-year survival for stages I, II and III disease were 89%,76% and 51% respectively. Local pelvic failure was 9%. Overall significant late toxicity (SLT) rate was 13%, with lower rates for post-operative treatment than primary chemoradiation (4% vs. 16%). SLT with single phase treatment was 29% versus 12% following multiphase EBRT and 16% when <2 areas were shielded versus 6% with ≥3 shielded areas (p=0.01). CONCLUSION: Shielding and multi-phase treatment not only reduce dose to organs at-risk but can also reduce late toxicity without compromising local control or survival.