PERCUTANEOUS CYSTOLITHOLAPAXY AS AN ALTERNATIVE APPROACH FOR GIANT BLADDER STONES: A CASE SERIES OF PATIENTS WITH SIGNIFICANT COMORBIDITIES

Objective: We reported two giant bladder stones cases, with significant comorbidities and mentally impaired patients, treated with PCCL. Case(s) Presentation: We report two cases of giant cystolithiasis (sized 8.8 cm x 7.2 cm and 7.0 cm x 5.8 cm) in male patients with impaired renal functions and mental illness. We performed PCCL on both patients with cystoscopy-guided bladder puncture and dilation, under spinal anesthesia. Stone fragmentation through transurethral (pneumatic) and percutaneous (suprapubic amplatz ultrasound) lithotriptors was performed simultaneously. Discussion: Stone fragments were evacuated through the nephroscope. These fluoroscopy-free procedures were performed under one hour. The patients were discharged on day three post-operatively without indwelling catheter. Conclusion: We performed PCCL with simultaneous transurethral fragmentation in giant bladder stone cases presenting with impaired renal functions and mental illness. We faced no significant post-operative issue. This technique, or its modified approach, is safe and applicable

Acquired brain injury and serious criminal offenders: An argument to expand the court's therapeutic jurisdiction

<p>Brain injury is a debilitating mental impairment. It can cause aggression, impulsivity, and other socially challenging behaviours, including criminal offending. This is largely a consequence of damage to the frontal lobes, the part of the brain that facilitates selfregulation and emotional control. Remedying this requires specialist rehabilitation, preferably in dedicated facilities. However, rather than being in such facilities, a disproportionate number of brain injured New Zealanders are in prison, often for violent or sexual offences. By contrast, other mentally impaired offenders, such as the intellectually disabled and mentally ill, are not kept in prison but instead transferred to the health jurisdiction to receive treatment or care. This raises a question as to why brain injured offenders do not receive the same therapeutic response by our criminal justice system. This paper explores that question by examining the current legislative framework for diverting mentally impaired offenders into healthcare through therapeutic dispositions on sentencing. It demonstrates the inadequacy of this framework for violent or sexual offenders with brain injury by showing how the gateway definitions of “intellectual disability” and “mental disorder” exclude that condition. It then explores the appropriateness of imprisoning serious offenders with brain injury by examining whether their detention breaches the state’s statutory obligations, and argues that the status quo violates both the Corrections Act 2004 and the New Zealand Bill of Rights Act 1990. Finally, in recognition of the current exclusion of brain injured offenders from therapeutic dispositions, and the potential illegality of their detention in prison, this paper argues for an expansion of the court’s therapeutic jurisdiction and examines mechanisms to achieve this.</p>

Acquired brain injury and serious criminal offenders: An argument to expand the court's therapeutic jurisdiction

<p>Brain injury is a debilitating mental impairment. It can cause aggression, impulsivity, and other socially challenging behaviours, including criminal offending. This is largely a consequence of damage to the frontal lobes, the part of the brain that facilitates selfregulation and emotional control. Remedying this requires specialist rehabilitation, preferably in dedicated facilities. However, rather than being in such facilities, a disproportionate number of brain injured New Zealanders are in prison, often for violent or sexual offences. By contrast, other mentally impaired offenders, such as the intellectually disabled and mentally ill, are not kept in prison but instead transferred to the health jurisdiction to receive treatment or care. This raises a question as to why brain injured offenders do not receive the same therapeutic response by our criminal justice system. This paper explores that question by examining the current legislative framework for diverting mentally impaired offenders into healthcare through therapeutic dispositions on sentencing. It demonstrates the inadequacy of this framework for violent or sexual offenders with brain injury by showing how the gateway definitions of “intellectual disability” and “mental disorder” exclude that condition. It then explores the appropriateness of imprisoning serious offenders with brain injury by examining whether their detention breaches the state’s statutory obligations, and argues that the status quo violates both the Corrections Act 2004 and the New Zealand Bill of Rights Act 1990. Finally, in recognition of the current exclusion of brain injured offenders from therapeutic dispositions, and the potential illegality of their detention in prison, this paper argues for an expansion of the court’s therapeutic jurisdiction and examines mechanisms to achieve this.</p>

“What Are The Challenges of Treating Mentally Impaired Patients in The Era of a Pandemic?” : Qualitative Exploration Caregivers

Introduction: Caregivers provide support for mental disorders in the form of care such as assistance in daily life activities, but during a pandemic it is a challenge in itself. Objective: To explore the caregiver's experience in caring for clients with mental disorders in remote areas during a pandemic. Methods: Using a phenomenological qualitative research design with 25 participants. The sampling technique used was purposive sampling with data collection techniques using in-depth interviews and field notes then analyzed using IPA (Interpretative Phenomenological Analysis). Results: This study found 6 themes, namely: Caregiver Workload and Tension, Threats to Caregivers' Physical and Psychological Well-Being, The Need for a Continuing Family Role, Holistic Care, Coping Strategy, Communication is getting harder.Conclusion: our research provides unique findings about the experience of treating mental disorders needs during the COVID-19 pandemic. Caregivers of mental disorders struggle with parenting difficulties during the pandemic, which poses a threat to their well-being and potential harm to the mental disorder survivor-caregiver relationship.

Nazism and the Western Conscience

I offer here a scale of moral responsibility applicable to members of the Nazi Reich during the Final Solution: (1) oblivious: totally unaware, simply out to lunch or mentally impaired concerning the Nazi attempted genocide of the Jews, invincibly ignorant and without bad faith; (2) bystanding: aware but mute and passive, perhaps in bad faith or denial, concerning the Nazi attempted genocide of the Jews; (3) complicit: aware and publicly and privately supportive of the Nazi attempted genocide of the Jews, but primarily verbally or symbolically; (4) aiding and abetting: aware and more than verbally supportive, actively assisting and participating in the Nazi attempted genocide of the Jews, but short of pulling the trigger or dropping the gas pellets or ordering the same; and (5) directly murderous unto abomination: actually pulling the trigger or dropping the gas pellets or ordering the same, so as knowingly to aim at destroying the Jews as a race and Judaism as a moral and religious creed; in the extreme, also to aim at destroying one’s own conscience.

Turner Syndrome with Ring X Chromosome: Do They Have a Distinct Phenotype?

In contrast to classic Turner syndrome, Turner patients with ring X chromosome are associated with distinct dysmorphism and are likely to be mentally impaired. Four Turner patients with ring X chromosome were examined for phenotypic features of Turner syndrome and additional dysmorphism. Both patients 1 and 2 are twins with normal intelligence whereas patients 3 and 4 have mental impairment. With the exception of patient 4, the other three patients only have few Turner characteristics. None of the patients have the distinctive dysmorphism previously reported in Turner syndrome with ring X chromosome. Both twins developed spontaneous puberty. Patients 3 and 4 however had no spontaneous puberty. We postulate that this variation may be related to the ring size, the proportion of 45,X and ring X chromosome in cell lines of various body tissues as well as the ability of these rings to be inactivated as a result of lyonisation.

Postoperative pain

This chapter begins with a list of pain principles. It goes on to describe misunderstandings about pain and guidelines are given for diagnosing non-surgical causes of pain, such as myocardial ischaemia. Gauging the severity of pain and using pain scales are explained as well as the use of an acute pain service. Different techniques are described for assessing pain in different groups including the elderly, neonates, and the mentally impaired. Pre-emptive analgesia and multimodal analgesia are discussed. Suggestions for looking after patients with nerve blocks and day surgery patients are offered.

Ethical Dilemmas in the Lawyer–Client Relation: Concerns and Solutions

Lawyer–client relationship is the most important aspect of professional life of lawyers. When lawyers enter into professional relation with their clients they become bound by several ethical and professional duties. These duties are a mixture of status and contract emerging out of the nature of the relationship governing lawyer and client. Observing these duties is indispensable under the rules governing standards of professional conduct for lawyers. Lot has been written about these duties and the need to observe them, but the untraded area in the literature remains some of the challenges that arise in course of observing these duties due to some equally competing issues. The lawyers often face these challenges in their professional life, but little guidance is available to address them effectively. In this context, the aim of this article is to trace some of these competing issues and challenges and discuss the legal and regulatory framework that help to address them. The article begins by exploring the issues that arise at the very formation of the lawyer–client relationship. In the second part, the article examines the issue of lawyer’s scope and authority to make decisions in legal transactions for their clients. Also it covers the issues involving extent of lawyer’s authority to take decisions on behalf of mentally impaired or minor clients. Finally, the article looks into the issues that come up during the discharge of the lawyer–client relationship. The article concludes on the note that to ensure an effective and satisfactory lawyer–client relation it is an imperative that lawyers are sensitized with these issues and the principles they can look at for their resolution.