Time to Attain Full Enteral Feeds Among Preterm Fetal Growth Restricted Neonates With Absent/Reversed End-Diastolic Flow.

OBJECTIVES: To determine the difference in time to attainment of full enteral feeds between fetal growth restricted (FGR) preterm neonates with and without absent/reversed end-diastolic flow (AREDF). Secondary objectives were to compare the short-term outcomes including the incidence of necrotizing enterocolitis (NEC) and feed intolerance between the two groups and to determine the factors affecting the time to attainment of full enteral feeds (FEF) among preterm FGR neonates. METHODS: A prospective cohort study was conducted among consecutive preterm FGR neonates delivered at 28-36 weeks gestation admitted in level III NICU. An umbilical artery doppler ultrasound was performed antenatally for all participants to detect AREDF. FGR neonates with AREDF were taken as the study group and those without AREDF were taken as the comparison group. Time to attain FEF was defined as time taken to establish enteral feeds of 150 ml/kg/day and tolerating it for the next 3 consecutive days. Delayed attainment of FEF was taken as ≥10 days needed to attain FEF. RESULTS: The median (IQR) time to attainment of full feeds was longer among neonates with AREDF compared to those without AREDF [12 (8, 16.5) vs 8 (5, 10) days; P < 0.001]. Neonates with AREDF had more feed intolerance [RR, 95% CI = 1.51 (1.13 - 2.02); P = 0.004], higher mortality [RR, 95% CI = 2.5 (1.02 - 6.2); P = 0.036], prolonged time to regain birth weight [15 (11.5, 19) days, P = 0.035], longer NICU stay [10 (7, 15), P < 0.001] and longer hospital stay [33 (23, 49), P < 0.001]. Also, neonates with AREDF had more hypoglycemia [RR, 95% CI=2.15 (1.2-3.7); P = 0.004], hypoxic ischemic encephalopathy [RR, 95% CI 5.05 (1.13 - 22.4); P = 0.016], hypothyroidism [RR, 95% CI= 8.08 (1.02 - 63.4), P = 0.016], cholestasis (P = 0.007), prolonged parenteral nutrition requirement [10 (7, 15) days, P < 0.001] and oxygen requirement [4.5 (2, 8) days, P < 0.001]. Multivariable logistic regression showed, AREDF [aOR 95% CI 2.91 (1.49 - 5.68), P = 0.002], lower gestational age [aOR 95% CI 0.724 (0.604 - 0.867), P < 0.001] and thrombocytopenia at birth [aOR 95% CI 2.625 (1.342 - 5.136), P = 0.005] are significant predictors of delayed attainment of full feeds among preterm FGR neonates. CONCLUSION: Preterm FGR neonates with AREDF are slower to attain FEF, have more feed intolerance, higher mortality, need longer time to regain birth weight, prolonged NICU stay and hospital stay. AREDF, lower gestation, sepsis and thrombocytopenia at birth are significant predictors of delayed full feed attainment among preterm FGR neonates. It is essential to devise strategies to reduce morbidity and mortality among this group of preterm neonates.

The role of local governments in the implementation of evidence-based nutrition interventions in Kerala.

OBJECTIVE: To study the involvement and influence of local participatory governments consisting of Panchayat Raj institutions (PRIs) in implementing evidence-based interventions for eliminating maternal and child undernutrition in the state of Kerala, India. METHODS: In-depth interviews were carried out among stakeholders in six selected local governments using a semi-structured questionnaire. Transcribed interviews were coded and thematically analysed. RESULTS: PRIs facilitated nutrition interventions through additional resource mobilisation, nutrition monitoring and surveillance, acting as a more approachable point of governance, utilising general acceptance to mobilise volunteers to tackle local challenges, enabling formal and informal platforms for community participation and spaces of co-creation. Changes in the attitude of different stakeholders, timely policy backing and support, and interconnections at the local level aided the process. Gaps exist in awareness creation, dietary diversification, feeding behaviours, maternal mental health, infrastructure development, monitoring of anthropometric indicators and planning for nutrition interventions during emergencies. CONCLUSION: Results illustrate complex linkages PRIs have within the health system and how these linkages help in the implementation of interventions. The study explored previously identified pathways from the literature and identified additional pathways through which local participatory governance contributes to the successful implementation of nutrition interventions.

OBJECTIF: Étudier l'implication et l'influence du système de gouvernement participatif local, composé des institutions du Panchâyat Raj (PRI), dans la mise en place d'interventions fondées sur des données scientifiques en vue d'éliminer la sous-nutrition maternelle et infantile dans l'État du Kérala, Inde. MÉTHODES: Des entretiens approfondis, avec questionnaire semi-structuré, ont été réalisés avec les parties prenantes de six gouvernements locaux préalablement sélectionnés. La transcription des entretiens a été codée et analysée de manière thématique. RÉSULTATS: Les PRI ont facilité les interventions nutritionnelles en mobilisant des ressources supplémentaires, en organisant une surveillance et un suivi nutritionnels, en agissant en tant que point de contact gouvernemental plus accessible, en misant sur l'acceptation générale afin de mobiliser les volontaires pour s'attaquer aux problèmes locaux, en mettant en place des plateformes de participation communautaire formelles et informelles et en laissant la place à la co-création. Les changements d'attitude de différentes parties prenantes, un soutien politique opportun et les liens tissés au niveau local ont contribué au processus. Certaines lacunes ont été observées, en matière d'actions de sensibilisation, de diversification alimentaire, de comportements alimentaires, de santé mentale des mères, de développement des infrastructures, de suivi des indicateurs anthropométriques et de planification des interventions nutritionnelles en période d'urgence. CONCLUSION: Les résultats mettent en évidence les liens complexes entre les PRI et le système de santé, et comment ces liens contribuent à la mise en place des interventions. Cette étude a analysé certains moyens, précédemment décrits dans la littérature, et en a identifié de nouveaux par lesquels les gouvernements participatifs locaux contribuent à la bonne mise en place des interventions nutritionnelles.

Risk Factors of First Episode Simple Febrile Seizures in Children Aged 6 Month to 5 Year: A Case Control Study.

OBJECTIVES: To study the risk factors of first episode simple febrile seizures in children. METHODS: This case control study was conducted at the pediatric department of our tertiary care hospital. Cases were children of age group 6 months to 5 years presenting with first simple febrile seizures (n=214), and Controls were children of same age group presenting with short febrile illness but without any seizures (n=214). Blood investigations were done to diagnose iron deficiency, which was diagnosed by adopting cut off of hemoglobin value <11 g/dL, serum ferritin < 12 ng/mL and red cell distribution width >15%. Other risk factors studied included age, gender, socioeconomic status, prematurity, family history of febrile seizure and epilepsy in first degree relatives, consanguinity, neonatal hospital admissions, day care attendance (for >1 mo), under nutrition, and immunization status of the child. Univariate analysis for crude odds ratio and multivariate analysis (logistic regression) was performed to study the adjusted odds ratio and independent risk factors. RESULTS: The significant risk factors for first episode simple febrile seizure were iron deficiency [OR (95% CI) 5.78 (3.56-9.38); P=0.001], family history of febrile seizure [OR 4.31 (2.37- 7.83), P<0.001] or epilepsy [OR 4.25(2.21-8.19), P<0.001] in first degree relatives, day care attendance for >1 month [OR 4.81 (2.41-9.59), P<0.001], and prematurity at birth [OR 5.18 (2.48-10.84), P<0.001]. CONCLUSION: Iron deficiency, family history of febrile seizure and epilepsy in first degree relatives, day care attendance and premature birth are the risk factors for first episode simple febrile seizures in children.

Hospital-based sentinel surveillance for bacterial meningitis in under-five children prior to the introduction of the PCV13 in India.

INTRODUCTION: A hospital-based sentinel surveillance network for bacterial meningitis was established in India to estimate the burden of bacterial meningitis, and the proportion of major vaccine-preventable causative organisms. This report summarises the findings of the surveillance conducted between March 2012, and September 2016 in eleven hospitals. METHODS: We enrolled eligible children with bacterial meningitis in the age group of one to 59 months. CSF samples were collected and processed for biochemistry, culture, latex agglutination, and real-time PCR. Pneumococcal isolates were serotyped and tested for antimicrobial susceptibility. RESULTS: Among 12 941 enrolled suspected meningitis cases, 586 (4.5%) were laboratory confirmed. S. pneumoniae (74.2%) was the most commonly detected pathogen, followed by H. influenzae (22.2%), and N. meningitidis (3.6%). Overall 58.1% of confirmed bacterial meningitis cases were children aged between one, and 11 months. H. influenzae meningitis cases had a high (12.3%) case fatality rate. The serotypes covered in PCV13 caused 72% pneumococcal infections, and the most common serotypes were 14 (18.3%), 6B (12.7%) and 19F (9.9%). Non-susceptibility to penicillin was 57%. Forty-five (43.7%) isolates exhibited multidrug resistance, of which 37 were PCV13 serotype isolates. CONCLUSIONS: The results are representative of the burden of bacterial meningitis among under-five children in India. The findings were useful in rolling out PCV in the National Immunization Program. The non-susceptibility to penicillin and multidrug resistance was an important observation. Timely expansion of PCV across India will significantly reduce the burden of antimicrobial resistance. Continued surveillance is needed to understand the trend after PCV expansion in India.

Adverse health impacts of cooking with kerosene: A multi-country analysis within the Prospective Urban and Rural Epidemiology Study.

BACKGROUND: Kerosene, which was until recently considered a relatively clean household fuel, is still widely used in low- and middle-income countries for cooking and lighting. However, there is little data on its health effects. We examined cardiorespiratory effects and mortality in households using kerosene as their primary cooking fuel within the Prospective Urban Rural Epidemiology (PURE) study. METHODS: We analyzed baseline and follow-up data on 31,490 individuals from 154 communities in China, India, South Africa, and Tanzania where there was at least 10% kerosene use for cooking at baseline. Baseline comorbidities and health outcomes during follow-up (median 9.4 years) were compared between households with kerosene versus clean (gas or electricity) or solid fuel (biomass and coal) use for cooking. Multi-level marginal regression models adjusted for individual, household, and community level covariates. RESULTS: Higher rates of prevalent respiratory symptoms (e.g. 34% [95% CI:15-57%] more dyspnea with usual activity, 44% [95% CI: 21-72%] more chronic cough or sputum) and lower lung function (differences in FEV1: -46.3 ml (95% CI: -80.5; -12.1) and FVC: -54.7 ml (95% CI: -93.6; -15.8)) were observed at baseline for kerosene compared to clean fuel users. The odds of hypertension was slightly elevated but no associations were observed for blood pressure. Prospectively, kerosene was associated with elevated risks of all-cause (HR: 1.32 (95% CI: 1.14-1.53)) and cardiovascular (HR: 1.34 (95% CI: 1.00-1.80)) mortality, as well as major fatal and incident non-fatal cardiovascular (HR: 1.34 (95% CI: 1.08-1.66)) and respiratory (HR: 1.55 (95% CI: 0.98-2.43)) diseases, compared to clean fuel use. Further, compared to solid fuel users, those using kerosene had 20-47% higher risks for the above outcomes. CONCLUSIONS: Kerosene use for cooking was associated with higher rates of baseline respiratory morbidity and increased risk of mortality and cardiorespiratory outcomes during follow-up when compared to either clean or solid fuels. Replacing kerosene with cleaner-burning fuels for cooking is recommended.

Immunochromatography in CSF improves data on surveillance of S. pneumoniae meningitis in India.

INTRODUCTION: Streptococcus pneumoniae is a significant cause of childhood bacterial meningitis in India. The United States Food and Drug Administration has licensed an immunochromatographic (ICT) test, Binax®NOW™, to detect the C polysaccharide antigen of S. pneumoniae in cerebrospinal fluids (CSF). Accurate etiological diagnosis of bacterial meningitis in India is essential for effective treatment strategies and preventive interventions. MATERIALS AND METHODS: CSF samples from 2081 children admitted, with clinically suspected bacterial meningitis at 11 sentinel sites of hospital based sentinel surveillance network for bacterial meningitis in India between September 2009 and December 2016 were tested with ICT. Concurrent CSF cultures were processed using standard procedures. RESULTS AND DISCUSSION: S. pneumoniae was detected thrice the number of times by ICT than by CSF culture, with a sensitivity and specificity of 100% and 95.3% respectively. This rapid ICT test proves to be of immense use as a diagnostic test for meningitis patients with/without prior antibiotic treatment, especially in facilities with limited laboratory infrastructure in resource limited settings.

Pediatric Appropriate Evaluation Protocol for India (PAEP-India): Tool for Assessing Appropriateness of Pediatric Hospitalization.

OBJECTIVE: To develop and assess Pediatric Appropriateness Evaluation Protocol for India (PAEP-India) for inter-rater reliability and appropriateness of hospitalization. DESIGN: Cross-sectional study. SETTING: The available PAEP tools were reviewed and adapted for Indian context by ten experienced pediatricians following semi-Delphi process. Two PAEP-India tools; newborn (≤28 days) and children (>28 days-18 years) were developed. These PAEP-India tools were applied to cases to assess appropriateness of admission and inter-rater reliability between assessors. PARTICIPANTS: Two sets of case records were used: (i) 274 cases from five medical colleges in Delhi-NCR [≤28 days (n=51); >28 days to 18 years (n=223)]; (ii) 622 infants who were hospitalized in 146 health facilities and were part of a cohort (n= 30688) from two southern Indian states. INTERVENTIONS: Each case-record was evaluated by two pediatricians in a blinded manner using the appropriate PAEP-India tools, and 'admission criteria' were categorized as appropriate, inappropriate or indeterminate. OUTCOME MEASURES: The proportion of appropriate hospitalizations and inter-rater reliability between assessors (using kappa statistic) were estimated for the cases. RESULTS: 97.8% hospitalized cases from medical colleges were labelled as appropriate by both reviewers with inter-rater agreement of 98.9% (k=0.66). In the southerm Indian set of infants, both reviewers labelled 80.5% admissions as appropriate with inter-rater agreement of 96.1% (k= 0.89). CONCLUSIONS: PAEP-India (newborn and child) tools are simple, objective and applicable in diverse settings and highly reliable. These tools can potentially be used for deciding admission appropriateness and hospital stay and may be evaluated later for usefulness for cost reimbursements for insurance proposes.

Comparative diagnostic test evaluation of serum procalcitonin and C-reactive protein in suspected bloodstream infections in children with cancer.

PURPOSE: To compute diagnostic test properties of C-reactive protein (CRP) and serum procalcitonin (PCT) levels in bloodstream infections in children with cancer and suspected sepsis, in comparison with blood culture as the gold standard. METHODOLOGY: Consecutive paediatric cancer patients, aged ≤14 years, with clinically suspected bloodstream infections were evaluated with blood culture and assay of PCT and CRP levels. Blood culture was taken as the gold standard for comparison. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) and receiver operating characteristic (ROC) with area under ROC curve (AUC) were calculated to assess the diagnostic test performance for PCT and CRP.Results/Key findings. The ROC curve for PCT was better than that for CRP, with an AUC of 0.751 for PCT at a cut-off of 2.25 ng ml-1. The AUC for CRP was 0.638 at a cut-off of 8.0 mg dl-1. Among the three cut-off values of PCT selected from the ROC curve applicable to the patients under study, the cut-off value of ≥0.49 ng ml-1 had the maximum sensitivity of 81.4 % and an NPV of 94.67 %; ≥2.25 ng ml-1 had a sensitivity and specificity of 65.12 and 71.6 %, respectively, and ≥6.47 ng ml-1 had a maximum specificity of 82.10 %. For CRP, the cut-off value of ≥5.3 mg dl-1 had the maximum sensitivity of 72.09 %; ≥8.0 mg dl-1 had a sensitivity and specificity of 58.14 and 68.09 %, respectively, and ≥8.4 mg dl-1 had the maximum specificity of 70.04 %. CONCLUSION: PCT is a better serological marker for excluding bloodstream infections than CRP. The cut-off value of 0.49 ng ml-1 with a negative predictive value of 94.67 % will be ideal in a clinical setting of immune-compromised children with suspected sepsis.

Does greater individual social capital improve the management of hypertension? Cross-national analysis of 61 229 individuals in 21 countries.

INTRODUCTION: Social capital, characterised by trust, reciprocity and cooperation, is positively associated with a number of health outcomes. We test the hypothesis that among hypertensive individuals, those with greater social capital are more likely to have their hypertension detected, treated and controlled. METHODS: Cross-sectional data from 21 countries in the Prospective Urban and Rural Epidemiology study were collected covering 61 229 hypertensive individuals aged 35-70 years, their households and the 656 communities in which they live. Outcomes include whether hypertensive participants have their condition detected, treated and/or controlled. Multivariate statistical models adjusting for community fixed effects were used to assess the associations of three social capital measures: (1) membership of any social organisation, (2) trust in other people and (3) trust in organisations, stratified into high-income and low-income country samples. RESULTS: In low-income countries, membership of any social organisation was associated with a 3% greater likelihood of having one's hypertension detected and controlled, while greater trust in organisations significantly increased the likelihood of detection by 4%. These associations were not observed among participants in high-income countries. CONCLUSION: Although the observed associations are modest, some aspects of social capital are associated with better management of hypertension in low-income countries where health systems are often weak. Given that hypertension affects millions in these countries, even modest gains at all points along the treatment pathway could improve management for many, and translate into the prevention of thousands of cardiovascular events each year.

Does greater individual social capital improve the management of hypertension? Cross-national analysis of 61 229 individuals in 21 countries

INTRODUCTION:Social capital, characterised by trust, reciprocity and cooperation, is positively associated with a number of health outcomes. We test the hypothesis that among hypertensive individuals, those with greater social capital are more likely to have their hypertension detected, treated and controlled.METHODS:Cross-sectional data from 21 countries in the Prospective Urban and Rural Epidemiology study were collected covering 61 229 hypertensive individuals aged 35-70 years, their households and the 656 communities in which they live. Outcomes include whether hypertensive participants have their condition detected, treated and/or controlled. Multivariate statistical models adjusting for community fixed effects were used to assess the associations of three social capital measures: (1) membership of any social organisation, (2) trust in other people and (3) trust in organisations, stratified into high-income and low-income country samples.

Determinants of symptom profile and severity of conduct disorder in a tertiary level pediatric care set up: A pilot study.

BACKGROUND: Conduct disorders (CDs) are one of the most common causes for referral to child and adolescent mental health centers. CD varies in its environmental factors, symptom profile, severity, co-morbidity, and functional impairment. AIMS: The aim was to analyze the determinants of symptom profile and severity among childhood and adolescent onset CD. SETTINGS AND DESIGN: Clinic based study with 60 consecutive children between 6 and 18 years of age satisfying International Classification of Disease-10 Development Control Rules guidelines for CD, attending behavioral pediatrics unit outpatient. MATERIALS AND METHODS: The family psychopathology, symptom severity, and functional level were assessed using parent interview schedule, revised behavioral problem checklist and Children's Global Assessment Scale. STATISTICAL ANALYSIS: The correlation and predictive power of the variables were analyzed using SPSS 16.0 version. RESULTS: There was significant male dominance (88.3%) with boy girl ratio 7.5:1. Most common comorbidity noticed was hyperkinetic disorders (45%). Childhood onset group was more predominant (70%). Prevalence of comorbidity was more among early onset group (66.7%) than the late-onset group (33.3%). The family psychopathology, symptom severity, and the functional impairment were significantly higher in the childhood onset group. CONCLUSION: The determinants of symptom profile and severity are early onset (childhood onset CD), nature, and quantity of family psychopathology, prevalence, and type of comorbidity and nature of symptom profile itself. The family psychopathology is positively correlated with the symptom severity and negatively correlated with the functional level of the children with CD. The symptom severity was negatively correlated with the functional level of the child with CD.

All-cause mortality and cardiovascular mortality in Kerala state of India: results from a 5-year follow-up of 161,942 rural community dwelling adults.

BACKGROUND AND AIM: In India, Kerala has the best health indicators, having experienced dramatic shifts in mortality and fertility. However, the mortality pattern in Kerala has not been studied. In this article, the authors analyze and report the pattern of mortality in the PROLIFE cohort (n = 161,942). METHODS: Data on death were collected through regular home visits using a pretested, structured questionnaire. The data were validated by a physician. The deaths were grouped under disease categories using ICD 10. RESULTS: Out of 4271 deaths recorded during 5 years, diseases of the circulatory system contributed 40%. Coronary heart disease was the leading cause of death in men (31.1%) and women (17.6%). Age-standardized cardiovascular disease (CVD) death rates were 490 for men and 231 for women per 100,000 person years. CONCLUSION: The burden of CVD deaths in this community now exceeds that of industrialized countries.

Predictors of birthweight--a cross sectional study.

This study was conducted to find out the anthropometric, biosocial and obstetric predictors of birthweight in Kerala. The study sample consisted of 599 consecutive liveborn babies delivered at SAT Hospital, Medical College, Thiruvananthapuram and their mothers in November 2001. Details of maternal history, anthropometry, and biosocial and demographic factors were recorded. Birthweight was primary outcome variable. Multivariate analysis revealed that the biologically acceptable predictors of birthweight of a baby in our population are maternal height (P <0.001), parity (P < 0.001) gestational age (P < 0.001), pregnancy induced hypertension(P=0.05) and history of low birthweight in the previous pregnancy(P=0.05).

Efficacy and safety of a live attenuated, cold-adapted influenza vaccine, trivalent against culture-confirmed influenza in young children in Asia.

BACKGROUND: This study was designed to evaluate the efficacy and safety of cold-adapted influenza vaccine, trivalent (CAIV-T) against culture-confirmed influenza in children 12 to <36 months of age during 2 consecutive influenza seasons at multiple sites in Asia. METHODS: In year 1, 3174 children 12 to <36 months of age were randomized to receive 2 doses of CAIV-T (n = 1900) or placebo (n = 1274) intranasally > or =28 days apart. In year 2, 2947 subjects were rerandomized to receive 1 dose of CAIV-T or placebo. RESULTS: Mean age at enrollment was 23.5 +/- 7.4 months. In year 1, efficacy of CAIV-T compared with placebo was 72.9% [95% confidence interval (CI): 62.8-80.5%] against antigenically similar influenza subtypes, and 70.1% (95% CI: 60.9-77.3%) against any strain. In year 2, revaccination with CAIV-T demonstrated significant efficacy against antigenically similar (84.3%; 95% CI: 70.1-92.4%) and any (64.2%; 95% CI: 44.2-77.3%) influenza strains. In year 1, fever, runny nose/nasal congestion, decreased activity and appetite, and use of fever medication were more frequent with CAIV-T after dose 1. Runny nose/nasal congestion after dose 2 (year 1) and dose 3 (year 2) and use of fever medication after dose 3 (year 2) were the only other events reported significantly more frequently in CAIV-T recipients. CONCLUSIONS: CAIV-T was well tolerated and effective in preventing culture-confirmed influenza illness over multiple and complex influenza seasons in young children in Asia.

Factors affecting decisions to seek treatment for sick children in Kerala, India.

The purpose of this study was to measure the effects of social and economic variables, disease-related variables, and child gender on the decisions of parents in Kerala, India, to seek care for their children and on their choice of providers in the allopathic vs. the alternative system. A case-control analysis was done using data from the Kerala section of the 1996 Indian National Family Health Survey, a cross-sectional survey of a probability sample of households conducted by trained interviewers with a close-ended questionnaire. Of the 469 children who were eligible for this study because they had at least one common symptom suggestive of acute respiratory illness or diarrhea during the 2 weeks before the interview, 78 (17%) did not receive medical care, while the remaining 391 (83%) received medical care. Of the 391 children who received medical care, 342 (88%) received allopathic medical care, and 48 (12%) received alternative medical care. In multivariable analyses, parents chose not to seek medical care for their children significantly more often when the illness was mild, the child had a specific diagnosis, the mother had previously made fewer antenatal visits, and the family had a higher economic status. When parents sought medical care for their children, care was sought significantly more often in the alternative provider system when the child was a boy, the family lived in a rural area, and the family had a lower social class. We conclude that, in Kerala, disease severity and economic status predict whether children with acute respiratory infection or diarrhea are taken to medical providers. In contrast, most studies of this issue carried out in other populations have identified economic status as the primary predictor of medical system utilization. Also in Kerala, the gender of the child did not influence whether or not the child was taken for treatment but did influence whether care was sought in the alternative or the allopathic system.

A study of the ultrastructure of urinary calculi by scanning electron microscopy.

A study of urinary stones obtained from patients after surgery in the Medical College Hospital, Trivandrum, under the scanning electron microscope showed the presence of calcium oxalate and calcium biphosphate crystals as the main constituents. However, the pattern of the different phases of crystal growth was not uniform. Within the crystal lattice, fibrous structures, possibly of protein matrix, were invariably observed. Electron microscopy may be usefully adapted as a particularly suitable method for ultramicroscopic investigation of the fine structure of urinary stones including single crystal surface structure, section of urinary calculi and for possible presence of hitherto unknown components within the calculus.