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Leptospirosis is a potentially fatal bacterial disease that can display a wide array of clinical presentations thus mimicking better-known illnesses. Although, leptospirosis is primarily a zoonotic disease, it frequently inflicts severe illness and death on communities around the globe. A comprehensive overview of the disease in wake of the 2006 outbreaks in India is hereby presented and discussed.

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Presence of air and fluid with in the chest might have been documented as early as Fifth Century B.C. by a physician in ancient Greece, who practiced the so-called Hippocratic succession of the chest. This is due to a development of communication between intrapulmonary air space and pleural space, or through the chest wall between the atmosphere and pleural space. Air enters the pleural space until the pressure gradient is eliminated or the communication is closed. Increasing incidence of road traffic accidents, increasing awareness of healthcare leading to more advanced diagnostic procedures, and increasing number of admissions in intensive care units are responsible for traumatic (noniatrogenic and iatrogenic) pneumothorax. Clinical spectrum of pneumothorax varies from asymptomatic patient to life-threatening situations. Diagnosis is usually made by clinical examination. Simple erect chest radiograph is sufficient though; many investigations are useful in accessing the future line of action. However, in certain life-threatening conditions obtaining imaging studies can causes an unnecessary and potential lethal delay in treatment.

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A 19-year-old male presented to the emergency department (ED) following intermittent episodes of palpitations. Classical "epsilon waves" noted on his initial electrocardiogram prompted an evaluation for arrhythmogenic right ventricular dysplasia (ARVD). The diagnosis was confirmed with magnetic resonance imaging of the heart and stress test. A prompt recognition and management of this condition in the ED helped prevent significant mortality that may be associated with ARVD.

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In clinical medicine there may be times when clinical conditions manifest differently both when they present individually or concomitantly. Such scenarios warrant a broader differential diagnosis with thorough investigations. We present one such case of a patient of Bell's palsy with unexplained eye pain on the ipsilateral side. The patient had a chronic retinal detachment which became worse due to the concomitant Bell's palsy.

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Hepatic hydatid cysts may cause serious complications. Intraperitoneal rupture of hepatic hydatid cyst is rarely seen and the prognosis can be fatal. By experience, we know that it might be difficult to diagnose an unruptured cyst expulsed into the peritoneal cavity. In this report, we present the case of a 54-year-old man with an intraperitoneal cystic mass of 10 cm of diameter which had extruded out from the liver due to a blunt abdominal trauma.

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Sub-Saharan Africa has sparse imaging capacity, and data on ultrasound (US) use is limited. We collected prospective data on consecutive patients undergoing US to assess disease spectrum and US utility in Liberia. A total of 102 patients were prospectively enrolled. Average age was 33 years (0-84), 80% were female. US indications were: 53% Obstetrics/Gynecology (OB/GYN) (24% gynecologic, 17% second/third trimester, 12% first trimester), 14% hepatobiliary, 10% intraperitoneal/intrathoracic fluid, 8% cardiac, 5% focused assessment of sonography in trauma, and 4% renal. US changed management in 62% of cases. Greatest impact was in first trimester OB (86%), FAST (83%), ECHO (80%), and second/third trimester OB (77%). US changed management in 47% of right upper quadrant and 33% of gynecologic studies. Curvilinear probe addressed over 80% of need. The primary role for US in developing countries is in management of obstetrics, with a secondary role for traumatic and a-traumatic abdominal processes. Most needs can be met with the curvilinear probe. Training should begin with obstetrics and should be a primary focus for curriculum.

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Emergency medicine (EM) residency programs are a new concept to India. As these programs develop in India the need for effective teaching tools for skills education will rise. A high fidelity simulation workshop was conducted with a intent to expose current residents posted in emergency departments (EDs) to the concept of simulation technology. The participants were subjected to scenarios which tested their core competencies, medical knowledge, and procedural skills using simulation technology. 50 residents were tested over 5 days and an overall satisfaction score and personal comments were assessed to rate the performance of this study. A pre- and post simulation survey was done. Results showed that participants felt that their understanding of communication of expectations increased from 38% fair or good to 76% very good or best. The frequency in which they thought they would ask for help increased from 36% fair or good to 88% very good or best. It was found that students had increased their confidence to challenge a questionable order from a superior from 48% occasionally or half of the time to 76% who would do it the majority of the time or always. In the post-survey, 80% would the majority of the time or always admit that they did not know something from 46% who stated they would only do it occasionally or half of the time. We concluded that simulation as a tool for teaching unknown and stressful conditions of ED naturally pair. Resident core competencies can be taught and evaluated more effectively in the simulation lab in a controlled, safe, and collegial manner.

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