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A Community-Driven Analysis of Home Delivery Preference among Tribal Families in Bhimpur Block, Madhya Pradesh
Get PDFIntroduction: Despite the expansion of institutional maternal health services in India, home delivery remains prevalent among tribal communities. Socio-cultural traditions, geographical isolation, economic constraints, and trust in traditional birth attendants continue to influence childbirth practices. Understanding these factors is essential for designing culturally responsive maternal health interventions.
Aim & Objectives: The study aimed to analyze the socio-cultural, geographical, economic, and trust-based factors influencing the preference for home delivery among tribal communities in the Bhimpur Block of Betul district, Madhya Pradesh. The objectives included assessing awareness of government maternal health schemes, access to health facilities, and the role of elders and traditional dais in childbirth decision-making.
Materials & Methods: A cross-sectional descriptive study design was adopted. Purposive sampling was used to select 200 tribal elders from the villages of Guruwa, Pipariya, and Kasmarkhandi. Data was collected through face-to-face interviews using structured and semi-structured questionnaires. Descriptive statistics were employed for quantitative analysis, while thematic analysis was used for qualitative responses.
Results: The findings revealed that 66% of respondents preferred home delivery. Cultural practices significantly influenced this preference (66%), along with a high level of trust in traditional dais (81%). Elders played a dominant role in childbirth decisions (90%). Awareness of ambulance services (82%) and the Janani Suraksha Yojana (64%) was moderate; however, only 29% were aware of a nearby delivery facility, and 61% perceived health facilities as geographically distant.
Conclusion: The study concludes that the preference for home delivery is shaped by deeply rooted cultural norms, financial insecurity, limited accessibility, and trust-based relationships rather than mere personal choice. Culturally sensitive, decentralized maternal health strategies are essential to improve institutional delivery uptake in tribal regions
A Comparative Study of Lichtenstein's Technique & Modified Lichtenstein Techniquein the Surgical Management of Inguinal Hernia
Get PDFIntroduction: Inguinal hernia repair is among the most commonly performed surgical procedures worldwide. The Lichtenstein tension-free mesh repair is the standard approach, though modifications have been introduced to reduce postoperative complications, chronic pain, and recurrence.
Aim & Objective: This study aimed to compare the outcomes of the Modified Lichtenstein (ML) technique with the standard Lichtenstein (L) technique regarding postoperative complications, pain, and recurrence in patients undergoing open inguinal hernia repair.
Materials & Methods: A prospective comparative study was conducted at the Department of Surgery, J.A. Group of Hospitals, G.R. Medical College, Gwalior. Seventy adult patients with inguinal hernia were randomly assigned to two groups: Group L (n=35) underwent standard Lichtenstein repair, and Group ML (n=35) underwent the Modified Lichtenstein repair. Demographic data, hernia type and side, intraoperative details, postoperative complications, pain scores, and recurrence were recorded and analyzed.
Results: Both groups were comparable in age, gender, occupation, hernia type, and side, with most patients’ male (97.1%), aged 41–50 years (27.1%), right-sided hernia (55.7%), and indirect type (82.9%). All cases used spinal anesthesia and polypropylene mesh. Group L had significantly higher wound gaping (31.4% vs 5.7%, p=0.0118) and postoperative discharge (17.1% vs 0%, p<0.05). Seroma occurred in 11.4% of Group L and none in Group ML (p=0.1142). Mild pain predominated in Group ML at 24 and 48 hours, while moderate pain was more frequent in Group L. Recurrence at 11 months was observed in 17.1% of Group L and none in Group ML (p=0.0267).
Conclusion: The Modified Lichtenstein repair is a safe, simple, and effective alternative to the standard technique, offering fewer postoperative complications, better pain control, and reduced short-term recurrence
A Case on Posterior Shoulder Dislocation: The Hidden Injury
Get PDFIntroduction: Posterior shoulder dislocation (PSD) is a rare injury, accounting for a small proportion of glenohumeral dislocations, and is frequently missed at initial presentation due to subtle clinical signs and inconclusive standard radiographs. Delayed diagnosis may result in persistent instability, pain, and early degenerative changes, particularly when associated with osseous defects such as the reverse Hill-Sachs lesion (rHSL). Electrocution is a classic but often under-recognized mechanism leading to PSD because injury can occur without direct trauma.
Case Presentation: We report the case of a 21-year-old male who presented with acute pain and restricted external rotation of the right shoulder following accidental electrocution. Clinical examination revealed the arm held in addition and internal rotation with limited external rotation. Plain radiographs demonstrated features suggestive of posterior dislocation, including the lightbulb and trough line signs. Following closed reduction, magnetic resonance imaging revealed an engaging reverse Hill-Sachs lesion involving approximately 30% of the humeral head, with an associated reverse Bankart lesion. Given the size and engagement of the defect, the patient underwent an arthroscopic modified McLaughlin procedure combined with posterior labral repair.
Result: Postoperative rehabilitation resulted in a satisfactory range of motion and return to functional activity, with no evidence of instability at three-month follow-up.
Conclusion: This case highlights the importance of maintaining a high index of suspicion for PSD following electrocution. Advanced imaging is essential for identifying rHSLs and guiding management. Arthroscopic defect-addressing procedures combined with capsulolabral repair provide a reliable, joint-preserving solution in young patients with engaging humeral head defects
The Promise & Peril of Personalized Medicine
Get PDFEditorial
In the last decade, the term personalized medicine has transformed from a futuristic buzzword into a tangible revolution at the heart of modern healthcare [1]. Once, medicine was an art of averages - a prescription for the “typical” patient, a treatment designed to fit the majority. Today, fueled by advances in genomics, data analytics, and biotechnology, medicine is moving toward an era where treatment is not only based on disease but tailored to the individual who bears it [2-4]. The promise is profound. Genetic profiling can now identify how a person might respond to a drug, detect predispositions to conditions like cancer or Alzheimer's, and even guide preventive measures long before symptoms appear [1,3]. In oncology, for instance, targeted therapies have already begun to replace traditional chemotherapy with precision strikes on specific genetic mutations [10]. For many patients, this shift has meant longer survival and a better quality of life [5,10]. Yet, beneath this optimism lies a complex web of ethical, social, and economic challenges. Personalized medicine demands vast amounts of data - from genetic codes to lifestyle metrics - raising urgent questions about privacy and consent [8,9]. Who owns our genetic information? Can it be used to discriminate in employment or insurance? Furthermore, as cutting-edge therapies often carry astronomical price tags, there is a risk that personalized medicine could deepen the divide between those who can afford bespoke care and those who cannot [5,6]. Equally important is the issue of access to technology and representation in research. The genetic data driving personalized medicine has historically been derived largely from populations of European descent [7]. If this imbalance continues, the so-called “personalization” may fail to serve humanity in its entirety, leaving large segments of the global population without effective therapies [9]. To ensure that personalized medicine fulfills its humanitarian promise, we must marry scientific progress with ethical foresight [8]. Governments, researchers, and healthcare providers must establish transparent data governance systems, ensure equitable access to treatments, and promote diversity in biomedical research [7–9]. Education, too, plays a vital role - both for clinicians, who must interpret complex genetic information, and for patients, who deserve to understand their own biology [2,4]. Personalized medicine represents not merely a technological shift, but a philosophical one: a move toward seeing each patient as a unique biological narrative [11]. The challenge ahead lies in ensuring that this revolution serves not just the fortunate few but the collective human story. If guided wisely, personalized medicine may become not just the future of healthcare, but the future of humanity's relationship with itself [9]
Clinicopathological Spectrum of Intracranial Space-Occupying Lesions: A Tertiary Care Center Experience
Get PDFIntroduction: Intracranial space-occupying lesions (ICSOLs) comprise a heterogeneous group of neoplastic and non-neoplastic conditions with variable clinical presentation and biological behavior. Histopathological examination remains the gold standard for definitive diagnosis and grading, which directly influence management and prognosis.
Aim & Objectives: To evaluate the demographic profile, clinical presentation, histopathological spectrum, and WHO grade distribution of ICSOLs in a tertiary care center, and to assess associations between clinical features, lesion type, and tumor grade.
Material & Methods: This descriptive observational study included 100 consecutive ICSOL cases received in the Department of Pathology in collaboration with Neurosurgery. Clinical details and radiological information were recorded. Tissue specimens obtained by biopsy or excision were processed routinely and stained with hematoxylin and eosin; special stains and immunohistochemistry were performed where required. Lesions were classified according to WHO CNS tumor classification, and gliomas/meningiomas were graded as per WHO criteria. Data were analyzed using descriptive statistics, and χ² tests were applied to examine symptom–lesion associations and compare grade distribution; p < 0.05 was considered significant.
Results: Mean age was 41.3 ± 18.7 years (range 2–70), with a peak in 31–40 years (22%). There was marginal male predominance (52%). Neoplastic lesions predominated (95%). Gliomas were most common (30%), followed by meningiomas (24%) and schwannomas (15%). Headache was the commonest symptom (62%), followed by seizures (34%) and visual disturbance (28%). Significant symptom associations were observed for headache, seizures, visual disturbance, focal neurological deficit, and fever (p < 0.05). WHO grade distribution differed significantly between gliomas and meningiomas, with high-grade tumors (Grade III–IV) significantly more frequent among gliomas (χ² = 14.22, p = 0.00016).
Conclusion: ICSOLs in this cohort were predominantly neoplastic, with gliomas and meningiomas forming the major tumor burden. Clinicopathological correlations and WHO grading provide valuable diagnostic and prognostic insights, reinforcing the central role of histopathology in resource-limited settings
Difference In Clinico - Etiological Profile of Neonatal Hyperbilirubinemia at A Tertiary Care Hospital
Get PDFIntroduction: Neonatal hyperbilirubinemia is one of the most common conditions requiring medical attention in the neonatal period. While most cases are physiological, delayed diagnosis and inappropriate management can lead to severe complications, including acute bilirubin encephalopathy and kernicterus.
Aim & Objectives: To compare the clinico-etiological profile of neonatal hyperbilirubinemia between inborn and outborn neonates admitted to a tertiary care hospital and to identify key risk factors associated with pathological jaundice.
Material & Methods: This hospital-based cross-sectional study was conducted in the Special Newborn Care Unit (SNCU) of a tertiary care hospital in Greater Noida over 12 months. Enrolled patients included 360 neonates ≤28 days with hyperbilirubinemia, either clinically suspected or biochemically confirmed. Data collection was done using a structured proforma, and etiological diagnosis was determined based on clinical and laboratory findings. Statistical analysis was done using SPSS v28.0; Chi-square and independent t-test were employed, with significance confirmed at p<0.05.
Results: Of the 360 neonates included, 269 (74.7%) were inborn and 91 (25.3%) outborn. Pathological jaundice occurred more frequently among outborn neonates (60.4%) than inborn (28.6%) (p=0.001). In outborn infants, significantly higher prevalence for prematurity (36.1%), SGA status (56.1% vs 35.7%, p=0.002), and birth asphyxia (14.3% vs 4.8%, p=0.02) was observed. Neonatal sepsis was the most common etiology in outborn neonates (56.3%, p<0.001). On the other hand, ABO incompatibility (29.8%) and cephalohematoma (31.1%) were the principal factors among inborn infants. Total serum bilirubin levels were comparable between groups, though bilirubin testing was performed significantly earlier among inborn neonates (p=0.001).
Conclusion: Significant differences exist in the etiological and clinical profile of hyperbilirubinemia between inborn and outborn neonates. Optimized early screening, infection control, and appropriate referral systems are mandatory in the reduction of preventable complications among outborn neonates
A Prospective Study of Clinical Profile of Acute Appendicitis & Its Correlation with Ultrasonography Findings In Patients Admitted In J.A. Group of Hospitals, Gwalior
No full textIntroduction: Acute appendicitis remains one of the most common causes of acute abdomen requiring emergency surgical intervention. Despite classical signs and symptoms, its variable presentation can complicate diagnosis, leading to delayed treatment and serious complications. Ultrasonography (USG), being radiation-free, cost-effective, and readily available, plays a pivotal role in the diagnostic workup, especially in settings with limited access to advanced imaging.
Aim & Objective: To study the clinical profile of patients with acute appendicitis and correlate clinical features with ultrasonographic findings to improve diagnostic precision and surgical outcomes.
Materials & Methods: This prospective observational study was conducted over 18 months in the Department of General Surgery, J.A. Group of Hospitals, Gwalior, involving 89 patients aged 16–60 years with a provisional diagnosis of acute appendicitis. Detailed clinical history, physical examination, and ultrasonographic evaluations were performed. Diagnosis was confirmed intraoperatively. Data was analyzed for demographic distribution, clinical features, USG parameters, and outcomes.
Results: Most patients were males (67.41%) aged between 21–30 years. All presented with central abdominal pain migrating to the right iliac fossa. McBurney’s point tenderness and rebound tenderness were noted in 100% of cases. Ultrasonographically, probe tenderness was present in 97.75%, and the mean appendiceal diameter was 7.43 ± 0.98 mm. All cases showed concordance between clinical, USG, and intraoperative diagnosis. There were no complications or mortality, and all patients had a full recovery.
Conclusion: This study demonstrated a strong correlation between clinical signs and ultrasonographic findings in acute appendicitis. Combining both modalities improves diagnostic accuracy, enables timely surgical intervention, and reduces the risk of negative appendectomy and associated complications
A Rare Case of Vocal Mucosal Fold: Case Report
No full text Background: Vocal cord mucosal folds are rare benign lesions that can significantly impact voice quality, especially in vocal professionals such as singers. These lesions may cause respiratory distress and alterations in vocal quality, which can progressively worsen if not treated appropriately. Early diagnosis and surgical intervention are critical for restoring voice function and preventing long-term complications. Case Presentation: We present the case of a 43-year-old male singer who reported a gradual onset of respiratory distress and change in voice over six months. Endoscopic examination revealed a vocal cord flap originating from the left vocal cord, while all other clinical and laboratory parameters remained within normal limits. Pre-anaesthetic evaluation confirmed fitness for microlaryngoscopic excision, which was performed successfully without intraoperative complications. The patient recovered well post-operatively and was discharged the next day. A structured voice therapy program was initiated, leading to notable improvement in the Voice Handicap Index (VHI-10) scores, reflecting enhanced vocal quality and reduced symptoms. At subsequent follow-ups, the patient maintained stable voice quality, with no evidence of recurrence. Conclusion: Microlaryngoscopic excision of vocal cord mucosal folds, combined with post-operative voice therapy, is an effective strategy for symptom relief and voice restoration in vocal professionals. Early intervention and structured rehabilitation are key to achieving optimal vocal recovery.
The Role of Point of Care Ultrasound (POCUS) in Maternal Emergencies: Advancements, Applications, and Impact on Outcomes
Get PDF Introduction: Maternal emergencies are significant contributors to maternal morbidity and mortality, particularly in resource-limited settings where rapid diagnosis and intervention are crucial. Point-of-Care Ultrasound (POCUS) has emerged as a valuable tool for real-time, bedside diagnosis, enabling prompt clinical decision-making in critical obstetric scenarios such as ectopic pregnancy, postpartum hemorrhage, and hypertensive emergencies. Aim and Objective: This study aimed to evaluate the role of POCUS in the timely diagnosis and improved management of maternal emergencies. The primary objective was to assess its impact on diagnosis time and clinical outcomes compared to traditional methods. Materials and Methods: prospective observational study included 80 UPT-positive pregnant women with maternal emergencies at Maharani Laxmi Bai Medical College, Jhansi. Bedside POCUS using a portable BPL machine was performed. Emergencies included hemorrhage, ectopic pregnancy, seizures, shock, and reduced fetal movements. Patients with chronic illnesses or no consent were excluded. Diagnosis time and outcomes were compared. Ethical clearance was obtained. Results: POCUS significantly reduced diagnosis time in all categories of maternal emergencies, with the most notable reduction in ectopic pregnancy (mean time saved: 55 minutes) and preeclampsia/eclampsia (50 minutes). Out of 80 cases, 63 had resolved outcomes, while 17 developed complications. The highest resolution rate was observed in postpartum hemorrhage cases. POCUS facilitated early triage and management, contributing to improved maternal outcomes. Conclusion: POCUS is a valuable tool in maternal emergencies, enabling rapid and accurate diagnosis that improves clinical outcomes. Its integration into standard obstetric care, particularly in low-resource settings, is essential for reducing maternal complications and mortality through timely intervention and effective management.
A Clinical Study of Socio-Demographic Variables and Their Correlation to Psychiatric Morbidities in Dermatological Disorders
Get PDFIntroduction: Psychological factors are increasingly recognized as important contributors to dermatological disorders. Many patients with skin diseases experience significant emotional distress, which negatively affects their quality of life and interferes with overall well-being. Symptoms such as anxiety, depression, low self-esteem, and social withdrawal are commonly reported. In addition to psychological variables, socio-demographic factors-including age, gender, marital status, educational level, and socioeconomic status may influence both the onset and prognosis of dermatological conditions. Understanding these associations is essential for guiding patient-centred and holistic management.
Aim & Objective: The present study aims to evaluate socio-demographic variables and examine their correlation with psychiatric morbidities among patients with dermatological disorders.
Materials & Methods: This hospital-based prospective study was conducted among patients attending the outpatient department (OPD) and inpatient ward of the Dermatology Department at B. S. Kushwah Medical College, Kanpur. Relevant socio-demographic information, along with psychiatric symptoms and diagnoses, was systematically assessed.
Results: The findings demonstrate that gender, age, educational level, and socioeconomic status significantly influence the prevalence of psychiatric morbidities in dermatological patients. A statistically significant association was observed in married females, individuals aged 41–60 years, and those with education below the high-school level, who exhibited higher rates of psychiatric comorbidities compared to other groups.
Conclusion: This study underscores the strong relationship between socio-demographic characteristics and psychiatric morbidities in patients with dermatological disorders. As individuals presenting to hospitals are more likely to have moderate to severe disease, these findings may not fully represent the general population of dermatology patients. Integrating psychological assessment and support into dermatological care may improve overall treatment outcomes and enhance quality of life