Introduction: Chronic endometritis (CE) is persistent inflammation of uterus and is associated with a number of adverse reproductive outcomes including Recurrent pregnancy loss (RPL). Its role as a contributory factor for RPL has prevalence ranging from 7%-57%. Chronic endometritis which is emerging as a cause of unexplained RPL with very few studies in Indian population, has been evaluated through Endometrial biopsy and Hysteroscopy in our study. Objective: To determine prevalence of chronic endometritis in women with recurrent pregnancy loss (RPL) and to find out reproductive outcome after antibiotic therapy. Methods: Prospective observational study, 60 women with RPL were enrolled from OPD after meeting inclusion and exclusion criteria. All women underwent hysteroscopy and endometrial biopsy in postmenstrual phase. Presence of one or more plasma cell per 10 HPF was taken as diagnostic for CE in EB. The findings of CE on hysteroscopy were presence of micropolyp, hyperemia and stromal oedema. Women diagnosed with CE received Doxycycline for 14 days as first line therapy. All cases were followed for 6 months and clinical pregnancy rate was noted. Results: The prevalence of chronic endometritis by endometrial biopsy was 16.6% (10/60) and by hysteroscopy 10.2% (4/60). Clinical pregnancy rate (CPR) in subsequent cycle after antibiotic therapy was 66.7% (8/60) and it was 18.8% (9/48) in RPL women without CE. Conclusion: Unexplained RPL cases should be evaluated for Chronic endometritis as the treatment for the same improves future reproductive outcome.
Postintubation laryngotracheal stenosis is a potentially life-threatening but often underdiagnosed complication following prolonged endotracheal intubation. It typically presents weeks after extubation with nonspecific respiratory symptoms such as dyspnea, wheezing, or stridor, frequently mimicking asthma or chronic obstructive pulmonary disease. This case series describes four patients who developed significant tracheal stenosis following prolonged intubation for critical illness and trauma, respectively. These cases demonstrated granulation tissue and luminal narrowing on bronchoscopy, consistent with Grade III stenosis as per the Cotton–Myers classification. This report emphasizes the importance of clinical suspicion, early diagnosis using imaging and bronchoscopy, and a multidisciplinary approach to management. Regular monitoring of endotracheal tube cuff pressure is critical in preventing this avoidable complication.
Introduction: Medical residents frequently face long duty hours in hospitals. “Resident Duty Hours” offers a timely analysis of how these requirements are implemented and their effects on safety, education, and training institutions. A thorough review of sleep and human performance research highlights the necessity of providing more opportunities for sleep during residency to prevent acute and chronic sleep deprivation and reduce fatigue-related errors. This study aims to examine the perception of Interns working in operation theaters postnight duty in a State Medical College where patient load is high and requires interns to work for long hours. Aim: The aim of the study is to analyze the perception of Interns working in operation theater after doing night duty. Materials and Methods: This is a questionnaire-based observational study done in the State Medical College in Jharkhand on interns completing their posting in surgery where they have to do night duty, then do duty in operation theater the next day. Observation and Results: Most of the students faced lack of sleep and safety issues during night duty, facing difficulty in doing duty in OTs, postnight duty. Those who had a comfortable night duty did not face any problem in doing duty in OTs the next day. Conclusion: Sleep deprivation and safety are major concerns among interns working in the State Medical College of Jharkhand. Addressing these issues will help in making night duties and then duty in OTs more peaceful and fruitful.
Background: Rural healthcare systems in low- and middle-income countries (LMICs) face significant disparities compared to urban counterparts. This study synthesizes evidence on successful strategies for strengthening rural health systems in resource-constrained settings, focusing on approaches that have demonstrably improved health outcomes rather than dwelling on challenges. Methodology: This policy paper employed an expert consensus approach, drawing on specialized knowledge from healthcare professionals with substantial field experience in LMICs. Content development followed a structured five-step process, including identification of key topics, literature review, integration of field experiences, synthesis of evidence, and cross-review by multiple experts. This methodological approach allowed integration of diverse perspectives from published literature, gray literature, policy documents, and extensive field experience. Results: Five key strategies consistently demonstrated effectiveness across diverse LMIC contexts: (1) community health worker (CHW) programs that leverage local human resources, as exemplified by Brazil’s family health strategy, Rwanda’s CHW program, and Pakistan’s Lady Health Worker Program; (2) innovative financing mechanisms such as Thailand’s Universal Coverage Scheme and Rwanda’s community-based health insurance; (3) Digital health solutions adapted for rural contexts; (4) Task-shifting approaches addressing workforce shortages; and (5) Cultural integration practices promoting community engagement and ownership. Conclusion: Successful rural health system strengthening requires multifaceted approaches incorporating meaningful community engagement, integration with existing health systems, innovative human resource strategies, cultural appropriateness, and sustainable financing mechanisms. These evidence-based principles can guide context-specific interventions across different LMICs to reduce rural–urban health disparities and advance health equity.
Background: Lifestyle modification, particularly following an appropriate dietary pattern, can either prevent or promote type 2 diabetes mellitus (T2DM). The aim of the study was to investigate the dietary knowledge, attitude and practice (KAP) in T2DM patients and their accompanying family members in the North Indian rural population. Materials and Methods: A total of three hundred (300) T2DM patients and their accompanying family members attending the diabetic outpatient department in our hospital were recruited for the study, and a validated questionnaire on KAP of diabetic diet was used to assess KAP toward diabetic diet. Data were collected and analyzed using SPSS 21 (IBM, Armonk, NY, USA). Results: Dietary KAP mean score about diabetic diet in the questionnaire among T2DM patients was 2.65 ± 0.50, 2.78 ± 0.38, and 2.56 ± 0.33, respectively, whereas in their accompanying family members was 2.33 ± 0.43, 2.88 ± 0.44, and 2.41 ± 0.32, respectively, in the Likert’s maximum score of 04 on ordinal scale. There was a reported negative correlation between glycosylated hemoglobin of T2DM patients and their dietary practice (r = −0.248, P < 0.05) in Pearson’s correlation statistical analysis. It also appears that the accompanying family members’ scores for dietary KAP, family history, and complications of the T2DM patients were significantly correlated with dietary practice of the T2DM patients. Conclusion: The dietary attitude score of T2DM patients and their accompanying family members was moderate, but dietary knowledge and practices were poor. Dietary KAP of T2DM patients correlated positively with their accompanying family members in the present study.
Midline forehead swellings represent a diverse and clinically challenging group of pathologies ranging from benign congenital masses to life-threatening infections. These swellings are of significant clinical importance due to their potential for intracranial extension and communication with the central nervous system. The clinical presentation varies significantly depending on the underlying pathology and the age of the patient. Imaging includes ultrasound, computed tomography scan, and magnetic resonance imaging; however, advanced imaging is mandatory for surgical planning. This review highlights the need for a high index of suspicion, a systematic clinical history, comprehensive radiological imaging, and a multidisciplinary approach for favorable cosmetic and functional outcomes.
Background: Anorectal malformations (ARMs) are major congenital anomalies occurring in approximately 1 in 5000 live births, often causing lifelong morbidity. Although disruptions in hindgut development are recognized as the embryological basis, the effect of specific maternal nutritional deficiencies – especially Vitamin A – remains insufficiently explored in humans. Objectives: The objective of this study was to assess the correlation between maternal serum Vitamin A levels, dietary intake during pregnancy, and the incidence of ARM in neonates. Materials and Methods: A retrospective case–control study was conducted at a tertiary care hospital, including 30 mothers – 15 of neonates with ARM (cases) and 15 of healthy neonates (controls). Data on sociodemographic factors, antenatal history, and dietary habits were collected using a structured questionnaire. Maternal serum Vitamin A (retinol) was estimated by high-performance liquid chromatography. Statistical analyses used independent t-tests, Chi-square tests, and binary logistic regression to identify predictors of ARM. Results: Mean maternal serum Vitamin A levels were significantly lower among mothers of neonates with ARM compared to controls (18.6 ± 3.5 μg/dL vs. 26.8 ± 4.2 μg/dL; P < 0.001). Mothers in the case group also reported lower weekly intake of Vitamin A-rich foods, including green leafy vegetables (P = 0.01) and milk products (P = 0.03). On multivariable logistic regression, low serum Vitamin A (<20 μg/dL) (adjusted odds ratio [aOR] =3.9; 95% confidence interval [CI]: 1.2–8.6; P = 0.01) and inadequate antenatal care (<4 visits) (aOR = 2.7; 95% CI: 1.1–6.3; P = 0.04) were independent predictors of ARM. Conclusion: Maternal Vitamin A deficiency is strongly associated with a higher risk of ARMs in neonates. Strengthening antenatal nutritional counseling, ensuring adequate Vitamin A intake, and promoting regular antenatal visits may help prevent these anomalies.
Background: Medication misunderstanding related to limited health literacy is common in rural and resource-limited settings and contributes to poor adherence and preventable healthcare utilisation. Patients unable to read prescriptions often rely entirely on verbal counselling, which may be insufficient when multiple medicines with different dosing schedules are prescribed. Aim and Objectives: To evaluate whether a simple colour-coded visual medication instruction system improves medication understanding among illiterate patients attending a rural district hospital. Materials and Methods: This prospective multi-cycle clinical audit was conducted at a government district hospital in rural India. Adult patients unable to read prescriptions or medicine labels and prescribed at least one oral medication were included. Baseline medication understanding was assessed after routine verbal counselling. A colour-coded visual instruction system using dots and symbols indicating dosing frequency, time of administration, and relation to meals was then introduced. Medication understanding was reassessed after implementation and during a planned re-audit cycle. Results: At baseline, correct recall of medication dose, frequency, and timing was observed in 24% of patients. Following implementation of the visual instruction system, correct recall increased to 76%. During the re-audit cycle, recall remained high at 70%, indicating sustained improvement. Conclusion: A simple colour-coded visual instruction system can improve medication understanding among illiterate patients and is feasible for routine use in resource-limited outpatient settings.
Dextrocardia is a rare clinical phenomenon with a reported incidence of 1 in 5000–30000. Dextrocardia with situs solitus is often referred to as dextroversion, with the heart’s apex rotated into the right side of the chest. The authors report an incidental case of dextroversion in a patient who presented in the emergency department for evaluation of abdominal pain. An unmarried 40-year-old female, from Dharan was admitted in the emergency department of BP Koirala Institute of Health Sciences with complaints of pain in the left lumbar and hypochondriac region for 5 days. Her vitals were within the normal limits. On examination, her apex beat was heard in the right 5th intercostal space in mid clavicular line. On respiratory examination, normal vesicular breath sound was heard on the right, whereas decrease air entry was noted on the left side of chest. Abdominal ultrasound revealed reniform structure with echogenicity similar to kidney in the periumbilical region with nonvisualization of left kidney in the left renal fossa. Echocardiogram revealed situs solitus with pseudo dextrocardia with normal chamber size and valves. Isolated dextroversion, without associated congenital cardiac deformities, is rare. Such patients are usually asymptomatic, and identification of such condition goes unforeseen unless patient present with cardiac or noncardiac symptoms in emergency department.
The Rural WONCA Global Rural Health Action Collaboration Excellence (GRACE) initiative aims to recognize and celebrate the organizations globally that demonstrate exceptional
Background: Effective discharge communication is essential for ensuring patient understanding, treatment adherence, and continuity of care in general surgery. However, in high-volume rural district hospitals, limited consultation time and heavy patient loads may compromise the clarity of information delivered at discharge. This clinical audit aimed to evaluate patient understanding and experience during discharge from general surgery services and to determine whether a brief structured verbal communication approach could improve these outcomes. Methods: A prospective before–after clinical audit was conducted in the Department of General Surgery at a Rural District Government Hospital in Central India. Consecutive adult patients discharged from outpatient and emergency surgical services were included. Patient understanding and experience were assessed using a structured five-item verbal questionnaire addressing understanding of diagnosis, treatment rationale, medication instructions, follow-up advice, and perceived clinician attentiveness. A baseline audit of 150 patients was performed. Following the implementation of a structured verbal discharge communication approach, a re-audit was conducted among an additional 150 patients. Results: Baseline findings demonstrated substantial gaps in patient understanding, particularly regarding treatment rationale and follow-up instructions. After implementation of the structured communication approach, patient-reported understanding improved across all assessed domains. Overall discharge comprehension increased from 44% at baseline to 82% in the re-audit phase, with the greatest improvement observed in understanding of follow-up instructions. Conclusion: A simple, low-resource structured verbal communication approach significantly improved patient understanding and experience at discharge in a rural general surgery setting. Such interventions may support safer transitions of care and could be easily implemented in similar resource-limited healthcare environments.
The findings of the Lancet Commission have brought to light the diminished state of surgical care in low- and middle-income countries, especially the availability of surgical care in rural areas. Rural surgeons require different skillsets, and traditional surgical training is geared toward urban hospital practice. Little is known of the current state of educational support and training for rural surgery. The present study sought to investigate the state of training for surgery in austere environments by performing a review of the literature on existing courses and evaluations of their successes. The study aims to assess if there is a need for more formal resources to provide austere or rural environment surgical training. A literature search was performed on existing courses and training programs for surgery in austere environments. Courses or fellowships that imparted surgical skill for practice in rural/austere environments were included; programs that were not skill based, had no formal educational component, were nonsurgical or nonrural/austere environment related were excluded. Sixteen articles were included in the analysis. Eight pertained to short courses and eight pertained to long courses. Evaluation of outcome was performed through a mixture of knowledge assessment, competency assessment, as well as participant’s assessment of usefulness. There remains a paucity of reported courses or programs focused on providing surgical education in low-resource settings. Existing interventions are largely inadequately evaluated, with a lack of focus on real-world impact. Future interventions should focus on being collaborative and systems based with longitudinal real-world evaluation to assess for meaningful impact toward achieving the 2030 Lancet Commission goals.
The sheer volume of patients in India, driven by a vast population, coupled with an enormous rural–urban disparity in doctor distribution and limited infrastructure, means that efficiency is not merely a virtue but a fundamental necessity for accessibility. At the heart of this efficient delivery lies the remarkable skill set developed by Indian medical professionals. Operating under immense pressure, doctors in high-volume settings hone an exceptional ability for rapid diagnostic pattern recognition.
Laparoscopic cholecystectomy is among the most performed surgical procedures worldwide. While typically straightforward, a subset of cases presents significant technical difficulty due to inflammation, fibrosis, or anatomical distortion – factors that dramatically increase the risk of bile duct injury, conversion to open surgery, and other complications. Risk factors of a challenging cholecystectomy are male sex, older age, obesity, acute or recurrent cholecystitis, cirrhosis, and anatomical anomalies. A strong emphasis is placed on hepatobiliary anatomy, including variants of the cystic duct, cystic artery, Rouviere’s sulcus, and accessory bile ducts, which play a critical role in surgical safety. Mirizzi’s syndrome, though rare, represents a particularly hazardous scenario and is discussed in detail with respect to its classification and operative implications. Core surgical strategies are reviewed, highlighting the critical view of safety, liberal use of intraoperative cholangiography, and the value of intraoperative pauses. Bailout techniques, including subtotal cholecystectomy (STC), fundus-first dissection, and conversion to open surgery, are presented as essential tools to mitigate risk when standard dissection is unsafe or unachievable. STC is recognized as a key damage-control option with excellent outcomes in expert hands. Emerging adjuncts such as indocyanine green fluorescence cholangiography, robotic surgery, and early artificial intelligence technologies are explored for their roles in enhancing intraoperative visualization and decision-making. Ultimately, safe management of the difficult gallbladder requires anatomical expertise, a culture of intraoperative vigilance, and readiness to adapt when standard approaches are inadequate. This review aims to equip surgeons with a structured framework to anticipate difficulty, avoid injury, and optimize the outcomes in complex cholecystectomy scenarios.
Background: Animal bites, particularly those involving the hands, are common. However, the management of these injuries, especially through primary closure, remains controversial due to the associated risk of infection. This study investigates the safety of primary closure with passive drains in hand wounds caused by animal bites. Methods: A retrospective observational cohort study was conducted at a rural hospital in Western Australia, reviewing 68 cases of hand wounds from animal bites between 2017 and 2024. Data collected included patient demographics, wound characteristics, treatment details, and outcomes. Statistical analyses were performed to compare infection rates across different closure methods. Results: Of the 68 cases, 48 involved dog bites, 12 cat bites, and 8 bites from other animals. Cat bites were significantly more likely to be infected at the time of surgery (75%) compared to dog bites (22.9%). The overall postoperative infection rate was 5.88%, while primary closure with a passive drain resulted in an infection rate of 4.17%. Conclusion: Primary closure of animal bite wounds to the hand, when combined with a passive drain, appears to be safe, with infection rates comparable to those of typical laceration repairs. This approach may offer a viable alternative to traditional management strategies, potentially improving patient outcomes. However, further prospective studies are necessary to confirm these findings.
Digital literacy among India’s health workforce is crucial for effective healthcare delivery amid rapid digitization. Professionals increasingly use electronic health records, telemedicine, and mobile health tools under initiatives like the Ayushman Bharat Digital Mission (ABDM), enhancing patient care and operational efficiency. However, barriers such as inadequate formal training, generational gaps, redundant administrative tasks, poor rural infrastructure, and cybersecurity threats significantly hinder widespread adoption. To overcome these, structured training in digital tools must be integrated into healthcare curricula, accompanied by multilingual resources, improved rural infrastructure through public-private partnerships, and robust cybersecurity measures. Tailored mentorship programs can bridge generational divides, while policy-driven digital competency assessments and streamlined documentation processes further promote digital engagement. Addressing these areas comprehensively will enhance digital literacy across India’s healthcare workforce, leading to more efficient, integrated, and resilient health service delivery systems.
Global health initiatives driven by western ideologies often lack adaptation to local contexts in low- and middle-income countries (LMICs), leading to persistent health inequities, inadequate infrastructure, and limited access to care, especially in rural and marginalized areas. Attainment of equitable health care in LMICs is beset by many long-standing challenges. These are a multiplicity of sociocultural, political, economic, and infrastructural determinants preventing high access to quality care, mostly among rural and marginalized communities. The far-reaching effects of such denials are rising disease burdens, unnecessary preventable mortality, and widening health inequalities. Investing in rural healthcare infrastructure by establishing primary health centers and developing a stronger rural workforce through incentives, task-shifting, and continual training will improve service delivery. This is especially important where mobile health services and telemedicine strengthen primary healthcare services in the LMICs in addressing health disparities. For sustainable solutions, there is a need to build capacity at the level, reduce external dependency, and sustain the local supply chain. One of the means to promote health literacy and trust is through community participation, participatory health initiatives, and gendersensitivity programs. The network would thus additionally strengthen the bilateral and multilateral partnerships for improving mechanisms for knowledge and policy development. To strengthen health systems and advance Sustainable Development Goal 3 with a focus on health equity, LMICs require local solutions, sustainable investments, workforce incentives, appropriate technology, capacity building, decentralized decision-making, and global partnerships.
Optimizing healthcare delivery in underserved regions requires a strategic alignment of workforce planning and resource allocation. This paper explores comprehensive strategies and systemic interventions aimed at strengthening healthcare access and equity, particularly in rural and remote areas. It highlights critical issues such as workforce shortages, uneven distribution, and poor retention of health professionals, which exacerbate disparities in care. Through an integrated framework, the paper examines recruitment and retention initiatives, including education pipelines, incentives, and work-life balance strategies. It emphasizes the importance of adaptable, multimodal approaches that combine supportive policy environments with career development and community integration. Resource allocation plays a parallel role in improving healthcare delivery by addressing infrastructure gaps, enabling telemedicine, expanding mobile clinics, and investing in digital health and task-shifting models. Public-private partnerships and entrepreneurial initiatives further enhance service reach and sustainability by leveraging innovation and funding mechanisms. Policies are pivotal in directing these efforts; from financial incentives and workforce redistribution to AI-driven diagnostics and rural service mandates, sound policy enables efficient and equitable resource use. By interlinking workforce strategies with dynamic resource allocation and robust policy support, this paper proposes a holistic approach to health system strengthening. The analysis underscores the necessity of continuous policy evaluation, stakeholder engagement, and data-driven decision-making. Ultimately, the findings advocate for a resilient, motivated healthcare workforce equipped to meet evolving population health needs across diverse geographic settings.
A robust health workforce is foundational to achieving quality healthcare in low- and middle-income countries (LMICs), yet these regions continue to face chronic shortages, uneven distribution, and high migration of healthcare professionals. This article adopts a life cycle approach to explore the dynamics of health workforce development in LMICs, from training and recruitment through to retention, career progression, and retirement, aiming to identify key barriers and highlight scalable strategies that support sustainable rural health systems. Drawing on global evidence and country-specific innovations, the authors examine the multifaceted challenges contributing to workforce disparities, including maldistribution, professional dissatisfaction, limited training infrastructure, and the “brain drain.” Case studies from South Asia, Africa, and Latin America illustrate both systemic failures and promising interventions. Strategies such as rural clinical placements, financial and non-financial incentives, community health worker programs, and public–private partnerships have shown significant potential in strengthening rural healthcare delivery. Additionally, task-sharing, telemedicine, and locally-rooted training initiatives are critical to building a fit-for-purpose workforce. Findings emphasize the importance of professional recognition, mentorship, and locally adapted policies in driving retention and engagement. The authors conclude that a coordinated, life cycle-based framework is essential for closing rural–urban workforce gaps and addressing global health inequities, as sustainable health systems depend on long-term investment in health worker education, support, and policy reform—particularly in underserved regions.
