ESIC Hospital

Breastfeeding competency is a core professional requirement in midwifery practice and significantly influences maternal and neonatal health outcomes. Despite global recommendations advocating exclusive breastfeeding, gaps persist in practical skill preparation and clinical confidence among midwifery students. Simulation-based training has emerged as an innovative educational strategy; however, its conceptual meaning within breastfeeding competency development remains inadequately defined. This study aimed to clarify the concept of simulation-based training for breastfeeding competency development in midwifery practice using Walker and Avant’s eight-step concept analysis methodology. A systematic literature search was conducted across PubMed, Scopus, CINAHL, and Web of Science databases for studies published between 2000 and 2025. Sixty-four relevant articles were included in the final synthesis. Five defining attributes were identified: structured experiential learning, simulated clinical environment, competency-based evaluation, facilitated reflective debriefing, and clinical transferability. Antecedents included curricular gaps, technological advancement, maternal–infant health priorities, and ethical considerations in clinical training. Consequences encompassed improved psychomotor skills, enhanced clinical confidence, strengthened breastfeeding support practices, and potential improvement in maternal satisfaction and breastfeeding outcomes. An operational definition was developed to guide curriculum design, research standardization, and policy development. Concept clarification supports the integration of simulation-based strategies into competency-based midwifery education to enhance breastfeeding support quality and maternal–newborn health outcomes.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder increasingly diagnosed in early childhood. Concurrently, screen time exposure among young children has risen, prompting global concern. Understanding the potential association between early screen exposure and ASD risk is vital for informing parental guidance and policy. A narrative review was conducted using electronic databases including PubMed, Scopus, and Google Scholar. Studies published between 2010 and 2024 that assessed screen time exposure in children under five and its association with ASD or ASD-like symptoms were included. The review considered observational studies, meta-analyses, and systematic reviews. Socio-economic status, parental education, and urban-rural differences were evaluated as confounding factors where data allowed. Most studies indicated a potential association between excessive screen time (particularly passive screen use beyond 2 hours per day) and ASD-like symptoms or delayed verbal communication in children under five. However, the evidence remains inconclusive due to variability in study designs and measurement tools. Socio-economic background emerged as a significant moderator, with children from lower-income families showing higher screen exposure and reduced interactive parenting. While excessive screen time may be associated with ASD-related developmental concerns, causality cannot be established due to potential confounders. Public health interventions should focus on promoting balanced screen use and parent-child interaction, especially in socio-economically disadvantaged settings. Further longitudinal research is needed to clarify causation and guide early intervention strategies.

Background: Antenatal care (ANC) plays a critical role in improving maternal and neonatal health by enabling early detection and management of pregnancy-related complications. However, ANC utilization remains inadequate in many developing countries due to insufficient knowledge, unfavorable attitudes, and poor health-seeking practices. Objective: To assess knowledge, attitude, and practices related to antenatal care and to identify factors influencing ANC utilization among pregnant women attending a tertiary-level hospital in Dhaka, Bangladesh. Methods: A hospital-based cross-sectional study was conducted from January to June 2025 at the Antenatal Outpatient Department of Monowar Sikder Medical College and Hospital, Dhaka. Using consecutive sampling, 350 pregnant women were enrolled. Data were collected through a structured questionnaire and analyzed using descriptive statistics and Chi-square tests (p < 0.05). Results: Most participants were aged 21–30 years (77.1%), and 66.3% were literate. Knowledge of nutritional supplementation during pregnancy was high (93.1%), while awareness of gestational diabetes (11.4%) and recommended investigations (21.7%) was low. ANC utilization was suboptimal, with 40.0% reporting no ANC visits and only 2.3% completing four or more visits. Although 79.7% reported good accessibility, satisfaction with ANC services was moderate (48.3%), and 82.0% required spousal permission to attend clinics. Conclusion: Significant gaps in ANC knowledge and utilization persist despite generally positive attitudes. Targeted health education, improved service delivery, and greater family involvement are essential to enhance ANC uptake and maternal–neonatal outcomes.

Lumbopelvic Flexion-Rotation Movement Impairment Syndrome is a common pattern observed in individuals with mechanical low back pain (MLBP) characterised by altered postural control and neuromuscular dysfunction. Isolated balance training may offer focused benefits in such cases. To compare the effectiveness of an isolated balance exercise regimen with conventional physiotherapy in managing Lumbopelvic flexion-rotation movement impairment syndrome in male patients with MLBP. A single-centre experimental study was conducted on 30 male patients (aged 18-26years) diagnosed with Lumbopelvic flexion-rotation movement impairment syndrome. Participants were randomly assigned to Group A (Isolated Balance Exercise) or Group B (Conventional Physiotherapy). Outcomes were assessed pre- and post-intervention using standardised pain and disability scales. Both groups showed statistically significant improvements. Group A showed reductions in pain (Mean=1.86, SD=±0.639) and disability (Mean=1.60, SD=±0.736). Group B also improved in pain (Mean=1.66, SD=±0.899) and disability (Mean=1.60, SD=±0.7368). The isolated balance regimen was comparably effective with conventional therapy. Isolated balance training is an effective and viable standalone intervention for managing MLBP due to Lumbopelvic flexion-rotation movement impairment syndrome.

Abstract Traumatic ear amputation secondary to human ear-bite is one of the common emergencies. If left untreated, it results in a deformity that causes social embarrassment and stigmatizes the victim. This case study documents primary ear reconstruction with “spare-part” amputated cartilage in a middle-aged, diabetic male after 24 hours of amputation. This reconstruction was performed using modified Mladick's Pocket technique in three stages over 90 days. There was complete cartilage take. Partial flap necrosis was managed conservatively. Over 18 months, the ear settled well and was nearly symmetrical to the opposite ear. There was a good skin match and minimal donor site morbidity. In favorable circumstances, primary non-microsurgical reconstruction using amputated cartilage of the ear in human bite is a feasible option even after 24 hours of amputation in patients with comorbidities. Primary ear reconstruction has the technical advantage of having unscarred tissues for repair.

Despite advances in neonatal care, delayed diagnosis and treatment of congenital hypothyroidism (CH) remain prevalent in regions lacking universal screening. This retrospective study evaluated catch-up growth patterns in 65 children with a delayed diagnosis of CH. Study children were stratified into four groups based on age at thyroxine initiation: Groups A (< 1 year), B (1-<3 years), C (3-<5 years), and D (5-10 years). Growth outcomes, in terms of serial height z scores, skeletal maturation, proportion achieving catch-up growth, and time to catch-up, were assessed at baseline and after 3 years of thyroxine. Within 3 years of treatment initiation, 64.6% (42/65) of children achieved complete catch-up in linear growth, and 56.9% (37/65) attained optimum catch-up. Among those treated before 1 year of age (Group A), 76% (19/25) achieved complete and optimum catch-up over a median (IQR) duration of 22 [12-33] months. In children diagnosed after 1 year of age (Groups B-D combined), 57.5% (23/40) attained complete catch-up, of whom 78.3% (18/23) achieved optimum growth, with time to catch-up increasing progressively with later age at diagnosis (median range-25-34 months). The greatest change in height z-scores was observed in the first-year post-treatment across all groups, with a decline thereafter. Catch-up in skeletal maturation was observed in 72.3% (47/65) of children and occurred earlier than catch-up in linear growth. Early thyroxine initiation in CH is critical for optimal linear and skeletal growth. Delayed diagnosis is associated with slower, suboptimal recovery and an increased risk of compromised final adult height.

Background: While training interventions on bio-medical waste (BMW) management have shown immediate improvements in knowledge and practices among healthcare workers, there is limited evidence on the sustainability of such outcomes. This study follows up with the same cohort from the 2022 intervention at three hospitals in Rajasthan to assess long-term behavioural retention and operational compliance six months post-training. Methods: This observational follow-up study included 124 of the original 156 participants. A structured survey and observational audit were conducted to measure retention of knowledge and adherence to BMW segregation protocols, PPE usage, and reporting mechanisms for needle-stick injuries. Spot-checks and supervisor feedback were also recorded. Results: The average knowledge score declined slightly from 16.4 (post-training) to 14.8 after six months but remained significantly higher than the pre-training baseline (9.2, p&lt;0.001). Sustained compliance was observed in 85% for colour-coded segregation, 89% for PPE use, and 82% for hand hygiene. Reporting of needle-stick injuries, however, dropped from 89% to 63%. Class 4 and housekeeping staff showed the most retained improvement, suggesting lasting value in training lower-cadre employees. Conclusions: While slight declines were observed, most key behaviours related to BMW management remained significantly better than baseline. This underscores the value of refresher modules and continuous monitoring to sustain impact. Structured interventions, when coupled with audits and reinforcement, can yield lasting operational changes even in low-resource hospital settings.

Chronic liver disease (CLD) poses a growing public health burden in India, with hepatitis B virus (HBV) remaining a preventable contributor despite the nation's expanding immunization and screening frameworks. This narrative review critically appraises programme-level preventive strategies for HBV-related CLD in India, structured across three tiers of prevention: public awareness, vaccination and screening. Evidence was synthesized from 26 eligible studies, incorporating national surveys, cohort studies, policy reports and qualitative analyses. Findings reveal substantial deficits in HBV-related knowledge, particularly among socio-economically disadvantaged and rural populations, where stigma, mis-information and poor health literacy impede timely diagnosis and care-seeking. Although hepatitis B vaccination is part of India's Universal Immunization Programme, birth-dose coverage remains sub-optimal due to labor-room workflow challenges, cold chain fragility and provider hesitancy, especially in high-fertility states. Uptake among healthcare workers and medical students is also inconsistent, highlighting gaps between theoretical knowledge and preventive behavior. Screening efforts, primarily through the National Viral Hepatitis Control Programme, remain fragmented, with significant inter-state disparities in antenatal HBsAg testing and limited penetration in tribal and remote regions. While decentralized, community-led models have shown promise; broader scale-up is hampered by logistical and infrastructural constraints. The review underscores the urgent need for culturally tailored awareness campaigns, cold chain automation, subsidized adult vaccination and robust digital linkage-to-care models. Generating rural-specific cost-of-illness and willingness-to-pay data will be vital for evidence-informed policymaking. A life-course approach anchored in equity, digital health and decentralization is essential to achieving HBV elimination goals and reducing the burden of chronic liver disease in India.