BackgroundEmergency separation of conjoined twins is performed when one twin is already dead or dying and threatens the survival of the other. The particular decision to perform an emergency separation of conjoined twins provides an ethical dilemma that needs special attention. Adding to the complexity of surgical and postsurgical management in emergency separation, ethical and sociocultural aspects further complicate decision-making.Case presentationFrom 1987 to 2022, 18 conjoined twin separations were performed in our centre. This paper describes three conjoined twin emergency separations. (...) In the first case of thoracoomphalopagus babies at nine days of age, one baby was diagnosed with necrotizing enterocolitis with frequent desaturation and seizures, and the other baby was healthy. Emergency separation was performed on the twelfth day of age; unfortunately, neither baby survived the surgery. In the second case, emergency separation was performed on the 110th day of life due to sepsis in one baby. The nonseptic twin passed away six hours after surgery, while the septic twin died 12 days after surgery due to wound dehiscence and abdominal sepsis. The third case was of an omphalopagus conjoined twin with a parasitic twin. The healthy baby was deemed nonviable but found to be healthy upon birth. Immediate emergency separation was performed at 2 h of age. The living baby survived the surgery but passed away two months later.ConclusionsWhen separation is deemed necessary to save one twin, it becomes difficult to apply standard ethical medical reasoning. The decision to separate results in most cases in very high-risk surgeries with poor outcomes during surgery and postsurgery. Compounded by the complexity of the case, sociocultural and religious aspects further add to the dynamics of decision-making. A multidisciplinary team must work together with a health ethics committee and navigate through this ethical conundrum with the patient and family at its decision-making centre to decide on the best plan of care. (shrink)

Literary renditions of cities have always gravitated towards the spatial imagination and its ethical counterpart outside the textual space. This paper explores the multicultural geography of the North Indian city Allahabad observed through Neelum Saran Gour’s postcolonial narratives Allahabad Aria and Invisible Ink, projecting the narrative alignment of spatial aesthetics and cultural ethics. Interrogating the spatial dimensions of a “narrative world” within narrative theory and its interdisciplinary crossover with cultural geography, the article seeks to examine Gour’s literary city not simply (...) as an objective homogeneous representation, but as a “kshetra” of spatio-cultural cosmos of lived traditions, memories, experiences and collective attitudes of its people, in the context of E. V. Ramakrishnan’s theoretical reflections. The article proposes new possibilities of adapting the Indian concept “kshetra” to spatial literary studies; its aim is also to suggest a new source of knowledge about the city of Allahabad through a community introspection of “doing culture” in the texts, bringing into view people’s shared experiences, beliefs, religious practices and traditions as offshoots of the postcolonial ethos. The article aims to re-contextualize the city’s longstanding multicultural ethics in the contemporary times of crisis, which may affect a shift in the city’s relevance: from regional concern to large-scale significance within ethnically diverse South Asian countries and beyond. (shrink)

For anyone wondering what is spiritual enlightenment, it is essential to learn of the 24 Tirthankaras of the past, and Tirthankaras of the present. In previous eras, it was possible to achieve instant enlightenment simply from meeting a Tirthankara. At present, such sudden enlightenment is not possible here on earth. In the current era, if one is seeking spiritual awakening, one can search for spiritual teachers, with hopes of understanding the meaning of spirituality and achieving spiritual transformation. But to attain (...) Self realization one must meet a living Gnani Purush (embodiment of Self knowledge). A living Gnani has the spiritual power both to give spiritual enlightenment, and to connect one with living Tirthankaras of the present, such as Simandhar Swami of Mahavideh Kshetra. In the book “The Current Living Tirthankara Shree Simandhar Swami”, Gnani Purush Dada Bhagwan offers spiritual guidance about Self realization, and how best to cultivate a connection with Simandhar Swami for the sake of ultimate liberation, or moksha. Whether on a spiritual quest to attain knowledge of Self, or simply to discover the highest level of spiritual people currently alive, this book is an invaluable resource. Among the many spiritual books available today, “The Current Living Tirthankara Shree Simandhar Swami” contains information that seekers will not find elsewhere. (shrink)