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Pathogenesis Primary brain stem injury is the result of the direct effect of the trauma which results in its distortion and displacement. Kalyanaraman and Ramamurthi (1969) reported 42 cases of brain stem injury among 1100 cases of head injury patients admitted to their head injury unit in 18 months.[[1]] As late at 2007, Shukla et al. stated, "Several autopsy studies of head injury are available, but pathology of brain stem and hypothalamus injury are addressed in very few of them. "In many general surgical works today the diagnosis of primary brain stem injury amounts to pronouncement of death sentence" (Kalyanaraman and Ramamurthi 1969) It is interesting that around the same time as the above statement on ominous saying in some centers in Delhi acquired a similar predicament, "Yeh to brain stem ho gaya ab iska kuch nahi ho sakta" (He has become brain stem, now nothing can be done about it). While brain stem hemorrhage is more common in the secondary group of brain stem lesions, these are not uncommon in the primary injury especially in the lateral part of the mid-brain, the superior cerebellar peduncle, and rostral pons. [Extracted from the article]

Objective: This study analyses the research output in India in neurosciences during the period 1999-2008 and the analyses included research growth, rank, global publications' share, citation impact, share of international collaborative papers and major collaborative partner countries and patterns of research communication in most productive journals. It also analyses the characteristics of most productive institutions, authors and high-cited papers. The publication output and impact of India is also compared with China, Brazil and South Korea. Materials and Methods: Scopus Citation database was used for retrieving the publications' output of India and other countries in neurosciences during 1999-2008. Results: India's global publications' share in neurosciences during the study period was 0.99% (with 4503 papers) and it ranked 21st among the top 26 countries in neurosciences. The average annual publication growth rate was 11.37%, shared 17.34% of international collaborative papers and the average citation per paper was 4.21. India was far behind China, Brazil and South Korea in terms of publication output, citation quality and share of international collaborative papers in neurosciences. Conclusion: India is far behind in terms of publication output, citation quality and share of international collaborative papers in neurosciences when compared to other countries with an emerging economy. There is an urgent need to substantially increase the research activities in the field of neurosciences in India. [ABSTRACT FROM AUTHOR]

Objective: Guillain-Barre Syndrome (GBS) is an acute inflammatory polyradiculoneuropathy causing limb weaknesses. The mortality is around 8%, with about 20% of patients remaining disabled. The purpose of this study is to examine the performance of Indian Medical Scientists in the area of GBS over a period of 40 years. India's contribution to GBS has been examined based on the global publication output and share, growth rate, citation impact, publication share in various field, highly cited papers and their impact, most productive authors and their citation impact and collaboration of research on GBS with the international community . Materials and Methods: The data for this study has been taken from Scopus, a multidisciplinary database using keywords GBS and Miller Fisher Syndrome. The contribution of India on GBS has been compared with different countries for its publication and citation count during a period of 40 years (1973-2012). Results: It is found that there were 10,633 publications available from global medical research covering the various aspects of GBS. India's share is 2.92% of global output and holds 10th rank in overall publication output on GBS, whereas United States topped the rank with the highest number of publications. Sanjay Gandhi Post-graduate Institute of Medical Research, Lucknow is the most productive institutions while Tally AB from the National Institute of Mental Health and Neurosciences, Bangalore is the most productive author who has contributed the highest number of papers on GBS. Conclusion: India is far behind in GBS research as compared to other countries like USA, as there might be a low case report of GBS in Indian population. Still the research focusing this disease is quite prominent and needs a careful medical attention through research capacity building in order to look for better treatment of the disease in Indian cases. This study shall be helpful in enhancing the awareness of the GBS by Indian scientists. [ABSTRACT FROM AUTHOR]

Context: The highest cited papers published in a journal provide a snapshot of the clinical practice and research in that specialty and/or region.Aims: The aim of this study was to determine the highest cited papers published in Neurology India and analyze their attributes.Setting and Design: This study was a citation analysis of all papers published in Neurology India since online archiving commenced in 1993.Methods: All papers published in Neurology India between the years 1993-2014 were listed. The number of times each paper had been cited up till the time of performing this study was determined by performing a Google Scholar search. Published papers were then ranked on the basis of total times cited since publication and the annual citation rate. Statistical Techniques: Simple counts and percentages were used to report most results. The mean citations received by papers in various categories were compared using the Student's t-test or a one-way analysis of variance, as appropriate. All analyses were carried out on SAS University Edition (SAS/STAT®, SAS Institute Inc, NC, USA) and graphs were generated on MS Excel 2016.Results: The top papers on the total citations and annual citation rate rank lists pertained to basic neuroscience research. The highest cited paper overall had received 139 citations. About a quarter of the papers published had never been cited at all. The major themes represented were vascular diseases and infections.Conclusions: The highest cited papers reflect the diseases that are of major concern in India. Certain domains such as trauma, allied neurosciences, and basic neuroscience research were underrepresented. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome (CTS) is a disease caused by compression of the median nerve passing through the wrist. Patients suffer from severe pain and paresthesis in the median nerve. Compression of the median nerve occurs, with prolonged working on keyboards (computer or laptop or music players) being one of the reasons along with others such as diabetes or rheumatoid arthritis. CTS research holds great promise for the patients as well as doctors for better medical treatment. The study has been carried out with an objective to analyze research progress based on the literature published on CTS during the last 35 years. The retrospective study has been carried out from the data indexed in SCOPUS multidisciplinary database from 1983 to 2017 (35 years). The study involves analysis of publication trends in terms of total articles, productive countries, institutions, journals, productive authors, most cited articles along with impact in terms of citation and h-Index. The SCOPUS database yielded 13187 articles during the study period. These articles were analyzed further for interpreting results. In the last 35 years, the number of scientific publications on CTS has been increasing with an annual growth rate of 9.86% per year. USA has been the most productive country. Literature pertaining to females is more than clinical studies involving males. [ABSTRACT FROM AUTHOR]

Objective: This paper highlights the hydrocephalus research efforts undertaken at AIIMS, New Delhi, supporting progress in the field.Material: Over a period of three decades, basic research, clinical investigations, and multicentric studies were undertaken. This report will review the work mainly to emphasize the need for future generations to pursue further research. Studies that impacted hydrocephalus care (mainly in India) are described, and some of these findings may be useful in other resource-challenged situations.Results: Investigative studies on the effect of shunting on brainstem auditory evoked responses (BAER), transcranial Doppler (TCD), and CT-SPECT were published offering management options for patients. Participation in the International Infant Hydrocephalus Study (IIHS) study offered opportunities to compare our approaches and develop modifications in patient care. This effort proved shunting was equal or better for young children with congenital aqueductal stenosis. Shunt infection protocols and changes made in a systematic manner helped develop local protocols to reduce postoperative shunt infections.Conclusions: Hydrocephalus research over three decades at AIIMS, New Delhi was productive and educational, confirming that locally performed investigative work can help in decision making. Further studies and active participation in international efforts are necessary to advance the field. [ABSTRACT FROM AUTHOR]

Background: Low- and middle-income countries (LMICs) bear the majority of the neurosurgical burden of diseases but lack the resources to meet these needs.Objective: As we increase access to neurosurgical care in LMICs, we must understand patient attitudes toward neurosurgery.Methods and Material: PubMed, LILACS, and African Journals Online databases were searched systematically from inception to January 4, 2020, for studies on neurosurgical patient perceptions in LMICs. The articles found were blindly reviewed with Rayyan by two authors. The two authors resolved conflicts between themselves, and when this was not possible, a third reviewer was consulted. All the articles included were then appraised, and the results were summarized.Results: Six of the 1,175 articles met the inclusion criteria. The studies were set in Brazil, Ethiopia, India, Nigeria, South Korea, and Sub-Saharan Africa. Four of the studies (50%) were phenomenological studies, and the other two were grounded theory and narrative. The studies identified patient attitudes toward neurosurgical practitioners, diseases, and interventions. Ethiopian and Nigerian patients believed cranial diseases to be otherworldly and resorted to traditional medicine or spiritual healing first, whereas Brazilian patients were more comfortable with cranial diseases and even more so if they had had a previous craniotomy. The Indian paper was a recount of a neurosurgeon's experience as a spine patient.Conclusions: There are few studies on neurosurgery patient perception in LMICs. LMIC neurosurgeons should be encouraged to study their patient beliefs concerning neurosurgical diseases and interventions, as this can explain health-seeking behaviors. [ABSTRACT FROM AUTHOR]

The article presents the author's views regarding the contribution of neuroscientist Acharya Jagdish Chandra Bose. Topics mention including the study about electromagnetic waves and their effect on the inorganic matter, publication of scientific papers and monographs and measuring the action potentials in 1970.

Introduction: Anterior and anterolaterally situated foramen magnum meningiomas are a technically complex subgroup of meningiomas. The need for an extensive exposure and bone work and their complex anatomy make them a difficult and challenging group of tumors to resect. The bone work has ranged from an extensive condylar resection to condylar preserving exposures. In this paper, we present our experience with condylar preserving or minimal condylar resection based approaches to these tumors.Materials and Methods: All patients who underwent surgical resection of anterior and anterolaterally situated foramen magnum meningiomas were included in the analysis. The study period was more than 10 years from 2005 to 2015 at our institute; a tertiary referral centre in India. The records along with demographic profile, clinico-radiological features, surgical strategies, outcomes as well as mortality and morbidity were analysed.Results: There were a total of 20 patients (9 males and 11 females) who were operated during the study period. The average age was 36.7 years. In 16 patients, gross-total or near-total resection could be achieved, four patients underwent subtotal resection. Eight patients had fresh morbidity in the form of new motor deficits, pseudomeningocele formation, worsening of the lower cranial nerve functions or post-operative adhesions leading to syrinx formation. The follow-up ranged from 6 months to 140 months.Conclusion: Foramen magnum meningiomas are an eminently treatable group of tumors. Condylar preservation provides a good visualization, while helping to preserve joint stability and in avoiding instrumental stabilization. [ABSTRACT FROM AUTHOR]

Background: Almost one-fifth of patients undergoing surgery for sellar/supra-sellar tumors do not gain a significant improvement in their vision. Various methods have been described to predict prospective visual outcomes in them, although they lack uniformity. Objective: The study was conducted to predict visual outcomes following surgery for sellar and supra-sellar tumors compressing the anterior optic pathway based on pre-operative optical coherence tomography (OCT) parameters. Methods and Materials: This was a record-based observational descriptive longitudinal study done in a tertiary care center in India. Thirty-seven patients (74 eyes) diagnosed with sellar supra-sellar lesions were included in the study. Patients' ophthalmic evaluations, done pre-operatively and 3 months post-operatively, were reviewed. Spectral-domain OCT and segmentation were done using the automated segmentation technology of Spectralis software. The thickness of the respective layers was measured. Results and Conclusions: The mean age of the study population was 42.68 years. Eyes with a pre-operative visual acuity component of VIS (visual impairment score) ≤61, pre-operative ganglion cell layer thickness ≥26.31 um, a pre-operative inner plexiform layer thickness of ≥25.69 um, a pre-operative ganglion cell inner plexiform layer thickness of 52.00 um, pre-operative ganglion cell complex thickness ≥84.47 μm, and a pre-operative inner retinal layer thickness of ≥205.25 μm were more likely to have an improved visual outcome. Eyes with a pre-operative duration of visual symptoms of ≥15 months, VIS ≥126.50, a pre-operative decimal visual acuity of <0.035, a pre-operative visual field index of ≤8%, a pre-operative macular thickness of ≤287.06 um, a pre-operative macular RNFL (retinal nerve fiber layer) thickness ≤66.00 μm, and a pre-operative peri-papillary RNFL thickness ≤64.62 μm were unlikely to have visual improvement. [ABSTRACT FROM AUTHOR]

The article offers information on the 27th National Conference of Neurological Society of India (NSI) that was held at the Armed Forces Medical College (AFMC) in Pune, India. It mentions that the conference started with a continuing medical education (CME) program. It mentions that the surroundings were clean and modest, typical of middle class family.

Presents a letter to the editor about Indian references in "Neurology India". Alleged lack of adequate efforts by authors to quote significant Indian publications; Examples of papers without Indian references.

Background and Objective: For 1.3 billion population in India, there are only scarce reports on disability of epilepsy using disability-adjusted life year (DALY) as a measure. Our objective was to estimate DALY using real-life data over a period of time for a cohort of people with epilepsy (PWE) admitted to an Epilepsy Monitoring Unit (EMU) of a tertiary care epilepsy center. Materials and Methods: We ascertained survival status as on December 31, 2016 of all eligible admissions to the EMU between 01/01/2005 and 12/31/2015. We examined the medical records of randomly selected 200 of the 1970 survivors and all the expired PWE (n = 40) for clinical characteristics. The cumulative real-life DALY (cr-DALY) for individual was calculated as the sum of the years lost to disability (YLD) and the years of life lost (YLL). Annual population-based DALY (p-DALY) was estimated from the cr-DALY, total patient-years of follow-up, and regional population prevalence. Results: The cr-DALY per PWE was 17.63 (generalized seizures only). The cr-DALY increased by 23.7% when all seizure types were considered (23.12). PWE with epilepsy onset <10 years of age, focal epilepsy (particularly, extratemporal lobe epilepsy), and premature death had significantly higher cr-DALY. Those who underwent surgery for epilepsy or achieved remission had significantly lower cr-DALY. The computed p-DALY was 583/1,00,000 population (generalized epilepsy contributed 165/1,00,000 population; focal epilepsy contributed 418/1,00,000 population). Conclusion: Our study had identified, for the first time, several determinants that reduced DALY significantly. Real-life DALY, rather than prevalence-based DALY, captures the cumulative disability of affected individuals. Epilepsy leads to loss of 23 years of disability-adjusted life span for the affected person. This can be extrapolated to substantial economic benefits. [ABSTRACT FROM AUTHOR]

Background: Optic chiasmatic-hypothalamic gliomas are sellar-suprasellar lesions with variable radiological features. The advocated treatment is mainly primary radiotherapy without a histological diagnosis. However, in developing countries, like India infective granulomas (tuberculomas) in the suprasellar region radiologically can mimic optic chiasmatic-hypothalamic gliomas. Hence primary radiotherapy without histological confirmation may have deleterious consequences. Aim: The aim of the paper was to analyze the sensitivity and specificity of magnetic resonance imaging (MRI) in these lesions and to analyze the feasibility of primary radiotherapy. Patients and Methods: The magnetic resonance imaging (MRI) characteristics of 24 patients with either histologically proven optic chiasmatic "pilocytic astrocytoma" or radiologically suspected optic chiasmatichypothalamic gliomas were analyzed. They were grouped into three groups on the basis of radiological features and treated with a suspected diagnosis. The final diagnosis was correlated with preoperative diagnosis, and the feasibility of managing these lesions without a histopathological confirmation is discussed. Results: The three radiological groups were: Group-1 solid tumors with or without microcysts in 9 patients (histology: 8 pilocystic astrocytomas and 1 tuberculoma); Group-2 mixed tumors with solid and cystic components in 9 patients (histology: 7 pilocytic astrocytomas and 2 craniopharyngiomas); Group-3 ring enhancing lesions in 6 patients (all the 6 patients initially received antituberculous treatment, in 3 patients the lesion resolved and in the remaining 3 patients the lesion was subjected to biopsy as it did not resolve, the biopsy was suggestive of pilocytic astrocytoma). Thus, MRI was shown to have a sensitivity of 83.33% and a specificity of 50% for diagnosing optic chiasmatic-hypothalamic gliomas. Conclusions: Various lesions like craniopharyngiomas, tuberculomas can mimic optic chiasmatic-hypothalamic gliomas radiologically, and it is not possible to diagnose them with certainty on the basis of radiological findings alone. Biopsy and tissue diagnosis should always be sought before instituting radiotherapy or chemotherapy for optic chiasmatic-hypothalamic gliomas. [ABSTRACT FROM AUTHOR]

The article offers information on history of neurosurgery in the Armed Forces. It mentions information on AC Ray, who is the first neurosurgeon of the Armed Forces Medical Services received his neurosurgical training in the Great Britain, and returned to start the neurosurgery department at Military Hospital (MH), Lucknow, India in 1957. It states that 18th century and 19th century were a period of self‑actualization, and neuroscientists began to make their presence felt in fora and meetings.

Stereotactic radiosurgery (SRS) has been well received by the neurosurgical community since its introduction in India. Knowledgeable radiosurgeons and visionary neurosurgeons have contributed to its success. At present, we have five functional and busy gamma knife centers, one proton radiosurgery center, and seven CyberKnife centers in India. However, there is a need for more such centers and formal training facilities, especially in the unorganized private sector. Radiosurgery has expanded its horizon from its initial indications of vascular and benign disorders to functional ailments and metastasis. Here, we take a look at the seminal points in its development in India along with the centers of excellence that contributed to the same. While we have tried to cover all the facets of its development, it is natural to miss some undocumented events not available in public domain. Nonetheless, the future of radiosurgery seems promising in India with the assurance of minimally invasive, safe, and effective treatment delivery. [ABSTRACT FROM AUTHOR]

Objective: The legal definitions of brain death are tantamount for legal dogmas and sometimes criminal intimidation of the treating doctors. The tests for brain death are only applicable to patients planned for organ transplantation. We intend to discuss the necessity of the "Do Not Resuscitate (DNR)" legislature in cases of brain death patients and applicability of tests for brain death irrespective of the intention for organ donation. Methods: A comprehensive review of the literature was performed till May 31, 2020 from the MEDLINE (1966 to July 2019) and Web of Science (1900 to July 2019). Search criteria included all publications with the MESH terms: "Brain Death/legislation and jurisprudence"[Mesh] OR "Brain Death/organization and administration"[Mesh] AND "India" [Mesh]. We also discuss the different opinions and implications of brain death versus brain stem death in India with the senior author (KG) who was responsible for South Asia's first multi-organ transplant after certifying brain death. Additionally, a hypothetical scenario of a DNR case is discussed in the current legal paradigm of India. Results: The systematic search yielded only five articles reporting a series of brain stem death cases with an acceptance rate of organ transplant among brain stem deaths being 34.8%. The most common solid organs transplanted were the kidney (73%) and liver (21%). A hypothetical scenario of a DNR and possible legal implications of the same under the current 'Transplantation of Human Organs Act (THOA)' of India remains unclear. A comparison of brain death laws in most Asian countries shows a similar pattern regarding the declaration of brain death and the lack of knowledge or legislature regarding DNR cases. Conclusion: After the determination of brain death, discontinuation of organ support requires the consent of the family. The lack of education and the lack of awareness have been major impediments in this medico-legal battle. There is also an urgent need to make laws for cases that do not qualify for brain death. This would help in not only realistic realization but also better triage of the health care resources while legally safeguarding the medical fraternity. [ABSTRACT FROM AUTHOR]

The author presents several facts that will explain why their is a pressing need for a reassessment of the neurosurgical training program in India, including his views on is it necessary to require the continuation of the three years post MS (Surgery) program. These include the lack of appreciation at the political level which requires neurosurgical intervention, the pressure of the long hours of duty for trainees which affects training and the unbalance number of neurosurgeons in the country.

The article offers information on the brachial plexus surgery. It mentions Traumatic brachial plexus injuries are devastating injuries and result in socio‑economic; and also mentions that traumatic brachial plexus injuries are very common injuries and mainly affect the young population in the productive periods of their lives.

A response from the authors of the article regarding the programs and telemedicine services by the government of India for stroke patients, is presented.

The article presents a calendar of various conferences to be held in India including the 10th Annual Conference of the Indian Society for Stereotactic and Functional Neurosurgery which will be held in Kolkata, India during October 26-28, 2007 and the 3rd National Conference of the Telemedicine Society of India which will be held along with the 12th International Conference for Telemedicine and eHealth in Chennai, India during November 2-4, 2007.

Doctors in India are heirs to a ling tradition of ethics from thier pwn forebears and those from the West.This paper discusses ethical aspects of topics of relevance to neurological scientistc such as brain death, neural transplant and whole brain transplant. Many other topics such as ethics in reseach, patients with AIDS,patients in a persistent vegetative state and euthanasia deserve similar considetion and debate. [ABSTRACT FROM AUTHOR]

The authors offer their views about head injuries caused by vehicle accidents in India. Topics discussed include a study by Tripath and colleagues which assessed the profile of head injured patients vis a vis safety measures undertaken by road users, the importance of a multi-pronged national road safety plan, and the programs initiated by India's government to promote road safety practices.

Background: Disability evaluation as per World Health Organization includes assessment of impairments, activity limitations, and participation restriction, which unfortunately is not assessed by the existing guidelines of disability in India.Aim: The aim of this study wasto comparea new study criterion with the existing guidelines for assessing cognitive disability for chronic neurological conditions.Methodology: A cross-sectional pilot study was conducted on 41 participants. They were assessed on an existing guideline (Gazette India 200,1 assessing physical domain and Intelligence Quotient[IQ]) and study criterion assessing three aspects of cognitive capacity: IQ, neurocognitive functioning, and QOL.Results: The existing guideline underestimated 84% of cases for disability. The average percentage of disability measured by the study criterion was 33.2% more as compared to existing guidelines with S.D of 26.6.Conclusion: Cognitive capacity assessment is an important element to be measured in chronic neurological disability certification. However, a large sample is required to make an affirmative claim for the same. [ABSTRACT FROM AUTHOR]

Context: Autologous bone is the most commonly used flap in cranioplasty to repair the defect; however, synthetic materials are available. Poly methyl methacrylate (PMMA) is an effective polymer owing to its thermoplastic and radiolucent properties comparable to bone strength. Three-dimensional (3D) printing combined with computer-assisted design (CAD) is a simple, low-cost method to print molds that ensure surgical success.Materials and Methods: A total of 114 patients underwent cranioplasty (July 2015-April 2018), and 25 of them using 3D printed template molds due to unavailability of autologous bone. The clinical features, patient demographics, and surgical parameters were analyzed. The visual analog score for cosmesis (VASC) and Odom's score was obtained pre and post-op.Results: The mean age of the patients is 38.4 ± 14.6 years (Range, 9-66). The primary pathology for undergoing craniectomy is stroke (n = 13; 52%), traumatic brain injury (10; 40%) and tumor (2; 8%). The reason for nonavailability of flap was infection (n = 14;56%), flap resorption (4;16%), and trauma or tumor (7;28%). The mean time for manufacturing the 3D printed template is 13.2 ± 2.1 h. On follow-up, median Odom's score is excellent in 52% of cases, good in 40%, and fair in 8%. The mean VASC score on follow up is 8.2 ± 1.3. Three patients developed minor postoperative complications.Conclusion: This is the first study from a single tertiary care center in India to systematically evaluate the outcomes in 3D cranioplasty using CAD and 3D printing technology. This method would be optimal especially in developing countries since PMMA is cost effective and also gives an ideal cosmetic effect. [ABSTRACT FROM AUTHOR]

Background: Stroke is a heterogeneous disorder comprising of clinical subtypes and many risk factors, also alluded to as cerebrovascular disorders (CVDs). Increase in the global burden of stroke in developed and developing countries has been alarming. To galvanize the efforts towards the prevention and treatment, there is a need for robust data on the burden of stroke.Objective: The aim of this study was to estimate the burden of stroke, a systematic review of community-based studies was conducted.Material and Methods: Systematic search of PubMed and Google Scholar for studies from January 1960 to December 2018 was done. The articles were screened and the data was retrieved and sorted into incidence, prevalence and mortality rates. Meta-analysis was done on Medcalc statistical software version 19.2.6.Results: Prevalence rate of stroke for total population inclusive of urban and rural population, varied from 44.54 to 150/100000.For the urban population prevalence rate was 45 to 487/100000 and 55 to 388.4/100000 for rural population. The incidence rate varied from 33 to 123/100000 in the urban population and in the rural population it was estimated to be 123.57/100000. The 30 days case fatality rate of stroke varied from 41.08% to 42.06% in urban population and 18% to 46.3%.in the rural population.Conclusions: Systematic review and meta-analysis reveal that the stroke burden in India is quite high. [ABSTRACT FROM AUTHOR]

Background: Recently, the International League Against Epilepsy (ILAE) has proposed new classification schemes for seizures and epilepsy. The applicability of these classification schemes has not been studied in resource-poor countries.Aim: To determine the incidences of epilepsies in a cohort of school children using the ILAE 2017 classification of epilepsies.Materials and Methods: The study cohort included 7,408 school going children [age range 5-15 years]. They were followed for new-onset unprovoked seizure and seizure recurrence through first grade to fifth grade. The data collected during the first visit included clinical details including details of seizure semiology. All children had EEG and contrast CT scan. All these data were used to classify seizure type and epilepsy using ILAE classification schemes. The ILAE 2014 epilepsy definition was used to diagnose epilepsy. The average annual incidence rates (AAIR) and 95% confidence intervals (CI) were calculated for epilepsies by onset and by etiology.Results: The AAIR of epilepsy was 57.85 (95% CI 39.0-82.6) per 100,000 population. The AAIRs per 100,000 for different epilepsies by mode of onset were focal epilepsies 25.07 (95% CI 13.35-42.87); generalized epilepsies 13.5 (95% CI 5.43-27.8); and unknown onset epilepsies 19.28 (95% CI 9.25-35.46). The AAIRs per 100,000 of epilepsies by etiology were focal genetic epilepsies 7.71 (95% CI 2.1-19.75); genetic generalized epilepsies 13.5 (95% CI 5.43-27.8); and epilepsies due to structural cause 17.36 (95% CI 9.25-35.46). The lesional epilepsies seen in this cohort were geographically specific to resource-poor countries. The AAIR of epilepsy due to calcific neurocysticercosis (cNCC) was 9.64 (95% CI 3.1-22.5) per 100,000.Conclusions: This study demonstrates that the ILAE 2017 classification of epilepsies can be applied in resource-poor countries with limited workup. Lesional epilepsies seen in this study is geographically specific to resource-poor countries. [ABSTRACT FROM AUTHOR]

Background: Although low-and middle-income countries (LMIC) bear the burden of the pituitary adenomas, most research is conducted in developed countries. However, there has been significant growth in research on pituitary adenomas in India from 1995 to 2020. The cost of patient treatment, management, and surgery of pituitary lesions are comparatively lower in India in comparison to high income countries.Objective: The intended goal is to highlight the current scenario of pituitary research in India with regards to prevalence/incidence, tumor size, treatment modalities, cost of pituitary surgery, and potential strategies for tackling pituitary adenoma disease burden in the country.Methodology: In addition to the literature review, recommendations were included from neurosurgeons, endocrinologists, and radiologists from various centers in India.Results: There is an increasing evidence of pituitary adenoma heterogeneity compared to western populations. Although there has been significant increase in research on pituitary tumors from India, it is considerably less as compared to the data from the rest of the world. The major challenges for the treatment of this benign disease in India are lack of imaging facility in rural areas, poor patient follow up, and financial constraints for periodic imaging and biochemical assessment.Conclusion: A computerized pituitary registry and genetic screening and testing will significantly boost research and lead to better patient outcome in the country. Special emphasis should be laid on multimodal management to ascertain optimal long-term tumor control with best hormonal outcome. [ABSTRACT FROM AUTHOR]

Introduction: There is a great deal of heterogeneity, both phenotypically and genotypically among the autosomal dominant cerebellar ataxias (ADCA). Their prevalence also varies in different populations. Trinucleotide repeat expansions (CTG/CAG) have been shown predominantly to cause a number of ADCAs.Aim: The present study describes the frequency of spinocerebellar ataxias (SCA) and the CAG repeat sizes among the different regions of India.Settings and Design: Molecular data from our central reference laboratory were retrospectively analyzed for SCAs 1, 2, 3, 6, 7, 10, 12, 17 and DRPLA. Correlation between age at diagnosis and the CAG repeats of the expanded and the normal alleles were tested with the Spearman correlation test.Results: The presence of SCAs vary according to geographical regions and ethnicities; SCA 12 was detected with the highest frequency (229/901), but was restricted to a specific ethnic population, followed by SCA 2 with a positivity of 12% (101/845). SCA 3 previously known as Machado-Joseph Disease had a prevalence of 4.05% (32/789), whereas SCA 1 was diagnosed in 30/773 (3.88%). No positivity was seen for SCA 10 from the 103 samples tested and for SCA 17 from the 131 samples tested either as a part of an extended panel or stand-alone.Conclusion: In this report, we are able to expand the portrait of SCAs in India by presenting the largest ever molecular data from a central reference laboratory. [ABSTRACT FROM AUTHOR]

Many neurological conditions may result in long-term disability. The measures of prevalence and mortality vastly understate the disability they cause. In the Persons with Disabilities Act 1995 (equal opportunities, protection of rights, and full participation), neurological conditions are ignored. Although Indian Disability Evaluation and Asessment Scale (IDEAS), which assesses psychiatric conditions, does include dementia as one of the neurodegenerative conditions. Additionally, according to the global burden of disease report, 33% of years lived with neurological disability and 13% of disability-adjusted life years (DALYs) are due to neurological and psychiatric disorders. In 2001, the World Health Organization (WHO) established a new definition of disability, declaring it an umbrella term with the following three major components; 1) impairments: problems in body function or structure, 2) activity limitations: difficulties encountered by a person in executing a task or action, and 3) participation restrictions: problems of involvement in life situations experienced by a person. Hence, an attempt was made to rectify the above concerns. To address the above mentioned concerns, we think that there is a need of a comprehensive format for neurological disabilities assessment which would also include objective neuropsychological assessments. As future directions, national level meetings are required to formulate 'Indian Standard Track for Assessing Neurological Disability' (I-STAND) and uniform guidelines for disability assessment in 'chronic neurological conditions' with a special focus on "neuropsychological disability". [ABSTRACT FROM AUTHOR]

The article reports the historical perspective on the Department of Neurosurgery at the Nizam's Institute of Medical Sciences (NIMS) in Hyderabad, Telangana. Topics discussed include information on Department of Neurosurgery at NIMS which was established on 1976 by S Balaparameswara Rao, Professor of Neurosurgery; information on NIMS that became the first government institute to perform stereoelectroencephalography; and performing of microsurgical procedures with effective results at NIMS.

Aim: To evaluate whether the residency training programs in India are meeting the expectations and aspirations of the present-day trainees.Introduction: Residents in training today are the neurosurgeons of tomorrow. Significant resources are dedicated to their training and education. Neurosurgical residency in India-when compared to the rest of the world-is relatively new. However, the structure of the Indian neurosurgical training programs has remained relatively unchanged since they were first introduced. In contrast, the treatment paradigms for neurosurgical conditions have changed rapidly in recent years, as new subspecialties have gained prominence.Methods: An online questionnaire based survey was prepared considering the common themes of neurosurgery residency. The links to the survey were mailed to residents in training all over the country. Results were evaluated after a minimum of 100 responses was collected. The responses were anonymized to ensure free and frank answers to the survey questions.Results: A total of 104 responses were received from all the major post-graduate training institutes of the country. The period of joining residency ranged from July 2010 to August 2018. Respondents generally agreed on the need for work hour regulations, the importance of history taking and clinical examination and the significance of imaging interpretation as major training goals. The residents were desirous of more hands-on opportunities during operative teaching. Deficiencies were recognized in the exposure to various upcoming subspecialties such as endovascular therapy, radiosurgery, epilepsy surgery, etc. The residents were generally satisfied with the pattern of examination system and showed a clear preference for electronic resources for reading and knowledge acquisition.Conclusion: The survey highlights the perception of the residents towards the training programs that they are enrolled into. Several lacunae and potential areas of improvement are brought to our attention, which have been necessitated by the recent advancements in technology affecting the neurosurgical treatment paradigms. The training programs need to keep pace with the aspirations and hopes of the residents so that the training experience is mutually fruitful for the trainees and educators. This is important to ensure that the present-day residents can step into their future roles with confidence and preparedness. [ABSTRACT FROM AUTHOR]

The Achanta Lakshmipathi Neurosurgical Center (ALNC) and Post Graduate Institute of Neurological Surgery is a private teaching neurosurgical institution located in the VHS (Voluntary Health Services) Hospital Chennai. It has been a leader and trendsetter among the private academic neurosurgical training institutions, and because of its unique legacy, has influenced the progress of Neurosurgery in India. The center was the second neurosurgical Institute to be created by Prof. B Ramamurthi and has trained neurosurgeons in the unique ALNC school of Neurosurgery. The Institute has grown to become a centre of excellence in microsurgery, and spinal surgery and has become a training centre for neurosurgery since 1985. The unique humanitarian aspects of the Voluntary Health Services Hospital helped in bringing the best of Neurosurgery to all strata of society. Forty years after its inception, the ALNC continues its delivery of excellence in clinical neurosurgery and academics. [ABSTRACT FROM AUTHOR]

Background: E-learning platforms, especially the online neurosurgical video sharing sites, are playing a key role in the dissemination of knowledge related to the essential steps of operative neurosurgery.Aim: A national survey was undertaken to assess the utility of neurosurgical operative videos exhibited on the online video-sharing sites.Materials and Methods: Resident trainees in neurosurgery, as well as junior and senior consultant neurosurgeons practicing in India were provided, on the Google platform, a questionnaire consisting of nine multiple-choice questions and a space for remarks. 520 people were contacted using e mail and/or whattsapp modalities, out which 98 responses were considered valid.Results: Majority (n = 87, 88.8%) of the responders voted that internet videos have helped them in improving their surgical skills. There was no statistically significant difference between people working in rural and urban areas in this regard (P = 0.517). Both senior and junior neurosurgeons were utilizing these online videos for enhancing their surgical skills, and there was no statistically significant difference regarding the perception of the usefulness of these online video channels between the two groups (P = 0.660). However, the response rate to the questionnaires sent was only 18.84%.Conclusions: Online video-sharing platforms are useful, especially in a country like India with diverse neurosurgical infrastructure. The need for the development and maintenance of a dedicated, high-quality, structured video bank through collaboration and cooperation of high volume centers and institutes of repute in India is strongly advocated. [ABSTRACT FROM AUTHOR]

The article presents the biography of S. Sriramachari, founder neuropathologist. It mentions that he obtained his degrees from Andhra University. In 1954, he was deputed for training in neuropathology at the Armed Forces Institute of Pathology (AFIP) at Washington, DC. It mentions that he did under-graduation at Andhra Medical College.

Introduction: Sjogren's syndrome (SS) is a systemic autoimmune disease that apart from involving the exocrine glands can affect any organ. Involvement of the peripheral nervous system results in a wide spectrum of neuropathic manifestations.Objective: To evaluate the clinico-electrophysiological patterns as well as pathological characteristics of neuropathy in SS patients presenting to a neuromuscular clinic in a tertiary hospital from South India.Materials and Methods: This is a retrospective study from the Departments of Neurology, Rheumatology, and Pathology from Nizam's Institute of Medical Sciences. Twenty-one patients with the diagnosis of SS and peripheral neuropathy, seen between 2010 and 2016 were analyzed. Clinical records, conventional nerve conduction studies, and lip and nerve biopsy reports were collected.Results: Twenty one patients with SS had associated neuropathy. Female-to-male ratio was 2:1. In 14 (66.7%) patients, neuropathy was the initial manifestation, while in 4 (20%), exocrinopathy preceded neuropathy. The patterns of neuropathy included mononeuropathy multiplex (MNM) in 7 patients (30%), ganglionopathy in 4 (20%), length-dependant trigeminal autonomic neuropathy, and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) in 2 (10%), and cranial neuropathy in 1 (10%). Eighteen (86%) were seropositive with either anti Ro/SS-A or anti La/SS-B antibodies. Schirmer's test was positive in 13 (61.9%) patients. Nerve biopsy showed vasculitis in 5 patients and demyelinating and axonopathy in 2 patients each.Conclusions: We conclude that neuropathy is frequently the initial presentation of SS. MNM is the most common pattern followed by ganglionopathy. The pattern of neuropathy helps in arriving at the diagnosis of SS. Serology is a useful initial laboratory test. However,confirmation of SS is not by mere serology. Schirmer's test and lip biopsy are equally essential for the diagnosis, especially in seronegative patients when the clinical index of suspicion is high. [ABSTRACT FROM AUTHOR]

The term 'scientist' was coined to describe Mary Somerville (1780-1872) as her contributions to astronomy commanded recognition of her excellence in science. Up to then, the term 'man of science' had been in use. In fields traditionally considered the province of males, the entry of women was viewed with consternation, apprehension and alarm. Resistance was instinctive in most leading scientists. This attitude was strengthened by illogical and pseudoscientific statements on the frailty of women. The pioneers blazing trails in medicine for their sisters to follow braved ridicule, hostility, and discrimination. At times they used subterfuge. The example of Dr. James Barry (Margaret Ann Bulkley) is well-known. Thanks to them, we now have nationally and internationally eminent scientists from the gentler sex, and some of them in commanding positions. The neurosciences developed in India as a result of the efforts made by pioneer neurosurgeons such as Drs. Jacob Chandy (Vellore), B. Ramamurthi (Madras), R.G. Ginde (Bombay), Dr. Prakash N. Tandon (New Delhi) and neurophysicians such as Drs. Baldev Singh (New Delhi), T.K. Ghosh (Calcutta) and Noshir H. Wadia (Mumbai). They and others such as Drs. V.R. Khanolkar, Darab K. Dastur, B.K. Bachhawat and Obaid Siddiqui encouraged individuals like Dr. Vimla Virmani, Dr. Devika Nag, Dr. T.S. Kanaka and Dr. Gourie Devi in the clinical neurosciences and Drs. Kamal Ranadive, V.S. Lalitha, Veronica Rodrigues and Gomathy Gopinath in the basic neurosciences. Two eminent neuroscientists from abroad (Drs. Nancy Kopell and Indira Raman), and three from India (Drs. Vijaylakshmi Ravindranath, Chitra Sarkar and Vidita Vaidya) have been chosen by me as representatives and their careers, contributions and views on discrimination against women in science discussed in brief. (This is not to deny outstanding work by others but limitations of space have made this choice necessary.) The factors favouring the blossoming of women in science include encouraging and stimulating parents, a conducive environment at home and mentors. A compelling drive to excel, hard work and sincerity are crucial to success. Nasty forms of experiences demoralise women. Sexual harassment by seniors and colleagues in the laboratory and elsewhere can lead to the victim leaving the field altogether. Discrimination in selection, promotion and publication lower morale and impact output in terms of research and contributions to journals and books. Suggestions made by the five eminent neuroscientists named above to liberate women from such negative behaviour by males are presented. The Indian Women Scientists' Association is playing an important role in helping their members, making their work known to society and generally empowering them. Since unity strengthens, collaborative activities with other similar organisations will augment efficacy. One such organisation is the much older Association of Medical Women of India. [ABSTRACT FROM AUTHOR]

Background: Electromagnetic fields (EMFs) emitted by cellular telephones may cause neurological ill effects like cognitive dysfunction, emotional instability, and even brain tumors. Slowing of brain activity on electroencephalography (EEG) has been shown. However, these findings need further validation.Aims: EEG changes and adverse effects experienced following cell-phone use were studied.Settings and Design: The study was conducted in the Department of Neurology of a tertiary care university hospital in India on North Indian students of the University, from August 2017 to October 2017.Materials and Methods: Twenty-one students underwent video-EEG recording before and after application of Samsung GT-56312 dual SIM smart phone in switched off, switched on, and switched on mode with conversation.Statistical Analysis Used: Average EEG frequencies and amplitudes were calculated for different brain regions. Chi-square tests and t-tests were used for comparison between variables.Results: The mean age of 7 (33.3%) male and 14 (66.7%) female subjects was 20.76 ± 1.48 years. The average EEG frequencies following mobile phone application with conversation were higher and the amplitudes lower than the baseline values. Frequencies were greater on the right side. Slow waves were detected in the frontal region in 38.1%, in the parietal region in 33.3%, in the occipital and temporal region in 19.1%; and, generalized slow waves were seen in 9.5% students. During the experiment, 23.8% experienced headache, 19% experienced irritation, and 9.5% felt drowsy. Headache and loss of concentration (33.3%), sleep disturbances (28.6%), and fatigue (19%) were frequent in daily life.Conclusions: Experimental application of mobile phones may lead to some EEG changes and certain ill effects on the well-being. Hence, prolonged use of these gadgets warrants caution. [ABSTRACT FROM AUTHOR]

The Department of Neurosurgery was founded in the Grant Medical College, Mumbai, in the year 1958, and is celebrating its 60th anniversary. The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was one of the first government medical colleges to start a Neurosurgery Department within the state. The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centers throughout Maharasthra and in several other parts of the country. The patients opt for this institution to get a standard of care that may be comparable with the highest standards prevalent, and the students achieve their goal of getting excellent education in Neurosurgery at par with the best institutes of the world. The department has, therefore, over the years, established its place in the country as a premier training facility and an epitome of medical excellence. This article traces the illustrious history of the Department of Neurosurgery, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, and also of the eminent faculty members and residents, who helped in advancing the standards of Neurosurgery in the region as well as the rest of India. [ABSTRACT FROM AUTHOR]

Introduction: Recent advances in the molecular biology of adult diffuse gliomas have brought about a paradigm shift in their diagnostic criteria, as witnessed in the World Health Organization (WHO) 2016 guidelines for central nervous system tumors. It is now mandatory to perform several molecular tests to reach a definitive integrated diagnosis in most of the cases. This comes with additional cost and higher turnaround time, which is not always affordable in developing countries like India. In addition, the non-uniform distribution of advanced research and diagnostic testing centers adds to the difficulty.Methods: The Indian Society of Neuro-oncology (ISNO) multidisciplinary expert panel consisting of neuropathologists, neurosurgeons, and radiation/medical oncologists convened to prepare the national consensus guidelines for approach to diagnosis of adult diffuse gliomas.Results: Algorithms for arriving at an integrated diagnosis of adult diffuse gliomas predominantly using immunohistochemistry and with minimum possible additional molecular testing were agreed upon, thus addressing the problems of cost, accessibility, and turnaround time. Mandatory and optional tests were proposed for each case scenario.Conclusion: This document represents the consensus of the various neuro-oncology disciplines involved in diagnosis and management of patients with adult diffuse gliomas. The article reflects a practical adaptation of the WHO recommendations to suit a resource constrained setup. [ABSTRACT FROM AUTHOR]

The article offers information on neurosurgery in Sawai Man Singh (SMS) Medical College which was founded by Sawai Man Singh II, the erstwhile king of India. It mentions information on Dr. MG Sarin who had undergone training in Neurosurgery from Christian Medical College (CMC). It states that Neurological Society of India annual conference 2018 will be hosted in Jaipur in a collaborative effort between the Department of Neurosurgery, Fortis Hospital and the Department of Neurosurgery.

The article offers information on Dr. Vijay Shankar Dave who introduced neurosurgery in Uttar Pradesh, India. Topics discussed include information on his works as civil assistant surgeon in the Mahatma Gandhi Hospital in Jodhpur, India; information on the Montreal Neurological Institute (MNI), founded by Dr. Wilder Penfield and Dr. William Cone, after receiving funding from the Rockefeller foundation; and determination of importance of coagulation factor by Vijay Shankar Dave.

The trials and trepidations of an emerging department, uncertainties of its survival midway through its course, the innovative ideas that initiated its development, a regimental discipline, addition of newer technological advances with changing times, and its blossoming as the one of the best departments in the region, mark the origin and development of the Department of Neurosurgery at Andhra Medical College (AMC) and King George Hospital (KGH) Visakhapatnam. AMC and KGH are getting ready to celebrate their centenary in 2023. This history of the department is derived from the knowledge of the immense effort and academic discipline that was required to bring it to its current stature. Dr. Sunkara Balaparameswara Rao (SBP Rao) established the Neurosurgical Unit at the AMC and the KGH, Visakhapatnam on 2nd April 1956. He has had the unique privilege of witnessing the entire history of the department, from the inception till today, which represents 60 years of continuous progress of the department after its establishment. He also took a very active role in organizing its Diamond Jubilee function held on 23rd September 2016. The first author of this article has also had the privilege of witnessing and being a part of the history of the department during the past half a century. This is a narration of what may be better termed 'the (hi) story of 60 years of Neurosurgery at AMC and KGH', Visakhapatnam, India. [ABSTRACT FROM AUTHOR]

Chordoma and chondrosarcoma are locally aggressive tumors occurring in one-third cases at the base of the skull. These tumors often recur locally with significant morbidity and mortality. The mainstay of treatment is maximal safe tumor debulking. However, in spite of gross total resection, these tumors are likely to recur. Hence, adjuvant radiation is provided to reduce the risk of local recurrence and to improve outcomes. These tumors are considered relatively radioresistant; hence, high doses of radiation are generally required during treatment. However, the presence of several important structures around the lesion poses a major challenge with respect to covering the target with the prescribed high dose. In this regard, protons, for their physical and dosimetric advantages, have become the accepted modality of treatment in these tumors. With the evolution of proton beam therapy (PBT) over the years, especially pencil beam scanning techniques; which result in an extremely high conformal intensity-modulated proton beam therapy (IMPT), robust and Monte Carlo optimization, computational algorithms, and biological modelling are the significant advances which have further enhanced the value of this technology and have improved outcomes. Herein, we would like to report our experience of two cases of skull base tumors treated with intensity-modulated proton therapy at our center along with a review of the literature. [ABSTRACT FROM AUTHOR]

The Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka has a long tradition of excellence in education, teaching, research, and patient care. Its exceptional alumni, as well as current and past faculty members, have made considerable contributions to the development of neurological services throughout the world. The six decades of its existence have seen a momentous growth in clinical, investigative, and community Neurology. As a result of the immense scientific individual as well as collaborative contributions of the faculty members in various departments, the Institute has had the honour of attaining the status of an autonomous 'Institute of National Importance' under the Ministry of Health, Government of India, through a novel concept of collaboration and partnership of central and state governments. This article traces the dedicated pursuit of members of the Department of Neurology, NIMHANS, in managing neurologic diseases through compassionate patient-centred care, transformative research and education. [ABSTRACT FROM AUTHOR]

History helps us to become better students, judge wisely, understand change, and most importantly, it tells us who we are. It helps us to understand what happened, why it happened and what its ramifications are. Winston Churchill once said: "Study history, study history. In history lie all the secrets of statecraft." Here, we take this opportunity to pay our gratitude to our esteemed teachers who worked relentlessly for uplifting of the department of Neurology, PGIMER, Chandigarh; and, narrate chronicles of all those people who made this department reach the heights where it stands today. [ABSTRACT FROM AUTHOR]

Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial (K.E.M.) Hospital, Mumbai were inaugurated in 1925. This article traces its illustrious history and of the eminent neurosurgeons who shaped its destiny. [ABSTRACT FROM AUTHOR]

The Department of Neurosurgery founded in the Trivandrum Medical College, Kerala, the first teaching hospital in Kerala state, is celebrating its 50th anniversary. The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was the first medical college to start a Neurosurgery department within the state.The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centres throughout Kerala and in several other parts of the country. This article traces the illustrious history of the Department of Neurosurgery, Trivandrum Medical College and also of the eminent faculty members and residents, who helped in advancing the standards of Neurosurgery in the region as well as the rest of India. The Department of Neurosurgery was founded in the Trivandrum Medical College, Kerala, the first teaching hospital in Kerala state, in the year 1951, and is celebrating its 50th anniversary. The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was the first medical college to start a Neurosurgery department within the state.The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centres throughout Kerala and in several other parts of the country. This article traces the illustrious history of the Department of Neurosurgery, Trivandrum Medical College and also of the eminent faculty members and residents, who helped in advancing the standards of Neurosurgery in the region as well as the rest of India. [ABSTRACT FROM AUTHOR]

Introduction: Over a quarter of the world's trauma deaths occur in India, with traumatic brain injury (TBI) as the leading cause of death and disability within trauma. With little known about TBI in India, we set out to do a systematic review to characterize the quantitative literature on TBI in India.Materials and Methods: The following databases were searched from their inception to December 31, 2015: PubMed, Cochrane, Web of Science, and the World Health Organization's Global Health Library, using the keywords: neurotrauma, brain injury, traumatic brain injury, TBI, head injury, and India. Articles were screened by two independent reviewers, with disagreements arbitrated by discussion or a third reviewer.Results: A total of 72 manuscripts were included, encapsulating 19962 patients over 27 years in 14 states of India. The sample-size-weighted mean age was 31.3 years, male-to-female ratio was 3.8:1, and sample-size-weighted mean in-hospital mortality was 24.6%. Age and mortality did not change significantly over time. Road traffic accidents (55.5%) and falls (29.2%) were the most commonly reported mechanisms of injury for TBI in India. The mean quality of reporting on TBI in India was 65.7%, according to the appropriate EQUATOR guideline score.Conclusion: The quality of reporting of quantitative studies published on TBI in India is low, and future methodological excellence should be ensured. The demographics and outcomes identified can be used as an epidemiological baseline for future research on TBI in India. Future research can build upon this platform to develop and refine context-appropriate policy recommendations and treatment protocols. [ABSTRACT FROM AUTHOR]