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Background: Subtotal petrosectomy (STP) has attracted massive interest over last two decades. The aim is to present our experience of this uncommon surgery. The indications, outcomes, and our variation in surgical technique would be presented and literature reviewed. Methods: A retrospective observational study of all patients who underwent STP at a tertiary care center in India was analyzed. Results: A total of 9 ears (in 8 patients) underwent STP over last 5 years at our center. The pathological conditions for which STP was done included chronic otitis media squamous (four ears), middle ear tumors (three ears), petrous apicitis (one ear), and traumatic cerebrospinal fluid (CSF) otorhinorrhea (one ear). The indication of STP included disease clearance (eight ears), unserviceable hearing (seven ears), hearing rehabilitation with otological implants (six ears), and intraoperative CSF gusher (one ear). Intraoperative indications included CSF gusher, large tegmen defect with erosion of apical turn of cochlea, and erosion of anterior bony wall of external auditory canal. The mean follow-up period was 36 months (range of 6 months to 60 months). None of the patients had any dehiscence of blind sac closure or secondary acquired cholesteatoma on imaging. Conclusions: STP facilitates disease clearance by providing unmatchable exposure in difficult otological scenarios and additionally isolates middle ear cleft from external environment, thereby eliminating problems of mastoid cavity. Furthermore, it also prepares ear for second stage otological implants. It is a safe surgery with minimal complications. [ABSTRACT FROM AUTHOR]

Study design: We conducted a mixed-methods sequential explanatory study. In India, most spinal cord injuries (SCI) occur within low socioeconomic status populations, typically resulting in poor vocational outcomes post-injury and difficulty reintegrating into the community. This study will increase our understanding of how vocational rehabilitation affects patients with SCI. Objectives: This study aims to understand the factors affecting vocational outcomes, quality of life and social inclusion for patients who have completed the Amar Seva Sangam (ASSA's) rehabilitation program, by examining both quantitative and qualitative measures. Methods: Conducted at the University of Toronto, we used self-administered questionnaires via REDCap for quantitative data collection and semi-structured interviews for qualitative data collection to capture aspects of lived SCI experience for five participants. Results: Thirty-two participants completed the quantitative phone questionnaire of which 17 were paraplegic and 15 were quadriplegic. Four themes emerged including physical barriers to employment, social inclusion of SCI patients, low income, and state of mental health. Conclusion: This study provided a detailed examination of demographic information and lived experiences of ASSA participants. The findings will be relevant and applicable to both clinical and public health sectors in SCI rehabilitation in India and other low- and middle-income countries by directing rehabilitation programs to better address areas of function that allow patients to find success following rehabilitation. [ABSTRACT FROM AUTHOR]

Justification: Neurodevelopmental disorders, as per DSM-V, are described as a group of conditions with onset in the development period of childhood. There is a need to distinguish the process of habilitation and rehabilitation, especially in a developing country like India, and define the roles of all stakeholders to reduce the burden of neurodevelopmental disorders. Process: Subject experts and members of Indian Academy of Pediatrics (IAP) Chapter of Neurodevelopmental Pediatrics, who reviewed the literature on the topic, developed key questions and prepared the first draft on guidelines. The guidelines were then discussed by the whole group through online meetings, and the contentious issues were discussed until a general consensus was arrived at. Following this, the final guidelines were drafted by the writing group and approved by all contributors. Objectives: These guidelines aim to provide practical clinical guidelines for pediatricians on the prevention, early diagnosis and management of neurodevelopmental disorders (NDDs) in the Indian settings. It also defines the roles of developmental pediatricians and development nurse counselor. Statement: There is a need for nationwide studies with representative sampling on epidemiology of babies with early NDD in the first 1000 days in India. Specific learning disability (SLD) has been documented as the most common NDD after 6 years in India, and special efforts should be made to establish the epidemiology of infants and toddlers at risk for SLD, where ever measures are available. Preconception counseling as part of focusing on first 1000 days; Promoting efforts to organize systematic training programs in Newborn Resuscitation Program (NRP); Lactation management; Developmental follow-up and Early stimulation for SNCU/NICU graduates; Risk stratification of NICU graduates, Newborn Screening; Counseling parents; Screening for developmental delay by trained professionals using simple validated Indian screening tools at 4, 8, 12, 18 and 24 months; Holistic assessment of 10 NDDs at child developmental clinics (CDCs)/district early intervention centre (DEICs) by multidisciplinary team members; Confirmation of diagnosis by developmental pediatrician/developmental neurologist/child psychiatrist using clinical/diagnostic tools; Providing parent guided low intensity multimodal therapies before 3 years age as a center-based or home-based or community-based rehabilitation; Developmental pediatrician to seek guidance of pediatric neurologist, geneticist, child psychiatrist, physiatrist, and other specialists, when necessary; and Need to promote ongoing academic programs in clinical child development for capacity building of community based therapies, are the chief recommendations. [ABSTRACT FROM AUTHOR]

Background: An increase in the on-field intensity in modern cricket, results in an increased number of player injuries. Integration and easy access to professional physiotherapy, technology, rehab protocols, and mental/physical conditioning aid in early return to sports in the injured; however, at the grassroots, these facilities may not be available with untrained support staff and limited funds. Injuries can go unnoticed and, therefore, there is a need for an easy process of identification and documentation of such injuries. We devised a questionnaire-based survey to evaluate its effectiveness at the junior level of professional cricket. Materials and Methods: An Online self-administered questionnaire was prepared and the link was given to active Union Territory Cricket Academy (UTCA), Chandigarh, cricketers of any gender between 15 and 35 years of age, through different online platforms like WhatsApp, Telegram and emails, for the submission of their responses. Results: The questionnaire was administered to 98 participants out of which 77 participants' responses were evaluated (41 males and 36 females). 74/77 participants were below 30 years of age. There were 18 wicketkeepers, 33 bowlers and 26 batsmen as per their major role in the team. 37/77 cricketers (20 males, 17 females) had injuries during the previous 2 years; this included 17 bowlers, 11 batsmen and 9 wicketkeepers. The most common body part injured in the survey were fingers (12) followed by the back (7). The amount of training time lost, reported in the survey ranged from a week up to 1 year. Conclusion: Online surveys could be the first step to accumulating data and making initial player profiles, starting even at junior levels of cricket. Further detailed evaluations may be performed after this, and coaches and administrators could potentially profile cricket injuries and identify chronic issues. [ABSTRACT FROM AUTHOR]

Background: Expenditure for rehabilitation following knee arthroplasty for osteoarthritis- and rehabilitation-related challenges following discharge to home after surgery is not available in the Indian context. Objectives: To estimate cost of rehabilitation and document challenges in following rehabilitation advices, from a patient perspective. Methods: We conducted a hospital-based cross-sectional study of patients visiting the orthopedic department at a tertiary care public-funded hospital in New Delhi and included those who recently (less than 4 months) underwent primary knee arthroplasty for osteoarthritis. A trained physiotherapist not involved in clinical care collected information on expenditures incurred after discharge from hospital, patient's ability to recall the advices given by the physician and challenges they experienced using a semi-structured questionnaire. We report median costs by category of direct and indirect cost and used linear regression to explore determinants of cost. Results: We interviewed 82 consecutive patients (mean age 60.8 years and 68% females) with median time since surgery of 28 days. More than half (52%) sought some support for physiotherapy. The median cost of rehabilitation was INR 18,395 (Interquartile-range 11,325–27,775). Direct medical cost contributed to 74% of total cost (32% fee for services, 21% medications and lab investigations, 21% assistive devices). Twenty percent higher costs were incurred among those undergoing bilateral knee surgery after adjusting for age, sex, income, and type of physiotherapy support sought. Challenges were related to recall of advices, not understanding the recovery process and pain management. Conclusion: About half patients undergoing knee arthroplasty seek support for rehabilitation after discharge to home contributing to a major portion of expenses incurred during rehabilitation. Cost-effective support mechanism for home-based rehabilitation is required for improving patient rehabilitation experiences. [ABSTRACT FROM AUTHOR]

Background: The ultimate success of a total hip replacement lies in patients forgetting about their artificial joints during routine activities. "Forgotten Joint Score (FJS)" is emerging as an important tool in assessing outcomes of total hip arthroplasty. There has been no version of this score available in commonly spoken vernaculars in India. This study aims to formulate and validate the Hindi version of FJS in Indian population. Methods: A total of 136 patients with a minimum follow-up of 6 months and a maximum follow-up of 18 months after total hip arthroplasty were asked to fill the translated and adapted version of FJS questionnaire, at two points of time 2 weeks apart. The Hindi version of FJS (I-FJS) was tested for reliability and responsiveness, floor and ceiling effect and validity against modified Harris Hip Score (mHHS). Construct validity was expressed as the Pearson correlation coefficient. Internal consistency was expressed as Cronbach's alpha and test–retest reliability as the intra-class correlation coefficient (ICC). Results: I-FJS showed excellent internal consistency with Cronbach's alpha of 0.88. Intra-class correlation coefficient (ICC) was 0.94. I-FJS showed good correlation with m-HHS (r = 0.8, p = 0.001). The standard error of measurement was 3.6 and the smallest detectable change was 9.97. There was no floor or ceiling effect observed with I-FJS. Data from this study were insufficient to establish adequate responsiveness of I-FJS. Conclusion: I-FJS is a valid, reliable and reproducible score for hip function in post-THA patients. It is devoid of any floor or ceiling effect. Hindi version of FJS could be an effective tool for studying hip function in the Indian population. [ABSTRACT FROM AUTHOR]

In the modern era, rehabilitation after sports injury has become a domain for specialists, and its evolution has necessarily brought together the sports physiotherapist, the sports physician, and the orthopedic surgeon. The changing profile of sports related injury, as well as limited availability of facilities for rehabilitation in many areas of India, is a matter of concern. Elite sportspersons have some protection, but the average athlete is often left to fend for himself. Key factors in successful sports injury rehabilitation protocols are the application of modern rehabilitation protocols under appropriate supervision, appropriate and well timed surgical interventions, and judicious and need based use of pharmaceutical agents. Modern rehabilitation protocols emphasize teamwork and proper rehabilitation planning, and the rehabilitation team has to be lead by a trained sports physiotherapist, with an understanding of the protocols and interventions required at various stages. Injury specific rehabilitation protocols are being practiced worldwide but need to be introduced according to the nature of the sport as well as available facilities. Even in India, sports physicians are increasingly joining specialist rehabilitation teams, and they can help with medication, nutritional supplements, and specialized tests that could improve injury understanding. Inputs from surgeons are mandatory if surgical interventions have been performed. What is often missing in the underdeveloped world is psychological support and a clear understanding by the athlete of his/her rehabilitation protocols. World over, the primary aims are safe return to sports and minimizing reinjury on return to sport; this involves rehabilitation in stages, and current methodology clearly demarcates acute and chronic phases of injury. Close coordination with trainers and coaches is mandatory, and all need to understand that the reconditioning phase is crucial; skill assessment before progression has now become a specialized domain and needs to be introduced at all levels of the sport. A key factor in all sports injury rehabilitation protocols is injury prevention; this involves data maintenance by teams or trainers, which is still not fully developed in the Indian context. The injury and subsequent problems need to be comprehended both by athletes and their coaches. The current review is an attempt to clarify some of the issues that are important and routinely used world over, with the aim to improving rehabilitation after sports even in the underdeveloped world. [ABSTRACT FROM AUTHOR]

Programming platforms need to recognize the diversity of malnutrition epidemiology in India and choose appropriate implementation designs. With severe chronic malnutrition as the dominant epidemiologic entity, the net needs to be cast wide, focusing on: food security, health care, agriculture, water and sanitation, livelihoods and women's empowerment. Community-based malnutrition treatment and prevention programs need to collaborate to complement treatment with socioeconomic and preventive interventions. Expansion of nutrition rehabilitation centers should be limited to areas/districts with high wasting. Pediatric services with nested nutrition services (including counseling) requires urgent strengthening. Continuum of Care is a weak link and requires strengthening to make both hospital and community-based models meaningful. [ABSTRACT FROM AUTHOR]

There has been a welcome interest in the issue of malnutrition by policy makers as well as technical experts in the recent years. The current public health systems for management of malnutrition, the ICDS and NRHM, have attempted to evolve approaches to the management of severe malnutrition. This paper makes a fresh analysis of data from well-accepted existing sources, indicating that 36- 44% of all children with Severe Acute Malnutrition (SAM) are likely to be missed by current criteria of screening and referral; simultaneously, a large proportion of children selected for referral to Nutritional rehabilitation centres are likely not to have SAM. The paper also highlights other areas of inconsistencies between the ICDS and the NRHM in the continuum of care required for the prevention and proper management of severe malnutrition. Thus, the paper identifies areas that need further exploration to achieve a seamless and effective program for tackling severe malnutrition. [ABSTRACT FROM AUTHOR]

Background: The spinal cord injured patients if congregated early in spinal units where better facilities and dedicated expert care exist the outcome of treatment and rehabilitation, can be improved. The objective of this study is to find out the various factors responsible for a delay in the presentation of spinal injury patients to the specialized spinal trauma units and to suggest steps to improve the quality of care of the spinal trauma patients in the Indian setup. Materials and Methods: Sixty patients of traumatic spinal cord injury admitted for rehabilitation between August 2005 and May 2006 were enrolled into the study and their data was analyzed. Results: Eighty-five per cent of the spinal cord injured patients were males and the mean age was 34 years (range 13-56 years). Twenty-nine (48.33%) of the spinal injuries occurred due to fall from height. There was an average of 45 days (range 0-188 days) of delay in presentation to a specialized spinal unit and most of the time the cause for the delay was unawareness on the part of patients and/or doctors regarding specialized spinal units. In 38 (62.5%) cases the mode of transportation of the spinal cord injured patient to the first visited hospital was by their own conveyance and the attendants of the patients did not have any idea about precautions essential to prevent neurological deterioration. Seventeen (28.33%) patients were given injection solumedrol with conservative treatment, 35 (60%) patients were given only conservative treatment and seven patients were operated (11.66%) upon at initially visited hospital. Of the seven patients operated five were fixed with posterior Harrington instrumentation (71.42%) and two (28.57%) were operated by short segment posterior pedicle screw fixation. None of the patients were subjected to physiotherapy-assisted transfers or wheel chair skills or even basic postural training, proper bladder/ bowel training program and sitting balance. Conclusion: Awareness on the part of the general population, attendants of the patients, clinical and paraclinical team regarding spinal cord injury needs to be addressed. Safe mode of transportation of spinal cord injured patient and early presentation at tertiary spinal care center with comprehensive spinal trauma care team should be stressed upon. [ABSTRACT FROM AUTHOR]

The author reflects on trauma care which has been an integral part of any fighting force, and the considerable variation in the approach to trauma care in the Armed Forces establishments and in the civilian setting. He mentions that comprehensive rehabilitative care is the single most important hallmark of total trauma care. He also opines that though trauma training is given to the medical professionals in the Army at various levels, there is still some scope for refinement.