Consensus Statement on Neurorehabilitation during COVID-19 Times: Expert Group on Behalf of the Indian Federation of Neurorehabilitation (IFNR).

The COVID19 pandemic in India is causing significant morbidity and disruptions of healthcare delivery. The rapidly escalating contagion is straining our public health system, which is already under pressure due to a shortage of infrastructure and inadequate workforce. Neuro rehabilitation services that are still in its infancy in our country have been significantly interrupted in the last six months. An expert group from Indian Federation of Neurorehabilitation (IFNR) have formulated the guidelines and consensus recommendations for Neurologists, Physiatrists, and Therapists managing neurological disabilities during COVID 19. The aim of this consensus paper is to sensitize the clinicians and therapists about maintaining the continuum of care and rehabilitation needs of Covid patients as well as non Covid patients with neurological disorders during the ongoing COVID 19 pandemic.

Education, Training, and Practices of Neurorehabilitation in India During the COVID-19 Pandemic.

Background: Corona virus disease (COVID-19) was declared a pandemic by the World Health Organization in March 2020. This has affected service delivery among all medical disciplines in India including neurorehabilitation services. Aims and Objectives: The aims and objectives of the study were to assess the effect of COVID-19 pandemic on neurorehabilitation services across India. Methodology: A prospective nationwide survey study was undertaken by the Indian Federation of Neurorehabilitation during the pandemic. A questionnaire was prepared using Google forms software consisting of four sections: demography, neurorehabilitation practice before COVID-19 pandemic, neurorehabilitation practice during COVID-19 pandemic, and continuing medical education during COVID-19 pandemic. Results: Responses (872) were received from neurorehabilitation professionals across the country out of which 2.2% professionals did not give consent for participating in the survey. Participants (36.6%) were practicing traditional or independent referral basis rehabilitation, while 63.4% participants were practicing multidisciplinary rehabilitation. On an average, respective units were conducting 500-750 therapy sessions per month. Majority of the rehabilitation units in India lacked a physiatrist, rehabilitation nurse, music therapist, cognitive therapist, and urologist. Approximately 80% of the rehabilitation units have the basic rehabilitation modalities and advance technology was present in only 20% of the rehabilitation units. During COVID-19 pandemic, 19.5% centers were providing elective services, 50.3% emergency services, 15.6% new outpatient services, and 22.7% were providing follow-up outpatient services. Centers (51.5%) were providing telerehabilitation services for neurological conditions during the times of COVID-19 pandemic. Professionals (61.1%) providing telerehabilitation were working from home. Among the patients who needed neurorehabilitation, 28% were doing their exercises independently, 31% were supervised by caregivers, 17% were supervised by therapists, and 24% were not receiving any therapy. Participants (95.5%) wanted to receive more training in the field of neurorehabilitation. The participants utilized webinars (71%), online courses (22%), case discussion forums (19%), panel discussions (13%), and literature search (8%) during COVID-19 pandemic to continue education. Conclusion: The study reflects the situation of neurorehabilitation service delivery in India during the pandemic as the respondents were from all parts of the country and included most components of the neurorehabilitation team. Neurorehabilitation services were severely affected across India during the COVID-19 pandemic. Tele-neurorehabilitation has emerged as a new service delivery model during the pandemic. Online means of education has emerged as the primary source of continuing medical education during the pandemic.

The Department of Neurosurgery, Grant Medical College and Sir J.J Group of Hospitals, Mumbai.

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.

Unusual site of Rathke's cleft cyst: A case report and review of literature.

We report an eight years female child of symptomatic giant Rathke's cleft cyst extending from right parasellar, paraventricular region to right fronto-temporo-parietal cortical surface which is an unusual site for Rathke's cyst. MRI Brain scans of patient who presented with diminution of vision in right eye with headache and vomiting revealed a large cystic mass in right parasellar, paraventricular region with peripheral enhancement and midline shift. In this case, we performed the right fronto-temporo-parietal craniotomy with drainage and marsupilization of cyst wall. Histopathologically, it was inflamed Rathke's cleft cyst with focal epithelial metaplasia.

Pure cortical ependymoma: A rare entity.

Ependymomas are mostly infratentorial, intraventricular tumor, accounting for 2-9% of all central nervous system tumors. Supratentorial pure cortical ependymoma are extremely rare tumor with definite ependymal morphology and uncertain histogenesis. They are mostly low grade tumor and are cured with resection, rendering them favorable prognosis. Our case is of 14-year-old female presenting with headache and convulsion of short duration. She underwent gross total excision of the tumor without radiation therapy and her follow-up is uneventful.

Cerebrospinal acanthamebic granulomas. Case report.

The authors present the case of a previously healthy 26-year-old man who presented with cerebrospinal acanthamebic granulomas, and they review the literature on acanthamebic granulomas of the central nervous system (CNS). The appearance of the lesion on imaging studies suggested the presence of tuberculous granulomas, which are common in India, and antituberculosis treatment was started. Despite surgical excision of a granuloma located in the right temporoparietal region and an intramedullary granuloma at T7-8, the disease progressed and resulted in death. Unlike other cases, this patient was not immunocompromised, had no history of engaging in water activities, and had no ulcers on his body, leaving in question the mode of entry used by the ameba. Acanthamebic granulomas can cause severe infections in healthy patients as well as in sick ones. This disease should be considered in the differential diagnosis when treating infective granulomas of the CNS.