Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions

Demystifying Plastic Surgery

30-32Myths such as plastic surgeons use plastic in their surgeries or plastic surgery does not produce scars are rampant due to ignorance and are largely baseless

Spectrum of primary bone grafting in cranio maxillofacial trauma at a tertiary care centre in India

Background: In past several years, traumas following road traffic accidents and other causes have increased, owing to an increase in mechanization and pace of life. These patients frequently have complicated injuries involving soft tissue and the craniofacial skeleton. Assessment of bony injuries and loss of portions of facial skeleton and their management has proved to be a challenge to the reconstructive surgeon. Aims: Primary bone grafting of craniofacial skeletal injuries provides an opportunity for one stage correction of bony defects. The varied spectrum of primary bone grafts for management of craniomaxillofacial injuries are evaluated in this study. Materials and Methods: Patients with a history of acute trauma resulting in facial skeletal injuries with or without bone loss were included in the study. Primary bone grafting was undertaken in situations requiring contour correction, replacement of skeletal losses and for rigid fixation of fracture segments. Olecranon, Iliac crest, ribs, Vascularized as well as nonvascularized outer table calvarial grafts and nonvascularized inner table calvarial grafts were used in this study. Results: Sixty two patients of craniomaxillofacial injury following trauma requiring primary bone grafting were considered in this study. Fifty seven percent of patients (n=32) required primary bone grafting for replacement of bone loss while bone grafting for contour correction was done in twenty three patients. The parietal calvaria overlying the non-dominant hemisphere was used as a source of bone graft in forty-nine patients. Nearly ninety-two percent of the patients were satisfied with the results of primary bone grafting. Conclusions: Functional and aesthetic assessment of each of these patients, managed with primary bone grafting revealed a low rate of disabilities and high percentage of satisfaction in this study

Feeding interventions among cleft lip/palate infants: A systematic review and meta-synthesis

Cleft lip and palate (CLP) affect about one baby of every 700 newborn due to alterations in the normal development of the primary and/or secondary palate. The prevalence of clefts in India is between 27,000 and 33,000/year. Searches were undertaken in PubMed, Cochrane database, Web of Science, Scopus, and Google Scholar databases, for primary research studies that report on feeding interventions/feeding techniques/feeding methods, challenges faced by mother/care taker/health personnel as they include most of the publications in this area. Papers were independently reviewed by two authors and Thomas et al's assessment criteria checklist (2003) was used to assess the methodological quality. This systematic review was registered in PROSPERO under number CRD42020208437. The review included 25 studies: 21 quantitative, 2 qualitative, and two mixed methods study, involving 1564 infants and children (age ranging from 1 week to 5 years old) and 790 mothers of Infants with CLP from 13 countries. While comparing the efficacy of the three feeding techniques such as paladai fed, bottle fed, and spoon fed in improving the weight gain pattern the result showed mean weight gain among paladai feeding was better than the bottle or spoon-feeding. Common feeding problems observed were nasal regurgitation, vomiting, and choking, etc. Infants with cleft palate had some major challenges such as aspiration, choking, and inadequate growth. Beyond the esthetic and psychologic implications of the presence of orofacial clefts, the feeding of the child is usually the next concern of the parents and caregivers, a factor which can result in considerable stress to the mother. A prompt diagnosis, especially of a CP, and visit by the cleft team immediately after the birth so that the family can be supported and taught the skills of feeding, is essential

The scope of mobile devices in health care and medical education

The use of mobile Internet devices (MIDs), smartphones, and proprietary software applications (also known as "apps" in short) can improve communication among medical caregivers. The utilization of these mobile technologies has further transformed health care, communications, commerce, education, and entertainment, among other fields. Newer technologies have the potential to be adapted for improvement in health care and medical education in general. Mobile technology is one of the latest strings of technological innovations that can be integrated into medical education. M-learning (the use of mobile technologies in teaching/training) has been used as a complimentary resource for interaction between students and instructors for motivation and learning. The main uses described for mobile devices in medical education can be divided into (a) information management (IM), (b) communication, and (c) time management. The field of mobile technology in health-care services and medical education is quite new and throws open ample opportunities for researchers to conduct further studies. Educators in medicine, dermatology, and public health as well as practicing physicians and surgeons need to embrace this new technology, study its further adoption, and assist in the responsible integration of these devices into the art and practice of medicine

Diode laser ear piercing: A novel technique

Earlobe piercing is a common office room procedure done by a plastic surgeon. Various methods of ear piercing have been described. In this article, we describe a novel method of laser ear piercing using the diode laser. An 18-year-old female patient underwent an ear piercing using a diode laser with a power of 2.0 W in continuous mode after topical local anaesthetic and pre-cooling. The diode laser was fast, safe, easy to use and highly effective way of ear piercing. The advantages we noticed while using the diode laser over conventional methods were more precision, minimal trauma with less chances of hypertrophy and keloids, no bleeding with coagulation effect of laser, less time taken compared to conventional method and less chance of infection due to thermal heat effect of laser