Congenital fibrinogen deficiency is an inherited disorder due to genetic mutations with diverse presentations arising from reduced fibrinogen levels (hypofibrinogenemia), absence of fibrinogen in circulation (afibrinogenemia), abnormal functioning (dysfibrinogenemia) or both reduced levels and abnormal functioning (hypodysfibrinogenemia) of fibrinogen. The decreased fibrinogen concentration in congenital fibrinogen deficiency necessitates fibrinogen replacement therapy with fresh frozen plasma, cryoprecipitate, or human fibrinogen concentrate. However, the use of fresh frozen plasma and cryoprecipitate is limited owing to their longer transfusion time, requirement of high doses, volume overload, risk of viral transmission, and other safety concerns. The availability of human fibrinogen concentrate has made it the preferred replacement alternative due to its reduced risk of viral transmission, smaller infusion volume, and accurate dosing. The hemostatic efficacy and safety of human fibrinogen concentrate in congenital fibrinogen deficiency is well established in the literature. We review the prevalence of congenital fibrinogen deficiency in India and the current role of human fibrinogen concentrate in its management.

Background: Hemineglect is the inability to sense stimuli given on the paretic side. It is most frequently seen in individuals with left hemiplegia resulting from temporoparietal lobe damage. On the basis of duration poststroke, hemineglect can be acute (<3 months) or chronic (>6 months). The patients experience many challenges in rehabilitation of motor function, cognitive function, and in gaining functional independence. Aim: To identify the challenges faced by physiotherapists in rehabilitation of individuals with poststroke hemineglect. Methodology: Data Identification: An English language literature search using Google Scholar, Scopus, PubMed, and Pedro was done. Study Selection: Articles were identified and those which fulfilled the specific requirements were selected. Data Extraction: In accordance with the inclusion criteria, 9 studies done between 1997 and 2017 were reviewed. Results: In this study, we reviewed a number of studies on the treatment of hemineglect which show a variety of treatment options. The various interventions include robotic mirror therapy, repeated parietal theta-burst stimulation, low-frequency transcranial magnetic stimulation, trunk rotation and scanning training, forced use therapy, prism glass adaptation, movement detection bracelets, each of which have different effects. Conclusion: There are a limited number of studies on the different treatment methods that are currently available. Further research is needed on these treatment methods to prove their efficacy and find a suitable method to overcome the challenges that the patients with hemineglect face at present.

Background- Stroke rehabilitation involves a multidisciplinary team providing comprehensive care to the patient.(1) The functioning of Stroke Units (SU), the highest evidence available for stroke care, is guided by the World Stroke Organisations (WSO) roadmap of core recommendations and key quality indicators.(2) Objectives- To evaluate the quality of stroke rehabilitationin comparison to the WSO core recommendations at a tertiary care centre in India Methodology-A mixed method design with an exploratory research model was used. The study was conducted in 2 phases including retrospective data extraction from medical records and telephonic follow-up on the patients functional status and adherence to physiotherapy post-discharge. 84 patient records (those admitted between Jan –June 2021) were screened. Data was extracted from 49 patient files that fulfilled inclusion criteria. 35 patients were excluded due to unavailability of patient files, non-stroke related hospital admissions. In Phase 2, qualitative data was gathered using telephonic interviews, from 7 patients who consented for the same. Results- The mean age of the sample was 56.9 ±13years with approximately two third being males and a predominance towards ischaemic strokes (62%). Those with severe impairment on Fugl Meyer assessment were 28% of the sample. It was observed that there was inconsistent documentation of various core recommendations provided by WSO (<20%) while 16% of the services provided were not documented at all. Only two of the five key quality indicators of stroke rehab were documented.

Background COVID-19 exposed the weakened healthcare sector and burdened the economic sector. Patients with neurological diseases require physical rehabilitation from the acute to chronic phase irrespective of their COVID positive status. Objective To evaluate the qualitative and quantitative changes in neurological physiotherapy at hospital/clinic and home-based settings in India during the COVID-19 pandemic. Methodology Using an online survey, a cross-sectional observational study was implemented among physiotherapists in India who treated neurological patients amidst the pandemic at hospital/clinic and for home-based settings using an online survey. Convenience sampling was used for recruiting participants in the study. Results and Conclusion Most of the physiotherapists, whether working in hospitals or in patients’ homes, indicated a decline in the number of referrals and therapy sessions given to their patients. Both groups resorted to the use of various forms of telerehabilitation in delivering therapy. Even though there is evidence supporting the necessity of physiotherapy for respiratory care, most of the respondents did not put it into practice. No protocols/guidelines for therapy delivery were implemented or used by our sample of respondents. This paper highlights the needs under 3 main categories: (a) development and implementation of contextualized clinical-practice-guidelines and clinical-monitoring systems for neurological physiotherapy, (b) incorporating respiratory physiotherapy sessions supported by research to treat neurological cases in such pandemics, and (c) to modify policies both at public and private domains ensuring incorporation and implementation of physiotherapy for neurological conditions, and to raise campaigns that educate the public on the significance of receiving uninterrupted physiotherapy, even during similar pandemics.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized primarily by either hyperactivity or inattention or both. Non-Invasive brain stimulation techniques including Transcranial direct current stimulation (tDCS) and Repetitive Transcranial magnetic stimulation (rTMS) act by altering brain activity and modulating neuronal networks. Both rTMS and tDCS have been previously used in pediatric population and now being used as an intervention for ADHD. The aim of this study was to review the existing literature on Non-Invasive stimulation in ADHD as a means of treatment. An English Language Literature search using Google Scholar, Scopus, PubMed and Pedro was done to identify the data. PRISMA guidelines were followed and those studies which fulfilled the specific requirements were selected. Methodological quality of these studies was assessed using PEDro scale. In accordance with the inclusion criteria; eight studies done between 2010 and 2019 were reviewed. Studies were grouped according to intervention given: rTMS and tDCS. Our findings reveal that both rTMS and tDCS have positive effects on improving inhibitory control, executive function as well as the impulsive symptoms in ADHD. It was concluded that Non-invasive stimulation is a promising and upcoming tool for improving executive functions and inhibitory control in ADHD. More number of high quality randomized control trials are required to strengthen the evidence and incorporation of these tools in clinical practice.