Arachnoid pit and extensive sinus pnematization as the cause of spontaneous lateral intrasphenoidal encephalocele

Increasing nursing student interest in rural healthcare: lessons from a rural rotation program in Democratic Republic of the Congo

BACKGROUND

Many challenges exist in providing equitable access to rural healthcare in the Democratic Republic of the Congo (DRC). WHO recommends student exposure to rural clinical rotations to promote interest in rural healthcare. Challenges to rural engagement include lack of adequate infrastructure and staff to lead rural education. This case report highlights key steps in developing a rural rotation program for DRC nursing students. Case presentation To implement a rural rotation (RR) program, ICAP at Columbia University (ICAP) consulted with students, the Ministries of Health (MoH) and Education (MoE), and nursing schools to pilot and expand a rural rotation program. Nursing schools agreed to place students in rural clinics and communities. Key stakeholders collaborated to assess and select rural sites based on availability of nursing mentors, educational resources, security, accessibility, and patient volume. To support this, 85 preceptors from 55 target schools and 30 rural health facilities were trained of which 30 were selected to be "master trainers". These master trainers led the remaining 55 preceptors implementing the rural rotation program. We worked with rural facilities to engage community leaders and secure accommodation for students. A total of 583 students from five Lubumbashi schools and two rural schools outside Kinshasa participated across 16 rural sites (298 students in 2018-2019 school year and 285 in 2019-2020). Feedback from 274 students and 25 preceptors and nursing school leaders was positive with many students actively seeking rural assignments upon graduation. For example, 97% agreed or strongly agreed that their RR programs had strengthened their educational experience. Key challenges, however, were long-term financial support (35%) for rural rotations, adequate student housing (30%) and advocacy for expanding the rural workforce.

CONCLUSIONS

With nearly 600 participants, this project showed that a RR program is feasible and acceptable in resource-limited settings yet availability of ample student accommodation and increasing availability of rural jobs remain health system challenges. Using a multipronged approach to rural health investment as outlined by WHO over two decades ago remains essential. Attracting future nurses to rural health is necessary but not sufficient to achieve equitable health workforce distribution.

Intrasphenoidal Encephalocele with Spontaneous Cerebrospinal Fluid Rhinorrhea in Idiopathic Intracranial Hypertension: Need for Clarity in Terminology and Imaging Delineation

BACKGROUND

Magnetic resonance imaging plays an important role in identification of any underlying structural cause in spontaneous cerebrospinal fluid (CSF) leaks-either rhinorrhea or otorrhea. Sphenoid bone defects have been reported in those presenting as idiopathic intracranial hypertension with or without CSF rhinorrhea. Sphenoid lateral recess defect with intrasphenoidal encephalocele is one of the uncommon causes of spontaneous CSF leakage. Many classifications of basal encephaloceles have been used along with associated predisposing anatomic factors for the CSF leak.

CASE DESCRIPTION

We report 2 cases of spontaneous CSF rhinorrhea in 2 middle-aged females and had intrasphenoidal encephalocele on imaging using 3-dimensional magnetic resonance cisternography and computed tomography.

CONCLUSIONS

We discuss the various classification systems of sphenoidal encephaloceles and review the terminology and comprehensive imaging details to be included in reporting such cases for appropriate treatment planning.

Quantitative characterization of breast tissues with dedicated CT imaging

A quantitative characterization of the soft tissues composing the human breast is achieved by means of a monochromatic CT phase-contrast imaging system, through accurate measurements of their attenuation coefficients within the energy range of interest for breast CT clinical examinations. Quantitative measurements of linear attenuation coefficients are performed on tomographic reconstructions of surgical samples, using monochromatic x-ray beams from a synchrotron source and a free space propagation setup. An online calibration is performed on the obtained reconstructions, in order to reassess the validity of the standard calibration procedure of the CT scanner. Three types of healthy tissues (adipose, glandular, and skin) and malignant tumors, when present, are considered from each sample. The measured attenuation coefficients are in very good agreement with the outcomes of similar studies available in the literature, although they span an energy range that was mostly neglected in the previous studies. No globally significant differences are observed between healthy and malignant dense tissues, although the number of considered samples does not appear sufficient to address the issue of a quantitative differentiation of tumors. The study assesses the viability of the proposed methodology for the measurement of linear attenuation coefficients, and provides a denser sampling of attenuation data in the energy range useful to breast CT.