Ataxia in Africa: current efforts and recommendations

Ataxia which is a disorder of the nervous system with the primary symptom being unsteady mobility is becoming more prevalent especially within the African continent. Nonetheless, it is suggested that there may be more cases of ataxia that are still undiagnosed roughly and this has to do with very few health care facilities offering genetic testing. This disease is most commonly associated with a variety of neurological illnesses, including stroke and brain damage leading to the uncontrollable moving of the limbs. However, in Africa, the primary contributors to the increase in ataxia are infectious diseases and food scarcity caused by drought. In our article, we analyze the different types of ataxia according to their epidemiology and describe how sociological factors aggravate the situation. We detail existing national strategies and programs aimed at solving this problem, particularly increasing funding for the infrastructure necessary for genetic testing, imagining and brain studies. Even with these measures, there remain a number of gaps with regard to epidemiology studies that need painting so as aid in accurating in the diagnosis. Awareness of the problem regarding patient education and active healthcare personnel has to be raised too. We advocate working on various fronts, including nutritional intervention, support groups for the patients, or modifying occupation therapy programs. Such measures are necessary to increase the effectiveness of ataxia treatment and improve the quality of life of patients.

Comparative effectiveness of intra-arterial thrombolysis vs. mechanical thrombectomy: a literature review

Background

Acute ischemic stroke (AIS) remains one of the leading causes of morbidity and mortality worldwide. Time is the single most critical factor in the management of patients presenting with AIS, where re-opening of occluded blood vessels is paramount. Intra-arterial thrombolysis (IAT) and mechanical thrombectomy (MT) are two such therapies employed to reestablish cerebrovascular blood flow in patients with AIS. This review compares both IAT and MT according to their efficacy, safety profiles, recanalization rates, clinical outcomes, and adverse procedural events.

Methods

Study abstraction from electronic search databases comprising PubMed/MEDLINE, ResearchGate, and the National Library of Medicine was used. Screening and selection of relevant articles were comprehensively conducted for this review. Direct comparisons between IAT and MT in terms of variables including recanalization rates, clinical outcomes, and adverse procedural events were warranted for study inclusion. Research determined to exhibit insufficient data or without comparable groups were subsequently excluded.

Results

MT was prompter when executing procedures than IAT, achieving greater rates of recanalization. Both interventions displayed similar results regarding rates of symptomatic intracranial hemorrhage (sICH) and mortality. Despite current available data indicating MT to demonstrate more efficiency as a procedure, further research is needed to examine IAT in light of specific patient demographics, clinical presentation, and circumstances.

Conclusion

This review elucidated that MT often takes less time peri-procedurally, achieving greater success in revascularization compared with that of IAT. Regarding mortality and sICH rates, IAT and MT comparison showed equivocal results. Thus, while making therapeutic decisions, it is important to consider the unique clinical features of each patient as well as the timing of interventions in order to maximize treatment outcomes.

Exploring the burden of non-communicable diseases on surgical services in Africa: a comprehensive literature review

Introduction

Non-communicable diseases (NCDs) encompass five major categories: cardiovascular disease, cancer, diabetes mellitus, mental health disorders, and chronic respiratory diseases. The burden of NCDs is rising in Africa, particularly in sub-Saharan Africa, having increased by 67% from 1990 to 2017, which puts additional pressure on healthcare services. Although most treatments for NCDs are non-surgical, surgical intervention plays a crucial role in managing many of these diseases. Unfortunately, barriers to accessing surgical care for NCDs remain in Africa.

Methods

A comprehensive literature review was conducted employing the following search databases: AJOL, PubMed/Medline, and Google Scholar. Search strategies that combined terms pertaining to "non-communicable disease," "surgical care," and "Africa" were utilized.

Results

The main barriers to surgical access in the management of NCDs in Africa include restricted financial resources, a lack of adequate infrastructure, and deficiencies in competent surgical training. Measures to improve surgical intervention associated with NCDs include international collaborations, improved education and training of professionals, and the use of mobile technology tools.

Discussion

There is a need to implement strategies that seek to improve access to surgery for the treatment of NCDs on the African continent. Some of these strategies involve multi-professional action alongside the establishment of prevention actions and policies aimed at the management of NCDs. Furthermore, support from the governments of each nation, as well as ongoing research on the subject, also contribute to better development of surgical care for these diseases in the African context.

Ethical considerations in surgical research conducted in African LMICs: a comprehensive narrative review

Introduction

Surgical research has revolutionized healthcare by improving the efficacy, safety, and efficiency of surgical interventions. This research has the potential to significantly impact healthcare delivery in Africa, where surgical diseases pose a major public health burden. Studies suggest surgery alone could reduce the global disease burden by 11%, with a substantial portion stemming from conditions prevalent in sub-Saharan Africa like traumatic injuries, childbirth complications, and surgical infections. However, conducting surgical research in Africa presents unique ethical challenges. The continent's diverse socio-economic environments and rich cultural contexts necessitate careful consideration of ethical principles. Traditional research models often don't translate well to African settings, raising concerns about informed consent, community engagement, and benefit-sharing.

Aim

This review aims to shed light on various ethical dilemmas posed within surgical research, conducted in African countries. Further, standard practices and recommendations that involve a multi-pronged approach to mitigate said issues were explored.

Materials and methods

A meticulous analysis of the existing literature pertaining to the ethical issues proffered in Africa was performed. Databases employed comprised PubMed/MEDLINE, Embase, Scopus, and EBSCOhost. Pertinent case studies were also reviewed to comprehend said issues, providing comprehensive recommendations.

Results

In addressing the ethical challenges in the research, the importance of resource limitation, sociocultural factors, informed consent barriers, technological obsolescence, training deficits, power dynamics, vulnerable populations, regulatory oversight, and compliance was highlighted. The proposed approaches include conducting focused research lectures and practical workshops on surgery, organizing surgical boot camps for medical students, interns, and residents, promoting research in related fields such as anesthesia, radiology, and pathology, ensuring the presence of on-site surgeons as needed, and arranging outreach surgical and educational camps for patients.

Conclusion

Promoting community engagement and training local researchers and surgeons are crucial for navigating the unique ethical landscape in Africa. By prioritizing ethical considerations, surgical research can contribute to improved healthcare outcomes and a more equitable healthcare system across the continent.

The importance of neurosurgical nursing in low- and middle-income countries - a critical review

Background

Neurosurgical nursing involves the provision of pre- and post-operative care to neurologic patients. Specialized nurses in the field of neurosurgery are vital for patient outcomes and wellbeing. Nevertheless, there is underestimation and limited access to neurosurgical nursing in low- and middle-income countries (LMICs). This review primarily aims to shed light on the significance of nursing in the neurosurgical department of LMICs. It provides insight into the healthcare systems, the collaborative approaches that emerged in this concern, and the issues pertaining to integrating neurosurgical nursing in these countries.

Methods

Literature search was conducted from March 2024, where the articles were retrieved from PubMed/Medline, EBSCOhost, Google Scholar, and Embase. The terms "neurosurgical nursing," "neurosurgery," "neurosurgical care," "neurosurgical nurses," and "low- and middle-income countries OR LMICs" were used to search relevant studies. Previous articles discussing neurosurgical care in LMICs were considered in this review.

Results

Nurses participate in 90% of interactions between healthcare providers and patients. They provide holistic care by considering the physical, cultural, and psychosociological needs pertaining to their patients. Furthermore, they possess ability to establish rapport via communication with patients which improves the standard of care delivered. To achieve results satisfactory to the wellbeing of affected populations, neurosurgical disciplines necessitate the aid of skilled nursing colleagues. However, there is a lack of relevant technology, innovations, and funding alongside human resources in LMICs.

Conclusion

Education, training, and dynamic collaboration are crucial factors for neurosurgical nurses to provide the best quality of care to patients. It is also pivotal to focus on research concerning the present issue, implement further policies which encourage dynamic cooperation between the neurosurgical multidisciplinary team, and collaborate on a global level to enhance neurosurgical nursing in LMICs.

Immunotherapy in gastrointestinal cancers: current strategies and future directions - a literature review

Introduction

The National Cancer Institute defines the disease of "cancer" as a group of disorders in which aberrant cells proliferate uncontrollably and have the potential to infiltrate neighboring tissues. It is well established that cancer remains a significant etiology contributing to worldwide mortality. Gastrointestinal (GI) neoplasms are a type of cancer that affects the digestive system and adds to the total cancer burden. Conventionally, several therapies have been employed, such as radiation and chemotherapy; nevertheless, their adverse effects have prompted the need for an improved therapeutic alternative. Immunotherapy thus became a notable medium of treatment for several malignancies, including tumors of the GI tract.

Aim

This comprehensive review seeks to provide insight on future directions and prospective therapies under development, as well as information regarding the present strategies utilized to mitigate one of the primary forms of cancer, GI cancer.

Methods

A detailed analysis of the existing literature on GI cancers has been conducted. Several databases were employed to gather this information, mainly PubMed/MEDLINE. Different aspects of the disease were considered when searching the databases to provide a comprehensive review of the current and future strategies being incorporated to mitigate the negative consequences of this disease.

Results

Many strategies are being used currently, and some are still under development. These comprise the usage of immune checkpoint inhibitors (ICIs), cytokine therapy, cancer vaccines, oncolytic viruses, and adoptive cell therapy. For instance, various monoclonal antibodies have been developed to inhibit the immunomodulatory effects of programmed death-1 and programmed death-1 ligand. There are also results of several clinical trials showing significant benefits and many changes are introduced to make the best of these strategies and minimize the challenges to group sizes. These challenges include overcoming the tumor's immunosuppressive environment, finding suitable predictive biomarkers, and reducing the adverse effects. Additionally, several novel immunotherapeutic approaches, such as chimeric antigen receptor T-cell (CAR-T) therapy, are being studied. In 2017, the US FDA approved the use of two CAR-T therapies, which marks a major milestone following extensive research and clinical trials. New approaches such as toll-like receptor-directed and helminth-based immunotherapies are being developed for the treatment of GI cancers as well. These therapies, along with targeted treatments, represent the future of immunotherapy in GI cancers.

Conclusion

Immunotherapy plays a significant role in the different types of GI cancers. However, optimizing these treatments will require overcoming barriers such as immune resistance, minimizing side effects, and improving the selection of patients through biomarkers. Continued research into these novel therapies and the mechanisms of immune modulation will be key to maximizing the therapeutic benefits of immunotherapy in the future.

Advances in the diagnosis of colorectal cancer: the application of molecular biomarkers and imaging techniques: a literature review

Background

Following neoplasms of the lung and breast, colorectal cancer (CRC) is the third most frequent malignancy globally. Screening for CRC at the age of 50 years is strongly encouraged for prompt earlier diagnosis owing to prognoses being greatly correlated with time of detection and cancer staging.

Aim

This review aimed to elucidate the most recent advancements in the detection of CRC, with an emphasis on the latest innovations in diagnostic molecular biomarkers in conjunction with radiological imaging alongside stool-based tests for CRC screening.

Methods

A comprehensive review of the literature was performed, focusing on specific terms in different electronic databases, including that of PubMed/MEDLINE. Keywords pertaining to "colorectal cancer," "diagnosis," "screening," "imaging," and "biomarkers," among others, were employed in the search strategy. Articles screened and evaluated were deemed relevant to the study aim and were presented in the medium of the English language.

Results

There have been several innovations in the diagnostics and identification of CRC. These generally comprise molecular biomarkers, currently being studied for suitability in disease detection. Examples of these include genetic, epigenetic, and protein biomarkers. Concurrently, recent developments in CRC diagnostics highlight the advancements made in radiological imaging that offer precise insights on tumor biology in addition to morphological information. Combining these with statistical methodologies will increase the sensitivity and specificity of CRC diagnostics. However, putting these strategies into reality is hampered by several issues.

Conclusion

Progress in diagnostic technology alongside the identification of a few prognostic predictive molecular biomarkers suggested great promise for prompt detection and management of CRC. This clearly necessitates further efforts to learn more in this specific sector.