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Background: The current neurosurgical workforce is not large enough to address the significant burden of neurosurgical disease worldwide, and women are under-represented in this surgical specialty. However, trainee opportunities are particularly scarce in lower- and middle-income countries, where the burden of neurosurgical disease is high. Thus, the primary aim of this study was to assess the effects of gender and country on perceived access to neurosurgical research and mentorship opportunities., Methods: A cross-sectional survey evaluating perceived access to neurosurgical research and mentorship opportunities was distributed electronically to medical students and unspecialized residents in 10 countries (Colombia, India, Ghana, Nigeria, Saudi Arabia, Spain, Uganda, the United Kingdom, the United States, and Venezuela)., Results: 34.0% of men versus 24.9% of women reported interest in neurosurgery (P < 0.001). Only 16.1% of trainees reported adequate access to neurosurgical research opportunities, which did not vary by gender overall (P = 0.070). However, more women reported inadequate access in the United States (P = 0.038), and more men reported inadequate access in Colombia (P = 0.043). In Colombia (P < 0.001), Nigeria (P = 0.003), Saudi Arabia (P = 0.038), the United States (P = 0.004), and Venezuela (P < 0.001), a lower proportion of women than men reported ever having a neurosurgery mentor of their same gender. 59.0% of female respondents noted that having access to female neurosurgeon mentors would increase their interest in neurosurgery, compared to 28.5% of male respondents (P < 0.001)., Conclusions: More male than female medical trainees in the surveyed countries reported interest in neurosurgery. However, access to adequate neurosurgical research opportunities, although relatively low overall, did not vary by gender in most countries. Access to gender-concordant mentorship was less common for women than for men, but women expressed that enhanced access to female neurosurgeon mentors would increase their interest in the field. These findings suggest potential avenues for intervention to augment and diversify the global neurosurgical workforce., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Intracranial fungal infections' (IcFIs) varying clinical manifestations lead to difficulties in diagnosis and treatment. African populations are disproportionately affected by the high burden of the disease. There is a lack of clarity as to the diagnostic and treatment modalities employed across the continent. In this review, we aim to detail the management, and outcome of IcFIs across Africa., Methods: This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, Cochrane Library, African Index Medicus, and African Journals Online were searched for relevant articles from database inception to August 10th, 2021. The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews guidelines were used to report the findings of the review., Results: Of the 5,779 records identified, 131 articles were included. The mean age was 35.6 years, and the majority (56.4%) were males. The majority (n = 8,433/8,693, 97.0%) of IcFIs presented as a meningitis, the most common communicable predisposing factor of IcFIs was HIV/AIDS (n = 7,815/8,693, 89.9%), and the most common non-communicable risk factor was diabetes mellitus (n = 32/8,693, 0.4%). Cryptococcus species was the most common (n = 8,428/8,693, 97.0%) causative organism. The most commonly used diagnostic modality was cerebrospinal (CSF) cultures (n = 4,390/6,830, 64.3%) for diffuse IcFIs, and MRI imaging (n = 12/30, 40%) for focal IcFIs. The most common treatment modality was medical management with antifungals only (n = 4,481/8,693, 51.6%). The most commonly used antifungal agent in paediatric, and adult patients was amphotericin B and fluconazole dual therapy (51.5% vs 44.9%). The overall mortality rate was high (n = 3,475/7,493, 46.3%), and similar for both adult and paediatric patients (47.8% vs 42.1%)., Conclusion: Most IcFIs occurred in immunosuppressed individuals, and despite the new diagnostic techniques, CSF culture was mostly used in Africa. Antifungals regimens used was similar between children and adults. The outcome of IcFIs in Africa was poor for both paediatric and adult patients., (© 2024. The Author(s).)

Objective: We aimed to synthesize evidence from published clinical trials on the efficacy and safety of tranexamic acid (TXA) administration in patients with aneurysmal subarachnoid hemorrhage (aSAH)., Methods: We followed the standard methods of the Cochrane Handbook of Systematic Reviews for interventions and the PRISMA statement guidelines 2020 when conducting and reporting this study. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until 1 January 2022. We selected observational studies and clinical trials comparing TXA versus no TXA in aSAH patients. Data of all outcomes were pooled as the risk ratio (RR) with the corresponding 95% confidence intervals in the meta-analysis models., Results: Thirteen studies with a total of 2991 patients were included in the analysis. TXA could significantly cut the risk of rebleeding (RR 0.56, 95% CI 0.44 to 0.72) and mortality from rebleeding (RR 0.60, 95% CI 0.39 to 0.92, p  = 0.02). However, TXA did not significantly improve the overall mortality, neurological outcome, delayed cerebral ischemia, or hydrocephalus (all p > 0.05 ). In terms of safety, no significant adverse events were reported. No statistical heterogeneity or publication bias was found in all outcomes., Conclusion: In patients with aSAH, TXA significantly reduces the incidence of rebleeding and mortality from rebleeding. However, current evidence does not support any benefits in overall mortality, neurological outcome, delayed cerebral ischemia, or hydrocephalus.

Background: Nigeria has an inadequate number of neurosurgeons to meet the population's demand for neurosurgical care. Furthermore, few Nigerian neurosurgeons are female. This study sought to evaluate perceived barriers to pursuing neurosurgery among Nigerian trainees., Methods: A 60-question survey was distributed electronically to medical students at the College of Medicine, University of Ibadan, and unspecialized intern physicians at the University College Hospital, Ibadan, Nigeria. Participation was voluntary., Results: One hundred fifty-seven respondents participated in the survey. A greater proportion of males indicated an interest in neurosurgery than females (40% vs. 18%, P = 0.010). Over 75% of respondents identified decreased family and personal time, long work hours, and limited access to maternity or paternity leave as potential barriers to neurosurgery, with no differences by gender. Respondents overall saw being female and low-income as disadvantageous to pursuing neurosurgery in Nigeria. Although they universally viewed research as important in neurosurgery, 59% of respondents reported inadequate access to research opportunities; this did not vary by gender. However, 65% of female respondents reported that having a female neurosurgery mentor would increase their interest in neurosurgery (vs. 37% of males, P = 0.001)., Conclusions: Nigerian medical trainees perceived the time commitment of neurosurgery as a major barrier to pursuing the specialty. Regardless of gender, they also reported low exposure to neurosurgery and inadequate access to research and mentorship opportunities. However, we found that enhanced female representation among neurosurgery mentors and improved work-life balance could increase interest in neurosurgery and help expand Nigeria's neurosurgical workforce., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Intraoperative neurosurgical adjuncts improve extent of resection whilst mitigating patient morbidity. The delivery of neurosurgical care via these adjuncts is the norm in high-income countries, but there is yet to be a study highlighting the usage of neurosurgical oncology adjuncts in Africa. This paper aims to provide awareness of the use of these adjuncts in Africa, reasons for limited procurement, and possible solutions to the problem., Methods: This scoping review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews guidelines. Semantic derivatives of neurosurgical oncology, adjuncts, and Africa were applied to medical databases. Studies in Africa with outcomes relating to adjunct usage, morbidity, mortality, and quality of life were selected. Book chapters and reviews were excluded., Results: Thirteen studies with 287 patients (0.5 to 74 years) were included in the final analysis. Most studies were cohort observational (46.2%) and originated from South Africa (46.2%). Meningioma was the most prevalent tumor histology (39.4%), and neuronavigation was the most readily used adjunct for surgical resection (30.8%). Using adjuncts, gross total resection was achieved in close to half the patient cohort (49.8%). Limited technology, lack of experience, cost of equipment, and inconsistency in power supply were noted as factors contributing to lack of adjunct usage., Conclusions: Neurosurgical adjuncts provide significant benefits in neurosurgical oncology. There is limited utilization of intraoperative adjuncts in most of Africa owing to limited resources and experienced professionals. Bilateral partnerships with a focus on donation and education will foster safe and sustainable adjunct incorporation in Africa., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: It is unknown whether efforts to expand access to neurosurgery worldwide have translated to an increase in the global neurosurgery workforce, particularly in low- and middle-income countries. The main objective of this study was to quantify the number and distribution of consultant neurosurgeons worldwide, while also identifying temporal and geographic trends in the neurosurgery workforce in different income levels and WHO regions, and analyzing what factors might contribute to the growth of a national workforce., Methods: This study was a subanalysis of an electronic cross-sectional survey administered to participants identified through neurosurgery societies, personal contacts, and online searches of all 193 countries and 26 territories, independent states, and disputed regions as defined by the World Bank (WB) and United Nations between October 2022 and March 2023. Population-weighted statistics for the consultant neurosurgery workforce and resource availability were estimated, and linear regression analysis was conducted to identify correlations with growth in the workforce., Results: Data were obtained for 192 countries (99.5%) and 25 additional territories, states, and disputed regions (96.2%). One hundred seventy-seven respondents participated in the survey. There were an estimated 72,967 neurosurgeons worldwide, representing a global pooled density of 0.93 neurosurgeons per 100,000 people and a median country density of 0.44 neurosurgeons per 100,000 people. The authors found an increasing density of consultant neurosurgeons, from low-income countries (0.12 per 100,000 people), to lower-middle-income countries (LoMICs; 0.37), to upper-middle-income countries (UpMICs; 1.13), and to high-income countries (2.44). The WHO African and Southeast Asia regions had the lowest pooled neurosurgeon density, while the Western Pacific region (WPR) had the highest density. There were 29 countries, 14 territories, and 1 independent state with no neurosurgeons. Neurosurgeons in countries with higher income-level designations had more frequent access to resources and equipment. The annual growth rates in workforce density were highest in LoMICs (26.0%) and UpMICs (21.3%), and the most rapid annual growth was in the Southeast Asia region (33.0%). Regression analysis revealed that an increasing population quartile, the Eastern Mediterranean region (relative to the WPR), the presence of a national neurosurgery society, increasing global development aid, and national gross domestic product were associated with relative growth in national neurosurgeon density., Conclusions: The authors estimate a global consultant neurosurgeon workforce of nearly 73,000 neurosurgeons, with stark disparities in the density and growth of the workforce in different WB income-level groups and WHO regions. The presence of a neurosurgery society was correlated with the growth of the workforce, and this study identified several regional targets for further intervention to expand access to neurosurgery.

Objective: A sustainable neurosurgery workforce depends on robust training pipelines, but the size and distribution of the global neurosurgery trainee workforce has not been described. The objective of this study was to identify the types of training programs that exist in the global neurosurgery workforce, the support that trainees receive, the diversity of trainee experiences, and the accreditation processes that exist to regulate training programs., Methods: This study was a subanalysis of a cross-sectional survey administered online in all 193 countries and 26 territories, independent states, and disputed regions as defined by the World Bank and United Nations. Participants were identified through neurosurgery society leadership, the personal contacts of the coauthors, and bibliometric and search engine searches. Population-weighted statistics were constructed and segregated by country income level and WHO regions., Results: Data were obtained for 187 countries (96.9%) and 25 additional territories, states, and disputed regions (96.2%). There were an estimated 1261 training programs and 10,546 trainees within the regions sampled, representing a global pooled density of 0.14 neurosurgery trainees per 100,000 people and a median national density of 0.06 trainees per 100,000 people. There was a higher density in high-income countries (HICs; 0.48 trainees per 100,000 people) compared with upper-middle-income countries (0.09 per 100,000), lower-middle-income countries (0.06 per 100,000), and low-income countries (LICs; 0.07 per 100,000). The WHO European (0.36 per 100,000) and Americas (0.27 per 100,000) regions had the highest trainee densities, while the Southeast Asia (0.04 per 100,000) and African (0.05 per 100,000) regions had the lowest densities. Among countries with training programs, LICs had the poorest availability of subspecialty training and resources such as cadaver laboratories and conference stipends for trainees. Training program accreditation processes were more common in HICs (81.8%) than in low- and middle-income countries (LMICs; 69.2%) with training programs., Conclusions: The authors estimate that there are at least 1261 neurosurgery training programs with 10,546 total trainees worldwide. The density of neurosurgery trainees was disproportionately higher in HICs than LMICs, and the WHO European and Americas regions had the highest trainee densities. The trainee workforce in LICs had the poorest access to subspecialty training and advanced resources.

Objectives: Epilepsy is a common neurological condition in low- and middle-income countries (LMICs). This study aims to systematically review, analyze, evaluate, and synthesize information on the current state of medical and surgical management and outcomes of epilepsy in LMICs., Materials and Methods: Systematic searches were conducted on MEDLINE, EMBASE, World Health Organization Global Index Medicus, African Journals Online, WOS, and Scopus, covering the period from the inception of the databases to August 18 th , 2021, focusing on studies reporting management and outcomes of epilepsy in LMICs., Results: A total of 2298 unique studies were identified, of which, 48 were included (38035 cases). The mean age was 20.1 ± 19.26 years with a male predominance in 60.92% of cases. The type of seizure commonly reported in most of the studies was absence seizures ( n = 8302, 21.82%); partial focal seizure ( n = 3891, 10.23%); and generalized tonic-clonic seizures ( n = 3545, 9.32%) which were the next most common types of seizures. Mesiotemporal epilepsy was less frequently reported ( n = 87, 0.22%). Electroencephalogram was commonly used ( n = 2516, 6.61%), followed by computed tomography scan ( n = 1028, 2.70%), magnetic resonance imaging ( n = 638, 1.67%), and video telemetry ( n = 484, 1.27%) in the care of patients with seizures. Primary epilepsy was recorded in 582 patients (1.53%) whereas secondary epilepsy was present in 333 patients (0.87%). Carbamazepine was the most used anti-epileptic drug ( n = 2121, 5.57%). Surgical treatment was required for 465 (1.22%) patients., Conclusion: In LMICs, epilepsy is underreported. There is still a lack of adequate tools for the diagnosis of primary or secondary epilepsy as well as adequate access to medical management of those reported., Competing Interests: There are no conflicts of interest., (© 2024 Published by Scientific Scholar on behalf of Journal of Neurosciences in Rural Practice.)

Introduction: The clinical presentation of coronavirus disease 2019 (COVID-19) can vary widely, and while the primary infection involves the respiratory system, other organs can also be affected. This study presents the clinical and epidemiological characteristics of hospitalized COVID-19 patients in a tertiary hospital in Ado Ekiti, South-West Nigeria., Materials and Methods: This is a retrospective study involving COVID-19 patients admitted to the isolation ward between August 2020 and January 2021. The data used for this study was obtained from the patient's medical record, which includes demographic characteristics, clinical presentation, baseline co-morbidities, and laboratory investigations., Results: The average age of the patients was 60.3 years, and more than two-thirds were male. The most common symptoms were fever, shortness of breath, cough, and tiredness. Comorbidities identified among the patients included diabetes mellitus, heart disease, obesity, and chronic kidney disease. The most common radiological findings were bilateral homogeneous patchy opacities and peripheral fluffy infiltrates. The overall mortality rate was 21.9%, with 13 deaths in patients with severe disease. Age and duration of admission were found to be significant predictors of death., Conclusion: The results of this study provide valuable insights into the clinical presentation of COVID-19 in Nigeria and may guide future management strategies for similar infections., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Dada et al.)

Objective: The current study highlights the differences in surgery wait times and postoperative length of hospital stay (LOS) for brain tumor patients between high income countries (HICs) and low- and middle-income countries (LMICs), and across countries with different payer health systems., Methods: A systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) guidelines. Outcomes of interest were surgery wait time and postoperative LOS., Results: Fifty-three articles were included totaling 456,432 patients. Five studies discussed surgery wait times and 27 discussed LOS. Three HIC studies reported mean surgery wait time of 4 days (SD not reported), 33 ± 13 days, and 34 ± 39 days, and 2 LMIC studies reported median surgery wait time of 4.6 (1-15) and 50 (13-703) days. Mean LOS was 5.1 days (95% CI: 4.2-6.1 days) from 24 HIC studies and 10.0 days (95% CI: 4.6-15.6 days) from 8 LMIC studies respectively. Mean LOS was 5.0 days (95% CI: 3.9-6.0 days) from countries with mixed payer system, and 7.7 days (95% CI: 4.8-10.5 days) from countries with single payer systems., Conclusions: There are limited data on surgery wait-times yet slightly more data on postoperative LOS. Despite a wide range of wait times, mean LOS in brain tumor patients tended to be longer in LMICs than HICs and longer for countries with single payer health systems than mixed payer health systems. Further studies are needed to evaluate surgery wait times and LOS for brain tumor patients more accurately., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: The protocol presents the methodology of a scoping review that aims to synthesise contemporary evidence on the management and outcomes of intracranial fungal infections in Africa., Methods and Analysis: The scoping review will be conducted in accordance with the Arksey and O'Malley's framework. The research question, inclusion and exclusion criteria and search strategy were developed based on the Population, Intervention, Comparator, Outcome framework. A search will be conducted in electronic bibliographic databases (Medline (OVID), Embase, African Journals Online, Cochrane Library and African Index Medicus). No restrictions on language or date of publication will be made. Quantitative and qualitative data extracted from included articles will be presented through descriptive statistics and a narrative description., Ethics and Dissemination: This study protocol does not require ethical approval. Findings will be reported in a peer-reviewed medical journal and presented at local, regional, national and international conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Research serves to bolster clinical neurosurgery by critically assessing various disease pathologies, while identifying important challenges and opportunities. However, there is limited information on the landscape of the Ghanaian neurosurgical literature., Methods: A scoping review and bibliometric analysis was conducted in accordance with PRISMA guidelines. PubMed, Embase, Global Index Medicus, and Web of Science electronic databases were searched from inception until December 21, 2021 for English language articles about neurosurgery in Ghana., Results: 927 articles were identified and 66 were ultimately included in the analysis. A majority of them, 42.4%, were retrospective cohort studies, with 62.1% published after 2010. There were no randomized controlled or basic science studies. Most articles were published in the West African Journal of Medicine (24.2%) and non-infectious/non-traumatic spinal pathology was the most commonly discussed topic (22.7%); 66.7% of articles included only authors affiliated with Ghanaian institutions, and international collaborators frequently originated from the United States (15.9%). Only 22.7% of the manuscripts reported a funding source. Commonly reported challenges included limited sample sizes, delays in diagnosis and treatment, and lack of proper diagnostic tools and specialized care., Conclusions: This review revealed that while the Ghanaian academic neurosurgery output has been increasing over time, these have been limited to cohort studies largely assessing spine pathology. The Ghanaian neurosurgical research environment may be bolstered by an increase in research funding, the establishment of longitudinal clinical databases, training in research methodology, increased incentives for researchers, strengthening of research collaborative networks, and increased engagement of neurosurgical trainees in research., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Africa bears more than 15% of the global burden of neurosurgical disease; however, it has the lowest neurosurgical workforce density worldwide. The past decade has seen an increase in neurosurgery residency programs on the continent. It is unclear how these residency programs are similar or viable. This study highlights the current status and interdepartmental and regional differences, with the main objective of offering a template for improving the provision of neurosurgical education on the continent., Methods: PubMed and Google Scholar were searched using keywords related to "neurosurgery," "training," and "Africa" from database inception to October 13, 2021. The residency curricula were analyzed using a standardized and validated medical education curriculum viability tool., Results: Curricula from 14 African countries were identified. The curricula differed in resident recruitment, evaluation mode and frequency, curriculum content, and length of training. The length of training varied from 4 to 8 years, with a mean of 6 years. The Eastern African region had the highest number of examinations, with a mean of 8.5. Few curricula had correlates of viability: ensuring that the instructors are competent (64.3%), prioritization of faculty development (64.3%), faculty participation in decision making (64.3%), prioritization of resident support services (50%), creating a conducive environment for quality education (42.9%), and addressing student complaints (28.6%)., Conclusions: There are significant differences in the African postgraduate neurosurgical education curriculum warranting standardization. This study identifies areas of improvement for neurosurgical education in Africa., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Africa has an increased burden of neurosurgical diseases with an estimate of 1,986,392 neurosurgical cases, 108,824 neurosurgical case capacity, and 1,877,568 case deficits yearly. Literature suggests that about 8420 neurosurgeons are needed to fill this vast gap. The main objective of this study is to elucidate barriers encountered in pursuing neurosurgery training in the African context., Methods: A cross-sectional electronic survey, developed in English and subsequently translated into French, was utilized. This was disseminated among medical students, medical interns, and junior doctors in all 5 African regions., Results: A total of 491 responses were received from the following 5 African regions: West Africa (30.5%), East Africa (30.3%), Central Africa (18.1%), North Africa (11.8%), and Southern Africa (9.2%). Of the participants, 55.2% were men and 44.8% were women. Seventy-six percent of respondents were aware of the neurosurgery deficit in Africa. Barriers to pursuing neurosurgery included discouragement from others over lack of an "ideal personality" trait, culture/cultural beliefs as related to gender roles, lack of mentorship, inadequate neurosurgical training opportunities, poor health infrastructure for neurosurgical practice in Africa, poor patient outcomes, and challenges with work/life balance were some of the barriers highlighted to pursuing neurosurgical career on the continent., Conclusion: Even with its robust population growth, Africa is not producing enough neurosurgeons to meet the demands of the population due to several barriers. Delineating these challenges and barriers represents an important step in developing sustainable mechanisms for recruitment, training, mentorship, and support of burgeoning African neurosurgeons., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The aim of the present work is to evaluate the rate and mechanisms of the aerobic biodegradation of biopolymer blends under controlled composting conditions using the CO 2 evolution respirometric method. The biopolymer blends of poly (butylene adipate terephthalate) (PBAT) blended with poly (lactic acid) (PLA), and PBAT blended with poly (butylene succinate) (PBS) by melt extrusion, were tested to evaluate the amount of carbon mineralized under home and industrial composting conditions. The changes in the structural, chemical, thermal and morphological characteristics of the biopolymer blends before and after biodegradation were investigated by FT-IR, DSC, TGA, XRD and SEM. Both blends showed higher degradation rates under industrial composting conditions, when compared to home composting conditions. This was confirmed by FT-IR analysis showing an increase in the intensity of hydroxyl and carbonyl absorption bands. SEM revealed that there was microbial colony formation and disintegration on the surfaces of the biopolymer blends. The obtained results suggest that industrial composting conditions are the most suitable for an enhanced biodegradation of the biopolymer blends viz PBAT-PBS and PBAT-PLA.

Introduction: Africa has the second highest neurosurgical workforce deficit globally. Despite the many recent advancements in increasing neurosurgical access in Africa, published reports have shown that the vast majority of undergraduate students have little or no exposure to neurosurgery. The lack of exposure may pose a challenge in reducing the neurosurgical workforce deficit, which is one of the long-term strategies of tackling the unmet burden of disease. Students may also miss the opportunity to appreciate the specialty and its demands as well as nurture their interest in the field. This study aims to assess the impact of a neurosurgical rotation during medical school in shaping the perception and interest of students towards a career in neurosurgery., Methods: The cross-sectional study will be conducted through the dissemination of a self-administered e-survey hosted on Google Forms from 21st February 2021 to 20th March 2021. The survey will contain five-point Likert scale, multiple-choice and free-text questions. The structured questionnaire will have four sections with 27 items: (i) socio-demographic background, (ii) neurosurgical experience, (iii) perception towards a neurosurgical career and (iv) interest in a neurosurgical career. All consenting medical students in African medical schools who are in their clinical years (defined as fourth to sixth years or higher years of study) will be eligible. Odds ratios and their 95% confidence intervals, Wilcoxon rank-sum test, Welch t -test and adjusted logistic regression models will be used to test for associations between independent and dependent variables. Statistical significance will be accepted at P  < 0.05., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2022.)

Background: The Coronavirus disease (COVID-19) pandemic as a large scale stressor could have negative effects on the mental health of medical students. Since gender differences in mental health may exist, it is important to see if a large scale stressor like the pandemic may be associated with variances in the psychological distress between both genders., Objectives: To assess and compare the psychological distress of male and female medical students during the COVID-19 pandemic., Methods: A cross-sectional survey was carried out among 1010 medical students from three universities in southwestern Nigeria within the first six months of the first reported case of the COVID-19 pandemic. The respondents were purposively selected. Data was obtained online on participants' demographic and psychological distress using the General Health Questionnaire 12 (GHQ-12). Data was analyzed using the SPSS version 21, student t and chi-square tests were used to assess gender differences, and multivariate regression to assess the predictors of psychological distress among both genders. p values less than 0.05were considered statistically significant., Results: Overall, female participants (OR=1.455, 95% CI= 1.095-1.936) were twice more likely to have experienced psychological distress than males during the COVID-19 pandemic. Age (OR=0.922, 95% CI= 0.867-0.979), being in pre-clinical years (OR= 1.394, 95% CI= 1.004-1.938), having a family income less than 100,000 naira (OR= 1.379, 95% CI=1.442-6.723) a previous history of mental illness (OR=3.077, 95% CI= 1.430-6.615) and having a relative/acquaintance diagnosed with COVID 19(OR=1.646, 95% CI= 1.062-2.551) were independently associated with psychological distress among the respondents. When comparing both genders, among females, age (OR=0.886, 95% CI= 0.803-0.978), family income less than 100,000 naira (OR=1.898, 95% CI= 1.306-2.759) and a previous history of mental illness (OR=5.266, 95% CI= 1.894-14.635) were associated with psychological distress, while, being in pre-clinical years (OR= 1.713, 95% CI= 1.052-2.790) was associated with psychological distress among males., Conclusion: Females had more psychological distress compared to male students. It is recommended that gender-specific interventions addressing psychological distress among medical students are instituted., (© 2022 Idowu OM et al.)

Background: Low-and middle-income countries (LMICs) are disproportionately affected by neurosurgical burden of disease. This health inequity causes constraints in decision-making. Neurosurgical ethics helps us to assess the moral acceptability and effectiveness of clinical decisions. We aimed to assess ethical neurosurgical care and its effect on patient satisfaction in Cameroon., Methods: Two questionnaires hosted on Google Forms were administered among inpatients and staff at two Cameroonian neurosurgery centers. The questionnaires covered the factors influencing health outcomes and ethics. Data were collected from November 11, 2020, to March 11, 2021 and analyzed with SPSS v 26 to generate non-parametric tests with a threshold of significance at 0.05., Results: Seventy patients and twenty healthcare providers responded to the survey. Most patients faced financial hardship (57.1%; 95% CI = 45.7-68.6%), and felt that this affected the care they received ( P = 0.02). Patients noticed changes in the care plan and care delivery attributable to the neurosurgical units' lack of resources. According to the patients and caregivers, these changes happened 31.0-50.0% of the time (42.9%, 95% CI = 5.7-21.4%). The majority of patients were pleased with their involvement in the decision-making process (58.6%; 95% CI = 47.1-70.0%) and felt their autonomy was respected (87.1%; 95% CI = 78.6-94.3%)., Conclusion: Multiple challenges to neurosurgical ethical care were seen in our study. Multimodal interventions based on the four ethical principles discussed are necessary to improve ethical neurosurgical decision-making in this low resource setting., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ankeambom, Motah, Ewane, Shlobin, Mbangtang, Dada, Kabulo, Tetinou, Endalle, Kanmounye, Jokonya and Esene.)

Objective: Africa has the second highest neurosurgical workforce deficit globally and many medical students in Africa lack exposure to the field. This study aims to assess the impact of a neurosurgical rotation during medical school in shaping the perception and interest of students toward a career in neurosurgery., Study Design: Cross-sectional study., Methods: A Google form e-survey was disseminated to African clinical medical students between February 21st and March 20th, 2021. Data on exposure and length of neurosurgical rotation and perception of, and interest in, neurosurgery were collected. Data was analyzed using descriptive statistics and adjusted logistic regression modeling., Results: Data was received from 539 students in 30 African countries (30/54, 55.6%). The majority of participants were male and were from Kenya, Nigeria and South Africa. Most students had undertaken a formal neurosurgery rotation, of which the majority reported a rotation length of 4 weeks or less. Students who had more than 4 weeks of neurosurgical exposure were more likely to express a career interest in neurosurgery than those without [odds ratio (OR) = 1.75, p < 0.04] and men were more likely to express interest in a neurosurgical career compared to women (OR = 3.22, p < 0.001), after adjusting for other factors., Conclusion: Neurosurgical exposure is a key determinant in shaping the perception and interest of medical students toward a career in neurosurgery. Our findings support the need: i) for a continent-wide, standardized curriculum guide to neurosurgical rotations and ii) to advocate for gender inclusivity in education and policy-making efforts across the African continent., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Dada, Ooi, Bukenya, Kenfack, Le, Ohonba, Adeyemo, Narain, Awad, Barrie, Sichimba, Ogunfolaji, Kitonga, Oriaku, Bamimore, Okor and Rominiyi.)

Background: Despite the growing incidence of traumatic brain injury (TBI) in Sub-Saharan Africa, there is yet to be a study to map the current burden of the disease on the continent. This scoping review aims to outline the literature on TBI., Methods: This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews. A search string was developed to identify studies relating to TBI epidemiology, management, and outcomes. The search was applied to Medline, Embase, and Global Medicus Index., Results: In total, 107 studies were included in the final analysis. More than one half originated from South Africa. Seventy-five studies were published in 2013 or later. Studies recruited a median of 115 patients: 83.5 male and 31 female. TBI affected all age groups (range = 0-105 years) and sexes but was more common among young males aged 20-40. Road traffic accidents caused TBI in a median of 71 patients. Other major causes included assault (median = 39.5) and falls (median = 12.5). Craniectomies were the most commonly reported surgical treatment (18.7%) followed by burr holes (7.5%). Four studies (3.7%) reported delays in seeking neurotrauma care, with delays in reaching a neurotrauma facility and delays in receiving care being reported in 15 studies (14%) each. Glasgow Outcome Scale score was reported in 28 (26.1%) studies, whereas quality of life measures were reported in 2 (1%). Younger age was associated with favorable outcomes., Conclusions: There is an increased need for TBI research, education, and training in Sub-Saharan Africa. This will aid stakeholders in optimizing patient management and outcome., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Global surgery is a growing movement worldwide, but its expansion has not been quantified. Google Search is the most popular search engine worldwide, and Google Trends analyzes its queries to determine popularity trends. We used Google Trends to analyze the regional and temporal popularity of global surgery (GS). Furthermore, we compared GS with global health (GH) to understand if the two were correlated., Methods: This is a retrospective cross-sectional study examining Google Trends of GS and GH. We searched the terms "global surgery" and "global health" on Google Trends (Google Inc., CA, USA) from January 2004 to May 2021. We identified time trends and compared the two search terms using SPSS v26 (IBM, WA, USA) to run summary descriptive analyses and Wilcoxon rank-sum tests., Results: The ten countries most interested in GS were India (5.0%), the United Kingdom (5.0%), Ireland (4.0%), the United States (4.0%), Australia (3.0%), Canada (3.0%), New Zealand (3.0%), Germany (2.0%), South Africa (2.0%), and Nigeria (1.0%). GS became more popular after 2015 (2.3% vs. 1.3%, P < 0.001) and was consistently less popular than GH (1.6% vs. 45.3%, P = 0.04). The difference between GS and GH interest levels increased after 2015 (45.4% vs. 42.9%, P = 0.04)., Conclusion: GS is less popular than GH, more popular in high-income countries, and has become more popular after 2015 when the Lancet Commission on Global Surgery published its seminal report. The World Health Organization passed resolution WHA 68.15. Future advocacy efforts should target low- and middle-income countries primarily., Competing Interests: The authors do not have any conflicts of interest to disclose., (© 2021 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Background: Worldwide, neurological disorders are the leading cause of disability-adjusted life years lost and the second leading cause of death. Despite global health capacity-building efforts, each year, 22.6 million individuals worldwide require neurosurgeon's care due to diseases such as traumatic brain injury and hydrocephalus, and 13.8 million of these individuals require surgery. It is clear that neurosurgical care is indispensable in both national and international public health discussions. This study highlights the role neurosurgeons can play in supporting the global health agenda, national surgical plans, and health strengthening systems (HSS) interventions. Methods: Guided by a literature review, the authors discuss key topics such as the global burden of neurosurgical diseases, the current state of neurosurgical care around the world and the inherent benefits of strong neurosurgical capability for health systems. Results: Neurosurgical diseases make up an important part of the global burden of diseases. Many neurosurgeons possess the sustained passion, resilience, and leadership needed to advocate for improved neurosurgical care worldwide. Neurosurgical care has been linked to 14 of the 17 Sustainable Development Goals (SDGs), thus highlighting the tremendous impact neurosurgeons can have upon HSS initiatives. Conclusion: We recommend policymakers and global health actors to: (i) increase the involvement of neurosurgeons within the global health dialogue; (ii) involve neurosurgeons in the national surgical system strengthening process; (iii) integrate neurosurgical care within the global surgery movement; and (iv) promote the training and education of neurosurgeons, especially those residing in Low-and middle-income countries, in the field of global public health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Lartigue, Dada, Haq, Rapaport, Sebopelo, Ooi, Senyuy, Sarpong, Vital, Khan, Karekezi and Park.)

Introduction: Most cases of paroxysmal sympathetic hyperactivity (PSH) result from traumatic brain injury (TBI). Little is known about its pathophysiology and treatment, and several neuroprotective drugs are used including beta-blockers. The aim of our study is to collate existing evidence of the role of beta-blockers in the treatment of PSH., Methods: We searched MEDLINE, ResearchGate, and Google Scholar, for keywords related to PSH and the role of beta-blockers in moderate-to-severe TBI on September 23, 2020. Two authors blindly screened the articles found with Rayyan. Both resolved their conflicts by mutual consent. If no solution was found, a third author was consulted. Simple descriptive data analysis was performed and the results were presented both in a narrative and tabular form., Results: Of the 19 items found, 10 met the criteria for inclusion. 50% were systematic reviews without meta-analysis, 40% were observational studies, and 10% were experimental studies. Propranolol was the main beta-blocker found in 80% of the studies and was the only molecule used in the treatment of paroxysmal sympathetic hyperactivity in 40% of the included studies. Only two studies evaluated and showed a significant association between beta-blockers and mortality rate (5.1% vs. 10.8%; P =0.03), (3% vs. 15%; P =0.002), respectively., Conclusion: Propranolol is the beta-blocker that has been shown to be effective in reducing the length of stay and mortality rate in moderate-severe traumatic brain injury patients with PSH. However, further studies are needed to precisely define the terms and conditions of its use., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Stéphane Nguembu et al.)

Background: There is no comprehensive report of neurosurgery postgraduate education in Africa. This narrative review aimed to map out the landscape of neurosurgery training in Africa and highlight similarities and differences in training., Methods: The keywords "neurosurgery," "education," and "Africa" were searched on PubMed and Google Scholar from inception to January 17, 2021. Next, a complementary hand search was conducted on Google using the keywords "neurosurgery," "residency," and the individual African countries in English and official languages. The relevant data were extracted and compiled into a narrative review., Results: A total of 76 African training programs that recruit more than 168 trainees each year were identified. Less than half (40.7%, n = 22) of African countries have at least 1 neurosurgery training program. Egypt (n = 15), Algeria (n = 14), and Nigeria (n = 10) have the highest number of training programs, whereas Algeria (0.33), Egypt (0.15), and Libya (0.15) have the highest number of training programs per 1 million inhabitants. The College of Surgeons of East, Central, and Southern Africa has 16 programs in 8 countries, whereas the West African College of Surgeons has 17 accredited programs in 3 countries. The duration of training varies between 4 and 8 years. There is limited information available in the public domain and academic literature about subspecialty fellowships in Africa., Conclusions: This review provides prospective applicants and African and global neurosurgery stakeholders with information to advocate for increased investment in African neurosurgery training programs., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Bacteriuria in urinary tract infection is severe and associated with considerable morbidity if left untreated. Therefore, the aim of the study was to evaluate the prevalence of bacteriuria among primary and secondary school pupils in Akure North Local Government Area. The study included subjects from the highly populated schools in this local government area. The samples analyzed were exclusively collected from volunteer pupils whose age and sex were documented by the questionnaire distributed to them. Urine samples were collected randomly under aseptic conditions from 250 pupils aged 5-20 attending primary and secondary schools. Urine samples were subjected to microbiological analysis by culturing 1 mL each on nutrient agar, mannitol salt agar, cystine lactose electrolyte deficient agar, plate count agar and chocolate agar for possible isolation of any bacteria. Bacterial colonies were enumerated and identified to the species level. Analytical indices revealed bacteriuria to be more common in female (41.2%) than male (3.2%) subjects. The highest bacterial count in female urine samples was 281 x 10(3) against 149 x 10(3) in male samples. A higher infection rate was recorded in secondary school pupils aged 11-20. Escherichia coli predominated among isolated bacteria species with 48.8%. Laboratory results confirmed urinary tract infection in some of the study pupils. As only volunteer pupils submitted their samples for analysis, this small population was represented in the study, predominated by female subjects. None of the pupils showed signs of infection, therefore routine laboratory checkup is important among children in order to limit damage to some of their vital tissues.