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Although randomized interventional studies are the gold standard of clinical study designs, they are not always feasible or necessary. In such cases, observational studies can bring insights into critical questions while minimizing harm and cost. There are numerous observational study designs, each with strengths and demerits. Unfortunately, it is not uncommon for observational study designs to be poorly designed or reported. In this article, the authors discuss similarities and differences between observational study designs, their application, and tenets of good use and proper reporting focusing on neurosurgery.The authors illustrated neurosurgical case scenarios to describe case reports, case series, and cohort, cross-sectional, and case-control studies. The study design definitions and applications are taken from seminal research methodology readings and updated observational study reporting guidelines.The authors have given a succinct account of the structure, functioning, and uses of common observational study designs in Neurosurgery. Specifically, they discussed the concepts of study direction, temporal sequence, advantages, and disadvantages. Also, they highlighted the differences between case reports and case series; case series and descriptive cohort studies; and cohort and case-control studies. Also, they discussed their impacts on internal validity, external validity, and relevance.This paper disambiguates widely held misconceptions on the different observational study designs. In addition, it uses case-based scenarios to facilitate comprehension and relevance to the academic neurosurgery audience.

Predatory journals (PJs) publish research with little to no rigorous peer review in exchange for money. It is unclear what proportion of researchers is vulnerable to PJs and which factors are associated with vulnerability. The aim of this study was to evaluate the vulnerability of African neurosurgery researchers to PJs and identify their correlates.A 3-part electronic survey in English and French versions was distributed via social media to African consultants and trainees from November 1 to December 1, 2021. Bivariable relationships were evaluated with χThere were 101 respondents to the survey (response rate 56.1%). Respondents had mean age of 34.9 years, 82.2% were male (n = 83), 38.6% were consultant neurosurgeons (n = 39), and 33.7% were from Central Africa (n = 34). Of respondents, 66 had published ≥ 1 articles in the past, and 13 had published at least 1 article in a PJ. A PJ had contacted 34 respondents via e-mail, and 8 respondents had reviewed articles for a PJ. The Think. Check. Submit initiative and Beall's list were familiar to 19 and 13 respondents, respectively. Publication in PJs was correlated with the respondent's age (R = 0.23, P = 0.02) and total scholarly output (R = 0.38, P0.01).Young African neurosurgery researchers are vulnerable to PJs primarily because they are not familiar with the concept of PJs or how to identify them.

Background Africa bears >15% of the global burden of neurosurgical disease. Yet to date, Africa still has the lowest neurosurgical workforce density globally, and efforts to fill this gap by 2030 need to be multiplied. Although the past decade has seen an increase in neurosurgery residency programs in the continent, it is unclear how these residency programs are similar or viable. This study aims to highlight the current status of neurosurgical training in Africa as well as the differences within departments, countries or African regions. Methods A literature search using keywords related to ‘neurosurgery’, ‘training’, and ‘Africa’ and relevant names of African countries will be performed on PubMed and Google Scholar. If unavailable online, the authors will contact local neurosurgeons at identified training programmes for their curricula. The residency curricula collected will be analysed against a standardized and validated medical education curriculum viability tool. Results The primary aim will be the description of African neurosurgical curricula. In addition, the authors will perform a comparative analysis of the identified African neurosurgical curricula using a standardized and validated medical education curriculum viability tool. Discussion This study will be the first to evaluate the current landscape of neurosurgery training in Africa and will highlight pertinent themes that may be used to guide further research. The findings will inform health system strengthening efforts by local training programme directors, governments, policymakers and stakeholders.

Introduction\ud 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, interdepartmental and regional differences, with the main objective of offering a template for improving the provision of neurosurgical education on the continent.\ud \ud Method\ud PubMed and Google Scholar were searched using keywords related to “neurosurgery,” “training,” and “Africa” from database inception to 10/13/2021. The residency curricula were analyzed using a standardized and validated medical education curriculum viability tool.\ud \ud Results\ud 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 four to eight years with a mean of six 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%).\ud \ud Conclusion\ud There are significant differences in the African postgraduate neurosurgical education curriculum warranting standardization. This study has identified areas of improvement for neurosurgical education in Africa.

Introduction: Gliomas are tumors of the supporting cells of the central nervous system. They have great heterogeneity in their clinical and pathological features as well as prognosis. There is paucity of glioma epidemiology data in Zimbabwe. We carried out a study to determine the landscape, presentation, and characteristics of brain gliomas in Zimbabwe. Materials and Methods: A prospective cross-sectional study was conducted in Zimbabwe over a 2 years period to determine descriptive epidemiological data with regards to demographic distribution, presentation, and tumor characteristics. Consecutive patients from across the country with brain gliomas were recruited in the study. Results: A total of 112 brain tumors were diagnosed histologically. Of these 43.8% (n = 49) were gliomas and hence recruited in the study. The mean age of study participants was 40.3 years (standard deviation = 23.1 years), range 3–83 years. Male to female ratio (M:F) was 1:1. The study population consisted of 14% caucasians (n = 7), 83.7% black (n = 41), and 2% (n = 1) were of mixed race. Eighty-six percent (n = 42) of participants were from urban areas. The most common presenting complaint was headache in 87.8% (n = 43). The majority (61.2%) presented with a Karnofsky score ≥70%. Astrocytomas were the most common gliomas constituting 57.1% (n = 28), followed by ependymomas and oligodendrogliomas being 8.1% (n = 4) each. There was no statistical difference in the hemisphere of the brain involved (P = 0.475). Eight percent of the population were HIV positive (n = 4). Age above 60 years has an adjusted odds ratio of 13 for presenting with high-grade tumors. Conclusion: There is a disproportionately high number of gliomas among Caucasians, urban dwellers, and those gainfully employed. The prevalence of HIV in glioma patients is less than that of the general population.

Background. Traumatic brain injury (TBI) imposes an enormous burden on health systems and it is the most frequent cause of hospitalization in children. This study aimed at describing the causes, presentation, management, and outcome of children with TBI admitted at a tertiary referral hospital in Harare, Zimbabwe. Methods. This prospective cohort study was conducted with a convenience sample of children aged ≤ 12 years and admitted with TBI at the study site from June 2018 to May 2019. The children were followed from their admission to one-month post-discharge. Sociodemographic, clinical, and neuroimaging data were collected. The median length of stay was calculated and the Chi-square, Fisher’s exact, and Kruskal Wallis tests were used. Results. 84 children with TBI were recruited. Most were males (66.7%) and (56.0%) had sustained TBI following a motor vehicle accident. An initial period of loss of consciousness that lasted a median of 6.5 (IQR = 4.8) hours was noted in 60.7% of patients. The most common symptom at presentation was headache (61.9%), and mild TBI was the most common type of TBI. Skeletal injuries were the most encountered associated injuries (13.1%) and the majority of patients were managed non-operatively – 79 (94.0%). Most patients (56.0%) experienced upper good recovery at one-month follow-up. Conclusions. Motor vehicle accidents are the main cause of pediatric TBI in Zimbabwe. Most patients do not require surgical treatment and have a good recovery.

Background Individuals living in Schistosoma haematobium endemic areas are often at risk of having other communicable diseases simultaneously. This usually creates diagnostic difficulties leading to misdiagnosis and overlooking of schistosomiasis infection. In this study we investigated the prevalence and severity of coinfections in pre-school age children and further investigated associations between S. haematobium prevalence and under 5 mortality. Methods A community based cross-sectional survey was conducted in Shamva District, Zimbabwe. Using random selection, 465 preschool age children (1–5 years of age) were enrolled through clinical examination by two independent clinicians for the following top morbidity causing conditions: respiratory tract infections, dermatophytosis, malaria and fever of unknown origin. The conditions and their severe sequels were diagnosed as per approved WHO standards. S. haematobium infection was diagnosed by urine filtration and the children were screened for conditions common in the study area which included HIV, tuberculosis, malnutrition and typhoid. Data was analysed using univariate and multinomial regression analysis and relative risk (RR) calculated. Results Prevalence of S. haematobium was 35% (145). The clinical conditions assessed had the following prevalence in the study population: upper respiratory tract infection 40% (229), fever of unknown origin 45% (189), dermatophytosis 18% and malaria 18% (75). The odds of co-infections observed with S. haematobium infection were: upper respiratory tract infection aOR = 1.22 (95% CI 0.80 to 1.87), dermatophytosis aOR = 4.79 (95% CI 2.78 to 8.25), fever of unknown origin aOR = 10.63 (95% CI 6.48–17.45) and malaria aOR = 0.91 (95% CI 0.51 to1.58). Effect of schistosomiasis coinfection on disease progression based on the odds of the diseases progressing to severe sequalae were: Severe pneumonia aOR = 8.41 (95% CI 3.09–22.93), p p = 0.02, severe dermatophytosis aOR = 20.3 (95% CI 4.78–83.20):p = 0.03, and fever of unknown origin aOR = 1.62 (95%CI 1.56–4.73), p = 0.02. Conclusion This study revealed an association between schistosomiasis and the comorbidity conditions of URTI, dermatophytosis, malaria and FUO in PSAC living in a schistosomiasis endemic area. A possible detrimental effect where coinfection led to severe sequels of the comorbidity conditions was demonstrated. Appropriate clinical diagnostic methods are required to identify associated infectious diseases and initiate early treatment of schistosomiasis and co-infections in PSAC.

IntroductionPneumonia is the biggest child killer, after the neonatal period. This is especially so in children from developing countries who are exposed to other infections simultaneously. In this article we investigated the impact of indolentSchistosoma haematobiuminfection on background of a respiratory infectionMethodA cross sectional study with 237 preschool age children with a respiratory infection, was performed during winter months in a schistosomiasis endemic area. Participants were clinically examined and investigated appropriately. Upper respiratory tract infection (URTI) and pneumonia were defined and classified as per IMCI and WHO guidelines, respectively.S. haematobiuminfection diagnosis was by urine filtration on urine collected over three consecutive days. Data was analysed using SPSS.ResultsS haematobiuminfection prevalence was 29% (69). Prevalence of repiratory infections were as follows: common cold 79% (188), pneumonia 15% (36) and severe pneumonia 6% (15). Eighty-one percent of participants with the common cold wereS. haematobiumnegative, whilst 80 % of those with severe pneumonia were infected. Schistosomiasis infected children were at greater odds of developing; pneumonia (aOR=3.61 (95% CI 1.73-7.55) and severe pneumonia (aOR=21.13 (95% CI 4.65-95.89). High intensity S. haematobium infection was associated with an increased risk of severe pneumonia RR= 23.78(95% CI 6.86-82.32). Mortality from coinfection emanated from severe pneumonia and severeS. haematobiuminfection intensity (RR= 26.56 (95% CI 1.49 to 473.89). Number needed to harm (NNH) forS. haematobiuminfected children who develop respiratory tract infection was 4:1 for pneumonia and 5:1 for severe pneumonia.ConclusionThe study demonstrated that coinfection with Schistosomiasis increases morbidity and mortality from respiratory tract infections by up to 20 times in children less than five years old. There is need to cover schistosomiasis screening and treatment in children under 5 years old to avert mortality and morbidity due to coinfection with respiratory infections.

Introduction Prompt diagnosis of acute schistosomiasis benefits the individual and provides opportunities for early public health intervention. In endemic areas schistosomiasis is usually contracted during the first 5 years of life, thus it is critical to look at how the infection manifests in this age group. The aim of this study was to describe the prodromal signs and symptoms of early schistosomiasis infection, correlate these with early disease progression and risk score to develop an easy to use clinical algorithm to identify early Schistosoma haematobium infection cases in resource limited settings. Methodology Two hundred and four, preschool age children who were lifelong residence of a schistosomiasis endemic district and at high risk of acquiring schistosomiasis were followed up from July 2019 to December 2019, during high transmission season. The children received interval and standard full clinical evaluations and laboratory investigations for schistosomiasis by clinicians blinded from their schistosomiasis infection status. Diagnosis of S. haematobium was by urine filtration collected over three consecutive days. Signs and symptoms of schistosomiasis at first examination visit were compared to follow-up visits. Signs and symptoms common on the last schistosomiasis negative visit (before a subsequent positive) were assigned as early schistosomiasis infection (ESI), after possible alternative causes were ruled out. Logistic regression identified clinical predictors. A model based score was assigned to each predictor to create a risk for every child. An algorithm was created based on the predictor risk scores and validated on a separate cohort of 537 preschool age children. Results Twenty-one percent (42) of the participants were negative for S. haematobium infection at baseline but turned positive at follow-up. The ESI participants at the preceding S. haematobium negative visit had the following prodromal signs and symptoms in comparison to non-ESI participants; pruritic rash adjusted odds ratio (AOR) = 21.52 (95% CI 6.38–72.66), fever AOR = 82 (95% CI 10.98–612), abdominal pain AOR = 2.6 (95% CI 1.25–5.43), pallor AOR = 4 (95% CI 1.44–11.12) and a history of facial/body swelling within the previous month AOR = 7.31 (95% CI 3.49–15.33). Furthermore 16% of the ESI group had mild normocytic anaemia, whilst 2% had moderate normocytic anaemia. A risk score model was created using a rounded integer from the relative risks ratios. The diagnostic algorithm created had a sensitivity of 81% and a specificity of 96.9%, Positive predictive value = 87.2% and NPV was 95.2%. The area under the curve for the algorithm was 0.93 (0.90–0.97) in comparison with the urine dipstick AUC = 0.58 (0.48–0.69). There was a similar appearance in the validation cohort as in the derivative cohort. Conclusion This study demonstrates for the first time prodromal signs and symptoms associated with early S. haematobium infection in pre-school age children. These prodromal signs and symptoms pave way for early intervention and management, thus decreasing the harm of late diagnosis. Our algorithm has the potential to assist in risk-stratifying pre-school age children for early S. haematobium infection. Independent validation of the algorithm on another cohort is needed to assess the utility further., Author summary Schistosoma haematobium causes urogenital infection and in endemic areas schistosomiasis is usually contracted during the first 5 years of life, thus it is critical to look at how the infection manifests in this age group. Prompt diagnosis of acute schistosomiasis is required to benefit the individuals and provide opportunities for early treatment and public health intervention. The study examined symptoms that correlated with early disease progression and risk scored to develop an easy to use clinical algorithm to identify early S. haematobium infection cases. The children received standard full clinical evaluations by clinicians who were blinded from schistosomiasis diagnosis by parasitological examination. An algorithm was created based on the predictor risk scores and participants had the following prodromal signs and symptoms; pruritic rash, abdominal pain, pallor, abdominal pain, inguinal lymphadenopathy and a history of facial/body swelling within the previous month. A risk score model, diagnostic algorithm, was created that compared to urine dipstick and parasitology. This study demonstrates the clinical signs and symptoms associated with early S. haematobium infection in pre-school age children. These prodromal signs and symptoms pave way for early intervention and management, thus decreasing the harm of late diagnosis common in populations from endemic areas.

Background Tumors are known to increase the risk of infections, more-so in the central nervous system where tumors may require insertion of surgical hardware/shunts such as in craniopharyngiomas. In contrast, our observation demonstrate that infections of surgical hardware are surprisingly scarce in craniopharyngioma cases. In this study, we explore the possibility of antimicrobial effects of craniopharyngioma cystic fluid. Methods The antibacterial effect of samples of craniopharyngioma cystic fluid against the selected human pathogens Escherichia. coli, S. aureus and S. pneumoniae was determined using the agar disc diffusion method. These results were compared with that of streptomycin and ampicillin.Results The samples of craniopharyngioma cystic fluid inhibited growth of gram-positive bacteria (S. aureus and S. pneumoniae) but not the gram-negative bacteria, E. coli. The samples showed highest zones of S. pneumoniae growth inhibition.Conclusion Craniopharyngioma cystic fluid demonstrated significant antibacterial properties against gram positive bacteria. More studies need to be carried out to further elucidate this unique finding.

Tumours are known to increase the risk of infections, especially those occurring in the central nervous system where insertion of surgical hardware/shunts such as in craniopharyngiomas may be required. However, infections are surprisingly scarce in craniopharyngioma cases. In this study, we explored the possibility of antimicrobial effects of craniopharyngioma cystic fluid. The antibacterial effect of craniopharyngioma cystic fluid samples against selected human pathogens: Escherichia. coli, S. aureus and S. pneumoniae were determined using the agar disc diffusion method. Streptomycin and ampicillin were used as controls. The test organisms were cultured in Mueller-Hinton broth overnight at 37 °C. McFarland standard was used as a reference to adjust the inoculum size of each test organism to a concentration of 1 × 106 CFU/ml using sterile broth. The craniopharyngioma cystic fluid inhibited growth of Gram-positive bacteria S. aureus and S. pneumoniae, but not the Gram-negative bacteria, E. coli. The samples showed the highest zones of S. pneumoniae growth inhibition of up to 20.0 ± 1.0 mm compared with 18.0 ± 1.0 mm of streptomycin and 9.0 ± 0.0 mm of ampicillin. Craniopharyngioma cystic fluid showed significant antibacterial properties against Gram-positive bacteria. This novel finding has implications in the way we view infections in craniopharyngioma patients. More studies need to be carried out to further elucidate this unique finding and possibly exploit these antimicrobial properties.

Background: Individuals living in S. haematobium endemic areas are often at risk of having other communicable diseases, simultaneously. This usually creates diagnostic difficulties leading to misdiagnosis and overlooking schistosomiasis infection. In this study we investigated the prevalence and effects of coinfections in pre-school age children.Methodology : About 465 Preschool age children were clinically examined for the following top morbidity conditions: respiratory tract infections, dermatophytosis, malaria and fever of unknown origin. S. haematobium infection was diagnosed by urine filtration and the children were screened for other communicable infections common in rural areas.Results : Prevalence of S. haematobium was 35% (145). A positive relationship between S. haematobium prevalence and under-5 mortality rate in Zimbabwean provinces was demonstrated. The odds of co-infections observed for S. haematobium were: upper respiratory tract infection AOR = 1.98 (95% CI 1.657 to 2.48), dermatophytosis AOR = 5.10 ( 95% CI 2.99 to 8.72), fever of unknown origin AOR = 9.07 ( 95% CI 5.70 to 14.44) and malaria AOR = 0.91 ( 95% CI 0.54 to1.54). The risk ratio of having S. haematobium and co-infections in children who had fever of unknown origin 138%, dermatophytosis 38%, Upper respiratory tract infection 1% increase risk and malaria had a 2% reduced risk. Odds of having severe sequelae following the above conditions were: severe pneumonia AOR = 8.41(95%CI 3.09-22.93), complicated malaria AOR = 7.09 (95% CI 1.51-33.39), severe and persistent dermatophytosis AOR=20.3 (95% CI 4.78-83.2) and seizures AOR=1.62 (95%CI 1.56-4.73).Conclusion : This study is novel as it identifies a possible causal relationship between S. haematobium infection and top morbidity conditions in children under five years. There is need to alert policy makers so as to initiate early treatment of schistosomiasis in pre-school age children.

Tumours are generally associated with a high rate of infections. More so for craniopharyngiomas which may have cranial hardware which increases the infection risk. We have however observed that in reality, cystic fluid shunts in craniopharyngioma patients have an unusually low infection rate, sometimes despite significant risk factors. We present 2 cases of children with histologically confirmed adamantinomatous type craniopharyngioma. Both had ommaya shunts inserted for cystic fluid aspiration as part of treatment. They then presented with exposed shunts but no signs of infection, despite significant risk factors for infection. Studies need to be carried out to determine the factors involved in this seeming omaya shunt infection resistance to these group of patients.

Additional file 1. Study questionaire.

Background: Headaches are common in Chiari Type 1 malformation (CM-1). The prevalence of migraine headaches in CM-1 is similar to that of the general population. However, when migraine headaches occur with CM-1, they tend to have an earlier age of onset, are more frequent and certainly more severe than when they occur without CM-1 association. The exact role or impact of CM-1 in migraine headaches has not been fully elucidated. Case Description: We report a fatal case of status migrainosus in 7 years old with CM-1 and review the literature on the possible associations. Conclusion: Migraines occurring in association with CM-1 pose a management challenge and can be potentially fatal especially if associated with autonomic symptoms. The exact pathophysiological interaction between these two conditions when they occur simultaneously needs to be further elucidated.

Introduction Complex regional pain syndrome (CRPS) is an under diagonised, chronic pain condition commonly described occurring in the extremities. Its occurrence in the trunk is rarely reported and is thought by some to be non existent. Case presentation We report an unusual case of trunkul CRPS post appendectomy which presented with debilitating pain and review relevant literature. Discussion and conclusion We recommend that subsequent descriptions and diagnostic criteria should include the trunk as a site of occurrence of CRPS and not just the extremities. This will help reduce under diagnosis of this important condition., Highlights • CRPS can also occur in the trunk and not only limbs as previously thought. • CRPS can also occur after appendicectomy and surgeons must be wary. • Early diagnosis and treatment are essential for better outcome.

Background: Because nearly 23,000 more neurosurgeons are needed globally to address 5 million essential neurosurgical cases that go untreated each year, there is an increasing interest in task-shifting and task-sharing (TS/S), delegating neurosurgical tasks to nonspecialists, particularly in low- and middle-income countries (LMICs). This global survey aimed to provide a cross-sectional understanding of the prevalence and structure of current neurosurgical TS/S practices in LMICs. Methods: The survey was distributed to a convenience sample of individuals providing neurosurgical care in LMICs with a Web-based survey link via electronic mailing lists of continental societies and various neurosurgical groups, conference announcements, e-mailing lists, and social media platforms. Country-level data were analyzed by descriptive statistics. Results: The survey yielded 127 responses from 47 LMICs; 20 countries (42.6%) reported ongoing TS/S. Most TS/S procedures involved emergency interventions, the top 3 being burr holes, craniotomy for hematoma evacuation, and external ventricular drain. Most (65.0%) believed that their Ministry of Health does not endorse TS/S (24.0% unsure), and only 11% believed that TS/S training was structured. There were few opportunities for TS/S providers to continue medical education (11.6%) or maintenance of certification (9.4%, or receive remuneration (4.2%). Conclusions: TS/S is ongoing in many LMICs without substantial structure or oversight, which is concerning for patient safety. These data invite future clinical outcomes studies to assess effectiveness and discussions on policy recommendations such as standardized curricula, certification protocols, specialist oversight, and referral networks to increase the level of TS/S care and to continue to increase the specialist workforce. Key words: Capacity, Global health, Global neurosurgery, LMIC, Task-sharing, Task-shifting, Workforce

Introduction: Neuromodulation in its various forms is emerging as a promising method of dealing with chronic pain and movement disorders. The scale of ablative vs augmentative procedures seems to be tilting towards augmentative procedures. We observed 8 patients who had failed medical treatment for muscle spasm respond to the cold application. Case summary: We report 2 cases of complete traumatic spinal cord injury patients, who developed severe, medically intractable muscle spasms. We applied cryotherapy to their legs with significant improvement. Outcome measurements: The spasm frequency score dropped immediately from a 4 to 0 in one patient. The other dropped from a 2 to 1 on day one then disappeared by day 7. Spasm severity dropped significantly on the first day in both cases. Conclusion: Cryotherapy as a form of neuromodulation, Is an effective, simple but safe way to symptomatically manage severe medically refractory muscle spasms in spinal cord injured patients. It becomes an important adjunct in the management of these patients in resource-limited settings where surgical options are not readily available.

Cardiovascular disease is a leading cause of mortality in all ages worldwide. Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease (CHD) accounting for 10%. There have been several reports of neurological complications associated with TOF. Although it is known, brain abscess (BA) is a serious complication in patients with uncorrected CHD mostly in the age of 4-7 years-old. We report a case of a 7 year old male who presented with a 3 month history of left sided body weakness and a 3 week history of a headache and fever. Patient was chronically unwell since birth where he would experience occasional episodes of exertional dyspnoea which was never investigated. Chest xray showed a globular-shaped heart. CT scan brain showed a 1,8 x 1,3 x 1,5 cm ring-enhancing lesion in the right parietal region with minimal perilesional vasogenic edema communicating with the body of the lateral ventricle, with enhancement of the ependymal lining of the ventricle; echocardiography revealed ventricular septal defect (VSD), overriding of aorta, obstruction to right ventricular outflow tract and hypertrophy of right ventricle consistent with a diagnosis of TOF. We elected to manage the patient conservatively on intravenous antibiotics, Patient improved significantly neurologically and was transferred to the cardiothoracic surgeons for further management of TOF.

Background Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is associated with an increased prevalence of some malignancies. However, some observational studies have revealed an ever-decreasing prevalence of HIV in glioma patients. The relationship between HIV and brain gliomas has not been well established. Methods A cross-sectional study was carried out in sub-Sahara Africa, a high HIV prevalence setting, to determine the prevalence of HIV among all glioma patients over a 2-year period. Results A markedly reduced prevalence of HIV was found in glioma patients (8.3%) in comparison to the general population (14.3%). The presumably "antiglioma effect" of HIV and/or its treatment resulted in a 42% decrease in glioma occurrence in HIV positive patients compared to HIV negative individuals. Age and sex-adjusted prevalence were also lower among glioma patients with the protective effect observed more in younger patients and female sex. Conclusion Our results corroborate the protective effect of HIV positivity vis-a -vis gliomas. This "antiglioma effect" could be attributed to either the HIV, its treatment, or both. Future studies focused on this "effect" may help unveil better preventative and possible therapeutic avenues for gliomas.