Academic Neurosurgery in Nigeria- Past, Present, and Future: A Review.

Nigeria's neurosurgical field faces profound challenges, including a critically low neurosurgeon-to-patient ratio and significant migration of medical professionals to developed countries. High costs, low socioeconomic status, and the urban-centric location of neurosurgical centers impede access to care. Key barriers to service delivery include lack of manpower, insufficient emergency care, limited imaging modalities, inadequate operative equipment, and ineffective political and administrative policies. Neurotrauma is the primary reason for neurosurgical intervention but is poorly managed due to delayed access and insufficient guidelines. The neurosurgical education system is strained by limited training capacity and the absence of subspecializations, restricting specialized care. Research output is low, hindered by limited infrastructure, lack of databases, insufficient funding, and minimal international collaboration. To address these issues, it is critical to enhance the imaging capabilities, ensure the availability of operative equipment, and establish effective policies for task sharing and communication at different levels of care. Other approaches include expanding training capacity, particularly in rural areas, implementing a uniform match system for residency, addressing gender disparities, and utilizing dual practice to ensure adequate compensation for neurosurgeons. Furthermore, stakeholders should develop subspecialization programs in areas such as neurovascular, neuro-oncology, pediatric neurosurgery, and minimally invasive neurosurgery to expand service scope. To transform the neurosurgical research landscape, efforts should be made to establish electronic medical databases, foster international collaborations to ensure funding, and make research mandatory for accreditation renewal to ensure continuous academic contribution.

Noma in the WHO's list of neglected tropical diseases: A review of its impact on undeveloped and developing tropical regions.

Background: Noma is a neglected tropical disease and a global health concern. Objectives: To elucidate the epidemiology, management, prevention, and public health implications of Noma. Methods: PubMed, Scopus, and Web of Science, supplemented by Google Scholar and World Health Organization databases, were searched using keywords to gather both published and grey literature from 1970 to 2023 in English. Results: Approximately 30,000-40,000 cases occur annually, with varying incidences across various African countries, such as Nigeria, Niger, and Chad. Incidence in Nigerian and Ethiopian states range from 0.6 to 3300 and 1.64 to 13.4 per 100,000 population, respectively. Mortality is approximately 8.5% in Niger. Risk factors include malnutrition, immunocompromised status, poor dental hygiene, inadequate sanitation, gingival lesions, low socioeconomic status, chronic and infectious diseases, low birth weight, high parity, diarrhoea, and fever. Diagnosis is primarily made based on clinical signs/symptoms and accordingly staging of disease is done. Stage I, II and II presents with acute necrotizing gingivitis, facial edema with halitosis, and necrotizing stomatitis, respectively. If the patient survives acute stages, the progress to Stage IV and Stage V manifests as trismus, difficulty in deglutition and phonation, and facial disfigurement, with increased severity in last stage. Treatment encompasses antibiotic therapy (amoxicillin, metronidazole, chlorhexidine, ampicillin, gentamicin), surgical interventions, wound management (honey dressing, ketamine), and nutritional support. Prevention strategies include oral hygiene, vaccination, health education, and community-based interventions. Conclusion: Noma's recent inclusion in WHO list of neglected tropical diseases is a milestone in recognizing the importance of prevention and early intervention to globally enhance health outcomes.

Isolated perinephric abscess as the initial manifestation of filariasis-an unusual presentation.

Key Clinical Message: Filariasis may present as an isolated perinephric abscess. Hence, a high index of suspicion should be maintained in endemic settings. Abstract: In cases with unexplained fever, eosinophilia and perinephric collection, it is necessary to do detailed infectious disease work up. High index of suspicion is required to diagnose filariasis due to its wide range of clinical presentation and laboratory findings. It may present as perinephric abscess, which can be diagnosed through ultrasonography.

Self-medication prevalence and associated factors among adult population in Northern India: A community-based cross-sectional study.

Objectives: This study aimed to determine self-medication prevalence and its associated factors. Methods: A community-based cross-sectional study was conducted in the urban and rural catchment areas of Uttar Pradesh, India, among 440 adults using a pretested, semistructured questionnaire. The Chi-square test and logistic regression were used to determine the association of self-medication prevalence with various independent variables. The associations were reported as adjusted odds ratios and 95% confidence intervals. Results: The prevalence of medication use was 66.4%. The majority of participants (45%) took medicine for fever, cough (40.1%), and cold (31.8%). Allopathy (83.2%) was the most common medicine system used for self-medication. More than half reported taking medicine such as paracetamol (52%), followed by cough syrup (21%) and antihistaminic (17%). Convenience (46%) and lack of time (35.3%) were commonly cited reasons for self-medication. Also, 64.4% of the respondents practiced self-medication on the pharmacist's recommendation. Urban participants (adjusted odds ratio: 9.85, 95% confidence interval: 5.32-18.23), females (adjusted odds ratio: 2.32, 95% confidence interval: 1.18-4.57), skilled workers (adjusted odds ratio: 5.62, 95% confidence interval: 1.80-17.5), and those who completed primary school (adjusted odds ratio: 2.48, 95% confidence interval: 1.16-5.25) were more likely to self-medicate than rural, male, unemployed, and illiterate participants, respectively. Also, participants whose income was 30,000 Indian rupees (adjusted odds ratio: 3.21, 95% confidence interval: 1.00-10.21) were more likely to self-medicate than those whose income was less than 4000. Conclusions: A high prevalence of self-medication was found, particularly in urban areas. Convenience and lack of time were commonly cited reasons for self-medication. Allopathy was the most widely used medicine system for self-medication. Antipyretics, cough syrups, and antiallergics were most commonly self-medicated. Gender, education, and income were associated with self-medication. The study highlighted the increased usage among females which could be further explored and role of pharmacists' recommendation as a major driver for self-medication.

Posterior reversible encephalopathy syndrome due to nonadherence to antihypertensive treatment: A case report from Nepal.

Key Clinical Message: Posterior reversible encephalopathy syndrome may occur secondary to abrupt cessation of antihypertensive therapy. A gradual reduction in blood pressure and counseling regarding medication adherence are crucial to prevent adverse consequences. Abstract: Posterior reversible encephalopathy syndrome (PRES) is a reversible clinical radiographic syndrome with headache, hypertensive encephalopathy, seizures, and visual disturbances as common modes of presentation. PRES can be attributed to several risk factors. We reported the case of a 66-year-old Asian female with PRES following nonadherence to antihypertensive treatment. Initially, her computed tomography scan of the head was normal. After 48 h, we again ordered a head CT scan, which showed lesions suggestive of hypertensive encephalopathy. We immediately reduced 20%-25% of mean arterial pressure, followed by a gradual blood pressure lowering to avoid adverse consequences. We did a follow-up CT scan of the head at 2 weeks, showing the resolution of early lesions. Hence, we made a diagnosis of PRES. In these patients, it is crucial to ensure medication adherence to avoid complications.