Pediatric speech-language pathology in East Africa: educational opportunities and availability of speech-language services.

OBJECTIVE: This paper describes the current situation of the provision of speech-language services in East Africa. An overview of the educational opportunities, workforce density, communication rehabilitation planning, caseload, and ethical and/or cultural challenges is provided. METHOD: A narrative review was performed. All papers referring to communication disorders in East African countries were identified from EMBASE, PubMed, ISI Web of Science: Science Citation Index Expanded, and ISI Web of Science: Conference Proceedings Citation Index-Science using the following search terms: speech therapy, speech pathology, speech-language pathology, speech-language rehabilitation, speech-language therapy, logopedics, East Africa, communication disorders, communication difficulties. Two concepts were combined with a Boolean operator 'AND'. RESULTS: At present, there is an alarming shortage of speech-language pathologists in East Africa. This issue is mainly related to the limited availability of educational programs in speech-language pathology. Although more and more universities are beginning to offer such educational programs, the number of available speech-language pathologists is still too low to meet the needs of all children with communication disorders. In addition, speech-language pathologists are often faced with different cultural and ethical obstacles when they provide intervention to East African children with communication disorders. These speech-language pathologists are therefore challenged to take a broader view of their role as a therapist. These alternative roles often include training of other individuals in the context of community-based rehabilitation. CONCLUSION: In the future, it will be important to carefully consider the development of sustainable learning opportunities in East African contexts. Initiatives, for example, "train-the-trainer" workshops, are needed to support the speechlanguage pathologists. Existing models like the communication disability model can aid to create holistic frameworks for the development of sustainable speech-language services in the East African countries.

Paraneoplastic Raynaud's phenomenon as sign of progression: a case report on a patient with breast cancer.

BACKGROUND: Paraneoplastic Raynaud's phenomenon is a rare complication occurring in patients with advanced cancer. METHODS: We present a case of a patient with breast cancer and presenting with acrocyanosis evolving into necrosis as a paraneoplastic phenomenon in progressive breast cancer. RESULTS: Unless a multidisciplinary approach was taken, improvement of the symptoms was only seen with prostacyclin analogs, and cancer treatment needed to be changed because of rapidly progressing disease. CONCLUSION: Paraneoplastic Raynaud's phenomenon is a rare but severe presentation of advanced and progressive cancer. Treatment with intravenous prostacyclin analogs should be considered and a multidisciplinary approach is necessary.

Psoriasis Vulgaris Exacerbation during Treatment with a PD-1 Checkpoint Inhibitor: Case Report and Literature Review.

OBJECTIVE: The incidence of immune-related adverse events is growing as the use of checkpoint inhibitors is exponentially increasing. Cutaneous adverse events are among the most frequent immune-related adverse events. The purpose of this case report and literature review is to highlight psoriasis as a potential adverse event with need for early recognition. CASE REPORT AND LITERATURE REVIEW: We describe the case of a 65-year-old woman with psoriasis exacerbation while treated with nivolumab (anti-PD-1) for a stage IV melanoma. She had a history of scalp psoriasis but she presented with psoriatic lesions on both lower and upper limbs. Our patient was treated with topical steroids. So far, 34 other cases with an exacerbation of psoriasis during treatment with anti-PDL-1 or PD-1 therapy have been reported in the literature. A broad range of therapies are described, without any available guidelines for this particular condition. CONCLUSION: Psoriasis exacerbation is an established side effect of PD-1/PDL-1 checkpoint inhibitors with 35 reported cases. Early recognition and management are challenging as there are no clear guidelines available. A close collaboration between oncologist and dermatologist is mandatory to manage this immune-related adverse event.