Purpose: To explore available literature on PNS mucoceles and its distortions of craniofacial-orbital anatomy with regard to orbital bony defects and ophthalmic manifestations, highlighting the PNS mucoceles that mostly result in these distortions. Methods: A comprehensive literature search was conducted in June 2024 for available literature on the subject matter viz.; Google Scholar, PubMed and Medline, and Cochrane Library. Eligible studies were subjected to bias assessment. Extracted data from eligible studies were synthesized using narrative synthesis. Results: Eighteen studies met the inclusion criteria. The 18 studies correspond to a total of 638 patients diagnosed with different types of PNS mucoceles, with males being the highest incidence of patients. Frontal, ethmoid, and fronto-ethmoidal mucoceles had the highest incidences (26.36%, 24.03%, and 23.29%, respectively). Orbital-bony defects, such as disruption and breach of the lamina papyracea, orbital wall erosion, and skull base erosion, were reported as the damage mostly caused by frontal and ethmoidal mucoceles. Ophthalmic manifestations such as proptosis, diplopia, ptosis, preorbital swelling, epiphora, vision problems, and exophthalmos were reported to occur in any type of the PNS mucoceles but are more common in mucoceles in the anterior sinuses. Conclusions: The narrative review summarizes the distortion of PNS mucoceles to craniofacial-orbital anatomy. Findings from this review will help to create more awareness of the extent of possible distortion that PNS mucoceles could have on craniofacial-orbital anatomy.

HIV/AIDS remains a global public health concern, with a high prevalence in sub-Saharan Africa. The President’s Emergency Plan for AIDS Relief (PEPFAR) initiatives, including preexposure prophylaxis (PREP) and postexposure prophylaxis (PEP), significantly reduced HIV infections in South Africa and Nigeria. The suspension of United States (U.S.) foreign aid may impact these preventive measures. Although some emergency aid programs were exempted, uncertainty persists, impacting global health initiatives, especially in South Africa and Nigeria. This study investigates the public health impacts of the United States (U.S.) government’s January 2025 suspension of U.S. foreign aid, focusing on its implications for HIV prevention initiatives, such as PREP and PEP, in South Africa and Nigeria. We comprehensively searched keywords such as PEPFAR, PREP, PEP, HIV infection in South Africa or Nigeria, antiretroviral (ARV) drugs, public healthcare impact, 2025 Trump’s foreign aid withdrawal, titles, and abstracts in Google Scholar, PubMed, and Web of Science. The search results were screened from 500 to 150 included articles based on their relevance and quality assessment for inclusion. The review unveiled that Nigeria maintained a continuous increase in HIV/AIDS-related deaths and new HIV infections from 1990, reaching the climax between 1999 and 2005, showing approximately 110,000 HIV/AIDS-related deaths and 200,000 new HIV infections. Notably, due to the PEPFAR intervention in Nigeria, an improved decrease in both HIV/AIDS-related deaths (45,000) and new HIV infections (75,000) was experienced from 2010 to 2023. South Africa experienced a rapid increase between 1990 and 2003 in both HIV/AIDS-related deaths and new HIV infections, reaching the climax around the early 2000s, with about 520,000 new HIV infections and 260,000 HIV/AIDS-related deaths in 2005. Furthermore, there was a continuous decline from 2005 onwards, with 50,000 HIV/AIDS-related deaths and 150,000 new HIV infections by 2023. Therefore, the suspension of this aid threatens disruptions in ARV therapy, possible increases in HIV transmission, shortages in PREP and PEP, the retrenchment of healthcare workers, the suspension of non-governmental organization activities, and the reversal of gains in vulnerable populations, reversing progress toward the 95-95-95 vision, increasing morbidity and mortality rates and financial strain on healthcare systems in these two countries. We recommend proactive measures, such as increased budget allocations for healthcare reforms, exploring local vaccine and health product development and diversifying funding sources in Nigeria, and implementing universal healthcare coverage for South Africans to mitigate the adverse consequences of aid withdrawal.

Background. Aneurysmal subarachnoid haemorrhage (aSAH) presents unique challenges within the African healthcare context. The reported incidence of aSAH in sub-Saharan Africa remains limited, creating the impression of a low disease burden in regions such as KwaZulu-Natal Province (KZN), South Africa. However, this perceived low incidence may reflect underdiagnosis, limited access to neuroimaging and gaps in referral pathways rather than a true epidemiological rarity. Objectives. To document the referral pathways, minimum detected incidence and seasonal presentation of patients with aSAH in KZN. Methods. This retrospective chart review included 445 patients diagnosed with aSAH from 11 health districts across KZN and Eastern Cape provinces who presented to a quaternary hospital in KZN between 2012 and 2021. Data collected comprised patient demographics (age and sex), time from ictus to presentation, and referral hospitals, which were categorised according to their respective health districts. Spearman’s rank correlation was used to assess the association between time to presentation and distance across health districts. Poisson regression analysis was performed to examine the relationship between health districts and the seasonal presentation of aSAH. Results. Most referrals originated from regional hospitals (66%). The patients’ ages ranged from 34 to 57 years, with a male-to-female ratio of 1:2. The cohort was predominantly black African, and 38% had hypertension as a comorbidity. The overall incidence of aSAH was 3.43 per 100 000 population. The time from ictus to presentation ranged from 2 to 14 days, and 23.6% of patients were HIV positive across the health districts. The annual highest minimum detected incidences were recorded in 2013 and 2018. OR Tambo district represented the farthest referral distance to the quaternary hospital. No significant correlation was observed between distance and time-based outcomes, including admission-to-endovascular treatment time (p=0.903) and length of stay (p=0.238). The rate of aSAH presentation was significantly higher in spring compared with autumn (incidence rate ratio 1.34, 95% confidence interval 1.03 - 1.74, p=0.030). Conclusion. The observed low incidence of aSAH in this setting likely reflects systemic factors, including under-reporting, a critical shortage of neurosurgical specialists and limited availability of definitive care services.