Background: Neurosurgical care is vital for conditions such as traumatic brain injury, brain tumors, and hydrocephalus. In African low- and middle-income countries (LMICs), access remains limited due to systemic and structural challenges. Despite bearing 15% of the global neurosurgical burden, the region faces a massive workforce deficit and underdeveloped infrastructure. Objective: To synthesize existing evidence on barriers impeding and facilitators improving access to neurosurgical care in African LMICs. Methods: A narrative review was conducted through a targeted search of PubMed, African Journals Online (AJOL), and Google Scholar for English-language studies published between 2014 and 2024. Studies were included if they focused on African LMICs and addressed access-related barriers or facilitators. In total, 48 studies were selected and analyzed thematically. Results: Barriers to access include an acute workforce shortage (0.15 neurosurgeons per million people), with only 32 of 54 countries offering neurosurgical training. Infrastructure deficits, such as a lack of Intensive Care Units beds, operating microscopes, and anesthesia services, compound these challenges. Financial constraints are significant, with some families in Eastern Africa paying over 130% of their annual income for surgery. Long travel distances (averaging 144 km), cultural stigma, reliance on traditional healers, and political instability further restrict access. Conversely, facilitators include successful international collaborations (e.g., Duke East Africa Neurosurgery Program, WFNS Rabat Training Centre), adoption of telemedicine and teleradiology, and growth in local research capacity, including disease registries and training exchanges. Conclusion: Transforming neurosurgical access in African LMICs demands bold investment in rural services, specialist training, and full integration into national health financing.

Background: Over the years, surgical techniques have evolved, resulting in an abundance of available procedures in the armamentarium of metabolic and bariatric surgeons, and the technology has also advanced in a similar way. Significant steps have been made in stapling technology especially, introducing artificial intelligence (AI) in optimizing this technology for better treatment outcomes. The introduction of AI in stapling technology showed a decrease in potential stapling complications not only in MBS, but also in other (surgical) specialties. Areas Covered: This review will cover the general principles of stapling in surgery, but with an emphasis on both the technical and anatomical considerations. We will also discuss the mechanisms of staplers and potential safety hazards. Finally, we will focus on how AI is integrated in stapling technology, potential pros and cons, and areas for future development of stapling technology and the integration of AI. Conclusions: In metabolic and bariatric surgery, stapling is a technical procedure that requires a comprehensive understanding of the anatomical and physiological characteristics of the target tissue. Variability in tissue thickness, vascularity, elasticity, and mechanical load, compounded by patient-specific factors and intraoperative dynamics, demands constant vigilance and adaptability from the surgeon. The integration of AI and digital technologies offers potential improvements in refining this process. By providing real-time feedback on tissue properties and supporting intraoperative decision-making, these tools can assist surgeons in optimizing staple-line integrity and minimizing complications. The ongoing combination of surgical expertise with intelligent technology may contribute to advancing precision stapling in metabolic and bariatric surgery.

Background: Endomyocardial fibrosis (EMF) is a chronic restrictive cardiomyopathy prevalent in tropical regions, often underdiagnosed and associated with poor outcomes. Although its etiology remains unclear, parasitic infections such as schistosomiasis, filariasis, and trypanosomiasis have been implicated in its development. This study conducted a systematic review of case reports and case series to assess the correlation between parasitic infections and the development of EMF, identifying clinical patterns, implicated parasites, diagnostic approaches, and clinical outcomes, aiming to improve strategies for prevention, diagnosis, and treatment. Methods: Following PRISMA 2020 guidelines, we searched multiple databases for case reports and case series describing patients with confirmed EMF associated with parasitic infections. 12 studies met the inclusion criteria, comprising 8 case reports and 4 case series, encompassing a total of 16 patients diagnosed with EMF related to parasitic infections. Results: The pooled analysis demonstrated that parasitic infections were predominantly caused by Schistosoma mansoni (10/16; 62.5%), followed by Schistosoma haematobium (3/16; 18.75%), with rare cases of Trypanosoma cruzi and Wuchereria bancrofti (1/16 each; 6.25%). Common clinical manifestations included signs of fibrosis of the right ventricular endocardium (81%), dilated right atrium (75%), pericardial effusion (75%), edema of both lower limbs (63%), and ascites (63%) and symptoms included abdominal distention (63%) and dyspnea (63%. Diagnosis was primarily established by echocardiography (92%), with additional confirmation by other imaging techniques and histopathology. Treatment mainly consisted of antiparasitic therapy and diuretics, with a survival rate of 50%, while 19% (3/16) of patients died from multi-organ failure and thromboembolic complications. Conclusion: This systematic review suggests a potential association between parasitic infections, particularly Schistosoma mansoni, and the development of endomyocardial fibrosis. Despite the limited sample size, the findings highlight the importance of early diagnosis and antiparasitic treatment. The variability in diagnostic and therapeutic approaches underscores the need for standardized guidelines and prospective studies in endemic areas to enhance clinical recognition and improve patient outcomes.

Introduction: Monkeypox, a zoonotic viral disease primarily endemic to Africa, has seen a global resurgence, raising concerns due to its potential for severe multisystem complications. While often self-limiting, the burden of monkeypox is heightened in low- and middle-income countries (LMICs), particularly in Africa, where healthcare resources are limited. Objective: To review the multisystem complications of monkeypox in LMICs across Africa, highlighting clinical challenges and gaps in healthcare management. Methods: A comprehensive systematic review was conducted using PubMed and Google Scholar to identify studies addressing monkeypox complications. Relevant literature covering dermatological, respiratory, neurological, gastrointestinal, cardiovascular, and ocular systems was reviewed, with a focus on clinical complications and healthcare constraints in African LMICs. Results: The review identified significant multisystem complications of monkeypox infection, including impetigo, cellulitis, and septic shock in the dermatologic system; bronchitis and severe pneumonia in the respiratory system; encephalitis and seizures in the neurologic system; haemorrhagic colitis, gastrointestinal bleeding, and severe dehydration in the gastrointestinal system; and viral myocarditis, pericarditis, congestive heart failure, arrhythmias, thrombotic events, and dilated cardiomyopathy in the cardiovascular system. In African LMICs, these complications are exacerbated by limited diagnostic tools, antiviral therapies, and inadequate healthcare infrastructure. Socioeconomic challenges, including poor healthcare access and limited public health awareness, further compound the weaknesses in the health system. Conclusion: Monkeypox presents complications across multiple organ systems. In African LMICs, healthcare barriers exacerbate disease burden. Strengthening infrastructure, improving diagnostics, and increasing awareness are key to mitigating the impact of monkeypox complications.

Introduction: In low-income countries faced by a constraint of resources, pediatric osteomyelitis is a major cause for morbidity, and its true burden in Africa has not been fully characterized. Objectives: To systematically synthesize evidence on the clinical presentation, microbiology, management strategies, outcomes, and novel insights in pediatric osteomyelitis in the last decade within Africa. Methods: The review was conducted using Pubmed, Scopus, Embase and Google Scholar to identify studies addressing pediatric osteomyelitis in Africa. Relevant literature covering osteomyelitis types, diagnostic criteria, pathogen and resistance data, treatment modalities, outcomes, length of stay, and follow-up duration were included. Nine studies were identified and analyzed. Results: Among the identified cases ( n = 284), 83.5% were chronic. The tibia (45.7%) and femur (31.7%) were the most commonly affected sites. Bacterial cultures were available for 130 cases and showed Staphylococcus aureus as the leading pathogen (43.9%). Exclusive surgical care was indicated in 51.85% of the cases, and the procedures included sequestrectomy and reconstructive procedures. Notable novel patterns included higher rates of chronic multifocal disease in rural, malnourished children; variable empiric antibiotic regimens driving antimicrobial resistance; and the use of gentamicin loaded beads and vascularized fibula flaps for post-osteomyelitis reconstruction. Conclusion: Chronic osteomyelitis is the most dominant form in African children. Despite advancements in management in African settings, gaps exist. Future directions include multicenter surveillance of disease burden, surveillance of antimicrobial resistance, community-level interventions for disease monitoring and capacity building for advanced surgical procedures.