Prevalence of spine surgery navigation techniques and availability in Africa: A cross-sectional study

Background: Africa has a large burden of spine pathology but has limited and insufficient infrastructure to manage these spine disorders. Therefore, we conducted this e-survey to assess the prevalence and identify the determinants of the availability of spine surgery navigation techniques in Africa. Materials and methods: A two-part questionnaire was disseminated amongst African neurological and orthopedic surgery consultants and trainees from January 24 to February 23, 2021. The Chi-Square, Fisher Exact, and Kruskal-Wallis tests were used to evaluate bivariable relationships, and a p-value \u3c0.05 was considered statistically significant. Results: We had 113 respondents from all regions of Africa. Most (86.7 %) participants who practiced or trained in public centers and centers had an annual median spine case surgery volume of 200 (IQR = 190) interventions. Fluoroscopy was the most prevalent spine surgery navigation technique (96.5 %), followed by freehand (55.8 %), stereotactic without intraoperative CT scan (31.9 %), robotic with intraoperative CT scan (29.2 %), stereotactic with intraoperative CT scan (8.8 %), and robotic without intraoperative CT scan (6.2 %). Cost of equipment (94.7 %), lack of trained staff to service (63.7 %), or run the equipment (60.2 %) were the most common barriers to the availability of spine instrumentation navigation. In addition, there were significant regional differences in access to trained staff to run and service the equipment (P = 0.001). Conclusion: There is a need to increase access to more advanced navigation techniques, and we identified the determinants of availability

Prevalence of spine surgery navigation techniques and availability in Africa: A cross-sectional study

Background: Africa has a large burden of spine pathology but has limited and insufficient infrastructure to manage these spine disorders. Therefore, we conducted this e-survey to assess the prevalence and identify the determinants of the availability of spine surgery navigation techniques in Africa. Materials and methods: A two-part questionnaire was disseminated amongst African neurological and orthopedic surgery consultants and trainees from January 24 to February 23, 2021. The Chi-Square, Fisher Exact, and Kruskal-Wallis tests were used to evaluate bivariable relationships, and a p-value \u3c0.05 was considered statistically significant. Results: We had 113 respondents from all regions of Africa. Most (86.7 %) participants who practiced or trained in public centers and centers had an annual median spine case surgery volume of 200 (IQR = 190) interventions. Fluoroscopy was the most prevalent spine surgery navigation technique (96.5 %), followed by freehand (55.8 %), stereotactic without intraoperative CT scan (31.9 %), robotic with intraoperative CT scan (29.2 %), stereotactic with intraoperative CT scan (8.8 %), and robotic without intraoperative CT scan (6.2 %). Cost of equipment (94.7 %), lack of trained staff to service (63.7 %), or run the equipment (60.2 %) were the most common barriers to the availability of spine instrumentation navigation. In addition, there were significant regional differences in access to trained staff to run and service the equipment (P = 0.001). Conclusion: There is a need to increase access to more advanced navigation techniques, and we identified the determinants of availability

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study.

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant. Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category. Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group

Congrès AFMED 2017 : Place de la diaspora dans l’évolution de la chirurgie à Lubumbashi : cas de la Clinique MEDPARK: Place of the diaspora in the evolution of surgery in Lubumbashi: case of the MEDPARK hospital

Contexte et objectifs. La diaspora Congolaise représente aujourd‟hui une alternative au développement du secteur médical en république Démocratique du Congo. C‟est le cas de la clinique MedPark qui est un véritable centre médical de référence, créé en Juillet 2016 à Lubumbashi dans la Province du Haut Katanga par le Professeur Muganza Adelin chirurgien Général et Viscéral oeuvrant à l‟université de Johannesburg, en collaboration avec d‟autres chirurgiens de la diaspora et ceux oeuvrant au pays. C‟est une clinique à vocation chirurgicale dans son ensemble et dispose d‟un service d‟urgences, de réanimation et d‟un plateau technique chirurgical performant.Nous allons présenter la pratique chirurgicale dans son ensemble sur 12 mois et montrer l‟impact de ce centre dans la formation continue à Lubumbashi en partenariat avec l‟université de Lubumbashi.Méthodes. Il s‟agit d‟une étude rétrospective portant sur 156 patients opérés à la Clinique MedPark, allant de Juillet 2016 au juillet 2017 et qui a consisté en une évaluation épidémiologique et une analyse statistique de la série.Résultats. Sur cette période, 156 patients ont été opérés durant la période d‟étude, l‟âge moyen étant de 38 ans, un sex ratio de 2,6 H/1F.La répartition selon la discipline chirurgicale permet de retrouver la chirurgie viscérale et générale dans une proportion de 32% des cas, la neurochirurgie 28% des cas et l‟urologie 17% des cas et la traumatologie et orthopédie 13% des cas.L‟évolution post-opératoire était favorable dans 78% des cas.Nous avons enregistré 2,5% des cas d‟infections postopératoires. La mortalité post-opératoire était de 6,4% des cas.Conclusions. Les médecins spécialistes de la diaspora Congolaise en collaboration avec des médecins spécialistes du pays et la Faculté de médecine de Lubumbashi représentent une alternative au développement de la chirurgie dans le Haut Katanga. Les résultats de la série sont encourageants

Neurosurgery Education Around the World: Africa

In Africa, neurosurgery, as an independent specialty, started approximately 60 years ago introduced by European neurosurgeons in their respective colonized countries. After gaining independence from Europe, in many African countries local physicians and especially neurosurgeons were scarce or absent. In 1998, the neurosurgeon/inhabitant ratio was 1/230,000 in the world, whereas in Africa they averaged at 1/1,238,000. Since 86% of African neurosurgeons were concentrated in the North and South, SSA had a ratio of 1/6,368,000. In North and South Africa, neurosurgery had a faster pace in developing than in Sub-Saharan Africa (SSA) for many reasons, including socioeconomics. Since then, efforts to grow the neurosurgery workforce have been very successful. Their success stemmed from the hard work of local neurosurgeons coupled with international efforts, including the World Federation of Neurosurgical Societies (WFNS). This joint venture created cost-effective neurosurgical training centers in Africa with high retention rate of the trained workforce. By 2025, the African population is expected to reach 1.4 billion people with 1.1 billion in SSA. Such growth poses opportunities and challenges to the continued efforts to improve the availability of workforce, facilities, equipment, and supplies to provide neurosurgical care in Africa. In this chapter, the authors provide background, data, and proposed strategies for the above-summarized topics

Clinical characteristics of COVID-19 patients hospitalized at Clinique Ngaliema, a public hospital in Kinshasa, in the Democratic Republic of Congo: A retrospective cohort study.

ObjectivesTo describe the clinical characteristics of patients infected with SARS-CoV-2 at Clinique Ngaliema, a public hospital, in Kinshasa, in the Democratic Republic of Congo (DRC).MethodsThis retrospective study analyzed medical records including socio-demographics, past medical history, clinical manifestation, comorbidities, laboratory data, treatment and disease outcome of 160 hospitalized COVID-19 patients, with confirmed result of SARS-CoV-2 viral infection.ResultsThe median age of patients was 54 years (IQR: 38-64), and there was no significant gender difference (51% of male). The most common comorbidities were hypertension (55 [34%]), diabetes (31 [19%]) and obesity (13 [8%]). Fever (93 [58%]), cough (92 [57%]), fatigue (87 [54%]), shortness of breath (72 [45%]) and myalgia (33 [21%]) were the most common symptoms, upon admission. Patients were categorized into mild (92 [57%]), moderate (19 [12%]) and severe (49 [31%]). Severe patients were older and were more likely to have comorbidities, compared to mild ones. The majority of patients (92% [147 of 160]) patients received hydroxychloroquine or chloroquine phosphate. Regression model revealed that older age, lower SpO2, higher heart rate and elevated AST at admission were all risk factors associated with in-hospital death. The prevalence of COVID-19 and malaria co-infection was 0.63% and 70 (44%) of all patients received antimalarial treatment before hospitalization.ConclusionOur findings indicated that the epidemiological and clinical feature of COVID-19 patients in Kinshasa are broadly similar to previous reports from other settings. Older age, lower SpO2, tachycardia, and elevated AST could help to identify patients at higher risk of death at an early stage of the illness. Plasmodium spp co-infection was not common in hospitalized COVID-19 patients

Impact de la mise en place d’un réseau des soins pour la traumatologie grave dans la ville de Kinshasa, RD Congo : étude quasi-expérimentale

Contexte et objectif: Une part non négligeable de décès posttraumatiques semble évitable par une meilleure prise en charge. L’objectif de la présente étude était d’évaluer l’impact de la mise en place d’un réseau des soins sur la mortalité des patients traumatisés graves dans la ville de Kinshasa. Méthodes: C’était une étude multicentrique quasi-expérimentale avant/après portant sur les patients adultes hospitalisés en réanimation ousoins intensifs pour traumatisme grave, entre le 1er janvier 2009 et le 31 décembre 2014. L’intervention a consisté à la mise en place d’un réseau de soins entre les deux groupes. La mortalité hospitalière ajustée sur l’âge, le sexe et le score RTS étaient le critère de jugement principal. Résultats: Au total, 4 hôpitaux ont participé et ont inclus 195 patients consécutifs dans le groupe pré-interventionnel contre 9 hôpitaux et 210 patients dans le groupe post-interventionnel. Entre les deux groupes, le taux d’admission directe s’est amélioré (48,6 % vs 75,9 %) ainsi que le temps d’arrivée à l’hôpital (6,5 h vs 4,2 h). Il a été relevé une diminution des volumes de perfusion associée à une augmentation des taux d’utilisation des catécholamines (2% vs 6,6 %), de la transfusion sanguine (15,8 % vs 25,7 %) et de l’acide tranexamique (zéro % vs 77,6 %). Le taux d’intubationen cas de GCS &lt; 9 (13,2 % vs 37 %), d’administration de mannitol en présence d’une mydriase (58 % vs 72,4 %) et de réalisation du scanner cérébral chez les patients ayant un GCS ≤14 (10,6 % vs 54,6%) ont augmenté également. En revanche, le pourcentage de patients ayant bénéficié d’un&nbsp; drainage thoracique (0,5 % vs 1,4 %) et la fréquence d’actes de chirurgie (43 % vs 50 %) n’ont pas significativement varié. La mortalité, quant à elle,&nbsp; est significativement passée de 73,3 % à 54,7 %. Conclusion: Une amélioration des pratiques et une baisse de la mortalité ont été observées après&nbsp; la mise en place du réseau de soins. &nbsp; English title: Impact of the establishment of a severe trauma care network in the City of Kinshasa, Democratic Republic of the Congo: a quasi-experimental study Context and objective: Better management is mandatory for avoidable post-traumatic deaths. This study aimed to assess the impact of the&nbsp; implementation of a trauma network on the mortality of severe trauma patients in Kinshasa, DR Congo. Methods: The multicentric quasic-experimental before/after survey included adult patients admitted in intensive care unit for trauma in Kinshasa&nbsp; between January 2009 and December 2014. The relevance of the implementation of a trauma network was assessed. In-hospital mortality adjusted&nbsp; for age, gender and RTS score was the primary endpoint. Results: A total of 195 consecutive patients was concerned from 4 hospitals in the pre-intervention group vs 210 patients from 9 hospitals in the&nbsp; postintervention group. In the two groups, the direct admission rate improved (48.6 % vs 75.9 %) as well as the time of arrival at the hospital (4.2 h&nbsp; vs 6.5 h). There was a decrease in infusion volumes associated with an increase utilization rate of catecholamines 2 % vs. 6.6 %), blood transfusion (15.8 % vs. 25.7 %) and acid tranexamic (0 % vs 77.6 %). The rate of intubation in the event of GCS &lt; 9 (13.2 % vs 37 %), administration of mannitol in&nbsp; the presence of mydriasis (58 % vs 72.4 %) and realization of the brain scan in patients with a GCS ≤14 (10.6 % vs&nbsp; 4.6 %) also increased. However, the&nbsp; percentage of patients who received chest drainage (0.5 % vs&nbsp; 1.4 %) and the frequency of surgery (43 % vs 50 %) did not vary significantly. Mortality, meanwhile, fell from 73.3 % to 54.7 %. Conclusion: An improvement in practices and a reduction in mortality were observed after the&nbsp; implementation of the trauma network