Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic.

BACKGROUND: This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic. METHODS: We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients' location by World Bank income groups (high [HIC], upper-middle [UMIC], and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality. RESULTS: Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37-5.74) compared to HIC. CONCLUSIONS: The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors.

Vulnerability of African Neurosurgery to Predatory Journals: An Electronic Survey of Aspiring Neurosurgeons, Residents, and Consultants.

BACKGROUND: Predatory journals (PJs) publish research with little to no rigorous peer review in exchange for money. It is unclear what proportion of researchers is vulnerable to PJs and which factors are associated with vulnerability. The aim of this study was to evaluate the vulnerability of African neurosurgery researchers to PJs and identify their correlates. METHODS: A 3-part electronic survey in English and French versions was distributed via social media to African consultants and trainees from November 1 to December 1, 2021. Bivariable relationships were evaluated with χ2 test, Mann-Whitney U test, Spearman ρ correlation, odds ratios, and 95% confidence intervals. A P value < 0.05 was considered statistically significant. RESULTS: There were 101 respondents to the survey (response rate 56.1%). Respondents had mean age of 34.9 years, 82.2% were male (n = 83), 38.6% were consultant neurosurgeons (n = 39), and 33.7% were from Central Africa (n = 34). Of respondents, 66 had published ≥ 1 articles in the past, and 13 had published at least 1 article in a PJ. A PJ had contacted 34 respondents via e-mail, and 8 respondents had reviewed articles for a PJ. The Think. Check. Submit initiative and Beall's list were familiar to 19 and 13 respondents, respectively. Publication in PJs was correlated with the respondent's age (R = 0.23, P = 0.02) and total scholarly output (R = 0.38, P < 0.01). CONCLUSIONS: Young African neurosurgery researchers are vulnerable to PJs primarily because they are not familiar with the concept of PJs or how to identify them.

The Impact of COVID-19 on Neurosurgical Services in Africa.

INTRODUCTION: COVID-19 has affected the global provision of neurosurgical services. We sought to review the impact of COVID-19 on the neurosurgical services in Africa. METHODS: A cross-sectional survey was distributed to African neurosurgeons seeking to review demographics, national and neurosurgical preparedness, and change in clinical services in April 2020. RESULTS: A total of 316 responses from 42 countries were received. Of these, 81.6% of respondents were male and 79.11% were under the age of 45 years. In our sample, 123 (38.92%) respondents were in training. Most (94.3%) respondents stated they had COVID-19 cases reported in their country as of April 2020. Only 31 (41.50%) had received training on managing COVID-19. A total of 173 (54.70%) respondents were not performing elective surgery. There was a deficit in the provision of personal protective equipment (PPE): surgical masks (90.80%), gloves (84.80%), N95 masks (50.80%), and shoe covers (49.10%). Health ministry (80.40%), World Health Organization (74.50%), and journal papers (41.40%) were the most common sources of information on COVID-19. A total of 43.60% had a neurosurgeon in the COVID-19 preparedness team; 59.8% were concerned they may contract COVID-19 at work with a further 25.90% worried they may infect their family. Mental stress as a result of COVID-19 was reported by 14.20% of respondents. As of April 2020, 73.40% had no change in their income. CONCLUSIONS: Most African countries have a national COVID-19 policy response plan that is not always fully suited to the local neurosurgery services. There is an ongoing need for PPE and training for COVID-19 preparedness. There has been a reduction in clinical activities both in clinic and surgeries undertaken.

A Continental Survey on the Impact of COVID-19 on Neurosurgical Training in Africa.

BACKGROUND: Containment measures for COVID-19 have affected surgical training globally. We sought to assess how neurosurgical training has been affected across Africa in April 2020. METHODS: A cross-sectional survey was distributed to African Neurosurgical trainees seeking to review demographics and effects of COVID on training. RESULTS: A total of 123 neurosurgery trainees responded from 23 African countries and a further 6 were abroad. A total of 91.80% were men, and 96.70% were training in public institutions. Only 41% had received training in COVID-19 with 61.79% worried that they would contract COVID-19 while performing their clinical duties. There was a marked reduction in clinical activities including a median reduction of elective surgery (-80%), clinics (-83%), and emergency surgery (-38.50%). A total of 23.58% of residents did not receive a formal salary, with 50% on less than $1000 USD gross per month. CONCLUSIONS: This is the first continental survey of neurosurgery trainees in Africa. COVID-19 has significantly affected clinical and learning opportunities. There are concerns of the long-term effects on their training activities for an uncertain period of time during this pandemic. Although there has been a global increase in e-learning, there is need to evaluate if this is accessible to all trainees.

COVID-19 and Autoimmune Diseases: A Systematic Review of Reported Cases.

INTRODUCTION: Over 4.9 million cases of Coronavirus disease 2019 (COVID-19) have been confirmed since the worldwide pandemic began. Since the emergence of COVID-19, a number of confirmed cases reported autoimmune manifestations. Herein, we reviewed the reported COVID-19 cases with associated autoimmune manifestations. METHODS: We searched PubMed database using all available keywords for COVID-19. All related studies between January 1st, 2020 to May 22nd, 2020 were reviewed. Only studies published in English language were considered. Articles were screened based on titles and abstracts. All reports of confirmed COVID-19 patients who have associated clinical evidence of autoimmune disease were selected. RESULTS: Among the 10006 articles, searches yielded thirty-two relevant articles for full-text assessment. Twenty studies has met the eligibility criteria. The twenty eligible articles reported 33 cases of confirmed COVID-19 diagnosis who developed an autoimmune disease after the onset of covid-19 symptoms. Ages of patients varied from a 6 months old infant to 89 years old female (Mean=53.9 years of 28 cases); five cases had no information regarding their age. The time between symptoms of viral illness and onset of autoimmune symptoms ranged from 2 days to 33 days (Mean of the 33 cases=9.8 days). Autoimmune diseases were one case of subacute thyroiditis (3%), two cases of Kawasaki Disease (6.1%), three cases of coagulopathy and antiphospholipid syndrome (9.1%), three cases of immune thrombocytopenic purpura (9.1%), eight cases of autoimmune hemolytic anemia (24.2%), and sixteen cases of Guillain-Barré syndrome (48.5%). CONCLUSION: COVID-19 has been implicated in the development of a range of autoimmune diseases, which may shed light on the association between autoimmune diseases and infections.

Letter to the Editor "COVID-19 and Neurosurgical Education in Africa: Making Lemonade from Lemons".

Never in history has the fabric of African neurosurgery been challenged as it is today with the advent of the novel coronavirus identified in 2019 (COVID-19). Even the most robust and resilient neurosurgical educational systems in the continent have been brought to their knees with neurosurgical trainees and young neurosurgeons bearing the brunt. In the face of this new reality, and in order to limit the impact of the current COVID-19 pandemic, multiple programs have implemented physical distancing to reduce in-person interactions. In some cases, residents have been asked to stay home at least until they are instructed otherwise. This unfortunate event presents an innovative opportunity for neurosurgical education in Africa. Herein, we detail the framework of an online neurosurgical education initiative to advance the education of African residents and young neurosurgeons during and after the COVID-19 pandemic.