Co-occurrence of rhino-orbital mucormycosis and acute lymphoblastic leukemia post-COVID-19 infection in a young adolescent male: A case report from a low middle-income country.

Key Clinical Message: Immunosuppression from B-acute lymphoblastic leukemia (B-ALL) chemotherapy and a preceding COVID-19 infection may predispose patients to rare complications such as rhino-orbital mucormycosis. Hence, a high index of suspicion should be maintained by physicians (and oncologists) if patients undergoing B-ALL treatment present with orofacial symptoms and ophthalmological manifestations such as peri-orbital swelling, ophthalmoplegia, and loss of vision, suggestive of infection. Abstract: Mucormycosis is a severe fungal infection that poses significant mortality and morbidity risks, particularly in immunocompromised individuals. We present a rare case of a 16-year-old patient with rhino-orbital mucormycosis following B-acute lymphoblastic leukemia (B-ALL) treatment and concurrent COVID-19 infection. We describe the clinical presentation, diagnosis, treatment, and outcome of this patient, and discuss the possible interactions and implications of these three conditions. A young 16-year-old male patient without significant clinical history was admitted with complaints of low-grade intermittent fever, fatigue, malaise, restlessness, and unexplained weight loss for the past 2 months. A bone marrow biopsy confirmed the diagnosis of B-ALL. Following the diagnosis of B-ALL, the patient underwent initiation of chemotherapy. Following the initial two cycles of chemotherapy, the patient experienced fever and cough and tested positive for COVID-19 infection. Nearly a week later, the patient presented to the chemotherapy emergency department with a clinical picture characterized by a fever up to 39°C associated with left facial swelling, severe headache, purulent rhinorrhea, and foreign body sensation in the ipsilateral nostril. The following day, erythema and left eyelid edema were observed, with ocular opening limitation. The diagnosis was confirmed based on the positive result of polymerase chain reaction for left-sided mucormycosis. Initial administration of liposomal and lipid amphotericin B at 1-1.5 mg/kg/d doses for 4-6 weeks was followed by surgical debridement of necrotic tissue on the left side of the face and nose. Subsequent ophthalmological examinations showed normal conditions of the left eye. The case underscores the importance of heightened clinical suspicion, early diagnosis through imaging and molecular techniques, aggressive multimodal therapy, and close interdisciplinary collaboration for improved outcomes in such rare and challenging clinical scenarios.

The influence of sociodemographic factors on parental health-seeking behavior for illnesses among the pediatric age group in Karachi: A cross-sectional study.

Background: Health-seeking behavior (HSB) is an individual's reaction to sickness, for which they seek medical attention, regardless of the form such care may take. Poor HSB is frequently associated with lower health outcomes and greater mortality and disease rates in a nation. Sociodemographic factors, including age, gender, family structure, occupation, ethnicity, and rates of literacy and poverty, can influence a person's HSB. This study would benefit Pakistani parents of the paediatric population to make more informed health choices for their children. Aim: This study aims to determine the influence of sociodemographic factors on parental HSB for illnesses among the pediatric age group in Karachi. Materials and Methods: A cross-sectional study was conducted in which 214 parents were interviewed about their choices for health-seeking healthcare for their pediatric children of the pediatric age group (birth-18 years), who were attending the pediatric OPD and wards at Dr. Ruth Pfau Civil Hospital, Karachi in May 2023. Only parents or guardians with sick children were included. Their sociodemographic characteristics and health-seeking choices were asked. Informed consent was obtained, and all data were recorded. SPSS version 25 was used for analysis. Results: For the first choice, the majority of parents (82.7%) preferred to seek healthcare for their children from medical doctors, followed by spiritual healers (10.7%), traditional healers (5.6%), and homoeopathic doctors (0.9%). For the second choice, the highest percentage was for a doctor (76.2%), followed by a spiritual healer (18.7%), a homoeopathic doctor (3.3%), and a traditional healer (1.9%). A significant correlation was found between the first visit and the decision makers (p = 0.019), the father's education level of the father (p = 0.001), the mother's occupation of the mother (p = 0.019), and the mother's education level of the mother (p = 0.001). Conclusion: Sociodemographic characteristics greatly influence parents' HSBs of parents for their children. Despite having low-paying jobs and being uneducated, most people choose to refer to a doctor for their child due to awareness.

Exploring the Impact of Artificial Intelligence on Global Health and Enhancing Healthcare in Developing Nations.

BACKGROUND: Artificial intelligence (AI), which combines computer science with extensive datasets, seeks to mimic human-like intelligence. Subsets of AI are being applied in almost all fields of medicine and surgery. AIM: This review focuses on the applications of AI in healthcare settings in developing countries, designed to underscore its significance by comprehensively outlining the advancements made thus far, the shortcomings encountered in AI applications, the present status of AI integration, persistent challenges, and innovative strategies to surmount them. METHODOLOGY: Articles from PubMed, Google Scholar, and Cochrane were searched from 2000 to 2023 with keywords including AI and healthcare, focusing on multiple medical specialties. RESULTS: The increasing role of AI in diagnosis, prognosis prediction, and patient management, as well as hospital management and community healthcare, has made the overall healthcare system more efficient, especially in the high patient load setups and resource-limited areas of developing countries where patient care is often compromised. However, challenges, including low adoption rates and the absence of standardized guidelines, high installation and maintenance costs of equipment, poor transportation and connectivvity issues hinder AI's full use in healthcare. CONCLUSION: Despite these challenges, AI holds a promising future in healthcare. Adequate knowledge and expertise of healthcare professionals for the use of AI technology in healthcare is imperative in developing nations.

The availability, access, challenges and advancements in neurosurgical care in Africa: a mini review.

The availability and accessibility of neurosurgical care across Africa remains limited despite recent advancements. Overall, Africa accounts for 15% of the global neurosurgical disease burden but has access to less than 1% of neurosurgeons globally. While the number of neurosurgeons has increased in recent decades, huge workforce shortages remain, with the region facing the second-largest neurosurgical deficit. Access to adequate facilities and equipment is also lacking. Barriers like poverty, conflicts, and distance from care centres negatively impact patients' ability to access services. However, training programs like the World Federation of Neurosurgical Societies Rabat Training Center have contributed to building local capacity. Use of technologies like neuro-endoscopy is expanding access to more cost-effective interventions for conditions such as hydrocephalus. Undergraduate medical education is also seeing a rise in African students interested in neurosurgery. Despite these advancements, workforce shortfalls, inadequate infrastructure, and challenges posed by geopolitical instability continue to hinder the provision of comprehensive neurosurgical care. Limited research and funding discourage experienced surgeons from practicing in their home countries. Increased international collaboration, support for education, and tackling of structural issues are needed to continue strengthening Africa's neurosurgical capacity and reducing the disease burden. This narrative review aims to provide an overview of the current state of neurosurgery on the continent, highlight achievements, and identify persisting challenges.

Care for breast cancer survivors in Asian countries: A review of sexual dysfunction.

Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997-2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%-91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.

Unraveling the leptospirosis epidemic: tales from the Philippine outbreak - a short communication.

Leptospirosis, also known as Weil's disease, is an emerging zoonotic infection that occurs worldwide but is particularly common in the tropics. There has been an increasing trend of leptospirosis in the Philippines since the outbreak occurred in 2020. The number of reported cases was 182 in 2020, 1661 in 2021, and 2794 in 2022. This present article aimed to access previously published studies on the prevalence, implications, and efforts to combat leptospirosis worldwide, with a particular focus on the Philippines from 2001 to 2023. In writing this article, we conducted a thorough search of databases such as PubMed, Researchgate, Web of Science, Scopus, and Google Scholar within 20 years. This present article found that more than 810 cases were reported from 1 January to 4 March 2023. The Cagayan Valley Region has 103 cases, the Zamboanga Peninsula has 77 cases, and the Western Visayas Region has 176 cases, making them the worst-hit areas. The increase in leptospirosis cases in the Philippines is primarily attributed to several factors. Firstly, the country is prone to natural disasters such as typhoons, floods, and landslides, which increase the risk of water sources and the environment being contaminated with Leptospira bacteria. To address the menace of leptospirosis in the Philippines, we urge the Philippine government to focus on improving healthcare infrastructure, providing swift, reliable, and effective treatments, implementing safety regulations, supplying personal protective equipment to medical authorities, and taking strict actions to improve water sanitation.

Exploring the current and prospective role of artificial intelligence in disease diagnosis.

Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems, providing assistance in a variety of patient care and health systems. The aim of this review is to contribute valuable insights to the ongoing discourse on the transformative potential of AI in healthcare, providing a nuanced understanding of its current applications, future possibilities, and associated challenges. The authors conducted a literature search on the current role of AI in disease diagnosis and its possible future applications using PubMed, Google Scholar, and ResearchGate within 10 years. Our investigation revealed that AI, encompassing machine-learning and deep-learning techniques, has become integral to healthcare, facilitating immediate access to evidence-based guidelines, the latest medical literature, and tools for generating differential diagnoses. However, our research also acknowledges the limitations of current AI methodologies in disease diagnosis and explores uncertainties and obstacles associated with the complete integration of AI into clinical practice. This review has highlighted the critical significance of integrating AI into the medical healthcare framework and meticulously examined the evolutionary trajectory of healthcare-oriented AI from its inception, delving into the current state of development and projecting the extent of reliance on AI in the future. The authors have found that central to this study is the exploration of how the strategic integration of AI can accelerate the diagnostic process, heighten diagnostic accuracy, and enhance overall operational efficiency, concurrently relieving the burdens faced by healthcare practitioners.

CRP Albumin Ratio: A novel noninvasive and cost-effective method for assessing the severity of acute pancreatitis.

Introduction: Acute pancreatitis is a significant and potentially life-threatening gastrointestinal disorder that requires prompt and accurate diagnosis for effective treatment. Current diagnostic methods often involve expensive and inaccessible imaging studies, such as CT scans, limiting their utility in emergency settings and underserved areas. Aim: This correspondence discusses an innovative and cost-effective approach to assessing the severity of acute pancreatitis, focusing on the C-Reactive Protein-Albumin Ratio (CAR). Methodology: We searched relevant articles and studies from 2015 till date on PubMed, Web of Science, and Google Scholar using these keywords: "C-Reactive Protein", "Albumin Ratio", "Acute pancreatitis", "Cost-effective", "Non-invasive", and "Severity". Result: The CAR diagnostic method involves a simple blood test that measures the levels of C-Reactive Protein (CRP) and albumin, both commonly used markers for assessing inflammation. Elevated CRP and decreased albumin levels are indicative of inflammation, and the CAR has shown a strong positive correlation with the severity of acute pancreatitis. This method offers a non-invasive, time-efficient, and cost-friendly alternative to traditional diagnostic techniques. Conclusion: The potential of CAR as an assessment tool for the severity of acute pancreatitis is highlighted, especially in resource-limited settings. This innovation holds promise for improving the timely and accurate diagnosis of acute pancreatitis, ultimately enhancing patient outcomes and reducing mortality rates.

Meningitis in Niger Republic amidst COVID-19: current issues and novel recommendations.

Amidst coronavirus disease 2019 (COVID-19), there has been a misplaced priority on meningitis in the Niger Republic, thus refocusing resources and attention away from the continuing meningitis campaign in the Niger Republic. The over-strained state of public health resources and staff has also led to decreased surveillance, postponed diagnoses, and constrained immunization efforts in Niger Republic. This review aims to bridge the gaps regarding meningitis amid COVID-19 in Niger Republic and offer recommendations to government to mitigate meningitis in the country, with the hope of finding a permanent solution to this debilitating disease. The authors reviewed 45 past and present pieces of literature on meningitis and COVID-19 from 2013 to 2023 in well-renowned scientific databases such as PubMed, ResearchGate, Google Scholar, African Journals Online, Medline, and Embase. Since 2015, Niger Republic has experienced multiple meningitis epidemics that have resulted in 20, 789 cases and 1, 369 deaths [a case fatality rate (CFR) of 6.6%]. A total of 231 cases of meningitis were reported from 1 November 2021 to 31 January 2022. And recently, 559 cases of meningitis (of which 111 are laboratory confirmed), including 18 deaths (overall CFR 3.2%), occurred in the Zinder region, southeast of Niger Republic, from 1 November 2022 to 27 January 2023. Meningitis remains a public health concern in the world, especially in Niger Republic, which could lead to serious long-term complications. Therefore, adequate and novel measures and therapeutic actions should be implemented by the Niger Government to lessen the burden of the disease in the country.

Impacts of the advancement in artificial intelligence on laboratory medicine in low- and middle-income countries: Challenges and recommendations-A literature review.

Background and Aims: Artificial intelligence (AI) has emerged as a transformative force in laboratory medicine, promising significant advancements in healthcare delivery. This study explores the potential impact of AI on diagnostics and patient management within the context of laboratory medicine, with a particular focus on low- and middle-income countries (LMICs). Methods: In writing this article, we conducted a thorough search of databases such as PubMed, ResearchGate, Web of Science, Scopus, and Google Scholar within 20 years. The study examines AI's capabilities, including learning, reasoning, and decision-making, mirroring human cognitive processes. It highlights AI's adeptness at processing vast data sets, identifying patterns, and expediting the extraction of actionable insights, particularly in medical imaging interpretation and laboratory test data analysis. The research emphasizes the potential benefits of AI in early disease detection, therapeutic interventions, and personalized treatment strategies. Results: In the realm of laboratory medicine, AI demonstrates remarkable precision in interpreting medical images such as radiography, computed tomography, and magnetic resonance imaging. Its predictive analytical capabilities extend to forecasting patient trajectories and informing personalized treatment strategies using comprehensive data sets comprising clinical outcomes, patient records, and laboratory results. The study underscores the significance of AI in addressing healthcare challenges, especially in resource-constrained LMICs. Conclusion: While acknowledging the profound impact of AI on laboratory medicine in LMICs, the study recognizes challenges such as inadequate data availability, digital infrastructure deficiencies, and ethical considerations. Successful implementation necessitates substantial investments in digital infrastructure, the establishment of data-sharing networks, and the formulation of regulatory frameworks. The study concludes that collaborative efforts among stakeholders, including international organizations, governments, and nongovernmental entities, are crucial for overcoming obstacles and responsibly integrating AI into laboratory medicine in LMICs. A comprehensive, coordinated approach is essential for realizing AI's transformative potential and advancing health care in LMICs.