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Assessment of neurosurgical workforce, infrastructure, and service delivery capacity in East Africa: A collaborative surve
No full textWorkforce development in healthcare is critical, especially in resource-limited regions such as East Africa, where a scarcity of neurosurgeons hinders patient care. This study aims to analyze neurosurgical workforce trends in Kenya, Rwanda, Tanzania, and Uganda over two decades, informing strategies for capacity enhancement. An online survey targeting neurosurgical institutions across the four countries was conducted, focusing on consultants, residents, and general practitioners for the target population. Traumatic brain injury (TBI) served as a proxy for neurosurgical conditions. Data on workforce and training, infrastructure and equipment, and service delivery were collected from April to July 2023, with thirty-two responses analyzed. Descriptive analysis facilitated comparisons across institutions and countries. Among the thirty-two respondents, data trends varied significantly by institution. There was an observed increase in the number of neurosurgeons and consultant positions across hospitals. However, infrastructure disparities persisted, affecting equipment access, with some institutions experiencing consistent equipment availability while others faced severe shortages. Service delivery assessments revealed a rising trend in neurosurgical consultations, cases, and procedures over the past two decades. The prevalence of TBI was high across hospitals, with notable variation in arrival times post-injury. Despite increased medical training and the number of neurosurgeons across countries over the past 20 years, infrastructure deficits persist within each neurosurgical center. Uneven workforce distribution emphasizes the importance of targeted interventions, while collaborations between local and international stakeholders are crucial to address infrastructure disparities and optimize resource allocation. Further research is essential to guide effective interventions and policy development. Clinical trial number. Not applicable
Single-cell-driven design of logic-gated CAR circuits for enhanced solid tumor immunotherapy
No full textBackground Chimeric antigen receptor (CAR) T-cell therapy has revolutionized cancer immunotherapy for hematological malignancies but faces critical barriers in solid tumors due to tumor antigen heterogeneity and on-target, off-tumor toxicities. Logic-gated multi-antigen targeting using Boolean operators (AND, OR, NOT) represents an emerging precision immunotherapy engineering approach to overcome these challenges. Methods We developed LogiCAR designer, a genetic algorithm-based computational framework that systematically identifies optimal logic-gated antigen combinations (i.e., ‘circuits’) from single-cell transcriptomics data. The algorithm identifies CAR circuits consisting of 1-5 antigens from 2,758 cell surface proteins, optimizing tumor-targeting efficacy while maintaining stringent safety requirements in normal tissues. We curated and applied this to the largest breast cancer single-cell dataset: ~2 million cells including \u3e620k tumor cells from 342 patients across 17 cohorts spanning all major subtypes. Safety evaluation utilized 689,601 normal cells from 31 Human Protein Atlas tissues. Results LogiCAR designer demonstrates superior efficiency, reducing computational time from ~450 days (brute force) to ~1 hour for 3-gene circuits. The best shared 3-gene circuit (’GABRP | PRLR | VTCN1’) achieved 60% mean tumor-targeting efficacy—234% more effective than the best current CAR-T clinical trial targets. Newly identified circuits significantly outperformed existing computational methods and clinical targets across independent validation cohorts (p\u3c 0.05), with superior tissue-specificity addressing critical toxicity concerns. However, shared circuits were still ineffective for some patients, highlighting the need for personalized approaches. To address this limitation, we demonstrated individual patient-specific CAR circuit design achieving remarkable efficacy: in our new 82-patient multi-ethnicity cohort, 76% of patients reached estimated complete response-equivalent targeting (\u3e99% efficacy score) and all patients achieved at least estimated partial response (\u3e66% efficacy score), with a 98% mean efficacy. Conclusions LogiCAR designer represents a comprehensive computational framework for systematic logic-gated CAR immunotherapy design, identifying circuits with unprecedented efficacy-safety profiles. While shared circuits substantially advance current approaches, personalized design offers transformative potential for precision CAR immunotherapy across cancer types
Inter-rater reliability of Glasgow Coma Scale at a Referral Care Facility in Uganda: effect of an educational intervention among health workers
No full textBackground: The Glasgow Coma Scale is a widely used tool in the assessment and tracking of patients with acute head and brain insults. However, its reliability and application in low-resource clinical settings have been least explored.
Purpose: The study aimed at determining the IRR of GCS among health workers and evaluating the effect of a standardized GCS Aid as an educational intervention in improving the accuracy and IRR of the GCS when assessing patients with neurological deficits at a tertiary facility in Uganda.
Methods and Materials: The study employed a pre-test, post-test quasi-experimental design. Participants included health workers working within wards with adult patients with acute brain insults. A total of 45 participants completed the study.
Results: Findings indicate that higher training levels increased knowledge of GCS (F = 3.753, p = 0.01). The GCS AID improved the accuracy and IRR of the GCS post-test with eye-opening showing the greatest improvement (α, 0.65-0.88) followed by verbal (0.74 to 0.89), motor (0.83 to 0.93).
Conclusion: The use of the GCS-AID improved the IRR of GCS among health workers in the assessment of patients with acute brain insults
Policy brief. Media framing of sexual and gender-based violence and femicide: An analysis of news stories in select Kenyan, Ugandan and Tanzanian media
No full textThis policy brief presents the findings of a regional study on media coverage of femicide and sexual and gender-based violence (SGBV) in Kenya, Uganda, and Tanzania. The study analysed coverage of femicide and SGBV between January 2024 and April 2025, from major digital platforms, supported by interviews with editors. It sought to understand how media frames femicide and SGBV, which actors are most visible, and what implications these patterns have for accountability, justice, and deterrence. The findings show that while victims of femicide are given extensive sympathetic coverage, with very high salience, perpetrators are almost entirely absent from media narratives. Only three per cent of stories examined placed perpetrators as central actors. This policy brief argues that the imbalance in media framing undermines journalism’s watchdog role and weakens public confidence in justice systems. Coverage should also amplify survivor voices and local advocacy actors to build public awareness and promote systemic solutions. There is an urgent need for collaboration among media regulators, policymakers, and civil society to develop clear reporting guidelines that balance narratives around victims, perpetrators, and institutions. Finally, sustained partnerships that bring together media, academia, and advocacy groups are necessary to embed intersectional and survivor-centred approaches within journalism training and practice
The impact of donating human milk on the health of the donor and their infant: Evidence from two systematic reviews
No full textBackground: Using human milk has been associated with decreased morbidity and mortality in preterm/low birth weight infants. Donor human milk (DHM) is recommended when maternal milk is unavailable. The benefits of DHM for the recipient are well documented, but the impact of donation on donors and their infants is not clear.Objective: To evaluate the effects of donation on donors and their infants.Methods: Literature searches were conducted (April 2024) to identify studies (observational, quasi-experimental, and randomized control trials (RCTs)) assessing the impact of human milk donation on donor health, nutrition, well-being, and lactation and on their infants\u27 health, growth and development. Bias was assessed using the Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) scale. Meta-analysis was conducted when possible. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.Results: Nine studies examined donor outcomes, and six studies examined donor infant outcomes. No differences were found between donors and non-donors regarding the prevalence of overweight (RR: 1.27, 95% CI [0.81, 2.01]), postpartum depression (RR: 0.60, 95% CI [0.21, 1.72]), postpartum anxiety (RR: 0.84, 95% CI [0.59, 1.18]), need to pump for their infant (RR 1.09, 95% CI [0.63, 1.89]), mastitis (RR: 1.48, 95% CI [0.71, 3.05]), chapped/cracked nipples (RR 0.61, 95% CI [0.34, 1.12]), and breast engorgement (RR 1.88, 95% CI [0.94, 3.77]). Similarly, no differences were found between donor and non-donor infants regarding feeding intolerance (vomiting) (RR: 1.26, 95% CI [0.53, 3.01]), slow weight gain (RR: 0.36, 95% CI [0.13, 1.02]), oral thrush (RR: 0.55, 95% CI [0.12, 2.37]), or need for phototherapy (RR: 2.21, 95% CI [0.93, 5.23]). Certainty of evidence was very low for all outcomes.Conclusion: Limited, very low certainty evidence does not support any short-term harms or benefits of human milk donation for donors or their infants. Registry and registry number for systematic reviews or meta-analyses: The protocols for both studies were registered with the International Prospective Register of Systematic Reviews (PROSPERO) on March 26, 2024. Study IDs: CRD42024529222 and CRD42024528803
Unnoticed early pregnancy during myomectomy with favorable outcome: Case report
No full textIntroduction
Uterine fibroids are a common cause of infertility, and myomectomy remains a key surgical intervention to improve reproductive outcomes. However, the occurrence of an undetected pregnancy during myomectomy is rare and poses significant clinical risks.
Case Presentation
We report a 34-year-old woman, nulliparous with a history of secondary infertility and three first-trimester miscarriages. She had multiple fibroids and was managed for polycystic ovarian syndrome and hyperprolactinemia. Scheduled for abdominal myomectomy, the surgery proceeded uneventfully, with six fibroids removed and no breach of the endometrial cavity. Five weeks postoperatively, she presented with symptoms suggestive of early pregnancy. Ultrasound confirmed a viable intrauterine gestation of 8 weeks and 1 day. She later developed cervical shortening at 11 weeks and underwent cerclage. The pregnancy progressed without further complications, and she delivered a healthy infant via elective caesarean section at 36 weeks and 2 days.
Discussion
This case underscores the importance of thorough preoperative assessment to exclude pregnancy. It also reflects emerging evidence suggesting that conception shortly after myomectomy does not necessarily increase obstetric risk, especially when the uterine cavity remains intact.
Conclusion
Although conception during or soon after myomectomy is generally avoided, favorable outcomes are possible with careful surgical technique and close antenatal monitoring. Individualized counseling may be more appropriate than rigid timing guidelines for conception post-myomectomy
miR-21 as a diagnostic and prognostic biomarker in glioma: Tissue and serum expression analysis in a Pakistani cohort
No full textBackground: Gliomas are heterogeneous primary brain tumors with a poor prognosis, particularly in higher grades. MicroRNA-21 (miR-21) has emerged as a potential oncogenic biomarker in various cancers, including gliomas; however, its clinical utility in low- and middle-income countries (LMICs) remains underexplored. This study investigates the prognostic and diagnostic potential of miR-21 in glioma tissues and serum, examining its association with clinical and molecular features, tumor volume, and patient survival.Methodology: We collected 90 tumor tissue samples, 42 paired pre-and post-operative serum samples from glioma patients, and 10 normal adjacent brain tissue (NAT) samples, along with serum samples from 8 healthy individuals, to assess miR-21 expression using RT-qPCR. The Shapiro-Wilk test was performed to evaluate the data distribution. To analyze differences in gene expression, we applied ANOVA, Fisher\u27s exact test, the Wilcoxon test, and pairwise Student\u27s t-tests. miR-21 expression levels were further examined for correlation with Kaplan-Meier survival curves and the status of molecular markers, including IDH, Ki-67, ATRX, and p53. The hazard ratio for miR-21 as a prognostic indicator was quantified using Cox regression analysis. Results: MicroRNA-21 expression in glioma tissue progressively increased with tumor grade when compared to controls and across different glioma grades. A significant elevation in miR-21 expression was observed between grade 4 glioma tissues and control tissues, with additional significant differences between grade 1 and grade 4, as well as between grade 2 and grade 4. While tissue expression of miR-21 showed a positive trend with tumor volume, this correlation did not reach statistical significance. Moreover, gliomas with IDH-wildtype status and high Ki-67 expression demonstrated significantly higher miR-21 levels compared to IDH-mutant and low Ki-67 groups, respectively. Patients with low miR-21 expression had significantly longer overall survival (OS) compared to those with high miR-21 expression levels. Quantitative hazard analysis revealed that patients in the high-expression group had a 3.4-fold increased risk of mortality (95% CI: 1.6-7.1), with an AUC of 0.742 (all p \u3c 0.05). Notably, significantly elevated miR-21 expression was found in patients over the age of 50. In serum samples, miR-21 expression was significantly lower in the healthy control group and in post-operative samples compared to pre-operative samples across grades 2, 3, and 4 glioma patients. This suggests its potential utility as a non-invasive diagnostic and monitoring biomarker. The decline in serum miR-21 levels following tumor resection supports its association with tumor presence and progression. However, the prognostic significance was limited by cohort size and grade imbalance. Conclusion: miR-21 is significantly upregulated in both glioma tissue and serum, particularly in high-grade and IDH-wildtype tumors. It is strongly associated with poor clinical outcomes and aggressive molecular features. Its prognostic value is robust both alone and in combination with established markers. Furthermore, dynamic changes in serum miR-21 levels post-surgery highlight its potential utility in disease monitoring. These findings support the incorporation of miR-21 into glioma diagnostic and prognostic frameworks, enhancing clinical decision-making and personalized treatment approaches. miR-21 serves as a strong tissue-based prognostic marker in gliomas and a promising serum biomarker for tumor monitoring. While tissue findings align with global data, further studies are required to validate the serum results. This work underscores the clinical relevance of miR-21 in low- and middle-income countries (LMICs), where non-invasive tools are urgently needed
Global transfusion practices in septic patients in the intensive care unit: insights from the InPUT-study sub-analysis
No full textBackground Transfusion practices among intensive care unit (ICU) patients with sepsis vary widely. While restrictive hemoglobin thresholds for red blood cell (RBC) transfusion are well studied, the indications and thresholds for platelet and plasma transfusions remain uncertain.
Methods We performed a sepsis-specific sub-analysis of the International Point Prevalence Study of Intensive Care Unit Transfusion Practices, a prospective, multicenter, observational study capturing all adult ICU admissions during four pre-scheduled weeks between March 2019 and October 2022. Patients admitted with sepsis or septic shock, or who developed sepsis during their ICU stay, were included. We recorded demographics, daily laboratory values, and transfusion triggers. Primary endpoints were the proportions of patients receiving RBCs, platelets, or plasma; secondary endpoints were indications, pre-transfusion thresholds, and blood loss.
Results Among 3643 screened patients, 799 (22%) fulfilled sepsis criteria; within this subgroup, 317 (40%) received at least one blood component. RBCs were transfused in 269 patients (34%), primarily to address anemia or hemodynamic instability, at a mean pre-transfusion hemoglobin of 7.5 ± 1.4 g/dL, consistent with restrictive practice. Platelets were given to 78 patients (10%) for prophylaxis or active bleeding at a median count of 26 × 109 cells/L (interquartile range 16–51 × 109 cells/L). Plasma was administered to 108 patients (14%), half for bleeding control and half for non-bleeding indications.
Conclusions This largest international snapshot of septic ICU transfusion practices confirms adherence to restrictive RBC thresholds but reveals substantial variability in platelet and plasma use. These findings underscore the need for targeted trials to refine transfusion guidelines in sepsis
Research NEXUS : Volume 31 - 2025
No full textResearcher Spotlight Research Milestones & News AKU Kenya Achieves Platinum Certification in Financial Grant Practice Research Townhall – Pakistan and United Kingdom Research Magazine: In case you missed it! Capacity Building Initiatives Global Webinar Explores Innovations in Research Administration Webinar Strengthens Understanding of Ethical Review in Research Community of Practice Explores NIH Other Support Requirements The Collective Spark: Our Academic Entities, Institutes and Centres at Work New Guidelines Advance Sustainable Cloud Computing for Research in LMICshttps://ecommons.aku.edu/research_outlook/1024/thumbnail.jp
