Abstract Background Pediatric cancer care in Nigeria is constrained by several patient- and system-related factors. In line with the World Health Organization’s Global Initiative for Childhood Cancer, this scoping review mapped the Nigerian literature on diagnostic delays, treatment access, clinical outcomes, and related system gaps. Methods We searched PubMed, Cochrane Library, Scopus, African Journals Online (AJOL), Taylor & Francis Online, and Google Scholar. Eligible studies were in English, published 2005–2025, and included individuals 0–18 years. Findings were synthesized thematically and narratively. Results Twenty-seven tertiary hospital-based studies (n = 2,920) were included, representing all six geopolitical zones. Most were retrospective. Frequently reported malignancies included Burkitt lymphoma, nephroblastoma, retinoblastoma, Hodgkin lymphoma, and acute leukemias. Symptom-to-presentation intervals ranged from 2 to 157 weeks (median 79.5 weeks), and two studies separately reported symptom-to-diagnosis intervals of 13.4 weeks and 54.1 weeks, respectively. Contributors to delayed diagnosis and poor treatment access included low awareness, traditional or alternative care-seeking, initial misdiagnosis, financial barriers, long travel distances, limited insurance coverage, and broader health-system constraints. Using study-reported definitions, treatment completion was 3.3% in one study and 62.8% in another; treatment discontinuation was 6.3% in one study and 64.7% in another; mortality was 6.3% in one study and 45.1% in another; and cohort-level loss to follow-up was 6.6% in one study and 52.6% in another, reaching 81.8% among patients discharged on follow-up chemotherapy in one cohort. Conclusion Pediatric oncology care in Nigeria is marked by prolonged diagnostic pathways, interrupted treatment, and poor reported outcomes. Priorities include standardized referral pathways and integration of childhood cancer into national health insurance. Graphical abstract
Orexin-A, a neuropeptide involved in regulating physiological processes, has potential implications in psychiatric disorders. Studies examining orexin-A levels in schizophrenia, bipolar disorder, and major depressive disorder have produced conflicting results, highlighting the need for further research. To address these inconsistencies, this meta-analysis aims to synthesize existing data on orexin-A levels across these disorders, clarifying its role and potential as a diagnostic or prognostic biomarker. This systematic review, registered with PROSPERO, investigated plasma orexin-A levels in schizophrenia, bipolar disorder, and major depressive disorder. Relevant studies were identified through PubMed and PsycINFO using specific keywords. Inclusion criteria targeted adult patients with these disorders and healthy controls, assessing quality and bias using the MINORS tool for non-randomized studies and the AXIS tool for cross-sectional studies. A meta-analysis compared orexin-A levels between groups, using random-effects models and evaluating statistical heterogeneity and publication bias. Of the 64 reviewed articles in full-text screening, 11 met the criteria for analysis, involving 1,778 participants (514 with schizophrenia, 149 with bipolar disorder, and 461 with major depressive disorder). The meta-analysis revealed significantly decreased plasma orexin-A levels in schizophrenia (SMD = -0.38; 95% CI: -0.72 to -0.05; p = 0.03) and increased levels in major depressive disorder (SMD = 0.38; 95% CI: 0.15 to 0.60; p = 0.001) compared to healthy controls. Moderate statistical heterogeneity was noted in the schizophrenia analysis (I^2 = 54%). Methodological quality was generally high; MINORS scores ranged from 12 to 20 (out of 24), and AXIS scores ranged from 17 to 19 (out of 20), indicating a moderate-to-low risk of bias. These findings suggest distinct orexin-A dysregulation in schizophrenia and major depressive disorder. However, findings in bipolar disorder were inconclusive due to high heterogeneity, indicating orexin-A's complex involvement in mood and energy regulation.
Individuals with unrepaired or incompletely repaired congenital heart disease (CHD) are at risk of infective endocarditis (IE). In low- and middle-income countries (LMICs), this burden is compounded by diagnostic delays, persistent defects, and poor infrastructure. This scoping review aimed to map the reported clinical presentation, microbiological profile, and outcomes, including in-hospital mortality where documented, of IE in this population. We searched PubMed, Embase, Google Scholar, Cochrane Central, African Journal Online, and Directory of Open Access Journals Online for English and French records from January 2007 to June 2026, focusing on individuals with unrepaired or incompletely repaired CHD and IE in LMICs. Eleven studies, comprising 58 patients across three LMIC regions, including ten case reports and one retrospective case series, were included in the review. Patient ages ranged from 0 to 45 years. Tetralogy of Fallot and ventricular septal defect (31.3
