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.
Introduction Social determinants of health (SDOH) are nonmedical factors that influence patient outcomes. This study aimed to determine the prevalence of randomized controlled trials (RCTs) reporting SDOH factors in their patient cohorts within several of the highest-impact spinal surgery journals. We hypothesize that SDOH factors will be infrequently reported and often miss variables such as socioeconomic status, employment status, insurance, and education level. Methods From 2020 to 2024, the PubMed database was queried to analyze spine RCTs reporting SDOHs from four high-impact journals. For each study, we determined the age, sex, and/or gender, body mass index (BMI), the year the article was published, the country of origin of the senior author, and self-reported SDOH factors. Results Of the 147 included RCTs, age (95.9%), sex/gender (94.6%), and BMI (72.8%) were reported by the majority of studies. There were a total of 33 countries represented by the RCTs reporting spine outcomes, where 25 (17.0%) RCTs were conducted in the United States, 22 (15.0%) RCTs conducted in China, 11 (7.5%) RCTs in the Netherlands, 9 (6.1%) RCTs in Japan and 9 (6.1%) RCTs in Turkey. Conclusion This paper provides valuable insights into the landscape of spine research and emphasizes the necessity of consistently reporting all SDOH factors. Future research can better inform clinical practice and policy decisions by addressing these considerations, ultimately improving healthcare outcomes for spine patients worldwide.
