The American University of the Caribbean School of Medicine (AUC) is a private medical school. Its main basic science campus is located in Sint Maarten, and separate administrative offices are located in Iselin, New Jersey, and Miramar, Florida, in the United States. AUC is owned by Adtalem Global Education.
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
This study systematically reviews outcomes of robotic-assisted total knee arthroplasty (rTKA) in complex primary and revision cases, compared with conventional TKA (cTKA). Complex cases include severe coronal deformity, high BMI, fixed flexion deformity, and revision arthroplasty. Outcomes assessed included coronal alignment, perioperative metrics, and patient-reported outcomes. Nineteen studies comprising 2,482 patients (2,535 knees: 1,931 rTKA, 604 cTKA) were included. Robotic-assisted TKA consistently restored coronal alignment, with greatest improvements observed in moderate-to-severe varus and valgus deformities. In revision cases, robotic assistance achieved near-neutral hip–knee–ankle alignment (mean deviation − 1.05°), low complication rates (4–17.9
Neonatal renal vein thrombosis (NRVT) is a rare and potentially fatal condition that can be frequently misdiagnosed as an infection by clinicians due to its nonspecific presentation. This report presents a preterm neonate who developed a renal vein thrombosis (RVT) complicated by adrenal hemorrhage as the result of an underlying protein C deficiency. This case highlights the importance of maintaining a broad differential when treating seemingly inconspicuous symptoms and identifying underlying etiologies. Increased understanding of this topic is essential for early diagnosis, management, and improved clinical outcomes for affected patients.
Background Opioid use disorder (OUD) remains a major public health challenge, with substantial morbidity, mortality, and healthcare costs. Emergency departments (EDs) represent critical intervention points for initiating evidence-based treatment. While ED-initiated buprenorphine improves treatment engagement, its economic value relative to referral-based care requires further evaluation. Methods We developed a decision-analytic Markov cohort model to assess the cost-effectiveness of ED-initiated buprenorphine with rapid primary care follow-up (ED-BUP) compared with referral alone in adults with OUD. The model used monthly cycles over a 5-year time horizon from a healthcare sector perspective. Clinical inputs were derived from randomized and observational studies. Outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness. Uncertainty was assessed using one-way deterministic and probabilistic sensitivity analyses with 1,000 Monte Carlo simulations. Results ED-BUP was associated with lower costs (−$225 per patient) and greater effectiveness (+ 0.012 QALYs) compared with referral alone, indicating that the intervention is dominant. Probabilistic sensitivity analysis showed that ED-BUP was cost-effective in 97% of simulations at a willingness-to-pay threshold of $100,000 per QALY and 99% at $200,000 per QALY. Sensitivity analyses confirmed robustness of results across key model parameters. Conclusions ED-initiated buprenorphine with rapid follow-up is a cost-effective strategy for managing OUD, improving health outcomes while reducing healthcare costs. These findings support broader implementation of ED-based treatment as part of public health and health system strategies to address the opioid crisis.
Colorectal cancer (CRC) is a major contributor to cancer-related mortality in the United States and remains a substantial public health challenge worldwide. Although screening modalities have proven efficacy in reducing both incidence and mortality, adherence to these preventive measures is still suboptimal. We present a Hispanic man in his early 50s with no prior screening who developed CRC. Our patient presented to the emergency department with a one-month history of chronic left upper quadrant abdominal pain, diarrhea, unintentional weight loss, decreased appetite, intermittent fevers, and an extensive history of cancer in his family. Investigations revealed a large, partially obstructive mass in the splenic flexure with extramural extension. He underwent an extended left colectomy with partial gastrectomy and loop ileostomy. Pathology confirmed low-grade colorectal adenocarcinoma. He reports no regular medical care and no prior esophagogastroduodenoscopy or colonoscopy. This case demonstrates an atypical presentation with left upper quadrant pain relating to splenic flexure involvement and the absence of rectal bleeding. It highlights the need to maintain a high index of suspicion for colorectal malignancy in patients with persistent or unexplained GI symptoms, even when the clinical presentation is atypical or localizes outside the expected distribution.
