History and Current State of Neurosurgery in the Gambia.

BACKGROUND: Despite global efforts to improve surgical care access, many low- and middle-income countries, especially in neurosurgery, face significant shortages. The Gambia exemplifies this, with only 1 fully qualified neurosurgeon serving its population of 2.5 million people. This scarcity results in higher morbidity and mortality. OBJECTIVE: We aim to document the history and current state of neurosurgery in the Gambia to raise awareness and promote neurosurgery development. METHODS: The study reviews the Gambia's health care system, infrastructure, neurosurgical history, workforce, disease burden, and progress, with information derived from reference sources as well as author experience and interviews with key partners in Gambian health care. RESULTS: Neurosurgery in the Gambia began in the 1970s, facing constraints due to competing health care demands. Significant progress occurred much later in the early 2010s, marked by the initiation of Banjul Neuro Missions and the establishment of a dedicated neurosurgery unit. We report significant progress with neurosurgical interventions in the past few years showcasing the unit's dedication to advancing neurosurgical care in the Gambia. However, challenges persist, including a lack of trained neurosurgeons, equipment shortages such as ventilators and diagnostic imaging. Financial barriers for patients, particularly related to the costs of computer tomography scans, pose significant hurdles, impacting the timely diagnosis and intervention for neurological conditions. CONCLUSIONS: Neurosurgery in the Gambia is progressing, but challenges like equipment scarcity hinder further progress. We emphasize the need for addressing cost barriers, improving infrastructure, and fostering research. Engaging the government and international collaborations are vital for sustained development in Gambian neurosurgery.

Advances in Spermatological Characters in the Digenea: Review and Proposal of Spermatozoa Models and Their Phylogenetic Importance.

The wide biodiversity and economic importance of digeneans have motivated a great deal of research in the last decade, focussing on their phylogenetic positions. Molecular research was instrumental for our understanding of phylogeny in the Digenea, but spermatological studies have also provided many results, which are potentially useful for phylogeny; however, the complete spermatological data set has never been reviewed in a whole phylogenetic perspective. Spermatological data are now available for more than 100 species, belonging to 15 superfamilies and 46 families. In this paper, we try to summarize the current knowledge about sperm structure in the digeneans and propose a classification of digenean spermatozoa into five basic models. The main ultrastructural characters used are (1) the type of axoneme, (2) the lateral expansion, (3) the association 'external ornamentation of the plasma membrane + cortical microtubules', (4) the field of cortical microtubules and its number, (5) the location of the external ornamentation, (6) the location of the maximum number of cortical microtubules and (7) the number of mitochondria. We also outline the most interesting features for phylogenetic inference and their possible value in the context of digenean systematics, phylogeny and evolution. Associations between sperm models and superfamilies were found as follows: Type 1 in the Schistosomatoidea; Type 2 in the Hemiuroidea; Type 3 in the Opecoeloidea, Lepocreadioidea, Haploporoidea and Opisthorchioidea; Type 4 in the Gorgoderoidea, Microphalloidea, Plagiorchioidea and Gymnophalloidea; Type 5 in the Echinostomatoidea, Microscaphidioidea, Paramphistomoidea, Pronocephaloidea and Brachylaimoidea.