History of African women in neurosurgery.

The number of women in the medical field has increased in Africa over the last few decades, yet the underrepresentation of women within neurosurgery has been a recurrent theme. Of all surgical disciplines, neurosurgery is among the least equitable, and the rate of increase in female surgeons lags behind other surgical disciplines such as general surgery. This historical review provides an overview of the history of women in neurosurgery and their current status on the African continent. To the authors' knowledge, this is the first article to provide such an overview.

Geriatric spontaneous trans-mesenteric herniation leading to death. Case report.

INTRODUCTION AND IMPORTANCE: Spontaneous trans-mesenteric hernia is a rare entity in adults. Its pre-operative diagnosis is challenging even with Computed Tomography Scanning. Most cases are diagnosed as incidental findings during laparotomy or postmortem. This case report highlights that even in geriatric patients without prior laparotomies, peritonitis or abdominal trauma which predispose to trans-mesenteric herniation, a differential diagnosis of a spontaneous trans-mesenteric hernia is of paramount importance as delay in diagnosis leads to death. CASE PRESENTATION: We report a case of a geriatric lady who presented with features of intestinal obstruction. Intra-operative findings revealed strangulated gangrenous small bowels extending from 170 cm from ligament of Treitz to the ileal caecal junction through a trans-mesenteric defect of about 12 cm in diameter. She underwent resection of the gangrenous small bowel with right hemi colectomy and jejunal-transverse colon end to side anastomosis. However, she succumbed two days post operatively. CLINICAL DISCUSSION: Spontaneous trans-mesenteric hernia is a rare cause of small bowel obstruction in adults, difficult to clinically and radiologically diagnose pre-operatively and mostly presents with bowel ischaemia due to strangulation. Early diagnosis is paramount in reducing morbidity and mortality rates in these cases. CONCLUSION: Delay in diagnosis of trans-mesenteric hernia leads to strangulation, gangrene of bowels and eventual death. A high index of suspicion is needed from both surgeons and radiologists even in cases of intestinal obstruction without prior histories of laparotomy, peritonitis or abdominal trauma.

The effect of the Dar es Salaam neurosurgery training course on self-reported neurosurgical knowledge and confidence.

Introduction: The Muhimbili Orthopaedic Institute in collaboration with Weill Cornell Medicine organises an annual neurosurgery training course in Dar es Salaam, Tanzania. The course teaches theory and practical skills in neurotrauma, neurosurgery, and neurointensive care to attendees from across Tanzania and East Africa. This is the only neurosurgical course in Tanzania, where there are few neurosurgeons and limited access to neurosurgical care and equipment. Research question: To investigate the change in self-reported knowledge and confidence in neurosurgical topics amongst the 2022 course attendees. Material and methods: Course participants completed pre and post course questionnaires about their background and self-rated their knowledge and confidence in neurosurgical topics on a five point scale from one (poor) to five (excellent). Responses after the course were compared with those before the course. Results: Four hundred and seventy participants registered for the course, of whom 395(84%) practiced in Tanzania. Experience ranged from students and newly qualified professionals to nurses with more than 10 years of experience and specialist doctors. Both doctors and nurses reported improved knowledge and confidence across all neurosurgical topics following the course. Topics with lower self-ratings prior to the course showed greater improvement. These included neurovascular, neuro-oncology, and minimally invasive spine surgery topics. Suggestions for improvement were mostly related to logistics and course delivery rather than content. Discussion and conclusion: The course reached a wide range of health care professionals in the region and improved neurosurgical knowledge, which should benefit patient care in this underserved region.