Global Research Endeavors to Advance Treatment of Neurological Disorders in Africa (GREAT Neurology)

神经疾病的负担对资源有限的热带环境造成不成比例的影响，导致 提供护理或进行研究的能力严重不足。这一全球研究计划旨在推进我们的 了解非洲常见神经疾病的情况，为当地预防和治疗提供信息 这些疾病的治疗，同时也阐明了更广泛的相关病理生理过程。这 将通过继续Birbeck博士的神经艾滋病毒和脑型疟疾研究来实现 此外，还为从事广泛研究的年轻临床科学家提供支持和指导。 研究活动包括-- ·脑型疟疾：在一项针对患有中枢神经系统疟疾的儿童的前瞻性队列研究中，我们将研究其作用 神经炎症性结构损伤和神经系统发病率的实验室评估 炎症、系列神经成像和长期神经学结果。新奇的学习人群 将把儿童纳入积极退烧药的随机对照试验(RCT)，以及更多 有代表性的非随机对照研究人群。SARS-CoV-2混合感染对寄生虫的影响 与疟疾死亡、神经系统后遗症和结构性疾病相关的炎症因子清除 包括缺血、出血和血栓在内的损伤将被确定。 ·神经艾滋病毒：鉴于艾滋病毒疗法的广泛应用，#年神经艾滋病毒护理面临的下一个挑战 非洲包括与慢性低度炎症相关的非传染性疾病。利用 我们的农村和城市艾滋病毒诊所网络，我们将研究与艾滋病毒相关的加速老龄化 神经系统。鉴于其高度炎症状态，SARS-CoV-2可能会导致这种情况 负担。在儿童中，我们最近报道了亚临床脑血管疾病的高发病率。 (CVD)，尽管长期有效地治疗了艾滋病毒。我们将继续进行进一步的成像研究，包括在 未感染艾滋病毒但接触过艾滋病毒的儿童和社区控制，以确定心血管疾病的风险因素，检查 抗逆转录病毒治疗对代谢的影响和评估早产儿心血管疾病之间的关系 和感染SARS-Co-V2。在感染艾滋病毒的成年人中，将对SARS-Co-V2感染进行评估 认知监测5年前瞻性队列研究中加速衰老的可能作用 精神损害、精神症状、中风、神经疾病和癫痫。 这项研究将在比尔贝克博士工作超过25年的赞比亚和马拉维进行。这 研究计划奖还将为奖学金提供基础设施、指导和充满活力的环境 以及实习生与美国和非洲学者的接触。

The burden of neurological disorders disproportionately impacts resource-limited tropical settings resulting in grossly insufficient capacity for care provision or research. This global research program aims to advance our understanding of common neurological disorders in the African context to inform the local prevention and treatment of these conditions while also elucidating pathophysiological processes more broadly relevant. This will be accomplished through the continuation of Dr. Birbeck's neuro-HIV and cerebral malaria investigations plus support and mentorship for young clinician scientists engaged in a broad range of research endeavors. Research activities include-- • Cerebral malaria: In a prospective cohort study of children with CNS malaria, we will examine the role of neuroinflammation in structural injury and neurologic morbidity with laboratory assessments of acute inflammation, serial neuroimaging, and long term neurological outcomes. The novel study population will include children in a randomized controlled trial (RCT) of aggressive antipyretics as well as a more representative non-RCT population. The effects of co-infection with SARS-CoV-2 on parasite clearance, inflammatory factors associated with malarial death and neurologic sequelae and structural injuries including ischemia, bleeding, and thromboses will be ascertained. • Neuro-HIV: Given the widespread availability of HIV therapies, the next challenge in neuro-HIV care in Africa includes noncommunicable disorders associated with chronic low grade inflammation. Utilizing our network of rural and urban HIV clinics, we will study HIV-associated accelerated aging of the nervous system. Given its highly inflammatory state, SARS-CoV-2 could potentially contribute to this burden. Among children, we have recently reported high rates of subclinical cerebrovascular disease (CVD) despite long-standing, effectively treated HIV. We will pursue further imaging studies including in HIV uninfected but exposed children and community controls to identify risk factors for CVD, examine the metabolic impact of antiretroviral therapies and assess the relationship between premature CVD and infection with SARS-Co-V2. Among adults with HIV, SARS-Co-V2 infection will be evaluated for its possible role in accelerated aging in a 5-year prospective cohort study monitoring for cognitive impairment, psychiatric symptoms, strokes, neuropathies and seizures. This research will be undertaken in Zambia and Malawi where Dr. Birbeck has worked for over 25 years. This research program award will also provide infrastructure, mentorship and a vibrant environment for scholarship and trainee engagement with both US and African academics.