Transcranial Doppler Ultrasonography Clinical and Research Centers of Excellence in Sub-Saharan Africa

项目摘要 世界范围内镰状细胞病、细菌性脑膜炎和脑炎的发病率和死亡率最高 疟疾发生在撒哈拉以南非洲(SSA)的儿童中。据估计，有22.5万名儿童出生时患有 非洲大陆每年都有镰状细胞病(SCD)，超过6万人患有缺血性中风 每年由于进行性血管病变。细菌性脑膜炎(BM)影响100多万人 每年，死亡率为30%-50%，主要原因是颅内并发症，包括 缺血性中风。疟疾每年导致40.5万人死亡。脑型疟疾是一种严重的疾病。 病死率从15%到40%不等。在超过50%的 存活下来的人，CM会导致大运动或感觉功能、认知和行为的缺陷。评估 在每种情况下的神经血管系统都有重要的诊断和治疗作用 对降低发病率和死亡率具有已证实的或可能产生影响的影响。然而， 先进的神经成像方法通常用于诊断脑血管疾病的病理生理变化 发达国家的神经血管系统在世界上一些地区并不普遍 受这些疾病影响最严重的。经颅多普勒超声(TCD)是一种便携式的，相对 廉价的非侵入性工具，实时评估脑血流速度(CBFV)和 所有主要脑血管的脑血流动力学。在过去的六年里，我们的团队 进行了几项试点研究，证实在SSA中使用TCD是可行的，并提供了有价值的见解 有SCD、BM和CM神经并发症风险的儿童的诊断和预后。 然而，在SSA获得TCD的机会仍然非常有限。我们的目标是建立TCD中心 在SSA的五个站点获得卓越(COE)。目标1将建立人力资源和物质基础设施 启动COE所需的。目标2将解决当地从业者的技能差距，方法是设计和 实施培训课程，教授扫描、口译和 SSA儿童经颅多普勒检查的记录。AIM 3将在 感兴趣的人群。也就是说，我们将在健康的非洲儿童中建立标准化的TCD价值观， 推进这一领域的必要步骤。此外，它还将形成儿童CBFV的集体数据库 与SCD、BM和CM一起提高我们对检查结果及其与 在这些人群中的结果。此建议意义重大，因为COE将满足未满足的 提高非洲儿童对神经系统疾病的诊断能力。COE在以下方面具有创新性 这将是SSA的第一个此类项目，可容纳受严重影响的儿童人口。 从长远来看，这个综合中心网络将定位于提供基于TCD的护理 研究旨在减轻非洲儿童因SCD、BM和CM造成的神经残疾负担。

Project Summary Most morbidity and mortality worldwide due to sickle cell disease, bacterial meningitis, and cerebral malaria occurs in children in sub-Saharan Africa (SSA). An estimated 225,000 children are born with sickle cell disease (SCD) annually on the continent, with upwards of 60,000 suffering ischemic strokes due to progressive vasculopathy each year. Bacterial meningitis (BM) affects over 1 million individuals annually and carries a 30-50% mortality rate, primarily due to intracranial complications including ischemic stroke. Malaria results in 405,000 deaths annually. Cerebral malaria (CM) is a severe manifestation of the disease with case fatality rates that range from 15% to 40%. In more than 50% of survivors, CM results in deficits in gross motor or sensory function, cognition, and behavior. Evaluation of the neurovasculature in each of these conditions has important diagnostic and therapeutic implications that have a proven or likely impact on morbidity and mortality reduction. However, advanced neuroimaging approaches commonly used to diagnose pathophysiological changes to the neurovasculature in developed countries are not widely available in the regions of the world that are most heavily impacted by these diseases. Transcranial Doppler ultrasound (TCD) is a portable, relatively inexpensive, non-invasive tool that evaluates, in real time, the cerebral blood flow velocities (CBFV) and cerebral hemodynamics in all the major cerebral vessels. Our group has, over the last six years, performed several pilot studies confirming TCD use is feasible in SSA and provides valuable insight into the diagnosis and prognosis of children at risk of neurologic complications from SCD, BM, and CM. Access to TCD in SSA, however, remains very limited. Our objective is to form TCD Centers of Excellence (COE) at five sites in SSA. Aim 1 will establish the human resource and material infrastructure required to launch the COE. Aim 2 will address the skills gaps of local practitioners by designing and implementing training courses to teach standardized approaches to scanning, interpretation, and documentation of TCD examinations in children in SSA. Aim 3 will define TCD parameters in the populations of interest. Namely, we will establish normative TCD values in healthy African children, a necessary step to advance the field. Furthermore, it will form a collective database of CBFVs in children with SCD, BM, and CM to improve our understanding of examination findings and their associations with outcomes in these population. This proposal is significant in that COE will fill an unmet need of improving diagnostic capabilities for neurologic disease in African children. The COE are innovative in that they will be the first of their kind in SSA, accommodating a severely affected population of children. In the long-term, this network of comprehensive centers will be positioned to provide TCD-based care and research aimed to reduce the burden of neurodisability from SCD, BM, and CM in African children.