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

项目摘要 镰状细胞病、细菌性脑膜炎和脑膜炎是世界上发病率和死亡率最高的疾病， 疟疾发生在撒哈拉以南非洲（SSA）的儿童中。估计有225，000名儿童出生时 镰状细胞病（SCD）每年在非洲大陆，有超过60,000人患有缺血性中风 因为每年都有进行性血管病变细菌性脑膜炎（BM）影响超过100万人 死亡率为30-50%，主要是由于颅内并发症， 缺血性中风疟疾每年造成405 000人死亡。脑型疟疾（CM）是一种严重的 这种疾病的表现，病死率在15%到40%之间。超过50%的 存活者，CM导致粗大运动或感觉功能、认知和行为的缺陷。评价 在这些疾病中的每一种中，神经血管系统的变化都具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或可能影响的影响。然而，在这方面， 先进的神经影像学方法通常用于诊断病理生理变化， 发达国家的神经血管系统在世界上 受这些疾病的影响最大。经颅多普勒超声（TCD）是一种便携式，相对 一种廉价的非侵入性工具，可真实的实时评估脑血流速度（CBFV）， 所有主要脑血管的脑血流动力学。在过去的六年里， 进行了几项试点研究，证实TCD在SSA中的使用是可行的，并提供了有价值的见解， 有SCD、BM和CM神经系统并发症风险的儿童的诊断和预后。 然而，撒南非洲获得中药的机会仍然非常有限。我们的目标是建立中医药中心， 在SSA的五个站点进行卓越（COE）。目标1将建立人力资源和物质基础设施 需要启动COE。目标2将解决当地从业人员的技能差距， 实施培训课程，教授标准化的扫描、解释和 记录SSA儿童的TCD检查。目标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规范的TCD值， 这是推动该领域发展的必要步骤。此外，它将形成儿童CBFV的集体数据库 与SCD，BM和CM的关系，以提高我们对检查结果及其与 这些人群的结果。这一提议的重要性在于，特遣队所属装备将填补 提高非洲儿童神经系统疾病的诊断能力。COE在以下方面具有创新性 他们将是撒哈拉以南非洲地区第一个这样的学校，容纳受严重影响的儿童。 从长远来看，这一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SCD、BM和CM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.