Effective leadership and advocacy are critical across the globe and in all disciplines. But there are often limited opportunities for formal professional development on this front and the routine training track undertaken by neurologists simply doesn’t prepare one for major leadership and advocacy roles. In the US, the Palatucci Forum has long served as an incubator of young talent and as developed some of our finest leaders. This year, they are expanding this opportunity to non-US neurologists. Applications are due March 4, 2019. Global Neurology needs global leaders. Apply now or forward this on to someone you think this would help develop.
The Palatucci Advocacy Leadership Forum teaches neurologists the following skills:
Action Planning: Create an effective plan that identifies your issue and resolves the problem
Media Relations: Sharpen your on-camera interview skills, work with reporters, and improve your confidence
Grassroots Advocacy: Get an inside look at how governments work and how to get results
In a recent issue of Neuroimmunology & Neuroinflammation, work by Kamtchum-Tatuene et al’s Blantyre-Liverpool collaboration further reinforce existing concerns that even with excellent access to antiretroviral medications in sub-Saharan Africa, there will be a public price to pay in comorbid health conditions exacerbated by HIV infection1. The researchers accessed biobanked samples from Dr. Laura Benjamin’s previously completed START study—a case-control study designed to identify risk factors for stroke in Malawi2. Taking advantage of the ~10% HIV prevalence in the population, they evaluated traditional serum markers for endothelial activation and injury among stroke vs. non-stroke patients stratified by HIV status. Surprisingly, despite relatively small numbers for analysis, they found an odds ratio of 3.6 (CI 1.3-10.6) for higher plasma levels of ICAM-1 (a biomarker of endothelial activation) among HIV-infected individuals regardless of their stroke status and even when they were on HIV treatments with good viral suppression. Chronic endothelial activation might be expected to increase all cardiovascular risks in the long run for HIV infected individuals who are otherwise doing well in terms of their infection. Additional concerns would be for increased risks of vascular dementia and peripheral neuropathies associated with diabetes or other metabolic problems. Further evaluations are also needed to determine how HIV-associated endothelial activation might impact the risks and neurologic injuries associated with severe malaria, whose effects are largely mediated by endovascular dysfunction.
- Kamtchum-Tatuene J, Mwandumba H, Al-Bayati Z et al. HIV is associated with endothelial activation despite ART, in a sub-Saharan African setting. Neurology 2018 Dec 21
- Benjamin LA, Allain, TJ, Mzinganjira H, et al. The Role of Human Immunodeficiency Virus–Associated Vasculopathy in the Etiology of Stroke. The Journal of Infectious Diseases 2017;216:545-553
Advances in Neurosurgical Capacity and Practice in Africa are improving options for patients while also informing care and offering training opportunities for neurosurgeons in the US. To learn more, listen to our interview with Dr. Benjamin Warf. Dr. Warf is the Director of the Neonatal and Congenital Anomaly Neurosurgery and Professor of Neurosurgery at Harvard Medical School. Early in his career, he moved his family to Uganda to direct a neurosurgical hospital for children funded by CURE. In 2012, he was awarded a MacArthur (‘genius’) Fellowship.
Three cheers for Dr. Mamta Bhushan Singh whose candid editorial in the November issue of Seizure really sums up the problems of epilepsy research and care in the developing world today. 1 Such a maddening paradox—70% of epilepsy cases would respond to basic treatment, if provided. And rather than expending efforts to assure we put systems in place to roll out sustainable care to the masses, we in the global epilepsy arena continue to focus most of our attention and resources on the 30% of patients with treatment resistant epilepsy. This approach might make sense in developed settings, but certainly not in low and middle income settings where the treatment gap really hasn’t budged in more than two decades.
Continue Reading “Fumbled Priorities and Lost Perspectives: Epilepsy in LMICs Today”
An anthropologist-friend some years ago described the average international student elective as “an experience of inflicting the unprepared upon the unsuspecting.” Thankfully, as US global health programs have expanded in number with many becoming formally incorporated into existing training programs, a growing body of knowledge and academic thought about what should be included in a global neurology curriculum is starting to emerge.1-4
Continue Reading “Another recipe for improving global neurology for US trainees—this time with a dash of ACGME-flavored core competencies”
I read with some interest the description of the recent development of not one, but two epilepsy surgery programs in Peru. There are certainly laudable aspects of the work including that, as described, it represents a true transfer of technical and medical capacity and not a “mission trip” with external experts dropping in briefly to declare victory over disease.
Continue Reading “In response to Establishment of Epilepsy Surgery in Peru”
In May 2018, the World Health Organization (WHO) published its first edition of a “Model List of Essential in Vitro Diagnostics” (EDL) in which they detail those clinical diagnostic tests which should be (ideally?) available and at which level of healthcare facility. Clearly, developing this list was no small undertaking and WHO is careful to state that the EDL is “not intended to be prescriptive…rather country programmes should make the ultimate decision about [EDLs] selected”. Nonetheless, there are some paradoxical recommendations hard to reconcile with realities. For example, the primary health care facility is delineated as:
“Primary health care: Health centres, doctors’ offices, health posts, outreach clinics. Typically, self-testing and rapid diagnostics tests are available, but there are either no laboratories, or small laboratories with trained health”
Continue Reading “The World Health Organization’s First Edition Essential Diagnostics List: More aspirational than feasible”
In this past week’s Neurology, Alladi and Hachinski1 provide a thoughtful review of what is known (or not) about dementia in the Global South vs. more developed regions. Continue Reading “Dementia in the Global South”
The epidemiology of PNEA in high income, western settings is fairly well described but little is known about this condition in Africa. At a referral hospital in Tanzania, Dekker and colleagues have recently made some interesting observations.1 Continue Reading “Psychogenic Non-Epileptic Attacks (PNEA)…in Africa”
In the world of TB, Tai et al.1 assessed the sensitivity and specificity of brain MRI for diagnosing CNS tuberculosis in Malaysia. They compared imaging in patients presenting with a meningoencephalitis who had TB confirmed by cerebrospinal fluid studies (PCR or AFB) and/or by tissue examination at autopsy to the MRI findings of patients with meningoencephalitis but not TB looking for what they termed “classical” TB imaging abnormalities which included—
- Basilar enhancement
- Basal ganglia or thalamic infarcts
- Vasculitis/vasospasm evident on MRA
They found that 89% of people with TBM had ≥ 1 classical MRI finding compared to only 4% of patients with other meningoencephalitides. Their study population was largely HIV uninfected (only 7% HIV positive). There would be significant value to determining if the excellent sensitivity and specificity of imaging in this population holds true for people with HIV.
- Tai MS, Mohn Nor, H., Rahmat, K., Viswanathan, S., Abdul Kadir, A., Ramli, N., Abu Bakar, F.K., Mohd Zain, N.R., Abdullak, S., Yap, J.F., Shaheed, J., Ng, B.S., Rafia, M.H., Tan, C.T. Neuroimaging findings are sensitive and specific in diagnosis of tuberculous meningitis. Neurology Asia 2017; 22(1): 15-23.