The World Health Organization’s First Edition Essential Diagnostics List: More aspirational than feasible

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”

Did consolidating acute stroke services in Denmark help?

Getting acute stroke patients to appropriate clinical care setting as fast as possible is very important. Hastrup et al report results of an initiative to centralize stroke care in 2012 in the Central Denmark Region (CDR). CDR has a population of 1.3million and area of 5040 square miles1. The purpose of the centralization was a) to ensure all stroke patients would receive care in designated areas and b) to reduce overall costs. The design of the study was pre/post with contemporaneous comparisons to the rest of Denmark. The centralization involved consolidating acute stroke care to 2 designated hospitals from a total of 6 hospitals in the region. These hospitals both offered thrombolysis, but endovascular therapy was only offered at one. A neurologist was on call 24 hours a day for calls from outside the acute stroke units. In addition, an outpatient clinic was established for minor stroke and TIA.

Continue Reading “Did consolidating acute stroke services in Denmark help?”

Publons – A useful resource for residents and fellows to become experienced reviewers, and get recognized for it.

The Neurology journal has recently become an official partner of Publons. Publons (publons.com), is a relatively new company founded in 2012 to help recognize reviewers for their contributions and train the next generation of reviewers. It currently boasts over 400,000+ users and the number is rapidly growing. Publons’ website has many resources that residents and fellows may find helpful in their early career development.

Continue Reading “Publons – A useful resource for residents and fellows to become experienced reviewers, and get recognized for it.”

What’s a picture worth?

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
  • Hydrocephalus
  • Basal ganglia or thalamic infarcts
  • Tuberculomas
  • 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.

  1. 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.

 

What’s Hot: Immune-mediated neurologic disorders

Immune-mediated neurologic disorders has been a hot and rapidly evolving topic in high income setting such as the US for the past few years. Now there is a burgeoning body of evidence suggesting that immune mediated phenomena deserve more attention in tropical setting as well.  In 2017, Johnson et al. discovered a leiomodin-1 autoantibody in the sera and CSF of patients with nodding syndrome that may be a result of Onchocercal volvulus (OV) infection. OV is the cause of River Blindness and has long been associated with Nodding Syndrome though direct infectious links have been ruled out.1 Also in 2017, Neurology published a report of Post Malaria Neurologic Syndrome (PMNS) in a patient found to have NEUREXIN-3a2 antibodies and another case report of PMNS associated with anti-voltage-gated potassium channel antibodies.3 PMNS has been previously described primarily in adults and involves neuropsychiatric manifestations, confusion or coma, and seizures, but pediatric cases have also been reported.4 In malaria endemic regions, acute febrile pediatric illnesses with seizure and coma for which no underlying etiology can be identified is a not uncommon clinical conundrum. One has to wonder what the full spectrum of PMNS might entail.

  1.  Johnson TP, Tyagi R, Lee PR, et al. Nodding syndrome may be an autoimmune reaction to the parasitic worm Onchocerca volvulus. Sci Transl Med 2017; 9(377).
  2. Costa A, Silva-Pinto A, Alves J, et al. Postmalaria neurologic syndrome associated with neurexin-3alpha antibodies. Neurol Neuroimmunol Neuroinflamm 2017; 4(5): e392.
  3. Sahuguet J, Poulet A, Bou Ali H, Parola P, Kaphan E. Postmalaria Neurologic Syndrome-Autoimmune Encephalitis With Anti-Voltage-Gated Potassium-Channel Antibodies. Ann Intern Med 2017; 167(1): 70-1.
  4. Kernan RJ, Gavin PJ, Butler KM, Leahy TR, Lynch B, Leonard J. Expanding the Spectrum of Post-malaria Neurologic Syndrome in the Pediatric Population. Pediatr Infect Dis J 2018; 37(5): 499-500.

 

Apply now to join the Neurology Resident & Fellow Section Editorial Team

The Neurology Resident & Fellow Section is trainee-run by an editorial team of more than 20 neurology residents and fellows with the responsibility for reviewing, editing, and publishing articles. Editorial team members are selected annually through a competitive process and each will serve a three-year term. Past editorial team members have gone on to other important editorial activities, at Neurology® and elsewhere, and they have found the experience a formative part of their careers.   Continue Reading “Apply now to join the Neurology Resident & Fellow Section Editorial Team”

Prophylactic antibiotic use in stroke patients

Hospital acquired infections (HAIs) are a devastating complication that can increase morbidity and mortality, particularly post-stroke due to the disruption in the blood-brain barrier. 1-17  The prevalence of HAI post-stroke ranges, with the majority of reports indicating the prevalence of HAI in stroke patients is between 20-40%.18-21  This prevalence is higher for stroke patients than in the general hospitalized population (3.5-15%), indicating a particularly at risk population. 22  To date, the results from randomized clinical trials assessing prophylactic antibiotic use in stroke patients have been mixed, with the most recent trials suggesting prophylactic antibiotic use does not promote better functional outcome post-stroke and only moderately decreases the proportion of HAI.23-30 Continue Reading “Prophylactic antibiotic use in stroke patients”