Background
Primary generalized dystonia due to the DYT1 gene is an autosomal dominant disorder caused by a GAG deletion on chromosome 9q34. It is a well‐defined, genetically proven, isolated dystonia ...syndrome. However, its pathophysiology remains unclear.
Objectives
This study was aimed at profiling the functional neuroimaging findings in DYT1 dystonia and harmonizing the pathophysiological implications for DYT1 dystonia from the standpoint of different neuroimaging techniques.
Methods
A systematic review was conducted using identified studies published in English from Medline, PsycINFO, Embase, CINAHL, and the Cochrane Database of Systematic Reviews (CDSR), between 1985 and December 2019 (PROSPERO protocol CRD42018111211).
Results
All DYT1 gene carriers irrespective of clinical penetrance have reduced striatal GABA, dopamine receptors and increased metabolic activity in the lentiform nucleus, supplementary motor area, and cerebellum in addition to an abnormal cerebellothalamocortical pathway. Nonmanifesting carriers on the other hand have a disruption of the distal (thalamocortical) segment and have larger putaminal volumes than manifesting carriers and healthy controls. Activation of the midbrain, thalamus, and sensorimotor cortex was only found in the manifesting carriers.
Conclusions
Therefore, we propose that DYT1 dystonia is a cerebellostriatothalamocortical network disorder affecting either the structure or function of the different structures or nodes in the network.
Achieving the objectives of rolling out genomic research programs in sub-Saharan Africa depends on how prepared indigenous biomedical researchers are for this type of research. We explored the level ...of preparedness of biomedical researchers in a sub-Saharan African country using in-depth interviews to obtain data on their understanding of genomics and genomic research and assess their awareness of the scope of the country's code of health research ethics. Thirty biomedical researchers were interviewed. Only eight were familiar with concepts of genomics, a form of "genomic health literacy." The majority were not aware of the country's code of research ethics. This study showed that generally biomedical researchers were not genomic health literate, unaware of the code and its limitations as a source of ethical guidance for the conduct of genomic research. These findings underscore the need for educational training in genomics and creating awareness of ethical oversight for genomic research in sub-Saharan Africa.
To evaluate the management of rare movement disorders (RMD) at the international level and identify care needs to be addressed, the Rare Movement Disorders Study Group of the International Parkinson ...and Movement Disorders Society (MDS) has conducted an exploratory survey. We sent an online survey to experts in Africa, Asia, Oceania and American continents following the classification of the MDS Regional Sections: Africa, Asia and Oceania (A&O), and Pan-America. We did not include Europe as the European Reference Network for Rare Neurological Diseases recently performed a similar care needs survey across European countries. We obtained responses from experts from 20 African, 26 A&O and 19 Pan-American countries. According to the respondents, only 55% of African countries had movement disorders experts, while these were present in 96% of A&O and 91% of Pan-American. Access to care for patients with RMD was stated difficult in 70% of African, 54% of A&O, and 65% of Pan-American countries. Africa was the region with greatest difficulties in accessing diagnostic tests. However, in Pan-America and A&O, large inequalities were observed between countries with quite variable access to therapeutic options such as deep brain stimulation. The survey results reflect wide variability in the management of RMD and provide evidence that a worldwide care-focused network is highly warranted. Scientific and medical organisations should raise awareness of deficits in managing RMD and care disparities among regions. The goals should be to facilitate the training of professionals, establish improvement strategies, and increase support and budgeting for these diseases.
•The survey results reflect wide variability in the management of rare movement disorders.•The need to improve education for allied healthcare professionals was a common concern.•African countries reported the greatest difficulties with accessing ancillary tests.•A worldwide care-focused network is highly warranted.
Commercialization of neglected and underutilized species is a reasonable pathway to food security, employment growth, and reducing poverty. Pigeon pea is one of the underutilized crops with great ...economic value and health benefits. Despite its potential, pigeon pea is still a minor crop. This study, therefore, examined the level of pigeon pea commercialization, influencing factors of the commercialization of pigeon pea production and the constraints faced in its commercialization in Nigeria. The descriptive statistics, the household commercialization index, and the Tobit regression model were used to analyse primary data collected from 160 randomly selected pigeon pea farmers. The results showed that the mean household commercialization index was 29.2%, implying that the farmers still had a gap of a minimum of 45.8% to attain a high level of commercialization in pigeon pea production. The positive influencing factors for the commercialization of pigeon pea production were access to credit, farming experience, farm size, farm output, extension services, the use of farm machinery, and pesticides. The distance to the market had a negative influence on the commercialization of pigeon pea production. Farmers' major challenges in commercializing pigeon pea production included a lack of credit, insufficient extension contacts, a poor transportation system, pests and diseases, high production input costs, inadequate storage facilities, and insufficient access to timely market information. Therefore, this study recommends encouraging pigeon pea commercialization by the government and non-governmental organizations through the provision of farm credits, production inputs, a good transportation system, and an improved agricultural extension system.
Commercialization of neglected and underutilized species is a reasonable pathway to food security, employment growth, and reducing poverty. Pigeon pea is one of the underutilized crops with great economic value and health benefits. Despite its potential, pigeon pea is still a minor crop. This study, therefore, examined the level of pigeon pea commercialization, influencing factors of the commercialization of pigeon pea production and the constraints faced in its commercialization in Nigeria. The descriptive statistics, the household commercialization index, and the Tobit regression model were used to analyse primary data collected from 160 randomly selected pigeon pea farmers. The results showed that the mean household commercialization index was 29.2%, implying that the farmers still had a gap of a minimum of 45.8% to attain a high level of commercialization in pigeon pea production. The positive influencing factors for the commercialization of pigeon pea production were access to credit, farming experience, farm size, farm output, extension services, the use of farm machinery, and pesticides. The distance to the market had a negative influence on the commercialization of pigeon pea production. Farmers' major challenges in commercializing pigeon pea production included a lack of credit, insufficient extension contacts, a poor transportation system, pests and diseases, high production input costs, inadequate storage facilities, and insufficient access to timely market information. Therefore, this study recommends encouraging pigeon pea commercialization by the government and non-governmental organizations through the provision of farm credits, production inputs, a good transportation system, and an improved agricultural extension system.
Abstract Background The increasing stroke burden in sub-Saharan Africa far outstrips the availability of skilled human resource to provide timely and efficient acute, rehabilitative and preventive ...services. The objective of this study was to examine the impact of a short-term task-shifting stroke training program on the stroke knowledge of a cohort of Nigerian non-neurologist health workers (NNHWs). Methods Utilizing a quasi-experimental design, NNHWs drawn from 53 local government areas of Ogun and Oyo states participated in an intensive, multicomponent one-day stroke workshop. Stroke knowledge was evaluated before and after the training using a self-administered questionnaire. Results Out of a total of 210 NNHWs who participated in the session, 116 (55.2%) completed the pre-workshop questionnaire survey of stroke knowledge while 191 (91.0%) completed the post-workshop questionnaire survey. There were no statistically significant differences in the distribution of the age, gender and professional categories of the two groups. The participants' knowledge was significantly increased at the end of the training about stroke risk factors (p < 0.001), stroke symptoms (p < 0.001) and how stroke develops (p = 0.009). The proportion of respondents who understood the FAST mnemonic increased from 10.3% before the training to 90.6% at the end of the training (p < 0.001). The professional category of participants was associated with knowledge gain about swallowing test and thrombolysis. Conclusion Our data support the effectiveness of stroke-specific task-shifting training for non-neurologist health workers in a low resource setting. Interim studies with intermediate outcomes are needed to show that improved knowledge results in better care despite resource limitation. Randomized controlled trials will be useful to confirm findings and translate knowledge improvement into practical intervention.
Introduction and objective
Telemedicine has reinforced its position as a means for the continuity of healthcare services and a cost-effective approach to improving health equity as demonstrated ...during the COVID-19 pandemic. The preparedness of health systems for telemedicine is an indicator of the scalability of their services, especially during catastrophes. We aimed to assess the maturity and preparedness of federally funded tertiary health institutions in Nigeria, to deploy telemedicine as such data are currently lacking and are required to drive improvements in health services delivery.
Methods
We conducted a cross-sectional survey of thirty randomly selected federally funded tertiary health institutions in Nigeria using the Pan American Health Organization's tool for assessing the maturity level of health institutions to implement telemedicine between 17 September 2020 and 1 September 2021. Descriptive statistics were used for overall maturity levels and non-parametric tests to compare scores for overall maturity and specific Pan American Health Organization domains per region. The level of significance was set at p-value <0.05.
Results
The response rate was 77.4% (24 of 30 randomly polled federally funded tertiary health institutions responded). Overall, the median telemedicine maturity level was 2.0 (1.75) indicating a beginner level. No significant inter-zonal difference in the median overall maturity level (p = 0.87). The median maturity levels for telemedicine readiness in specific domains were organizational readiness – 2.0 (2.0), processes 1.0 (1.0), digital environment 2.0 (3.0), human resources 2.0 (1.0), regulatory issues – 1.5 (1.0) and expertise 2.0 (2.0); mostly at beginner level, with no inter-zonal differences. Most participating institutions had no initiatives in place for domains of processes and regulatory issues.
Conclusions
The current telemedicine maturity level of federally funded tertiary health institutions in Nigeria is at the beginner level. This behoves policy-makers to advance the implementation and deployment of telemedicine nationwide as part of digital quality healthcare, to improve health equity and to ensure continuity of healthcare services in the event of another pandemic.
The pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré syndrome (GBS) is very rare. It is characterized by weakness of the upper extremities associated with bulbar symptoms and facial ...diplegia. Documented cases were post-infectious, a post-vaccination occurrence has not been documented in the available literature. Even rarer is the occurrence of any variant of GBS following the mumps measles rubella (MMR) vaccine. The neurophysiological hallmark of PCB variant of GBS is a combination of myelinopathy and axonopathy, hence, its consideration as a subtype of the acute motor axonal neuropathy (AMAN) variant. It should be suspected in any case of acute-onset flaccid symmetrical weakness of the upper extremities, as early diagnosis and treatment are key to preventing fatal bulbar weakness. Here we report a case of a middle-aged man, who presented with features of PCB a fortnight after being vaccinated for MMR.
Africa has over 1.3 billion inhabitants, with over 60% of this population residing in rural areas that have poor access to medical experts. Despite having a ridiculously huge, underserved population, ...very few African countries currently have any form of sustained and organized telemedicine practice, and even fewer have dedicated tele-neurology services. The ongoing COVID-19 pandemic has proved to be one of the most significant disruptors of vital sectors of human endeavor in modern times. In the healthcare sector, there is an increasing advocacy to deliver non-urgent care
telemedicine. This paper examined the current state of tele-neurology practice and infrastructural preparedness in sub-Saharan Africa. Currently, there is over 70% mobile phone penetration in most of the countries and virtually all of them have mobile internet services of different technologies and generations. Although the needed infrastructure is increasingly available, it should be improved upon. We have proposed the access, costs, ethics, and support (ACES) model as a bespoke, holistic strategy for the successful implementation and advancement of tele-neurology in sub-Saharan Africa.
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