Post-Vaccination Pharyngeal-Cervical-Brachial Variant of Guillain-Barré Syndrome

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

Assessment of Resident Doctors’ Perception of Postgraduate Medical Education in Nigeria Using the SPEED Tool: A Pilot Study

Background: Obtaining feedback from trainees is important in the evaluation and evolution of Postgraduate Medical Education (PME), and policies made based on their felt needs would go a long way in making residency training a worthwhile experience. This pilot study aimed to assess resident doctors’ perception of the training content, atmosphere, and organization using the Scan of Postgraduate Educational Environment Domains (SPEED) tool. Methodology: This was a cross-sectional study conducted amongst resident doctors at Babcock University Teaching Hospital (BUTH) in Nigeria, between May and August 2019. A self-administered questionnaire was used to collect participants’ sociodemographic data, their perception of PME in their respective departments, as well as the strengths and weaknesses of the training programmes. Validity and reliability indices were assessed, and descriptive, inferential, and correlational analyses were run where appropriate. Results: The mean score for the resident doctors’ perception of training content, atmosphere, and organization was 4.0 ± 0.4, 4.2 ± 0.5 and 3.69 ± 0.60 respectively, out of a maximum of 5, indicating a positive perception of training in BUTH. The major strengths perceived by most residents were good inter-personal relations between residents and their trainers, as well as conducive learning and work environment; while the weaknesses include poor remuneration and limited staffing which hampers rotations. Conclusion: Resident doctors in BUTH mostly had a positive outlook on their training. This study serves as a reference point for local policy change (in BUTH), and a framework from which future studies on PME can emerge

Neuroimaging findings in DYT1 dystonia and the pathophysiological implication: A systematic review

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

EMG indications and findings in a sub-Saharan African neurorehabilitation center

Objective: This study aims to assess the frequency and indication for electrodiagnostic referrals as well as to summarize the findings from the procedure at a neurorehabilitation center in Ibadan, Nigeria. Methods: This is a retrospective cross-sectional study. Data from referrals to Blossom Medical Centre/ World Federation for Neurorehabilitation (BMC/WFNR) center, Ibadan, Nigeria, from April 2014 to December 2016 were collated and analyzed. Results: Sixty referrals were received during the period of evaluation. Neurologists referred most of the patients (47; 71.7%). Disorders of the peripheral nerves were the most frequent reasons for electromyo- graphy (EMG), and they were the most common electrodiagnosis with better classified into axonal and demyelinating types. The overall congruence between the suspected diagnosis and final diagnosis was 58.3%. Requests by neurologists were significantly more appropriate than those by other specialists (p value = 0.02). Conclusion: Polyneuropathy, entrapment neuropathy, and disorders of the motor nerve root and plexus were the most common reasons for electrodiagnostic requests, and the majority of the referrals were from neurologists. Significance: EMG has changed the approach towards the diagnosis and management of neuromuscular disorders in Nigeria. It is hoped that with more neurophysiology education in this environment, neuro- physiological practice will become widely availabl

Relationship Between Obesity and Severity of Carpal Tunnel Syndrome in Tanzania

Background: Carpal tunnel syndrome (CTS) is the most common focal mononeuropathy in the general population, and obesity is one of its established independent risk factors The prevalence of obesity in CTS patients and its association with CTS severity are yet to be fully studied among Tanzanians. In this study, we determined the frequency of obesity in patients with CTS and its relationship with the electrophysiological severity of CTS in a Tanzanian private tertiary level hospital. Methods: This is a retrospective observational and analytical study of patients referred for electrodiagnostic (EDX) evaluation of suspected CTS at the clinical neurophysiology laboratory of the Aga Khan Hospital, Dar es Salaam, Tanzania. All EDX studies done for CTS indications between August 1, 2017, and December 31, 2019, were reviewed. The frequency of CTS patients with obesity (body mass index \u3e30 kg/m2) and overweight (25.0-29.9 kg/m2) was determined. Next, we explored the relationship between obesity and the electrophysiologic severity of CTS. Results: One-hundred nine hands were studied. The prevalence of obesity was 50.5% and overweight was 31.2%. Females were significantly more obese than males (P = 0.001). Many of the EDX parameters that defined CTS, including prolonged median nerve sensory and distal motor latencies as well as sensory conduction velocity, were significantly more abnormal in the obese when compared to the nonobese patients. On univariate analysis, severe CTS (stage 5) was commoner among nonobese patients (P = 0.031), while moderate CTS (stage3) was more prevalent among obese patients (P \u3c 0.001). Multivariate regression analysis, however, revealed no effect of obesity on CTS severity (P = 0.490). Conclusion: Obesity and overweight are prevalent among this cohort with CTS, but did not predict severe CTS. The use of other indices of adiposity may show a trend

sj-docx-1-dhj-10.1177_20552076221150072 - Supplemental material for Telemedicine ready or not? A cross-sectional assessment of telemedicine maturity of federally funded tertiary health institutions in Nigeria

Supplemental material, sj-docx-1-dhj-10.1177_20552076221150072 for Telemedicine ready or not? A cross-sectional assessment of telemedicine maturity of federally funded tertiary health institutions in Nigeria by Tolulope F Olufunlayo, Oluwadamilola O Ojo, Obianuju B Ozoh, Osigwe P Agabi, Chuks R Opara, Funmilola T Taiwo and Olufemi A Fasanmade, Njideka U Okubadejo in Digital Health</p

Management of rare movement diseases in different world regions

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