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Rizk HI, Magdy R, Emam K, Mohammed MS, Aboulfotooh AM. Substance use disorder in young adults with stroke: clinical characteristics and outcome. Acta Neurol Belg 2024; 124:65-72. [PMID: 37454034 PMCID: PMC10874343 DOI: 10.1007/s13760-023-02317-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Stroke incidence among young adults has risen in the last decade. This research attempts to determine the effect of substance use disorder (SUD) on the clinical characteristics of stroke, mortality, outcome after IV thrombolysis, and functional dependency after 1 month among young adults. METHODS Through a retrospective study, data were extracted from the electronic medical records of stroke in young adults admitted to intensive care units in Kasr Al-Ainy Hospital (February 2018-January 2021). The National Institute of Health Stroke Scale (NIHSS) and the Modified Rankin Scale were documented at the onset and after 1 month. RESULTS The study included 225 young adults with stroke (median age of 40, IQR: 34-44). Only 93 young adults (41%) met the criteria of SUD. Anabolic steroid use disorder was significantly associated with cerebral venous thrombosis (P-value = 0.02), while heroin use disorder was significantly associated with a hemorrhagic stroke (P-value = 0.01). Patients with tramadol, cannabis, and cocaine use disorders had significantly more frequent strokes in the posterior than the anterior circulation. Patients with heroin use disorders had significantly higher mortality than those without heroin use disorders (P-value = 0.01). The risk of poor outcomes was doubled by alcohol or heroin use disorder, while it was tripled by cocaine use disorder (P-value = 0.01 for each). CONCLUSION Forty-one percent of young adults diagnosed with a stroke had SUD, with a relatively higher posterior circulation involvement. Increased mortality was associated with heroin use disorder more than other substances. Poor stroke outcome was associated with alcohol, heroin, and cocaine use disorders.
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Affiliation(s)
- Hoda Ibrahim Rizk
- Department of Public Health and Community Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Magdy
- Department of Neurology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Khadiga Emam
- Department of Public Health and Community Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Soliman Mohammed
- Department of Public Health and Community Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Nasreldein A, Walter S, Mohamed KO, Shehata GA, Ghali AA, Dahshan A, Faßbender K, Abd-Allah F. Pre- and in-hospital delays in the use of thrombolytic therapy for patients with acute ischemic stroke in rural and urban Egypt. Front Neurol 2023; 13:1070523. [PMID: 36742046 PMCID: PMC9895407 DOI: 10.3389/fneur.2022.1070523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023] Open
Abstract
Background Reducing pre- and in-hospital delays plays an important role in increasing the rate of intravenous thrombolysis (IVT) in patients with acute ischemic stroke. In Egypt, the IVT rate has increased steadily but is still far away from an ideal rate. Aim The study aimed to investigate the factors associated with pre- and in-hospital delays of IVT among patients with acute ischemic stroke coming from urban and rural communities. Methods This prospective, multicenter, observational cohort study was conducted from January 2018 to January 2019. Patients with acute ischemic stroke, who did not receive IVT, were included in the study. Patients were recruited from three large university stroke centers in Egypt, Assiut (south of Egypt), Tanta (north of Egypt), both serving urban and rural patients, and the University Hospital in Cairo (capital city), only serving an urban community. All participants underwent the National Institutes of Health Stroke Scale and full neurological assessment, urgent laboratory investigations, and computed tomography or magnetic resonance imaging to confirm the stroke diagnosis. The patients were subjected to a structured questionnaire that was designed to determine the parameters and time metrics for the pre- and in-hospital delays among patients from rural and urban regions. Results A total of 618 patients were included in the study, of which 364 patients (58.9%) lived in rural regions and 254 (41.1%) in urban regions. General demographic characteristics were similar between both groups. Approximately 73.3% of patients who arrived within the therapeutic time window were urban patients. The time from symptom onset till hospital arrival (onset to door time, ODT) was significantly longer among rural patients (738 ± 690 min) than urban patients (360 ± 342 min). Delayed onset to alarm time (OAT), initial misdiagnosis, and presentation to non-stroke-ready hospitals were the most common causes of pre-hospital delay and were significantly higher in rural patients. For patients arriving within the time window, the most common causes of in-hospital delays were prolonged laboratory investigations and imaging duration. Conclusion The limited availability of stroke-ready hospitals in rural Egypt leads to delays in stroke management, with subsequent treatment inequality of rural patients with acute stroke.
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Affiliation(s)
- Ahmed Nasreldein
- Department of Neurology, Assiut University Hospitals, Assiut University, Asyut, Egypt
| | - Silke Walter
- Department of Neurology, Saarland University Hospital, Homburg, Germany
| | - Khaled O. Mohamed
- Department of Neurology, Assiut University Hospitals, Assiut University, Asyut, Egypt
| | - Ghaydaa Ahmed Shehata
- Department of Neurology, Assiut University Hospitals, Assiut University, Asyut, Egypt
| | - Azza A. Ghali
- Department of Neurology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Dahshan
- Department of Neurology, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | - Klaus Faßbender
- Department of Neurology, Saarland University Hospital, Homburg, Germany
| | - Foad Abd-Allah
- Department of Neurology, Cairo University Hospitals, Cairo University, Cairo, Egypt,*Correspondence: Foad Abd-Allah ✉
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He C, Chen Q, Shen Z, Zhang Y, Hou H, Pei Y, Wang W, Zhang X. Prevalence and the age of onset patterns of stroke in Jiangsu Province, China. Neurol Sci 2023; 44:215-227. [PMID: 36190684 DOI: 10.1007/s10072-022-06428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 09/23/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Little was known regarding the current age of onset patterns of stroke. This study aimed to examine the prevalence of stroke and explore the age of onset patterns of stroke in Jiangsu Province, China. MATERIALS AND METHODS Participants were recruited from April 2012 to April 2013 in Jiangsu Province, China. Survival analysis models were used to evaluate the hazards of stroke by a single year of age. Kaplan-Meier analysis and the log-rank test were used to explore the disparities of the age of onset patterns of stroke. RESULTS This population-based study was conducted among 39,887 participants aged ≥ 18 years in Jiangsu Province, China. Of the 740 (1.9%) events of stroke, 13.2% suffered from hemorrhagic stroke (HS) and 86.8% suffered from ischemic stroke (IS). The prevalence of HS and IS were 0.3% and 1.7%, respectively. The estimated mean age of onset of stroke was 71.98 (95% CI: 71.97-71.99) years by the survival model. Up to age of 45 years, the estimated hazards of stroke onset were at a relatively low level. From the age of 45 years, the increases in hazards accelerated and peaked at age 75 years. Urban, smoking, and drinking males had a higher risk of stroke than their counterparts (P < 0.05). However, no such difference was found among females. CONCLUSIONS The findings emphasize the importance of implementing stroke prevention interventions in Jiangsu Province, China, especially for urban, smoking, and drinking males. It is of great significance to strengthen comprehensive management of health-related behaviors, including smoking cessation and moderate consumption of alcohol to have sustained beneficial effects on stroke risk. Chenlu He and Qian Chen contributed equally to this work.
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Affiliation(s)
- Chenlu He
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, 221004, Jiangsu, China
| | - Qian Chen
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, 221004, Jiangsu, China
| | - Ziyuan Shen
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, 221004, Jiangsu, China
| | - Ying Zhang
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, 221004, Jiangsu, China
| | - Hao Hou
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, 221004, Jiangsu, China
| | - Yifei Pei
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, 221004, Jiangsu, China
| | - Wei Wang
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, 221004, Jiangsu, China.
| | - Xunbao Zhang
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, 221004, Jiangsu, China.
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Mohammed M, Li J. Stroke-Related Sarcopenia among Two Different Developing Countries with Diverse Ethnic Backgrounds (Cross-National Study in Egypt and China). Healthcare (Basel) 2022; 10:healthcare10112336. [PMID: 36421660 PMCID: PMC9689982 DOI: 10.3390/healthcare10112336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/24/2022] [Accepted: 11/05/2022] [Indexed: 11/23/2022] Open
Abstract
The prevalence of stroke-related sarcopenia differs according to the diagnostic criteria, the cut-off point for assessment, and ethnicity. Egypt and China are developing countries with different races where no research concerning stroke-related sarcopenia has been performed yet. We aimed to evaluate the prevalence of possible sarcopenia and confirmed sarcopenia among Egyptian and Chinese stroke survivors using the Asian Working Group of Sarcopenia (AWGS-2019) criteria and to assess the variables associated with the prevalence rate. A prospective cross-sectional study was carried out among 200 Egyptian and 195 Chinese stroke survivors from 2019 to 2021 using a structural health questionnaire. A hand-held dynamometer was used to measure grip strength. Anthropometric measures were used to estimate muscle mass. Data were analyzed using SPSS statistics version 20. p-values < 0.05 were considered statistically significant. The prevalence of possible sarcopenia ranged from 20.0% to 34.4% among Egyptian and Chinese groups, except for the Egyptian females where it was 52.0%. The prevalence of sarcopenia in both populations ranged from 13.6% to 18.6%. Pre-stroke independent variables that accelerated possible sarcopenia were age, history of dyslipidemia, diabetes mellitus, and ischemic heart disease, but stroke severity was a post-stroke risk factor. Age was the only pre-stroke variable for sarcopenia, while quitting smoking and having good nutritional status were variables for the reduction of possible sarcopenia. Quitting smoking, having a good nutritional status, and early rehabilitation reduced sarcopenia development. Controlling vascular risk factors, enhancing rehabilitation, and nutritional therapy are protective measures against sarcopenia. Longitudinal studies are required to identify further risk factors.
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Affiliation(s)
- Marwa Mohammed
- College of Rehabilitation Medicine, Nanjing Medical University, Nanjing 210029, China
- Faculty of Physical Therapy, Beni-Suef University, Beni-Suef 62521, Egypt
- First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Jianan Li
- First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
- Correspondence: ; Tel.: +86-137-7051-61766
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Popoola O, Ovbiagele B, Arulogun O, Akinyemi J, Akinyemi R, Uvere E, Akpa O, Salami A, Taiwo O, Olaniyan L, Walker R, Jenkins C, Owolabi M. African Rigorous Innovative Stroke Epidemiological Surveillance: Protocol for a Community-Based Mobile-Health Study. Neuroepidemiology 2022; 56:17-24. [PMID: 34903691 PMCID: PMC9840813 DOI: 10.1159/000518885] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/30/2021] [Indexed: 01/18/2023] Open
Abstract
Despite projections of stroke being a leading cause of mortality in Africa, reliable estimates of stroke burden on the continent using rigorous methods are not available. We aimed to implement a mobile-Health community-based interactive Stroke Information and Surveillance System to sustainably measure stroke burden and improve stroke health literacy and outcomes in urban and rural sites in Nigeria. African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) is an observational cohort study, which will be conducted in urban (Ibadan North LGA Ward 3) and rural (Ibarapa Central LGA) sites with a combined base population of over 80,000 people. The study will use a consultative approach to establish an mHealth-based Stroke Information and Surveillance System comprising a Stroke Alert System and a Stroke Finding System. These systems will enable the community to report stroke events and the research team/health workers find stroke cases using phone calls, short message service, and Voice Over Internet Protocols (VoIP). We will update community household data and geo-locate all households. Over the 5 years of the study, the system will collect information on stroke events and educate the community about this disease. Reported stroke cases will be clinically adjudicated at home and in prespecified health facilities. Baseline and endline community surveys will be conducted to assess stroke occurrence and other important study variables. The proportion of strokes alerted and found will be determined over the study period. Focus group discussions and key informant interviews will be conducted to understand community stroke literacy and perspectives. The study will also assess any impact of these efforts on time from stroke onset to referral, community uptake of orthodox health services for stroke patients. ARISES is anticipated to establish proof of concept about using mHealth for stroke surveillance in Africa. The potential impact of the SISS on improving patient outcomes will also be determined.
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Affiliation(s)
- Oluwafemi Popoola
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, University of California San-Francisco, USA
| | - Oyedunni Arulogun
- Department of Health Promotion, College of Medicine, University of Ibadan, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Statistics, College of Medicine, University of Ibadan
| | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, IAMRAT, College of Medicine, University of Ibadan, Nigeria,Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Ezinne Uvere
- Department of Medicine, Newcastle University, United Kingdom
| | - Onoja Akpa
- Department of Epidemiology and Statistics, College of Medicine, University of Ibadan
| | - Ayodeji Salami
- Department of Pathology, College of Medicine, University of Ibadan, Nigeria
| | - Olalekan Taiwo
- Department of Geography, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Lanre Olaniyan
- Department of Economics, Faculty of Social Sciences, University of Ibadan, Nigeria
| | - Richard Walker
- College of Nursing, Medical University of South Carolina, Charleston, USA
| | - Carolyn Jenkins
- Department of Medicine, Newcastle University, United Kingdom
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria,Department of Medicine, College of Medicine, University of Ibadan, Nigeria
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Khedr E, Tony AA, Habeel M, Nasreldein A. Frequency and risk factors of carotid artery disease among ischemic stroke patients in the south Egypt: hospital-based study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00382-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Limited data are available on the frequency of carotid artery disease among cerebrovascular ischemic stroke (CVS) patients in south Egypt. The aim of the present study is to determine the prevalence and risk factors of extracranial atherosclerosis among stroke patients using extracranial duplex ultrasound.
Results
142 patients (76.8%) were males and 43 (23.2%) were females. Their mean age was 63.3 ± 9.79 years with no significant difference between the mean age of the male and female groups. NIHSS score ranged from 3 to 25 (mean ± S.D; 11.89 ± 4.91). 66 patients (35.7%) had no atherosclerotic changes, 75 patient (40.5%) had stenosis < 70% and 44 patients (23.8%) had stenosis ≥ 70%. The most prevalent modifiable risk factors for atherosclerosis were hypertension (74.8%), hyperlipidemia (70.6%), smoking (59.7%) and DM (45.4%).
Conclusion
Atherosclerosis among people in the south Egypt is relatively high in comparison to other regions in Egypt and Middle East. This is a call for performing further population-based epidemiological studies, to address the exact magnitude of the problem and invest into prevention.
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Moyano LM, Montano SM, Vilchez Barreto P, Reto N, Larrauri L, Mori N, Cornejo-Olivas M, Guevara-Silva E, Urizar F, Najar E, Gamboa R, Azabache C, Herrer Ticse R, Bolivar-Herrada L, Doud A, Martinez P, Miranda JJ, Zunt JR, García HH. Prevalence of stroke survival in rural communities living in northern Peru. PLoS One 2021; 16:e0254440. [PMID: 34324513 PMCID: PMC8321101 DOI: 10.1371/journal.pone.0254440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Stroke is the leading cause of neurological impairment in the South American Andean region. However, the epidemiology of stroke in the region has been poorly characterized. METHODS We conducted a staged three-phase population-based study applying a validated eight-question neurological survey in 80 rural villages in Tumbes, northern Peru, then confirmed presence or absence of stroke through a neurologist's examination to estimate the prevalence of stroke. RESULTS Our survey covered 90% of the population (22,278/24,854 individuals, mean age 30±21.28, 48.45% females), and prevalence of stroke was 7.05/1,000 inhabitants. After direct standardization to WHO's world standard population, adjusted prevalence of stroke was 6.94/1,000 inhabitants. Participants aged ≥85 years had higher stroke prevalence (>50/1000 inhabitants) compared to other stratified ages, and some unusual cases of stroke were found among individuals aged 25-34 years. The lowest age reported for a first stroke event was 16.8 years. High blood pressure (aPR 4.2 [2.7-6.4], p>0.001), and sedentary lifestyle (aPR 1.6 [1.0-2.6], p = 0.045) were more prevalent in people with stroke. CONCLUSIONS The age-standardized prevalence of stroke in this rural coastal Peruvian population was slightly higher than previously reported in studies from surrounding rural South American settings, but lower than in rural African and Asian regions. The death rate from stroke was much higher than in industrialized and middle-income countries.
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Affiliation(s)
- Luz M. Moyano
- Cysticercosis Elimination Program, Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú
| | - Silvia M. Montano
- Sección de Epidemiologia, Instituto de Medicina Tropical Daniel Alcides carrión Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Percy Vilchez Barreto
- Cysticercosis Elimination Program, Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú
| | - Narcisa Reto
- Cysticercosis Elimination Program, Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú
| | - Luis Larrauri
- Centro Basico de Investigación en Demencia y enfermedades desmielinizantes, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Nicanor Mori
- Departamento de Medicina, Hospital Nacional Daniel Alcides Carriòn, Lima, Perú
| | - Mario Cornejo-Olivas
- Cysticercosis Elimination Program, Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú
- Neurogenetics Research center (MC), Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Erik Guevara-Silva
- Centro Basico de Investigación en Demencia y enfermedades desmielinizantes, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Fernando Urizar
- Cysticercosis Elimination Program, Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú
| | - Enrique Najar
- Departamento de Medicina, Hospital Nacional Cayetano Heredia, Lima, Perú
| | - Ricardo Gamboa
- Cysticercosis Elimination Program, Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú
| | - Cintya Azabache
- Cysticercosis Elimination Program, Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú
| | - Raquel Herrer Ticse
- Cysticercosis Elimination Program, Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú
| | - Lucia Bolivar-Herrada
- Cysticercosis Elimination Program, Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú
| | - Alex Doud
- Departments of Neurology, Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United State of America
| | - Peggy Martinez
- Departamento de Pediatría, Instituto Nacional del Niño, San Borja, Lima, Perú
| | - J. Jaime Miranda
- Cysticercosis Elimination Program, Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Joseph R. Zunt
- Departamento de Medicina, Hospital Nacional Cayetano Heredia, Lima, Perú
| | - Hector H. García
- Cysticercosis Elimination Program, Center for Global Health, Universidad Peruana Cayetano Heredia, Tumbes, Perú
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Sex, Knowledge, and Attitude of Stroke Survivors Attending Bebe Herbal Center on Risk Factors before and after Stroke. Stroke Res Treat 2021; 2021:6695522. [PMID: 34007438 PMCID: PMC8102117 DOI: 10.1155/2021/6695522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/23/2021] [Accepted: 04/22/2021] [Indexed: 12/26/2022] Open
Abstract
Objective The objective of this study was to investigate the extent stroke survivors who attended an herbal center knew of stroke risk factors and whether significant sex differences existed. Study Design. This was a cross-sectional study conducted from January to June 2018 at Bebe Herbal Center, and it involved two well-trained assistants who interviewed 149 first-time stroke survivors after consent and ethical approval were obtained. The survivors self-reported their knowledge, attitude, and beliefs on risk factors before and after stroke. Statistical Analyses. Means of continuous variables were compared using Student's unpaired t-test, while categorical variables between males and the females were analyzed using Pearson's chi-square test. P < 0.05 was taken as significant. Results Mean age of men (64.81 ± 1.24 yrs) was significantly higher than that of women (61.39 ± 1.42 yrs) (F = 0.096, t = 1.79, df = 147; P < 0.05). More men than women were 60 years and above while more women than men were below 60 years. Pearson's chi-square test showed significant association of sex with education (χ2 = 12.31; df = 3, P < 0.006), occupation (χ2 = 23.65; df = 4, P < 0.001), alcohol intake (χ2 = 24.23; df = 1; P < 0.001), and smoking (χ2 = 9.823; df = 1; P < 0.001). The commonest risk factor suffered was hypertension (73.1%), followed by alcohol intake (59.1%), smoking (31.5%), and diabetes mellitus (26.7%); these affected men more than women. Male survivors unaware of their hypertensive status were more likely to have stroke than females, and age had a significant effect on the likelihood of developing a stroke; the same was occupation. Conclusions These survivors suffered mainly from hypertension, triggered by psychosocial problems and diabetes mellitus; their stroke seemed fueled by unrecognized hypertension, unrecognized diabetes mellitus, ignorance of hyperlipidemia, and wide-scale belief in witchcraft as risk factor. Awareness programs in the third world should take these observations into consideration.
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Khedr EM, Abbass MA, Soliman RK, Zaki AF, Gamea A. Post-stroke dysphagia: frequency, risk factors, and topographic representation: hospital-based study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00281-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The frequency of dysphagia varies considerably across literature. Post-stroke dysphagia is a common cause of increased morbidity and length of hospitalization. This study aimed to estimate the frequency, risk factors of dysphagia following first-ever ischemic or hemorrhagic stroke and its neuroradiological correlation.
Methods
Two hundred fifty patients (180 ischemic and 70 hemorrhagic strokes) with first-ever stroke were recruited within 72 h of onset. Detailed history, neurological examination, and computed tomography and/or magnetic resonance were done for each patient. Severity of stroke was evaluated by the National Institutes of Health Stroke Scale (NIHSS). Swallowing function was assessed by water swallowing test (WST) and dysphagia outcome severity scale (DOSS).
Results
Ninety-eight (39.2%) of all stroke patients had dysphagia, 57 (31.7%) of ischemic group, 41 (58.6%) of hemorrhagic group. The mean age of ischemic group with dysphagia was older than ages of non-dysphagic and older than hemorrhagic stroke with dysphagia group. The mean total NIHSS was higher in dysphagic group than non-dysphagic group in both ischemic and hemorrhagic stroke. Dysphagia in ischemic group was highly associated with diabetes mellitus (DM), hypertension (HTN), and atrial fibrillation (AF). Dysphagia was commonly associated with middle cerebral artery (MCA), brainstem, and capsular infarctions as well as with intracerebral hemorrhage (ICH) with ventricular extension. Stroke severity and lesion size were the main determinant of dysphagia severity.
Conclusions
The frequency of post-stroke dysphagia is consistent with other studies. Advanced age, DM, HTN, and AF were the main risk factors. MCA, brain stem, capsular infarctions, and ICH with ventricular extension were frequently associated with dysphagia. Stroke severity and lesion size were independent predictors of dysphagia severity.
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Abstract
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
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Khedr EM, Abbass MA, Soliman RK, Zaki AF, Gamea A, El-Fetoh NA, Abdel-Aaal MA. A hospital-based study of post-stroke aphasia: frequency, risk factors, and topographic representation. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0128-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background and objective
The crude prevalence rate of stroke in Qena, Egypt, is high (922/100,000). For the first time, we estimate the frequency of aphasia following the first-ever ischemic stroke and its relationship to the site of lesion in Arabic-speaking countries.
Methods
The study was conducted on 180 acute or subacute ischemic stroke patients. Aphasia was diagnosed with the short form of the Boston Diagnostic Aphasia Examination after establishment of the cases (at least 10 days of stroke onset). Computed tomography and/or magnetic resonance imaging were performed for topographic localization of stroke, and routine laboratory investigations were done to evaluate the possible stroke risk factors.
Results
The frequency of post-stroke aphasia was recorded in 20%, and atrial fibrillation (AF) represents a high-risk factor for ischemic stroke with aphasia. The following categories were observed: global aphasia in 50%, motor aphasia in 27.7%, sensory aphasia in 11.1%, nominal aphasia in 2.8%, and conductive aphasia in 8.3%. Global aphasia was mainly associated with complete middle cerebral artery (MCA) territories infarction. Motor aphasia was associated mainly with frontal or frontoparietal operculum lesions as well as basal ganglionic lesions. Sensory aphasia was associated with temporal lobe lesions, inferior parietal lobe, and basal ganglia. Conductive aphasia showed lesions in the deep white matter of the frontal and parietal lobes. Anomic aphasia was associated with inferior parietal lobe lesion.
Conclusion
Our data are consistent with other reports as regards the frequency and risk factors of post-stroke aphasia. Atrial fibrillation represents a high-risk factor for ischemic strokes with aphasia. Global and motor aphasia are the major subtypes. The lesion locations are predictive of aphasia subtypes.
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Shaheen HA, Abdel Wahed WY, Hasaneen ST. Prevalence of Stroke in Fayoum Governorate, Egypt: A Community-Based Study. J Stroke Cerebrovasc Dis 2019; 28:2414-2420. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/08/2019] [Accepted: 06/18/2019] [Indexed: 11/26/2022] Open
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13
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Urban Versus Rural Egypt: Stroke Risk Factors and Clinical Profile: Cross-Sectional Observational Study. J Stroke Cerebrovasc Dis 2019; 28:104316. [PMID: 31416762 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/19/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Egypt is a densely populated country with living habits and health care services that differ from urban to rural regions. We aimed to study how characteristics of stroke vary among these regions. METHODS This is a cross-sectional observational study of ischemic stroke, thus hemorrhagic and venous strokes were excluded. A total of 1475 ischemic stroke patients were recruited for analysis from a tertiary hospital in Cairo representing urban area and from a secondary care hospital in Suhag representing rural region. RESULTS Analysis was done for 1143 ischemic stroke patients from urban and 332 from rural area. Onset to door was shorter in urban. Urban patients showed an older age and higher prevalence of hypertension and diabetes (65.9%, 48.6% respectively), while rural patients were characterized by female preponderance (51.5%), more dyslipidemia, smoking 44.6%, stroke in young 20.5%, atrial fibrillation 23.8% % and recurrent stroke 44.3%. Rural cases showed a severer deficit at onset and poorer outcome. CONCLUSION Vascular risk factors, stroke type, and presentation tend to differ in Egypt according to the geographic distribution whether urban or rural. Studying patterns of such difference may aid in planning specific targeted preventive and therapeutic strategies for stroke in urban and rural Egypt.
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Darwish MH, Ahmed S, Abdelalim A, Elsherif AA. Quantitative evaluation of shoulder proprioception 6 months following stroke. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:31. [PMID: 30459504 PMCID: PMC6223741 DOI: 10.1186/s41983-018-0038-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background Chronic shoulder pain following cerebrovascular stroke (CVS) is a major problem that persists after maximum recovery of motor functions. Such pain has been attributed to altered shoulder joint kinematics causing soft tissue damage. Aim Evaluation of shoulder proprioception in the ipsilateral paretic arm and contralateral unaffected side 6 months following cerebrovascular event. Subject and method Thirty adult patients (G1) with ischemic strokes ranging from 6 months to 1 year and 30 healthy control (G2) were assessed for shoulder proprioception. Angular displacement error was measured during active and passive repositioning of shoulder external and internal rotation in both patients’ shoulders and in control’s dominant upper limb. Results Statistically significant increase in angular displacement error was found in all tests in the affected shoulder compared to the unaffected contralateral shoulder and dominant arm of control subjects. The contralateral unaffected shoulder of patients showed within normal values and no differences with control values. Passive external and internal rotations showed statistically higher errors in patients with cortical lesions compared to those with subcortical lesions. Conclusion Six months following the CVS, shoulder proprioception deficit in the affected hemiparetic side persists. Contralateral side shows no abnormalities. Cortical lesions might be associated with late shoulder proprioception recovery compared to subcortical lesions. The side of the lesion does not seem to affect the severity of proprioception deficit.
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Affiliation(s)
- Moshera Hassan Darwish
- 1Department of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Sandra Ahmed
- 2Department of Neurology, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Ahmed Abdelalim
- 2Department of Neurology, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Abdelaziz Abdelaziz Elsherif
- 1Department of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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Li Q, Zhang Y, Kang H, Xin Y, Shi C. Mining association rules between stroke risk factors based on the Apriori algorithm. Technol Health Care 2018; 25:197-205. [PMID: 28582907 DOI: 10.3233/thc-171322] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stroke is a frequently-occurring disease and is a severe threat to human health. OBJECTIVE We aimed to explore the associations between stroke risk factors. METHODS Subjects who were aged 40 or above were requested to do surveys with a unified questionnaire as well as laboratory examinations. The Apriori algorithm was applied to find out the meaningful association rules. Selected association rules were divided into 8 groups by the number of former items. The rules with higher confidence degree in every group were viewed as the meaningful rules. RESULTS The training set used in association analysis consists of a total of 985,325 samples, with 15,835 stroke patients (1.65%) and 941,490 without stroke (98.35%). Based on the threshold we set for the Apriori algorithm, eight meaningful association rules were obtained between stroke and its high risk factors. While between high risk factors, there are 25 meaningful association rules. CONCLUSIONS Based on the Apriori algorithm, meaningful association rules between the high risk factors of stroke were found, proving a feasible way to reduce the risk of stroke with early intervention.
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16
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Cassidy SA, Bradley L, Bowen E, Wigham S, Rodgers J. Measurement properties of tools used to assess depression in adults with and without autism spectrum conditions: A systematic review. Autism Res 2018; 11:738-754. [PMID: 29360200 PMCID: PMC6001465 DOI: 10.1002/aur.1922] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/05/2017] [Accepted: 12/27/2017] [Indexed: 12/03/2022]
Abstract
Depression is the most commonly experienced mental health condition in adults with autism spectrum conditions (ASC). However, it is unclear what tools are currently being used to assess depression in ASC, or whether tools need to be adapted for this group. This systematic review therefore aimed to identify tools used to assess depression in adults with and without ASC, and then evaluate these tools for their appropriateness and measurement properties. Medline, PsychINFO and Web of Knowledge were searched for studies of depression in: (a) adults with ASC, without co‐morbid intellectual disability; and (b) adults from the general population without co‐morbid conditions. Articles examining the measurement properties of these tools were then searched for using a methodological filter in PubMed, and the quality of the evidence was evaluated using the COSMIN checklist. Twelve articles were identified which utilized three tools to assess depression in adults with ASC, but only one article which assessed the measurement properties of one of these tools was identified and thus evaluated. Sixty‐four articles were identified which utilized five tools to assess depression in general population adults, and fourteen articles had assessed the measurement properties of these tools. Overall, two tools were found to be robust in their measurement properties in the general population—the Beck Depression Inventory (BDI‐II), and the patient health questionnaire (PHQ‐9). Crucially only one study was identified from the COSMIN search, which showed weak evidence in support of the measurement properties of the BDI‐II in an ASC sample. Implications for effective measurement of depression in ASC are discussed. Autism Res2018, 11: 738–754. © 2018 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc. Lay Summary Depression is the most common mental health problem experienced by adults with autism. However, the current study found very limited evidence regarding how useful tools developed for the general population are for adults with autism. We therefore suggest how these tools could be adapted to more effectively assess depression in adults with autism, and improve these individuals access to mental health assessment and support.
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Affiliation(s)
- S A Cassidy
- School of Psychology, University of Nottingham, UK.,Institute of Neuroscience, Newcastle University, UK.,Centre for Innovative Research Across the Life Course, Coventry University, UK
| | - L Bradley
- Centre for Innovative Research Across the Life Course, Coventry University, UK
| | - E Bowen
- Centre for Violence Prevention, University of Worcester, UK
| | - S Wigham
- Institute of Neuroscience, Newcastle University, UK
| | - J Rodgers
- Institute of Neuroscience, Newcastle University, UK
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Abd-Allah F, Khedr E, Oraby MI, Bedair AS, Georgy SS, Moustafa RR. Stroke burden in Egypt: data from five epidemiological studies. Int J Neurosci 2018; 128:765-771. [PMID: 29258372 DOI: 10.1080/00207454.2017.1420068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Accurate data on the epidemiology of stroke in Egypt is scarce. The aim of this review is to address this issue based on available community-based studies and compare the resulting findings to those of other regional and international studies. METHOD A systematic literature search was conducted to identify population-based epidemiological studies of stroke in Egyptians. Original articles published in English between 1990 and 2016 were included. Five studies from five different governorates in southern Egypt fulfilled the study criteria (Qena, Sohag, Assiut, New Valley and Red Sea). RESULTS The mean and median crude prevalence rates (CPRs) across the five studies, which were conducted in southern Egypt were 721.6/100,000 and 655/100,000, respectively. The mean and median crude incidence rates (CIRs) were 187/100,000 and 180.5/100,000, respectively. The average CPR weighted by sample population size was 613/100,000 and the average CIR weighted by sample population size was 202/100,000. CONCLUSION The incidence and prevalence of stroke in Egypt are high. More population-based studies are urgently needed in northern Egypt and in Cairo - the capital of Egypt.
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Affiliation(s)
- Foad Abd-Allah
- a Department of Neurology , Cairo University , Cairo , Egypt
| | - Eman Khedr
- b Department of Neurology , Assiut University , Assiut , Egypt
| | - Mohammed I Oraby
- c Department of Neurology , Beni-Suef University , Beni Suef , Egypt
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18
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Bakr NM, Hashim NA, Awad A, Sarhan AA. Association between Interleukin-18 promoter polymorphisms and risk of ischemic stroke: A case-control study. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2018. [DOI: 10.1016/j.ejmhg.2017.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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19
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Khedr EM, Fawi G, Abbas MAA, Abo El-Fetoh N, Zaki AF, Gamea A, Al Attar G. Prevalence of neuromuscular disorders in Qena governorate/Egypt: population-based survey. Neurol Res 2016; 38:1056-1063. [DOI: 10.1080/01616412.2016.1243640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eman M. Khedr
- Faculty of Medicine, Department of Neuropsychiatry, Assiut University, Assiut, Egypt
| | - Gharib Fawi
- Faculty of Medicine, Department of Neuropsychiatry, Sohag University, Sohag, Egypt
| | | | - Noha Abo El-Fetoh
- Faculty of Medicine, Department of Neuropsychiatry, Assiut University, Assiut, Egypt
| | - Ahmed F. Zaki
- Faculty of Medicine, Department of Neuropsychiatry, South Valley University, Qena, Egypt
| | - Ayman Gamea
- Faculty of Medicine, Department of Neuropsychiatry, South Valley University, Qena, Egypt
| | - Ghada Al Attar
- Faculty of Medicine, Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt
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20
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El-Hajj M, Salameh P, Rachidi S, Hosseini H. The epidemiology of stroke in the Middle East. Eur Stroke J 2016; 1:180-198. [PMID: 31008279 DOI: 10.1177/2396987316654338] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/09/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose The purpose of this paper is to review and synthesize data from different countries in the Middle East on stroke and its potential risk factors. Method A systematic review of all published stroke articles in the Middle East between 1980 and May 2015 was conducted. Findings Sixty-four papers were included in the review. The incidence rate for all strokes ranged between 22.7 and 250 per 100,000 population per year. The prevalence rate for stroke ranged between 508 and 777 per 100,000 population. Among studies reporting gender differences, 75% reported a high male-to-female ratio among stroke patients. The mean age of stroke was within the sixth and the seventh decade. Ischemic stroke was the most reported type followed by intracerebral hemorrhage and subarachnoid hemorrhage. Hypertension was the most reported risk factor followed by diabetes. The overall case-fatality rate within one month was 12-32%. Discussion During the last decades, there was an increase in stroke incidence and mortality rates in the Middle East. The Middle East faces low rates of self-awareness and control of noncommunicable diseases and also lacks knowledge for stroke risk factors, awareness, causes, and symptoms. Conclusion There is an urgent need to develop more efficient and accurate methods to measure stroke in the Middle East. There is also a significant call to increase public awareness and implement interventions on stroke and its risk factors and symptoms to help people understand the negative impact of stroke on quality of life and potentially prevent this disease.
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Affiliation(s)
- Maya El-Hajj
- Lebanese University, Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Hadath, Lebanon.,Université Paris-Est, UMR 955, IMRM, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Pascale Salameh
- Lebanese University, Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Hadath, Lebanon.,Lebanese American University, School of Pharmacy, Byblos, Lebanon
| | - Samar Rachidi
- Lebanese University, Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Hadath, Lebanon
| | - Hassan Hosseini
- Université Paris-Est, UMR 955, IMRM, Institut Mondor de Recherche Biomédicale, Créteil, France.,Service de Neurologie, Hôpital Henri-Mondor, UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
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21
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Arulogun OS, Hurst S, Owolabi MO, Akinyemi RO, Uvere E, Saulson R, Ovbiagele B. Experience of Using an Interdisciplinary Task Force to Develop a Culturally Sensitive Multipronged Tool to Improve Stroke Outcomes in Nigeria. eNeurologicalSci 2016; 4:10-14. [PMID: 27331144 PMCID: PMC4908828 DOI: 10.1016/j.ensci.2016.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The burden of stroke is on the rise in Nigeria. A multi-faceted strategy is essential for reducing this growing burden and includes promoting medication adherence, optimizing traditional biomarker risk targets (blood pressure, cholesterol) and encouraging beneficial lifestyle practices. Successful implementation of this strategy is challenged by inadequate patient health literacy, limited patient/medical system resources, and lack of a coordinated interdisciplinary treatment approach. Moreover, the few interventions developed to improve medical care in Nigeria have generally been aimed at physicians (primarily) and nurses (secondarily) with minimal input from other key health care providers, and limited contributions from patients, caregivers, and the community itself. The Tailored Hospital-based Risk Reduction to Impede Vascular Events after Stroke (THRIVES) study is assessing the efficacy of a culturally sensitive multidimensional intervention for controlling blood pressure in recent stroke survivors. A key component of the intervention development process was the constitution of a project task force comprising various healthcare providers and administrators. This paper describes the unique experience in Sub-Saharan Africa of utilizing of an interdisciplinary Task force to facilitate the development of the multipronged behavioral intervention aimed at enhancing stroke outcomes in a low-middle income country. Involvement of Task force bridges gap between the research and the beneficiaries Task force strategy improves utilization/dissemination of research interventions. Effective and efficient management of stroke patients is enhanced.
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Affiliation(s)
| | - Samantha Hurst
- Department of Family and Preventive Medicine, University of California, San Diego, California
| | | | - Rufus O Akinyemi
- Department of Medicine, Federal Medical Center, Abeokuta, Nigeria; Institute of Advanced Medical Research and Training, University of Ibadan, Nigeria
| | - Ezinne Uvere
- Department of Medicine, University of Ibadan, Nigeria
| | - Raelle Saulson
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Bruce Ovbiagele
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
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22
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Owolabi MO, Akarolo-Anthony S, Akinyemi R, Arnett D, Gebregziabher M, Jenkins C, Tiwari H, Arulogun O, Akpalu A, Sarfo FS, Obiako R, Owolabi L, Sagoe K, Melikam S, Adeoye AM, Lackland D, Ovbiagele B. The burden of stroke in Africa: a glance at the present and a glimpse into the future. Cardiovasc J Afr 2016; 26:S27-38. [PMID: 25962945 PMCID: PMC4557491 DOI: 10.5830/cvja-2015-038] [Citation(s) in RCA: 248] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective Information on the current burden of stroke in Africa is limited. The aim of this review was to comprehensively examine the current and projected burden of stroke in Africa. Methods We systematically reviewed the available literature (PubMed and AJOL) from January 1960 and June 2014 on stroke in Africa. Percentage change in age-adjusted stroke incidence, mortality and disability-adjusted life years (DALYs) for African countries between 1990 and 2010 were calculated from the Global Burden of Diseases (GBD) model-derived figures. Results Community-based studies revealed an age-standardised annual stroke incidence rate of up to 316 per 100 000 population, and age-standardised prevalence rates of up to 981 per 100 000. Model-based estimates showed significant mean increases in age-standardised stroke incidence. The peculiar factors responsible for the substantial disparities in incidence velocity, ischaemic stroke proportion, mean age and case fatality compared to high-income countries remain unknown. Conclusions While the available study data and evidence are limited, the burden of stroke in Africa appears to be increasing.
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Affiliation(s)
- Mayowa O Owolabi
- College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | | | | | | | | | | | | | - Oyedunni Arulogun
- College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | | | | | | | | | | | - Sylvia Melikam
- College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Abiodun M Adeoye
- College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
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23
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Akinyemi RO, Ovbiagele B, Akpalu A, Jenkins C, Sagoe K, Owolabi L, Sarfo F, Obiako R, Gebreziabher M, Melikam E, Warth S, Arulogun O, Lackland D, Ogunniyi A, Tiwari H, Kalaria RN, Arnett D, Owolabi MO. Stroke genomics in people of African ancestry: charting new paths. Cardiovasc J Afr 2016; 26:S39-49. [PMID: 25962947 PMCID: PMC4557488 DOI: 10.5830/cvja-2015-039] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
One in six people worldwide will experience a stroke in his/her lifetime. While people in Africa carry a disproportionately higher burden of poor stroke outcomes, compared to the rest of the world, the exact contribution of genomic factors to this disparity is unknown. Despite noteworthy research into stroke genomics, studies exploring the genetic contribution to stroke among populations of African ancestry in the United States are few. Furthermore, genomics data in populations living in Africa are lacking. The wide genomic variation of African populations offers a unique opportunity to identify genomic variants with causal relationships to stroke across different ethnic groups. The Stroke Investigative Research and Educational Network (SIREN), a component of the Human Health and Heredity in Africa (H3Africa) Consortium, aims to explore genomic and environmental risk factors for stroke in populations of African ancestry in West Africa and the United States. In this article, we review the literature on the genomics of stroke with particular emphasis on populations of African origin.
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Affiliation(s)
- R O Akinyemi
- Division of Neurology, Federal Medical Centre Abeokuta, Nigeria; Institute of Neuroscience, Newcastle University, UK
| | - B Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, USA
| | - A Akpalu
- College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - K Sagoe
- College of Health Sciences, University of Ghana, Accra, Ghana
| | - L Owolabi
- Department of Medicine, Bayero University, Kano, Nigeria
| | - F Sarfo
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - R Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - M Gebreziabher
- Department of Neurosciences, Medical University of South Carolina, USA
| | - E Melikam
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - S Warth
- Department of Neurosciences, Medical University of South Carolina, USA
| | - O Arulogun
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - D Lackland
- Department of Neurosciences, Medical University of South Carolina, USA
| | - A Ogunniyi
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - H Tiwari
- Department of Public Health, University of Alabama at Birmingham, USA
| | - R N Kalaria
- Institute of Neuroscience, Newcastle University, UK
| | - D Arnett
- Department of Public Health, University of Alabama at Birmingham, USA
| | - M O Owolabi
- College of Medicine, University of Ibadan, Ibadan, Nigeria
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24
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Lahoud N, Salameh P, Saleh N, Hosseini H. Prevalence of Lebanese stroke survivors: A comparative pilot study. J Epidemiol Glob Health 2015; 6:169-76. [PMID: 26599284 PMCID: PMC7320477 DOI: 10.1016/j.jegh.2015.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/08/2015] [Indexed: 02/03/2023] Open
Abstract
Stroke is a leading cause of morbidity and mortality worldwide and its late burden has mainly been attributable to developing countries. Lebanon is one of these countries where epidemiological studies on stroke burden are scarce but necessary. Thus, the present study was conducted to assess the prevalence of stroke survivors among Lebanese inhabitants. A cross-sectional survey was carried out using randomly selected landline phone numbers on all governorates to retrieve data on stroke survivors and their sociodemographic characteristics. Results were then standardized over the Lebanese and the World Health Organization (WHO) world populations. A total of 6963 Lebanese inhabitants were included in the study; among these were 56 stroke survivors. This led to an adjusted stroke prevalence of 0.50% [95% confidence interval (CI) = 0.33–0.66%] and a world-standardized prevalence of 0.60% (95% CI = 0.42–0.78%). A significantly higher stroke prevalence was found among older age groups and more socioeconomically privileged areas. Overall, the study showed a relatively higher prevalence of stroke in this sample of Lebanese inhabitants when compared to other developing countries. However, larger community-based studies with a clinical assessment of stroke cases are needed to confirm our findings.
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Affiliation(s)
- Nathalie Lahoud
- Excitabilité Nerveuse et Thérapeutique, EA 4391, Université Paris Est, Créteil, France; Lebanese University, Doctoral School of Sciences and Technology, Hadath, Lebanon.
| | - Pascale Salameh
- Lebanese American University, School of Pharmacy, Byblos, Lebanon
| | - Nadine Saleh
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - Hassan Hosseini
- Excitabilité Nerveuse et Thérapeutique, EA 4391, Université Paris Est, Créteil, France; Henri Mondor Hospital, AP-HP, Paris, France
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25
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Sanya EO, Desalu OO, Adepoju F, Aderibigbe SA, Shittu A, Olaosebikan O. Prevalence of stroke in three semi-urban communities in middle-belt region of Nigeria: a door to door survey. Pan Afr Med J 2015; 20:33. [PMID: 26029322 PMCID: PMC4441143 DOI: 10.11604/pamj.2015.20.33.4594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 01/08/2015] [Indexed: 11/23/2022] Open
Abstract
Introduction The burden of stroke has been projected to increase for developing countries, but data are limited, especially in sub-Saharan Africa. This necessitated this study to determine the stroke prevalence in a semi urban community in middle-belt region of Nigeria. Methods A two-phase door-to-door study was performed in three semi-urban communities of Kwara state; in the first phase 12,992 residents were screened and probable stroke cases were identified by trained health care workers. In the second phase individuals adjudged to be positive for stroke were screened with a stroke-specific questionnaire and made to undergo a complete neurological examination by a neurologist. Stroke diagnosis was based on clinical evaluation using WHO criteria. Results Out of the numbers that were screened, 18 probable stroke cases were identified in the first stage, and of these, 17 fulfilled WHO criteria for stroke, giving a crude prevalence rate of 1.31/1000 population. The prevalence of stroke was higher among the males than the females (1.54/1000 vs. 1.08/1000) with a ratio 1.4: 1. Sixteen subjects (94.1%) had one or more risk factors for stroke. Uncontrolled systemic hypertension (82.4%) was the commonest risk factors for stroke followed by transient ischaemic attack (TIA) (41.2%). Conclusion Stroke is a condition that is prevalent in our environment; especially in older adults and men. Uncontrolled systemic hypertension and previous transient ischaemic attacks were the commonest risk factors for stroke in our community.
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Affiliation(s)
| | | | - Feyiyemi Adepoju
- Departments of Ophthalmology, University of Ilorin Teaching Hospital, Nigeria
| | | | - Akeem Shittu
- Departments of Hematology, University of Ilorin Teaching Hospital, Nigeria
| | - Olabode Olaosebikan
- Departments of Chemical Pathology, University of Ilorin Teaching Hospital, Nigeria
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26
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Abd Elaziz KM, Dewedar SA, Sabbour S, El Gafaary MM, Marzouk DM, Aboul Fotouh A, Allam MF. Screening for hypertension among adults: community outreach in Cairo, Egypt. J Public Health (Oxf) 2014; 37:701-6. [PMID: 25355687 DOI: 10.1093/pubmed/fdu085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Studies have shown alarming levels of hypertension among adults in the Middle East. The aim of our study is to measure the prevalence rate of hypertension among adults in Cairo (Egypt), identify possible risk factors for the development of hypertension and assess the rates of undiagnosed and uncontrolled hypertension. METHODS Cluster sampling was utilized and the fieldwork was conducted by 12 teams; each team consisted of a house officer, community worker and senior epidemiologist. A formulated questionnaire that addresses risk factors for hypertension was filled by all participants. Also, weight and height measurements were done to calculate the body mass index. Blood pressure measurement was done by calibrated sphygmomanometers. Blood pressure measurement was done twice, and a mean recording was calculated. A case which recorded both systolic blood pressure of ≥140 and diastolic blood pressure of ≥90 was considered hypertensive. RESULTS The study included 774 adult residents of Al-Waily District (Western Zone of Cairo) in late 2011 and early 2012. The mean age of the study participants was 46.5 (SD 17.9) years. Female subjects constituted 67.1% of the studied sample. The prevalence rate of hypertension in our study was 16.5% (95% confidence interval (CI): 13.9-19.3). The rate of hypertension was higher among females and three times higher among obese compared with normal or overweight adults. The prevalence of undiagnosed hypertension was 11% (95% CI: 8.4-13.9), and uncontrolled hypertension was 30% (95% CI: 24.2-37). CONCLUSIONS Community outreach campaigns should be conducted regularly in the future for early detection of hypertension cases and proper health education about hypertension and its dangerous consequences.
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Affiliation(s)
- Khaled M Abd Elaziz
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
| | - Sahar A Dewedar
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
| | - Sahar Sabbour
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
| | - Maha M El Gafaary
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
| | - Diaa M Marzouk
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
| | - Aisha Aboul Fotouh
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
| | - Mohamed Farouk Allam
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt
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Khedr EM, Fawi G, Abdela M, Mohammed TA, Ahmed MA, El-Fetoh NA, Zaki AF. Prevalence of Ischemic and Hemorrhagic Strokes in Qena Governorate, Egypt: Community-based Study. J Stroke Cerebrovasc Dis 2014; 23:1843-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.03.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 02/23/2014] [Accepted: 03/01/2014] [Indexed: 11/26/2022] Open
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Abd-Allah F, Moustafa RR. Burden of stroke in Egypt: current status and opportunities. Int J Stroke 2014; 9:1105-8. [PMID: 25041503 DOI: 10.1111/ijs.12313] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 05/20/2014] [Indexed: 11/30/2022]
Abstract
Middle East and North Africa (MENA) countries have a diversity of populations with similar life style, dietary habits, and vascular risk factors that may influence stroke risk, prevalence, types, and disease burden. Egypt is the most populated nation in the Middle East with an estimated 85.5 million people. In Egypt, according to recent estimates, the overall prevalence rate of stroke is high with a crude prevalence rate of 963/100,000 inhabitants. In spite of disease burden, yet there is a huge evidence practice gap. The recommended treatments for ischemic stroke that are guideline include systematic supportive care in a stroke unit or stroke center is still deficient. In addition, the frequency of thrombolysis in Egypt is very low for many reasons; the major one is that the health insurance system is not covering thrombolysis therapy in nonprivate sectors so patients must cover the costs using their own personal savings; otherwise, they will not receive treatment. Another important factor is the pronounced delay in prehospital and in hospital management of acute stroke. Improvement of stroke care in Egypt should be achieved through multi and interdisciplinary approach including public awareness, physicians' education, and synergistic approach to stroke care with Emergency Medical System.
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Adeloye D. An estimate of the incidence and prevalence of stroke in Africa: a systematic review and meta-analysis. PLoS One 2014; 9:e100724. [PMID: 24967899 PMCID: PMC4072632 DOI: 10.1371/journal.pone.0100724] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/27/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Stroke is increasingly becoming a challenging public health issue in Africa, and the non-availability of data has limited research output and consequently the response to this burden. This study aimed to estimate the incidence and prevalence of stroke in Africa in 2009 towards improved policy response and management of the disease in the region. METHODS A systematic search of Medline, EMBASE and Global Health for original population-based or hospital-based studies on stroke was conducted. A random effect meta-analysis was conducted on crude stroke incidence and prevalence rates, and a meta-regression-like epidemiological model was applied on all data points. The fitted curve generated from the model was used to estimate incident cases of stroke and number of stroke survivors in Africa at midpoints of the United Nation population 5-year age groups for the year 2009. RESULTS The literature search yielded a total of 1227 studies. 19 studies from 10 African countries were selected. 483 thousand new stroke cases among people aged 15 years or more were estimated in Africa in 2009, equivalent to 81.2 (13.2-94.9)/100,000 person years. A total of 1.89 million stroke survivors among people aged 15 years or more were estimated in Africa in 2009, with a prevalence of 317.3 (314.0-748.2)/100,000 population. Comparable figures for the year 2013 based on the same rates would amount to 535 thousand (87.0-625.3) new stroke cases and 2.09 million (2.06-4.93) stroke survivors, suggesting an increase of 10.8% and 9.6% of incident stroke cases and stroke survivors respectively, attributable to population growth and ageing between 2009 and 2013. CONCLUSION The findings of this review suggest the burden of stroke in Africa is high and still increasing. There is need for more research on stroke and other vascular risk factors towards instituting appropriate policy, and effective preventive and management measures.
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Affiliation(s)
- Davies Adeloye
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, Midlothian, United Kingdom
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Kitkhuandee A, Sawanyawisuth K, Johns J, Kanpittaya J, Tuntapakul S, Johns NP. Pineal calcification is a novel risk factor for symptomatic intracerebral hemorrhage. Clin Neurol Neurosurg 2014; 121:51-4. [PMID: 24793475 DOI: 10.1016/j.clineuro.2014.03.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 01/19/2014] [Accepted: 03/18/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pineal calcification is associated with symptomatic cerebral infarction in humans. However, there are limited data on the association of pineal calcification and intracerebral hemorrhage. We evaluated this association of symptomatic intracerebral hemorrhage and pineal calcification by computed tomography of the brain. METHODS We reviewed all computed tomographic (CT) scans of the brains of patients over 15 years of age during the year 2011 at a university teaching hospital. Symptomatic intracerebral hemorrhage was identified by having clinical syndrome of stroke and acute intracerebral hemorrhage from brain CT scans. Pineal calcification was also evidenced by brain CT scans. Other stroke risk factors were recorded. The association of various risk factors including pineal calcification and intracerebral hemorrhage was calculated using logistic regression analysis. RESULTS There were 2140 CT scans of the brains during the study period. Of those, 1071 scans (50.05%) met the study criteria. Intracerebral hemorrhage and pineal calcification were found in 77 (7.2%) and 689 (64.3%) patients, respectively. Pineal calcification was a significant risk factor for intracerebral hemorrhage with an adjusted odds ratio of 2.36 (95% confidence interval of 1.22-4.54). Other significant factors were age>50 years, hypertension, and diabetes. CONCLUSION Pineal calcification is associated with symptomatic intracerebral hemorrhage.
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Affiliation(s)
- Amnat Kitkhuandee
- Department of Surgery, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand; The Research and Training Center for Enhancing Quality of Life of Working-Age People, Khon Kaen University, Khon Kaen, Thailand.
| | - Jeffrey Johns
- Faculty of Pharmaceutical Sciences and Melatonin Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Jaturat Kanpittaya
- Department of Radiology, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand
| | - Supinya Tuntapakul
- Faculty of Pharmaceutical Sciences and Melatonin Research Group, Khon Kaen University, Khon Kaen, Thailand
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Verbal communication disorders in brain damaged post-stroke patients in Benin. Ann Phys Rehabil Med 2013; 56:663-72. [DOI: 10.1016/j.rehab.2013.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 08/20/2013] [Accepted: 08/20/2013] [Indexed: 11/20/2022]
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Wang S, Zeng R, Lei L, Huang J. Angiotensinogen gene polymorphism and ischemic stroke in East Asians: A meta-analysis. Neural Regen Res 2013; 8:1228-35. [PMID: 25206417 PMCID: PMC4107611 DOI: 10.3969/j.issn.1673-5374.2013.13.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 03/20/2013] [Indexed: 11/21/2022] Open
Abstract
Objective: To investigate the association between angiotensinogen gene M235T polymorphism and ischemic stroke in East Asians. Data Retrieval: A computer-based online search was conducted in PubMed, Google scholar, China National Knowledge lnfrastructure database between January 1990 and April 2012 for relevant studies. The key words were angiotensinogen or AGT, polymorphism or genetic and ischemic stroke or cerebral infarction. Selection Criteria: Case-controlled studies addressing the correlation between angiotensinogen gene M235T polymorphism and ischemic stroke in East Asians were included. The distribution of genotypes in the included studies was tested for Hardy-Weinberg equilibrium. Quality evaluation of the included studies was conducted by two physicians. Statistical analyses were carried out using Stata 12.0 software for meta-analysis. Heterogeneity tests, sensitivity analysis and publication bias were also conducted. Main Outcome Measures: The association between angiotensinogen gene M235T polymorphism and ischemic stroke risk in East Asians was assessed. Results: Six relevant studies involving 891 patients with ischemic stroke and 727 controls were included in this meta-analysis. Results showed that there was a significant association between angiotensinogen gene M235T polymorphism and the risk of ischemic stroke in East Asians (T vs. M: odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.10–2.16; TT vs. MM: OR = 2.24, 95%CI = 1.37–3.66; TT vs. MT: OR = 1.76, 95%CI = 1.41–2.20; MM + MT vs. TT: OR = 0.57, 95%CI = 0.46–0.70). Sensitivity analysis confirmed that the study results were stable and reliable, with no publication bias. Conclusion: The angiotensinogen gene M235T polymorphism is associated with ischemic stroke in East Asians, and the TT genotype and T allele are risk factors for ischemic stroke.
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Affiliation(s)
- Sheng Wang
- Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou 510080, Guangdong Province, China
| | - Rong Zeng
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou 510080, Guangdong Province, China
| | - Limin Lei
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou 510080, Guangdong Province, China
| | - Jinsong Huang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou 510080, Guangdong Province, China
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