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Ganek H, Ab AG, Abate F, Abera B, Demissie H, Demissie Y, Habte MG, Gravem PE, Hakonsen H, Haye AT, Holmefjord A, Mollenhauer C, Rose M, Shepherd T, Wadhwaniya Z, Eshete M. Experiences establishing a new speech-language pathology training program in Ethiopia, a resource-limited setting: Lessons learned. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-10. [PMID: 39089405 DOI: 10.1080/17549507.2024.2367518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
PURPOSE Ethiopia is the second most populous country in sub-Saharan Africa. While Ethiopia's health care system includes primary health centres, general, and specialised hospitals, allied health care like speech-language pathology was not available until 2003. This article was written with the aim of sharing the experience of establishing speech-language pathology as a profession and the first speech-language pathology training program in Ethiopia. METHOD In this paper, we retrospectively examine how the leadership of local stakeholders, a multidisciplinary team, and the development of a professional infrastructure led to the success of the program. The authorship group, who were involved in the program from inception to implementation, share their experiences. RESULT The speech-language pathology undergraduate program at Addis Ababa University graduated its first class in 2019. Plans to grow the training program at the graduate level are ongoing. CONCLUSION This novel program, grown from several international partnerships, is an example of how low- and middle-income countries can improve access to the service providers necessary to treat their populations.
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Affiliation(s)
- Hillary Ganek
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Abiye Gebre Ab
- Surgical Department, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Plastic Surgery Department, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Fikre Abate
- Plastic Surgery Department, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Berhane Abera
- Plastic Surgery Department, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Hanna Demissie
- Department of Neurology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yohannes Demissie
- Surgical Department, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Plastic Surgery Department, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | | | - Hanna Hakonsen
- Surgical Department, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Plastic Surgery Department, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
- Transforming Faces, Toronto, Canada
| | - Alemayehu Teklemariam Haye
- Department of Special Needs Education, College of Education and Behavioural Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anders Holmefjord
- Haukeland University Hospital, Bergen, Norway
- Transforming Faces, Toronto, Canada
| | | | | | - Tracy Shepherd
- Centralized Equipment Pool, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | | | - Mekonen Eshete
- Surgical Department, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Plastic Surgery Department, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
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Abissegue G, Yakubu SI, Ajay AS, Niyi-Odumosu F. A systematic review of the epidemiology and the public health implications of stroke in Sub-Saharan Africa. J Stroke Cerebrovasc Dis 2024; 33:107733. [PMID: 38663647 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107733] [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: 01/24/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND With approximately 11 million strokes occurring annually worldwide, and over 6.5 million deaths annually, stroke has made its place as one of the major killers in the world. Although developing countries make up more than 4/5 of the global stroke burden, well-grounded information on stroke epidemiology remains lacking there. AIMS This systematic review study aimed to provide a synthesis of studies on the incidence and prevalence of stroke among adults in sub-Saharan Africa (SSA), subsequently deduce the associated risk factors and public health implications (mortality rates and economic costs) of the disease on the population of this region. METHODS A systematic review of studies carried out in the region and published on PUBMED. Eligibility criteria were established using the PEO (Population/Patient, Exposure, Outcome) format. Research articles investigating either (or all) of the following: ischemic or haemorrhagic stroke, incidence, prevalence, and risk factors of stroke in adults (≥ 18 years old), in at least one region of SSA were included. Exclusion criteria comprised studies involving populations younger than 18 years old, research conducted outside the designated research region, and articles inaccessible in full text. The PRISMA guidelines were used for the search strategy. RESULTS Fifty-two studies were included review. Among them, over 11 studies investigated the prevalence of the disease. Some older studies within the continent (Nigeria, 2011) showed a prevalence of 1.3 per 100 while more recent studies (Zambia, 2021) showed a prevalence of 4.3 per 1000. The highest prevalence noted in this region was in Madagascar (2017) with 48.17 per 100, while the lowest was recorded in (Zimbabwe, 2017) with 0.61 per 100. The study in Tanzania showed a crude incidence of 94·5 per 100 000 (76·0-115·0) while the study in Ghana in 2018 showed an incidence of 14.19 events per 1000 person-years [10.77-18.38]. The identified risk factors included hypertension, diabetes, smoking, alcohol consumption, physical inactivity, poor diets (more salt, less vegetables), dyslipidaemia, HIV/AIDS co-infection, heart disease (cardiomyopathies, cardiac arrhythmias), obesity, previous stroke and/or family history of stroke. Over 21 studies investigated the mortality rates due to stroke in SSA, with most of the studies being in West Africa. These studies revealed mortality rates as high as 43.3% in Ghana, and as low as 10.9% in Cameroon. Few studies reported on the economic costs of stroke in the region; two in Benin, two in Nigeria and one in Tanzania. CONCLUSION The increasing incidence/prevalence, lifestyle factors and interactions with other diseases, including major communicable diseases, stroke is becoming a pressing public health problem for SSA. Reducing the incidence of stroke in Africa will surely lower mortality, morbidity, disability, and the neurological as well as cognitive aftereffects of stroke, as is clear from the experience of higher-income nations. We recommend a collective intervention involving the governments of nations, international organizations, civil society, and the private sector for greater impact and sustainable outcomes reducing the epidemiology and implications of stroke in SSA.
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Affiliation(s)
- Gisele Abissegue
- Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | | | - Aiswarya Seema Ajay
- Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Faatihah Niyi-Odumosu
- School of Applied Sciences, University of the West of England, Bristol, United Kingdom.
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Bernal-Jiménez JJ, Polonio-López B, Sanz-García A, Martín-Conty JL, Lerín-Calvo A, Segura-Fragoso A, Martín-Rodríguez F, Cantero-Garlito PA, Corregidor-Sánchez AI, Mordillo-Mateos L. Is the Combination of Robot-Assisted Therapy and Transcranial Direct Current Stimulation Useful for Upper Limb Motor Recovery? A Systematic Review with Meta-Analysis. Healthcare (Basel) 2024; 12:337. [PMID: 38338223 PMCID: PMC10855329 DOI: 10.3390/healthcare12030337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Stroke is the third leading cause of disability in the world, and effective rehabilitation is needed to improve lost functionality post-stroke. In this regard, robot-assisted therapy (RAT) and transcranial direct current stimulation (tDCS) are promising rehabilitative approaches that have been shown to be effective in motor recovery. In the past decade, they have been combined to study whether their combination produces adjuvant and greater effects on stroke recovery. The aim of this study was to estimate the effectiveness of the combined use of RATs and tDCS in the motor recovery of the upper extremities after stroke. After reviewing 227 studies, we included nine randomised clinical trials (RCTs) in this study. We analysed the methodological quality of all nine RCTs in the meta-analysis. The analysed outcomes were deficit severity, hand dexterity, spasticity, and activity. The addition of tDCS to RAT produced a negligible additional benefit on the effects of upper limb function (SMD -0.09, 95% CI -0.31 to 0.12), hand dexterity (SMD 0.12, 95% CI -0.22 to 0.46), spasticity (SMD 0.04, 95% CI -0.24 to 0.32), and activity (SMD 0.66, 95% CI -1.82 to 3.14). There is no evidence of an additional effect when adding tDCS to RAT for upper limb recovery after stroke. Combining tDCS with RAT does not improve upper limb motor function, spasticity, and/or hand dexterity. Future research should focus on the use of RAT protocols in which the patient is given an active role, focusing on the intensity and dosage, and determining how certain variables influence the success of RAT.
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Affiliation(s)
- Juan J. Bernal-Jiménez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - José L. Martín-Conty
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Alfredo Lerín-Calvo
- Neruon Neurobotic S.L., 28015 Madrid, Spain;
- Department of Physiotherapy, Faculty of Health Sciences, University La Salle, 28023 Madrid, Spain
| | - Antonio Segura-Fragoso
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain;
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain
| | - Pablo A. Cantero-Garlito
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Ana-Isabel Corregidor-Sánchez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Laura Mordillo-Mateos
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
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Syed W, AlHarbi AA, Samarkandi OA, Alobaid AM, Alsulaihim IN. Navigating the Knowledge of Risk Factors, Warning Signs, of Stroke - A Community-Based Cross-Sectional Study Among Saudi Adults in Riyadh Saudi Arabia. Int J Gen Med 2023; 16:5869-5883. [PMID: 38106975 PMCID: PMC10725702 DOI: 10.2147/ijgm.s437941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
Background The incidence of stroke is increasing in everyday life as a result of modifiable cerebrovascular risk factors and aging. Therefore, the goal of this study was to assess knowledge of the risk factors, and warning signs, of stroke and to determine associated demographic factors among individuals living in Riyadh, Saudi Arabia. Methods and Materials A cross-sectional online study using a convenience sampling of general population living in Riyadh was carried out over three months in 2023 using a series of questionnaires that was adopted from the previous study. Before data collection, the study tool was subjected to pilot testing among a small sample of individuals to validate for consistency and reliability. The data was collected using social media platforms. A statistical package for the social science (SPSS version 27) was used. Results Four hundred and sixty-two individuals completed the survey. Among those 69.5%, identified hypertension as a risk factor for stroke followed by hyperlipidemia (42.9%), heart disease (44.8%). In addition, most of the respondents (n = 332, 71.9%) knew that numbness or weakness of the face and/or limbs of the body was a warning sign of stroke. In this, 73.5% (n=249) of the respondents agreed that if they saw an individual suffering from a stroke, they would like to take the patient to the hospital immediately. However, there was a significant association between the knowledge of the respondents about the risk factor of stroke and educational degree (p=0.011), and parents working in healthcare settings (p =0.015). Conclusion In conclusion it was observed that a significant respondents had an adequate knowledge of stroke risk factors, while most were unaware of the early warning signs of a stroke. To promote primary prevention and early management/outcomes, we advise that future regional campaigns focus on raising knowledge and recognition of stroke symptoms.
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Affiliation(s)
- Wajid Syed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Asma Awadh AlHarbi
- Department of Nursing, College of Nursing King Saud University, Riyadh, 11451, Saudi Arabia
| | - Osama A Samarkandi
- Department of Basic Sciences, Prince Sultan College for Emergency Medical Services, King Saud University, Riyadh, 11466, Saudi Arabia
| | - Abdullah M Alobaid
- Department of Accident and Trauma, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh,Saudi Arabia
| | - Ibrahim Nasser Alsulaihim
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
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Zhu T, Liu K, Ni BY, Li L, Jin HP, Wu W. Effects of extracorporeal shock wave therapy combined with isokinetic strength training on spastic calf triceps in patients after a stroke: a double-blinded randomised controlled trial. Neurol Res 2023; 45:1019-1025. [PMID: 37668321 DOI: 10.1080/01616412.2023.2255413] [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: 10/25/2022] [Accepted: 08/31/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To evaluate the antitetanic effects of extracorporeal shock wave therapy (ESWT) combined with isokinetic strength training (IST) on calf triceps spasm in patients after a stroke. METHODS Forty-five patients with hemiplegia after a stroke and lower extremity spasms were randomly assigned into three groups: a control group (n = 15), an ESWT group (n = 15) and an ESWT+IST group (n = 15). All patients agreed to conventional rehabilitation therapy, while the ESWT and ESWT+IST groups received ESWT of 2.0-3.0 bar once a week for four weeks. In addition, the ESWT+IST group underwent four weeks of ankle IST. All groups were assessed using the modified Ashworth scale (MAS) and surface electromyography before and after four weeks of treatment. The ankle passive movement of all groups was measured using the BIODEX isokinetic system at angular velocities of 60°/s, 120°/s, 180°/s and 240°/s. RESULTS After four weeks of treatment, compared with the control group, the ESWT+IST groups showed a significant reduction in MASscores (P = 0.030). The ESWT+IST group had significantly lower MAS scores than the baseline (P = 0.002), while the ESWT group did not show a significant difference (P = 0.072). The average electromyography (AEMG) analysis demonstrated a significant difference among the groups after four weeks (P = 0.001), with the ESWT+IST group having lower AEMG values compared with the control group (P < 0.001) and the ESWT group (P = 0.042). Peak resistive torque significantly decreased in both the ESWT and ESWT+IST groups at all velocities (60°/s: P = 0.030, 120°/s: P = 0.039, 180°/s: P = 0.030 and 240°/s: P = 0.042). CONCLUSIONS Extracorporeal shock wave therapy combined with IST can significantly improve calf triceps spasm in patients after a stroke.
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Affiliation(s)
- Ting Zhu
- Department of Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kai Liu
- Department of Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bo-Ye Ni
- Department of Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Li
- Department of Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hua-Ping Jin
- Department of Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Wu
- Department of Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, China
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Farashi S, Shahidi S, Sarihi A, Zarei M. Association of vitamin A and its organic compounds with stroke - a systematic review and meta-analysis. Nutr Neurosci 2023; 26:960-974. [PMID: 36004815 DOI: 10.1080/1028415x.2022.2111746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE The main purpose of this systematic review was to evaluate the association between the stroke (risk of stroke and the mortality due to stroke) and vitamin A, its organic compounds and its provitamins. METHOD Major databases including PubMed, Scopus, and Web of Science were searched. Studies with human samples were included for risk assessment. The association was assessed using odds ratio (log(OR)) and a random-effect model. I2 statistic, variance (tau2) and prediction interval were used for heterogeneity assessment. The funnel plot was used for publication bias. RESULTS Twenty-one studies including 5789 stroke patients were retrieved. Twenty studies had sufficient information for quantitative analyses. The pooled effect showed an inverse association between vitamin A and its organic compound with the risk of stroke (log(OR) = -0.46 95%CI (-0.81;-0.12)) and with the risk of mortality due to stroke (log(OR) = -0.39 95%CI (-0.74;-0.04)). However, according to subgroup analyses, the association was dependent on the compound in a way that retinol and beta-carotene were the most effective compounds. The effects of several confounding factors and the threshold levels for vitamin A and its organic compound on the effectiveness were discussed. CONCLUSION Insufficiency of retinol and beta-carotene significantly increased the risk of stroke; however, due to heterogeneity between studies more studies are needed for evaluating clinical significance of this outcome.
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Affiliation(s)
- Sajjad Farashi
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Siamak Shahidi
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Physiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abdolrahman Sarihi
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Physiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Zarei
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Physiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Vincent M, Sereke SG, Nassanga R, Robert M, Ameda F. Correlation between clinical and brain computed tomography findings of stroke patients: A cross-sectional study. Health Sci Rep 2023; 6:e1248. [PMID: 37152223 PMCID: PMC10157266 DOI: 10.1002/hsr2.1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/10/2023] [Accepted: 04/22/2023] [Indexed: 05/09/2023] Open
Abstract
Background and Aims In developing countries, the burden of stroke is growing and causing significant morbidity and disability with high mortality rates. Neuroimaging plays a crucial role in differentiating ischemic stroke from an intracerebral hemorrhage, as well as entities other than stroke. This study sought to determine the correlation between the clinical and brain CT scan findings of stroke patients attending three hospitals in Kampala, Uganda. Methods This was a cross-sectional study of clinically suspected stroke patients who were sent for brain CT scan at three selected hospitals in Kampala, Uganda. All brain CT scans of patients with suspected stroke were evaluated and the Alberta stroke program early CT score (ASPECTS) was used for middle cerebral artery (MCA) strokes. Univariate analysis was used to describe the clinico-demographic and brain CT features of stroke and summarized them as percentages. Bivariate and multivariate analysis were used to determine the adjusted odds ratios as a measure of association with a 95% confidence interval (CI). Results Of the 270 study participants, 141 (52.2%) were male. 162 (60%) had CT findings of stroke, and 90 (33.3%) had normal brain CT findings. Eighteen (6.7%) had other CT findings like tumor, dural hemorrhage, epidermoid cyst, and others. Ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage accounted for 124 (45.9%), 34 (12.6%), and 4 (1.5%) respectively. Limb weakness (55.2%), headache (41.1%), and loss of consciousness (39.3%) were associated with stroke findings on CT. Among the acute ischemic strokes, 30 (73.2%) had a worse (0-7) ASPECT score. Those aged ≥65 years were associated with a worse ASPECTS [AOR: 22.01, (95% CI: 1.58-306.09) p = 0.021]. Conclusion More than a third of patients with a clinical diagnosis of stroke had either no CT features of stroke or had other findings. The most commonly affected vascular territory was left MCA. Old age was strongly associated with having the worst ASPECTS score.
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Affiliation(s)
- Mboizi Vincent
- Department of Radiology and Radiotherapy, College of Health SciencesMakerere UniversityKampalaUganda
| | - Senai Goitom Sereke
- Department of Radiology and Radiotherapy, College of Health SciencesMakerere UniversityKampalaUganda
| | - Rita Nassanga
- Department of Radiology and Radiotherapy, College of Health SciencesMakerere UniversityKampalaUganda
| | - Mukisa Robert
- Department of MedicineMulago National Referral HospitalKampalaUganda
| | - Faith Ameda
- Department of Radiology and Radiotherapy, College of Health SciencesMakerere UniversityKampalaUganda
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Abebe TG, Feleke SF, Dessie AM, Anteneh RM, Anteneh ZA. Development and internal validation of a clinical risk score for in-hospital mortality after stroke: a single-centre retrospective cohort study in Northwest Ethiopia. BMJ Open 2023; 13:e063170. [PMID: 36977538 PMCID: PMC10069517 DOI: 10.1136/bmjopen-2022-063170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE To develop and validate a clinical risk score for in-hospital stroke mortality. DESIGN The study used a retrospective cohort study design. SETTING The study was carried out in a tertiary hospital in the Northwest Ethiopian region. PARTICIPANTS The study included 912 patients who had a stroke admitted to a tertiary hospital between 11 September 2018 and 7 March 2021. MAIN OUTCOME MEASURES Clinical risk score for in-hospital stroke mortality. METHODS We used EpiData V.3.1 and R V.4.0.4 for data entry and analysis, respectively. Predictors of mortality were identified by multivariable logistic regression. A bootstrapping technique was performed to internally validate the model. Simplified risk scores were established from the beta coefficients of predictors of the final reduced model. Model performance was evaluated using the area under the receiver operating characteristic curve and calibration plot. RESULTS From the total stroke cases, 132 (14.5%) patients died during the hospital stay. We developed a risk prediction model from eight prognostic determinants (age, sex, type of stroke, diabetes mellitus, temperature, Glasgow Coma Scale, pneumonia and creatinine). The area under the curve (AUC) of the model was 0.895 (95% CI: 0.859-0.932) for the original model and was the same for the bootstrapped model. The AUC of the simplified risk score model was 0.893 (95% CI: 0.856-0.929) with a calibration test p value of 0.225. CONCLUSIONS The prediction model was developed from eight easy-to-collect predictors. The model has excellent discrimination and calibration performance, similar to that of the risk score model. It is simple, easily remembered, and helps clinicians identify the risk of patients and manage it properly. Prospective studies in different healthcare settings are required to externally validate our risk score.
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Affiliation(s)
| | | | | | | | - Zelalem Alamrew Anteneh
- Epidemiology, Bahir Dar University College of Medical and Health Sciences, Bahir Dar, Ethiopia
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Cao W, Feng Z, Zhu D, Li S, Du M, Ye S, Qi D, Li P, Chen Y, Fang Y. The Role of PGK1 in Promoting Ischemia/Reperfusion Injury-Induced Microglial M1 Polarization and Inflammation by Regulating Glycolysis. Neuromolecular Med 2023:10.1007/s12017-023-08736-3. [PMID: 36749430 DOI: 10.1007/s12017-023-08736-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/18/2023] [Indexed: 02/08/2023]
Abstract
Stroke is a leading cause of death, with a continuously increasing incidence. As a metabolic process that catabolizes glucose pyruvate and provides adenosine triphosphate (ATP), glycolysis plays a crucial role in different diseases. Phosphoglycerate kinase 1 (PGK1) facilitates energy production with biosynthesis in many diseases, including stroke. However, the exact role of PGK1/glycolysis in stroke remains to be elucidated. A rat model of middle cerebral artery occlusion (MCAO) was used to mimic ischemia/reperfusion injuries. Oxygen glucose deprivation/re-oxygenation (OGD/R) was used to induce injury to highly aggressively proliferating immortalized (HAPI) rat microglial cells. The extracellular acidification rate (ECAR) was determined using an XFe24 Extracellular Flux Analyzer. ATP, lactate dehydrogenase, tumor necrosis factor-alpha, and interleukin-6 levels were measured using commercial kits. Chromatin immunoprecipitation assay was performed to examine the interaction between H3K27ac or p300 and the PGK1 promoter region. PGK1 was either knocked down or overexpressed by lentivirus. Thus, to examine its role in stroke, real-time polymerase chain reaction and immunoblotting were used to measure gene expression. The expression of PGK1 was increased and associated with M1 polarization and glycolysis in MCAO rat models. OGD/R promoted M1 polarization and HAPI microglial cell inflammation by regulating glycolysis. Silencing PGK1 reduced OGD/R-increased M1 polarization, inflammation, and glycolysis. Conversely, the overexpression of PGK1 promoted HAPI microglial cell inflammation by regulating glycolysis. The mechanism showed that histone acetyltransferase p300 promoted PGK1 expression through H3K27 acetylation. Finally, data indicated that silencing PGK1 inhibited microglia M1 polarization, inflammation, and glycolysis in MCAO rat models. PGK1 could promote ischemia/reperfusion injury-induced microglial M1 polarization and inflammation by regulating glycolysis, which might provide a novel direction in developing new therapeutic medications for preventing or treating stroke.
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Affiliation(s)
- Wei Cao
- Department of Neurovascular Disease, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai, 200080, China
| | - Zhengzhe Feng
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Deyuan Zhu
- Department of Neurovascular Disease, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai, 200080, China
| | - Suya Li
- Department of Neurovascular Disease, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai, 200080, China
| | - Meng Du
- Department of Neurovascular Disease, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai, 200080, China
| | - Shifei Ye
- Department of Neurovascular Disease, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai, 200080, China
| | - Dayong Qi
- Department of Neurovascular Disease, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai, 200080, China
| | - Peng Li
- Department of Neurovascular Disease, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai, 200080, China
| | - Yan Chen
- Department of Neurosurgery, The Second Affiliated Hospital Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China.
| | - Yibin Fang
- Department of Neurovascular Disease, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, 1279 Sanmen Road, Shanghai, 200080, China.
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Melake A, Brhanie N. Angiotensin-converting enzyme gene insertion/deletion polymorphism and risk of ischemic stroke complication among patients with hypertension in the Ethiopian population. Front Neurol 2023; 14:1093993. [PMID: 37034069 PMCID: PMC10073506 DOI: 10.3389/fneur.2023.1093993] [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: 11/09/2022] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
Background Ischemic stroke is a complicated, multifaceted condition brought on by a confluence of vascular, environmental, and genetic variables. The burden of ischemic stroke is currently rising in terms of death, morbidity, and disability worldwide. Genetic variables also play significant roles in the pathophysiology of hypertension and ischemic stroke in addition to the greatest effects of demographic, clinical, and behavioral risk factors. The key functional variation of the ACE gene that has drawn the most interest is the ACE I/D variant. Even though the ACE gene I/D polymorphism has been widely studied, the findings of investigations on the involvement of this polymorphism in ischemic stroke were contradictory and provide conflicting data. The goal of this study was to look into the effect of the ACE gene I/D polymorphism on the risk of ischemic stroke in patients with hypertension. Methods A hospital-based case-control study was carried out in 36 cases of patients with hypertensive IS and 36 age- and sex-matched healthy controls. Clinical and biochemical parameters were measured to assess the associated risk factors. The DNA was isolated from blood samples, and the ACE I/D genotypes were identified using polymerase chain reaction and analyzed by agarose gel electrophoresis. Results The ACE-DD genotype (OR = 3.71, 95% CI = 1.02-13.5; P < 0.05) and D allele (OR = 2.07, 95% CI = 1.06-4.03; P < 0.05) were significantly more common in patients than in controls, indicating that it is a risk factor for the development of ischemic stroke in hypertensive individuals. Conclusion There is a significant correlation between the ACE gene I/D polymorphism and the development of ischemic stroke in patients with a history of hypertension in the Ethiopian population.
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Affiliation(s)
- Addisu Melake
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
- Department of Medical Biotechnology, Institute of Biotechnology, University of Gondar, Gondar, Ethiopia
- *Correspondence: Addisu Melake
| | - Nega Brhanie
- Department of Medical Biotechnology, Institute of Biotechnology, University of Gondar, Gondar, Ethiopia
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Risk Factors for Hemorrhagic Stroke among Adults in the Democratic Republic of the Congo: A Hospital-Based Study in a Limited Resource Setting. Stroke Res Treat 2022; 2022:7840921. [PMID: 36387269 PMCID: PMC9663232 DOI: 10.1155/2022/7840921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 10/10/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022] Open
Abstract
Background The prevalence of stroke is increasing in sub-Saharan Africa. The scarcity of hospital-based stroke data in Lubumbashi (in the Democratic Republic of the Congo) led to the study, which was designed to describe the epidemiology of stroke and identify risk factors associated with hemorrhagic stroke among adult patients in Lubumbashi. Methods This was a cross-sectional study of 158 adult patients admitted for stroke in the internal medicine department of Lubumbashi University Clinics from January 2018 to December 2020. Sociodemographic and clinical features, cardiovascular risk factors, and hospital mortality were collected. A logistic regression has determined the risk of developing a hemorrhagic stroke. Results Of 9,919 hospitalized patients, 158 had a stroke with a hospital prevalence of 1.6%; 86 (54.4%) patients had a hemorrhagic stroke while 72 (45.6%) had an ischemic stroke. Of which 41.1% (65/158) were women. The mean age was 60.8 ± 13.3 years. Main clinical signs were hemiplegia (63.3%), headache (48.7%), speech disorders (38.6%), and dizziness (38.6%). Hypertension (82.9%) and hyperglycemia (53.2%) were the most common risk factors. Inhospital mortality was 22.8%. After logistic regression, independent predictors for developing hemorrhagic stroke were hypertension (aOR = 8.19; 95% CI: 2.72–24.66; p < 0.0001) and atrial fibrillation (aOR = 4.89; 95% CI: 1.41–16.89; p = 0.012). Conclusion This study highlights the high stroke mortality in a resource-limited hospital and the burden of hypertension in the development of hemorrhagic stroke. It illustrates the need to establish stroke care setting to improve the quality of stroke care.
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Ayehu GW, Yitbarek GY, Zewdie EA, Amsalu BT, Abie Y, Atlaw D, Agegnehu A, Admasu FT, Azanaw MM, Amare AT, Emiru ZA. Risk profile, clinical presentation, and determinants of stroke subtypes among patients with stroke admitted to public referral hospitals, Northwest Ethiopia in 2021: A cross-sectional study. Front Neurol 2022; 13:988677. [DOI: 10.3389/fneur.2022.988677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStroke is the second leading cause of death worldwide, with a significant increase in stroke burden over the last two and half decades, especially in developing countries. African countries are undergoing an epidemiological transition from being dominated by infectious diseases to being double-burdened by non-communicable diseases, with existing infectious diseases driven by sociodemographic and lifestyle changes and a weak healthcare system. Data on the risk profile, clinical presentation, and predictors of stroke subtypes are still limited. Therefore, the main aim of this study was to assess the risk profile, clinical presentation, and predictors of stroke in public referral hospitals of Northwest Ethiopia.MethodsFor this study, 554 patients with stroke admitted to three public referral hospitals were prospectively followed up. Data were collected using a pre-tested interviewer-administered questionnaire. STATA version 16 was used for data analyses. Candidate variables significant in bivariate analysis were selected for multivariate binary logistic regression, and statistical significance was set at a p < 0.05.ResultsOf the 554 patients with stroke, 60.3% had an ischemic stroke. The mean age of the participants was 61 ± 12.85 years, and more than half (53.25%) of them were women. The most common risk factor identified was hypertension (29.7%), followed by congestive heart failure. The most common clinical presentation was hemiparesis, which was reported by 57.7% of the patients, followed by loss of consciousness (20.7%) and aphasia (9%). Through multivariable logistic regression, age (AOR = 1.03, 95% CI:1.01–1.05), sedentary physical activity level (AOR = 6.78, 95% CI:1.97–23.32), absence of a family history of chronic illness (AOR = 3.79, 95% CI:2.21–6.48), hypertension (AOR=0.51, 95% CI:0.31–0.85), and past stroke (AOR = 3.54, 95% CI:0.93–13.49) were found to be independent determinants of the stroke subtype.ConclusionAge, the level of sedentary physical activity, absence of a family history of chronic illness, hypertension, and past stroke were independent determinants of stroke subtype.
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Juli C, Heryaman H, Arnengsih, Ang ET, Defi IR, Gamayani U, Atik N. The number of risk factors increases the recurrence events in ischemic stroke. Eur J Med Res 2022; 27:138. [PMID: 35918760 PMCID: PMC9344667 DOI: 10.1186/s40001-022-00768-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Stroke is a significant cause of disability worldwide and is considered a disease caused by long-term exposure to lifestyle-related risk factors. These risk factors influence the first event of stroke and recurrent stroke events, which carry more significant risks for more severe disabilities. This study specifically compared the risk factors and neurological outcome of patients with recurrent ischemic stroke to those who had just experienced their first stroke among patients admitted to the Hospital. PATIENTS AND METHODS We observed and analyzed 300 patients' data who met the inclusion and exclusion criteria. This retrospective observational study was conducted on consecutive acute ischemic stroke patients admitted to the top referral hospital, West Java, Indonesia. The data displayed are epidemiological characteristics, NIHSS score at admission and discharge, and the type and number of risk factors. Data were then analyzed using appropriate statistical tests. RESULTS Most patients had more than one risk factor with hypertension as the most frequent (268 subjects or 89.3%). In patients who experienced ischemic stroke for the first time, the average National Institutes of Health Stroke Scale (NIHSS) score was lower (6.52 ± 3.55), and the alteration of NIHSS score was higher (1.22 ± 2.26) than those with recurrent stroke (6.96 ± 3.55) for NIHSS score and 1.21 ± 1.73 for alteration of NIHSS score). We processed the data with statistical analysis and showed a positive correlation between age (P < 0.05) and the number of risk factors (P < 0.001) in the recurrent ischemic stroke group. CONCLUSIONS Age and the number of risk factors correlate with recurrent ischemic strokes.
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Affiliation(s)
- Cep Juli
- Doctoral Program, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia.,Department of Neurology Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Henhen Heryaman
- Doctoral Program, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Arnengsih
- Doctoral Program, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Eng-Tat Ang
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Bandung, Singapore
| | - Irma Ruslina Defi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dr. Hasan Sadikin General Hospital, Padjadjaran University, Bandung, Indonesia
| | - Uni Gamayani
- Department of Neurology Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Nur Atik
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
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Ibrahim AO, Shabi OM, Agbesanwa TA, Olowoyo P. Five-year analysis of clinical presentations and predictors of stroke mortality in rural Southwestern Nigeria: A retrospective observational study. Afr J Emerg Med 2022; 12:12-18. [PMID: 35004136 PMCID: PMC8718731 DOI: 10.1016/j.afjem.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/15/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Stroke mortality and its predictors are important outcome measures in stroke epidemiological studies and clinical trials. There is an observed paucity of data regarding the clinical presentations and predictors of stroke mortality in Southwestern Nigeria. Few available related studies have centred on hospitals in the urban and sub-urban areas; however, none in the rural settings. This study, therefore, focuses on the clinical presentations and predictors of stroke mortality at the adult Emergency Centre of a tertiary hospital situated in rural Southwestern Nigeria. Methods A retrospective survey, using data form and standardized questionnaire, was used to study the patients admitted for stroke between January 2015 and December 2019. The data were analysed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. Results A total of 276 patients were studied. Their mean age was 67.3 ± 11.1 years. The most common clinical presentations were hemiparesis and cranial nerve deficit. The case of fatality was 10.1%. The predictors of stroke mortality were age ≥65 years [(AOR = 12.752; 95% CI: (1.022–159.190), p = 0.048)], Glascow coma score <8 [(AOR = 50.348; 95% CI: (7.779–325.866), p < 0.001)], uncontrolled blood pressure [(AOR = 23.321; 95% CI: (2.449–221.927), p = 0.006)], presence of atrial fibrillation [(AOR = 16.456; 95% CI: (2.169–169.336), p = 0.009)], convulsion [(AOR = 25.889; 95% CI: (2.374–282.296), p = 0.008)], heart failure [(AOR = 30.284; 95% CI: (3.265–256.347), p < 0.001)], and a repeat stroke [(AOR = 32.617; 95% CI: (2.410–441.381), p = 0.009)]. Conclusion The 7-day fatality was 10.1%. The predictors of stroke mortality were poor Glascow coma score, uncontrolled blood pressure, atrial fibrillation, heart failure, convulsion and a repeat stroke. This study strengthens the argument on the higher prevalence of stroke and its mortality in rural Southwestern Nigeria. Our findings may provide an impetus for prospective research on this outcome.
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Key Words
- AED, Accident and Emergency Department
- AF, Atrial fibrillation
- BMI, Body Mass Index
- DBP, Diastolic blood pressure
- FETHI, Federal teaching hospital, Ido-Ekiti
- GCS, Glascow Coma Score
- HR, Heart rate
- HS, Haemorrhagic Stroke
- IS, Ischemic Stroke
- Mortality
- Nigeria
- Predictors
- RR, Respiratory rate
- Rural
- SBP, Systolic blood pressure
- SSA, Sub- Saharan Africa
- Stroke
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Ma SY. Evaluating the impact of evidence-based nursing in combination with clinical nursing pathway for nursing care of patients with stroke: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28278. [PMID: 35029173 PMCID: PMC8758029 DOI: 10.1097/md.0000000000028278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Strokes are among the leading conditions that lead to disability and death. Currently, there is a lack of ideal nursing care for stroke patients. The aim of this study is to assess the effect of combining evidence-based nursing and clinical nursing pathway to establish a nursing model to provide care for patients who suffered a stroke. METHODS A comprehensive search of online-based databases will be carried out to identify relevant publications, the databases include EMBASE, Cochrane Library, PubMed, VIP databases, Chinese National Knowledge Infrastructure, and WanFang database. The search will consider all Randomized Controlled Trials, interrupted time series studies, and controlled before and after studies, all related to providing care for neurology and strokes by combining evidence-based nursing and clinical nursing pathway to elevate access and outcomes for patients with stroke. The language of publications will be restricted to English and Chinese. The author will select studies, extract data, and evaluate the quality of the involved articles. RevMan 5.3 software will be employed to perform all statistical analysis. RESULTS The outcomes of the proposed study will provide scientific evidence for the nursing care of evidence-based nursing combined with clinical nursing pathway for stroke patients. CONCLUSION The planned systematic analysis will be first to examine the effect of combining evidence-based nursing and clinical nursing pathway to present a nursing model to treat stroke patients. REGISTRATION NUMBER November 16, 2021.osf.io/6zr5a/. (https://osf.io/6zr5a/).
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Jung JY, Lee YB, Kang CK. Novel Technique to Measure Pulse Wave Velocity in Brain Vessels Using a Fast Simultaneous Multi-Slice Excitation Magnetic Resonance Sequence. SENSORS 2021; 21:s21196352. [PMID: 34640671 PMCID: PMC8512313 DOI: 10.3390/s21196352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 11/16/2022]
Abstract
In this study, we proposed a novel pulse wave velocity (PWV) technique to determine cerebrovascular stiffness using a 3-tesla magnetic resonance imaging (MRI) to overcome the various shortcomings of existing PWV techniques for cerebral-artery PWV, such as long scan times and complicated procedures. The technique was developed by combining a simultaneous multi-slice (SMS) excitation pulse sequence with keyhole acquisition and reconstruction (SMS-K). The SMS-K technique for cerebral-artery PWV was evaluated using phantom and human experiments. In the results, common and internal carotid arteries (CCA and ICA) were acquired simultaneously in an image with a high temporal resolution-of 48 ms for one measurement. Vascular signals at 500 time points acquired within 30 s could generate pulse waveforms of CCA and ICA with 26 heartbeats, allowing for the detection of PWV changes over time. The results demonstrated that the SMS-K technique could provide more PWV information with a simple procedure within a short period of time. The procedural convenience and advantages of PWV measurements will make it more appropriate for clinical applications.
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Affiliation(s)
- Ju-Yeon Jung
- Department of Health Science, Gachon University Graduate School, Gachon University, Incheon 21936, Korea;
| | - Yeong-Bae Lee
- Neuroscience Research Institute, Gachon University, Incheon 21565, Korea
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Korea
- Correspondence: (Y.-B.L.); (C.-K.K.); Tel.: +82-32-460-3346 (Y.-B.L.); +82-32-820-4110 (C.-K.K.)
| | - Chang-Ki Kang
- Department of Health Science, Gachon University Graduate School, Gachon University, Incheon 21936, Korea;
- Neuroscience Research Institute, Gachon University, Incheon 21565, Korea
- Department of Radiological Science, College of Health Science, Gachon University, Incheon 21936, Korea
- Correspondence: (Y.-B.L.); (C.-K.K.); Tel.: +82-32-460-3346 (Y.-B.L.); +82-32-820-4110 (C.-K.K.)
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Sinha RK, Singh A, Kishor A, Richa S, Kumar R, Kumar A. Evaluation of Oral Hygiene Status in Patients with Hemorrhagic and Ischemic Stroke. J Pharm Bioallied Sci 2021; 13:S233-S236. [PMID: 34447083 PMCID: PMC8375821 DOI: 10.4103/jpbs.jpbs_698_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Stroke can broadly be categorized into ischemic or hemorrhagic. Ischemic stroke accounts for 85% of cerebrovascular accidents (CVAs), whereas hemorrhagic stroke accounts for 15% of CVAs. Stroke is broadly associated with loss of sensation or unilateral paralysis of orofacial structures. Objectives: The present study was conducted to evaluate the prevalence of various oral features in patients with ischemic and hemorrhagic stroke. Materials and Methods: One hundred patients diagnosed with stroke admitted in the intensive care unit were included in the study. The evaluation of oral manifestations and their prevalence was done by a well-experienced oral medicine expert deputed in the dental department of the hospital. A single examiner performed all oral evaluations. Results: The mean and median for the age were 60.8 and 59. Sixty of 100 patients were male, whereas 38 were female. Forty patients had hemorrhagic stroke, whereas 60 had ischemic stroke. Senenty-eight patients of 100 had features of periodontitis, 90 of 100 patients presented with halitosis, 79 presented with caries, 83 patients had positive signs of tongue hypermobility, and 75 patients had dysphagia. Conclusion: Oral hygiene is the most neglected aspect during rehabilitation in stroke patients. It is critical for stroke patients to receive thorough oral care, as it can prevent other systemic ailments and potentially life-threatening complications like aspiration pneumonia.
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Affiliation(s)
| | - Anupama Singh
- Department of Dentistry, Darbhanga Medical College And Hospital, Darbhanga, Bihar, India
| | - Amit Kishor
- Primary Health Centre, Baniyapur, Saran, Bihar, India
| | - Shree Richa
- Department of Orthodontics and Dentofacial Orthopedics, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar, India
| | - Rajiva Kumar
- Dental Medical Officer, Primary Health Centre, Health Department, Government of Bihar, Rajpur, Rohtas, Bihar, India
| | - Abhishek Kumar
- Department of Oral and Maxillofacial Surgery, Buddha Institute of Dental Sciences and Hospital, Patna, India
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Kalirawna TR, Rohilla J, Bairwa SS, Gothwal SK, Tak P, Jain R. Increased concentration of serum gamma-glutamyl transferase in ischemic stroke patients. Brain Circ 2021; 7:71-76. [PMID: 34189349 PMCID: PMC8191536 DOI: 10.4103/bc.bc_47_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/07/2020] [Accepted: 03/10/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND: Stroke is responsible for the largest proportion of neurological disorders causing a significant morbidity. Gamma-glutamyl transferase (GGT) enzyme has an active involvement in atherosclerosis through its role in oxidative and inflammatory mechanisms. Recent evidence suggests that serum GGT is related to the risk and prognosis of cerebrovascular diseases. METHODS: A total of 200 patients (100 with acute ischemic stroke and 100 without stroke) were recruited from various medical wards and medical intensive care unit. Categorical variables were compared between two groups using Chi-squared test and odds ratio (OR). Independent sample t-test was used to see to compare mean GGT level of stroke patients with control. RESULTS: There was no statistical difference with respect to distribution of age groups (χ2 = 1.25, P = 0.741) and gender (χ2 = 2.678, P = 0.1018) between cases and controls. Mean age of stroke patients (mean [M] = 61.7, standard deviation [SD] = 13.8) did not differ from controls (M = 62.2, SD = 13.6), P = 0.80. The odds of suffering from diabetes were significantly higher in stroke patients than cases (OR = 2.25, P = 0.005). Independent sample t-test found a significant difference in serum GGT level between cases (M = 57.47, SD = 11.8) and control (M = 41.72, SD = 7.5), P ≤ 0.0001. CONCLUSIONS: Serum GGT was significantly higher in stroke patients than age-sex-matched nonstroke patients. Association remained significant in stroke patients irrespective of age, gender, and other risk factors. Stroke patients with diabetes, hypertension, dyslipidemia, obesity, and smoking had higher level serum GGT level than those without these risk factors. Prospective cohort studies can further explore the potential of GGT as a predictor of acute ischemic stroke.
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Affiliation(s)
- Teja Ram Kalirawna
- Department of Medicine, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India
| | - Jitendra Rohilla
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shyam Sunder Bairwa
- Department of Medicine, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India
| | - Sunil Kumar Gothwal
- Department of Medicine, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India
| | - Pinki Tak
- Department of Medicine, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India
| | - Rajesh Jain
- Department of Medicine, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India
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Luthra M, Ohri P, Kashyap PV, Maheshwari S. Predictors of Stroke Subtype and Severity in Patients of a Tertiary Care Hospital, Dehradun. Indian J Community Med 2021; 46:107-111. [PMID: 34035588 PMCID: PMC8117902 DOI: 10.4103/ijcm.ijcm_465_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/13/2021] [Indexed: 11/04/2022] Open
Abstract
Context Stroke caused 6.7 million deaths worldwide in 2013. In India, the cumulated incidence of stroke was 105-152/100,000 persons per year in last decade. Dearth of data on predictors of stroke subtype and severity in India lead to this study. Aims (1) To categorize presenting stroke patients by subtype and severity. (2) To establish association of risk factors with above. (3) To predict subtype and severity by risk factors. Settings and Design Hospital-based cross-sectional analytic, retrospective study. Subjects and Methods A predesigned, pretested, semi-structured questionnaire with standard tool (National Institute of Health Stroke Scale Score), informed consent after prior approval of institutional ethics and research committees. Statistical Analysis Used Percentages, proportions, Chi-square trends, linear regression, independent t-test, and analysis of variance (ANOVA). Results Mean age of 102 patients was 62.1 (±12.8 years). Stroke subtype associated with socioeconomic status (χ2 = 6.38775, P = 0.0115) and stroke severity (χ2 = 18.98, P = 0) and stroke severity associated with stroke subtype (χ2 = 9.79366, P = 0.0018). Stroke subtype could be predicted by stroke severity and stroke severity by subtype, sex, and dyslipidemia (regression models). Independent t-test revealed excessive alcohol intake was a significant predictor and one-way ANOVA revealed education was a significant predictor of severe stroke. Conclusions Stroke subtype is significantly associated with higher socioeconomic status and severe stroke. Stroke severity is significantly associated with hemorrhagic stroke. Stroke subtype, sex, dyslipidemia, alcohol intake, and education may act as predictors of stroke severity.
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Affiliation(s)
- Megha Luthra
- Department of Community Medicine, SGRRIM and HS, Dehradun, Uttarakhand, India
| | - Puneet Ohri
- Department of Community Medicine, SGRRIM and HS, Dehradun, Uttarakhand, India
| | - Priyanka V Kashyap
- Department of Medicine, Neurology Unit, SGRRIM and HS, Dehradun, Uttarakhand, India
| | - Sonam Maheshwari
- Department of Community Medicine, GDMC, Dehradun, Uttarakhand, India
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Zhang C, Chen S, Zhang Z, Xu H, Zhang W, Xu D, Lin B, Mei Y. Asiaticoside Alleviates Cerebral Ischemia-Reperfusion Injury via NOD2/Mitogen-Activated Protein Kinase (MAPK)/Nuclear Factor kappa B (NF-κB) Signaling Pathway. Med Sci Monit 2020; 26:e920325. [PMID: 32006420 PMCID: PMC7009775 DOI: 10.12659/msm.920325] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cerebral ischemia-reperfusion injury (CIRI) remains a serious health problem. Centella asiatica formulations are used to treat central nervous system disorders. In the present study, asiaticoside, an extract of the plant Centella asiatica, was investigated in CIRI in vivo and vitro. MATERIAL AND METHODS We made a CIRI model in vivo in SD rats treated by middle cerebral artery occlusion, and a cell model of ischemia-reperfusion injury was made in PC12 cells treated by deprivation of oxygen and glucose/restoration. CIRI in vivo was assessed by scores of neurological functions, encephaledema, and cerebral infarction area. Inflammation level and oxidative stress level were detected by the appropriate kits. TUNEL assay was performed for assessment of cell apoptosis and Western blot analysis was performed to assess protein expression levels. CCK8 assay was performed for evaluation of cell survival and flow cytometer was used to detect cell apoptosis in vitro. RESULTS Nervous function injury, brain edema, cell apoptosis, infarct size, apoptosis-related protein expressions, and protein expressions of the NOD2/MAPK/NF-kappaB signaling pathway in the CIRI model were all reversed by asiaticoside in rats. The cell apoptosis, inflammation level, and oxidative stress level in the model of cerebral ischemia-reperfusion injury were reduced by asiaticoside. The effects of asiaticoside on CIRI were reversed by NOD 2 agonists. CONCLUSIONS Asiaticoside showed a protective effect against cerebral ischemia-reperfusion injury via the NOD2/MAPK/NF-kappaB signaling pathway. These findings are vital for future research on use of asiaticoside in CIRI, providing a new avenue for alleviating CIRI.
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Affiliation(s)
- Chunhui Zhang
- Department of Clinical Nursing, Nursing and Health College of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Suyan Chen
- Department of Public Nursing, Nursing and Health College of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Zhenxiang Zhang
- Department of Fundamental Nursing, Nursing and Health College of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Hui Xu
- Department of Fundamental Nursing, Nursing and Health College of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Weihong Zhang
- Department of Basic Medicine, Nursing and Health College of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Dongqing Xu
- Rehabilitation Department, Henan Province Hospital of Traditional Chinese Medicine (TCM), Zhengzhou, Henan, China (mainland)
| | - Beilei Lin
- Department of Clinical Nursing, Nursing and Health College of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Yongxia Mei
- Department of Public Nursing, Nursing and Health College of Zhengzhou University, Zhengzhou, Henan, China (mainland)
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Fekadu G, Chelkeba L, Kebede A. Retraction Note: Risk factors, clinical presentations and predictors of stroke among adult patients admitted to stroke unit of Jimma university medical center, south west Ethiopia: prospective observational study. BMC Neurol 2019; 19:327. [PMID: 31847818 PMCID: PMC6916064 DOI: 10.1186/s12883-019-1564-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ginenus Fekadu
- Clinical Pharmacy Unit, Department of Pharmacy, Institute of Health Sciences, Wollega University, P.O Box 395, Nekemte, Ethiopia.
| | - Legese Chelkeba
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ayantu Kebede
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
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