Computed tomographic pattern of stroke among adult patients in north-eastern Nigeria

Stroke and its complications are major health problems in developing countries including Nigeria. It could be a major cause of death or disability especially when only clinical assessment is relied upon for diagnosis. Computed Tomography (CT) is a valuable tool for the diagnosis of stroke. CT pattern of stroke in the North Eastern Nigeria has not been fully described. This was a prospective descriptive study conducted at the Federal Teaching Hospital, Gombe, Nigeria from June 2016 to December 2016. One hundred and eleven patients who presented with clinical features of stroke and were referred to Radiology department for cranial CT were consecutively selected. Data were analysed using SPSS version 16.0 package. A p-value of ≤ 0.05 and confidence interval of 95% were adapted for statistical analysis. The variables were expressed as range, percentage and mean plus standard deviation. All comparison of variables was done applying kappa statistic and point-biserial correlation coefficient for the correlation analysis. There were 69 (62.2%) males and 42 (37.8%) females aged 18-90 years (mean ± SD of 57.49±13.47 years). Ninety-four (94) patients (84.7%) had ischaemic stroke, while the remaining 17 (15.3%) had haemorrhagic stroke. Lobar location was identified as the most common site of ischaemic stroke while thalamo-ganglionic area was the commonest location for haemorrhagic stroke. Age and hypertension were found to be the commonest risk factors associated with stroke. It is evident from this study that ischaemic stroke is the most prevalent stroke subtype. The middle cerebral artery territory was the commonest vascular territory involved in stroke while hypertension and age are common risk factors for both ischaemic and haemorrhagic stroke.

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Prevalence of the Frank’s sign by aetiopathogenic stroke subtype: A prospective analysis

PLoS ONE ◽

10.1371/journal.pone.0261080 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261080

Author(s):

Laura Sánchez-Cirera ◽

Saima Bashir ◽

Adina Ciscar ◽

Carla Marco ◽

Verónica Cruz ◽

...

Keyword(s):

Risk Factors ◽

Ischaemic Stroke ◽

Acute Stroke ◽

Haemorrhagic Stroke ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Stroke Subtype ◽

Cross Sectional ◽

Stroke Subtypes ◽

Artery Disease

Background and purpose The Frank’s sign is a diagonal earlobe crease running from the tragus to the edge of the auricle at an angle of 45°. Many studies have associated this sign with coronary artery disease and some with cerebrovascular disease. The objective of this study was to analyse the prevalence of the Frank’s sign in patients suffering from acute stroke with a particular focus on its prevalence in each of the five aetiopathogenic stroke subtypes. Special interest is given to embolic stroke of undetermined source (ESUS), correlating the sign with clinical and radiological markers that support an underlying causal profile in this subgroup. Methods Cross-sectional descriptive study including 124 patients admitted consecutively to a stroke unit after suffering an acute stroke. The Frank’s sign was evaluated by the same blinded member of the research team from photographs taken of the patients. The stroke subtype was classified following SSS-TOAST criteria and the aetiological study was performed following the ESO guidelines. Results The Frank’s sign was present in 75 patients and was more prevalent in patients with an ischaemic stroke in comparison with haemorrhagic stroke (63.9 vs. 37.5, p<0.05). A similar prevalence was found in the different ischaemic stroke subtypes. The Frank’s sign was significantly associated with age, particularly in patients older than 70 who had vascular risk factors. Atherosclerotic plaques found in carotid ultrasonography were significantly more frequent in patients with the Frank’s sign (63.6%, p<0.05). Analysing the ESUS, we also found an association with age and a higher prevalence of the Frank’s sign in patients with vascular risk factors and a tendency to a high prevalence of atherosclerosis markers. Conclusion The Frank’s sign is prevalent in all aetiopathogenic ischaemic stroke subtypes, including ESUS, where it could be helpful in suspecting the underlying cardioembolic or atherothrombotic origin and guiding the investigation of atherosclerosis in patients with ESUS and the Frank’s sign.

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Prevalence of stroke and associated risk factors: a population based cross sectional study from northeast China

BMJ Open ◽

10.1136/bmjopen-2016-015758 ◽

2017 ◽

Vol 7 (9) ◽

pp. e015758 ◽

Cited By ~ 20

Author(s):

Fu-Liang Zhang ◽

Zhen-Ni Guo ◽

Yan-Hua Wu ◽

Hao-Yuan Liu ◽

Yun Luo ◽

...

Keyword(s):

Risk Factors ◽

Ischaemic Stroke ◽

Northeast China ◽

Haemorrhagic Stroke ◽

Population Based ◽

Cross Sectional Study ◽

Cross Sectional ◽

Cerebrovascular Risk ◽

Lack Of Exercise ◽

Associated Risk Factors

ObjectivesEpidemiological studies aimed at stroke and its risk factors can help identify persons at higher risk and therefore promote stroke prevention strategies. We aimed to explore the current prevalence of stroke and its associated risk factors in northeast China.DesignPopulation based cross sectional study.SettingData were collected using a structured precoded questionnaire designed by the Stroke Screening and Prevention Programme of the National Health and Family Planning Commission of China, between January and March 2016.Participants4100 permanent residents, aged 40 years or older, who had lived in Dehui City of Jilin Province for more than 6 months volunteered to participate in the survey, with a response rate of 92.2%. For the purpose of the present analysis, 48 subjects were excluded due to missing values, giving a total of 4052 people included in this analysis.Main outcome measureThe questionnaire included demographic characteristics, stroke related behavioural factors, personal and family medical history of stroke, physical examination and laboratory testing.ResultsThe overall prevalence of stroke in Jilin Province was 7.2% (95% CI 6.3% to 8.2%). Of all stroke cases, 91.7% (95% CI 87.4% to 94.6%) were ischaemic stroke and 8.3% (95% CI 5.4% to 12.6%) were haemorrhagic stroke. The prevalence rates of dyslipidaemia, smoking and hypertension were ranked as the top three cerebrovascular risk factors and were 62.1%, 61.8% and 57.3%, respectively. We found that hypertension, dyslipidaemia and lack of exercise were associated with ischaemic stroke. However, only hypertension (OR=4.064, 95% CI 1.358 to 12.160) was significantly associated with haemorrhagic stroke.ConclusionsThe prevalence of stroke, especially ischaemic stroke, and associated cerebrovascular risk factors among adults aged 40 years or older in northeast China were high. A higher regional prevalence of hypertension, dyslipidaemia and lack of exercise may be responsible.

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Ischaemic stroke in Jordan: a 2-year hospital-based study of subtypes and risk factors

Eastern Mediterranean Health Journal ◽

10.26719/2004.10.1-2.138 ◽

2004 ◽

Vol 10 (1-2) ◽

pp. 138-146

Author(s):

Y. Bahou ◽

H. Hamid ◽

A. Hadidi

Keyword(s):

Risk Factors ◽

Ischaemic Stroke ◽

Internal Capsule ◽

Chronic Atrial Fibrillation ◽

Favourable Outcome ◽

Cardioembolic Stroke ◽

University Hospital ◽

Stroke Subtype ◽

Common Risk Factors ◽

Pure Motor

A retrospective study was made of 200 consecutive patients with first-ever ischaemic stroke, admitted to Jordan University Hospital over a 2-year period. The mean age was 61.2 years [range 29-95]. The most common stroke subtype was lacunar infarct [51.5%], but frequency of cardioembolic stroke was low [8.0%]. Hypertension, diabetes mellitus and smoking were the most common risk factors for atherosclerotic non-cardioembolic stroke. Chronic atrial fibrillation was the most common risk factor for cardioembolic stroke. No patient had severe extracranial carotid or vertebral artery stenosis [>50% narrowing]. Lacunar strokes presented predominantly as pure motor stroke [67/103] and were mainly in the internal capsule [34/ 103]. The favourable outcome [85% discharged home] may be due to the relatively young age and the predominance of lacunar infarcts

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Genetic variability of Mycobacterium tuberculosiscomplex in patients with no known risk factors for MDR-TB in the North-eastern part of Lima, Peru

BMC Infectious Diseases ◽

10.1186/1471-2334-13-397 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 9

Author(s):

Francesca Barletta ◽

Larissa Otero ◽

Jimena Collantes ◽

Belisa Asto ◽

Bouke C de Jong ◽

...

Keyword(s):

Risk Factors ◽

Genetic Variability ◽

The North ◽

North Eastern ◽

Mdr Tb ◽

North Eastern Part

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Evaluation of Cardiovascular Risk Factors In Patients With Familial Hypercholesterolemia From The North-Eastern Area of Romania

10.21203/rs.3.rs-61509/v1 ◽

2020 ◽

Author(s):

Cristiana-Elena Vlad ◽

Liliana Foia ◽

Laura Florea ◽

Irina-Iuliana Costache ◽

Andreea Covic ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Familial Hypercholesterolemia ◽

Lipid Lowering ◽

High Dose ◽

The North ◽

Increased Risk ◽

North Eastern ◽

North Eastern Part

Abstract Background. Familial hypercholesterolemia (FH) is one of the most frequent and important monogenic cholesterol pathology. Traditional and nontraditional cardiovascular risk factors increase the prevalence of atherosclerotic cardiovascular disease (ASCVD) in this population. Objective. To establish the prevalence and the cardiovascular risk factors of FH population, to identify the ASCVD through the clinico-biological and imaging modifications during the 24-months follow-up.Methods. This first prospective study in the north-eastern part of Romania, carried out between October 2017-October 2019, out of 980 patients with dyslipidemia evaluated with the Dutch Lipid Network (DLCN) and Simone Broome (SM) scores, only 61 patients with DLCN score above 3 and FH possible/probably (SM score) were included.Results. The 61 FH subjects recorded a mean age of 48.46±12.53 years, with more women compared to men. Regarding the traditional cardiovascular risk factors, we identified that high blood pressure was the main factor in all patients, followed by sedentary lifestyle, obesity, smoker status, personal cardiovascular history and type 2 diabetes. The measured DLCN score recorded: “possible” FH identified in 39.4%, the “probable”FH in 45.9% and the “definite” FH in 14.7%. After the administration of the lipid-lowering agents for 24 months, TC and LDL-C levels, carotid intima-media thickness (cIMT) and ankle-brachial index (ABI) decreased and HDL-C levels increased, but without reaching the guideline goals. In addition, the high-dose of statin alone, the high-dose of statin with fenofibrate, subjects with „possible” FH, the normal values of cIMT and ABI, had a reduced time of ASCVD occurrence. Also, the high cIMT values, physical inactivity, high TC, TG and high-sensitivity C-reactive protein (hsCRP) levels were associated with an increased risk of ASCVD. Conclusions. To reduce cardiovascular risk, the FH patients need a cascade screening and a specific management. Even though it was the first observational study in the north-eastern part of Romania, further molecular genetics studies are needed to confirm the FH cases.

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Evaluation Of Cardiovascular Risk Factors In Patients With Familial Hypercholesterolemia From The North-Eastern Area Of Romania

10.21203/rs.3.rs-61509/v5 ◽

2021 ◽

Author(s):

Cristiana-Elena Vlad ◽

Liliana Foia ◽

Laura Florea ◽

Irina-Iuliana Costache ◽

Andreea Covic ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiovascular Events ◽

Lipid Lowering ◽

The North ◽

North Eastern ◽

Lipid Lowering Agents ◽

North Eastern Part

Abstract Background. Familial hypercholesterolemia(FH) is one of the most frequent and important monogenic cholesterol pathologies. Traditional and non-traditional cardiovascular risk factors increase the prevalence of atherosclerotic cardiovascular disease(ASCVD) in this population. The aims of the study were:(a) to identify FH patients in the North-Eastern part of Romania and to analyze demographic, clinical and paraclinical data (b) to evaluate the risk of new cardiovascular events at follow-up in FH patients stratified by lipid-lowering agents. Methods. This first prospective study in the North-Eastern part of Romania was carried out between October 2017 and October 2019; out of 980 patients with dyslipidemia evaluated with the Dutch Lipid Network(DLCN) and Simon Broome(SM) scores, 61 patients with DLCN score above 3 and possible/probable FH(SM score) were included.Results. 980 patients were examined and 61 (6.2%) were received the clinical diagnosis of FH. The mean age was 48.5±12.5 years, with more female patients than male patients (63.9% versus 36%). Hypertension was the main cardiovascular risk factor for both genders, followed by physical inactivity and obesity for the female group and active smoking for the male group. The measured DLCN score recorded: “possible” FH identified in 39.4%, “probable” FH in 45.9% and “definite” FH in 14.7%. The effective lipid-lowering drugs used were statin alone and statin in association with fenofibrate, which improved both the lipid profile values and the subclinical atherosclerosis markers (ankle-brachial index, carotid intima-media thickness and high-sensitivity C-reactive protein). New ASCVDs that emerged during the study were most commonly represented by coronary heart disease and stroke. At the same time, the new cardiovascular events were delayed in patients receiving the lipid-lowering drugs, without significant differences between them. Conclusions. In patients with suspected FH, the lipid-lowering agents during the follow-up period delayed the new cardiovascular events, yet failed to reach the goals proposed by the guidelines.

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Epidemiological Overview of African Swine Fever in Uganda (2001–2012)

Journal of Veterinary Medicine ◽

10.1155/2013/949638 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 17

Author(s):

David Kalenzi Atuhaire ◽

Sylvester Ochwo ◽

Mathias Afayoa ◽

Frank Norbert Mwiine ◽

Ikwap Kokas ◽

...

Keyword(s):

Risk Factors ◽

National Parks ◽

Control Strategies ◽

African Swine Fever ◽

Viral Disease ◽

Eastern Region ◽

Central Administration ◽

The North ◽

Geographical Regions ◽

North Eastern

African swine fever (ASF) is a contagious viral disease, which can cause up to 100% mortality among domestic pigs. In Uganda there is paucity of information on the epidemiology of the disease, hence a study was carried out to elucidate the patterns of ASF outbreaks. Spatial and temporal analyses were performed with data collected monthly by the district veterinary officers (DVOs) and sent to the central administration at MAAIF from 2001 to 2012. Additionally, risk factors and the associated characteristics related to the disease were assessed based on semistructured questionnaires sent to the DVOs. A total of 388 ASF outbreaks were reported in 59 districts. Of these outbreaks, 201 (51.8%) were reported in districts adjacent to the national parks while 80 (20.6%) were adjacent to international borders. The number of reported ASF outbreaks changed over time and by geographical regions; however, no outbreak was reported in the North-Eastern region. ASF was ranked as second most important disease of pigs, and it occurred mostly during the dry season (P=0.01). Pig movements due to trade (OR 15.5, CI 4.9–49.1) and restocking (OR 6.6, CI 2.5–17.3) were the major risk factors. ASF control strategies should focus on limiting pig movements in Uganda.

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075 Association between intracranial stenosis and extracranial stenosis seen in stroke patients

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-anzan.74 ◽

2018 ◽

Vol 89 (6) ◽

pp. A30.3-A31

Author(s):

Geetha Guduguntla ◽

Cheng Ling Ting ◽

Tarun Jain ◽

Yash Gawarikar ◽

Ronak Patel

Keyword(s):

Risk Factors ◽

Ischaemic Stroke ◽

Univariate Analysis ◽

Intracranial Stenosis ◽

P Value ◽

Periventricular White Matter ◽

Chi Square ◽

Clinically Significant ◽

Fazekas Scale ◽

Extracranial Stenosis

IntroductionThe association between intracranial stenosis (ICS) and extracranial stenosis (ECS) using CT angiography (CTA) and the occurrence of ischaemic stroke and TIA has not yet been fully investigated.This study aimed to investigate if there is a clinically significant relationship between ICS and ECS with stroke and its risk factors, including diabetes, hypertension, hypercholesterolemia, atrial fibrillation (AF) and ischaemic heart disease (IHD).MethodsFour hundred and fifteen consecutive patients that presented to Calvary Public Hospital, Bruce were retrospectively analysed, with 158 excluded for incomplete CTA and MRA results. ICS and ECS severity was based on grading used in the WASID and SAMPRISS trials, while the Fazekas scale was used to grade periventricular white matter disease. CTA findings were used to base the presence and absence of stenosis.ResultsICS and/or ECS was present in 80% with ischaemic stroke, 78% with TIAs but comparatively only in 56% of those diagnosed as ‘mimics’ (p<0.05). Univariate analysis demonstrated an association between presence of ICS and AF, hypertension, IHD and diabetes (82%, 73%, 84%, 78%; p<0.001) respectively, while for ECS only with AF, hypertension and IHD (77%, 67%, 81%; p<0.001) respectively. Diabetes was independently associated as single biggest risk factor for ICS. Most steno-occlusive lesions were bilateral for ICS and ECS at 80% and 61%, respectively. There also seems to be an association between the presence of ECS and the presence of ICS, with ECS particularly demonstrating predictive value for ICS (ECS PPV for ICS=0.85, chi-square p-value<0.001).ConclusionThese findings suggest a significant association between the presence of ICS and ECS with the occurrence of ischaemic stroke and TIAs as well as with well-known stroke risk factors. This also indicates that perhaps the underlying pathophysiology for steno-occlusive lesions plays a role in ischaemic stroke and warrants further investigating.

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Evaluation of Cardiovascular Risk Factors in Patients With Familial Hypercholesterolemia From the North-Eastern Area of Romania

10.21203/rs.3.rs-61509/v2 ◽

2020 ◽

Author(s):

Cristiana-Elena Vlad ◽

Liliana Foia ◽

Laura Florea ◽

Irina-Iuliana Costache ◽

Andreea Covic ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Familial Hypercholesterolemia ◽

Cardiovascular Events ◽

Lipid Lowering ◽

The North ◽

Increased Risk ◽

North Eastern ◽

North Eastern Part

Abstract Background. Familial hypercholesterolemia (FH) is one of the most frequent and important monogenic cholesterol pathologies. Traditional and nontraditional cardiovascular risk factors increase the prevalence of atherosclerotic cardiovascular disease (ASCVD) in this population. Objective. (a)To identify FH patients in the North-Eastern part of Romania and to analyze demographic, clinical and paraclinical data (b)to identify of new cardiovascular events in FH patients throughout the follow-up based on the administrated lipid lowering drugs.Methods. This first prospective study in the North-Eastern part of Romania was carried out between October 2017 and October 2019; out of 980 patients with dyslipidemia evaluated with the Dutch Lipid Network (DLCN) and Simon Broome (SM) scores, only 61 patients with DLCN score above 3 and possible/probable FH (SM score) were included.Results. The 61 FH subjects recorded a mean age of 48.5±12.5 years, with more female patients than male patients. Hypertension was the main cardiovascular risk factor for both sexes, followed by physical inactivity and obesity for the female FH group and active smoker for the male FH group. The measured DLCN score recorded: “possible” FH identified in 39.4%, “probable” FH in 45.9% and “definite” FH in 14.7%. After the administration of the lipid-lowering agents for 24 months, low-density cholesterol lipoprotein(LDL-C) levels and carotid intima-media thickness(cIMT) have decreased, while the ankle-brachial index(ABI) and high-density cholesterol lipoprotein(HDL-C) levels have increased. Also, the cIMT values over 0.9mm, total cholesterol(TC), triglyceride(TG), and high-sensitivity C-reactive protein(hsCRP) levels were associated with an increased risk of ASCVD. In addition, statins administrated in monotherapy have delayed de new cardiovascular events.Conclusions. To obtain a reduction of cardiovascular events, FH patients need cascade screening for early identification and a specific management with possible administration of monoclonal antibodies, despite the significant socio-economic barriers.

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A Seven-Year retrospective review of stroke admissions in Benin-City, Southern Nigeria

Annals of Health Research ◽

10.30442/ahr.0501-2-32 ◽

2019 ◽

Vol 5 (1) ◽

pp. 11-19

Author(s):

Edith Kayode-Iyasere ◽

Francis Ehidiamen Odiase

Keyword(s):

Risk Factors ◽

Ischaemic Stroke ◽

Hospital Admissions ◽

Case Fatality ◽

Cerebral Haemorrhage ◽

Haemorrhagic Stroke ◽

World Health ◽

Clinical Criteria ◽

Benin City ◽

Southern Nigeria

Background: Stroke is a significant cause of hospital admissions, disability and mortality, but there is a lack of information on stroke in parts of the southern region of Nigeria. Objective: To analyze the frequency of stroke admissions, clinical presentations, risk factors, stroke types and outcomes over seven years, in a secondary level hospital in southern Nigeria. Methods: This was a retrospective study. The hospital record of patients hospitalized between January 2006 and December 2012 at the Central Hospital, Benin-City with the diagnosis of stroke based on the World Health Organization (WHO)-clinical criteria, were studied. Results: Four hundred and nineteen patients with stroke were hospitalized during the study period; this accounted for 3.1% of all the medical admissions. The mean age was 62.4 ± 13.6 years. There were 222 (53%) males and 197(47.0%) females. Ischaemic stroke occurred among 71% of cases; others included intra-cerebral haemorrhage (26%) and subarachnoid haemorrhage (3.1%). The main presenting features included hemiparesis (69%) and sudden loss of consciousness (27.2%). The risk factors included hypertension (84%) and diabetes mellitus (12.2%). The 7, 14 and 30 days case fatality rates were 21.2%, 25.5% and 30.8% respectively. A higher case fatality rate was recorded in haemorrhagic stroke compared to ischaemic stroke (68.8% vs 24%, p = 0.0001). Conclusion: Stroke was a significant cause of mortality amongst medical admissions and hypertension was the most common risk factor. Closer attention to the risk factors for stroke may likely help to reduce the burden of stroke.

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