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1.
Nicotine Tob Res ; 2023 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-38015428

RESUMO

INTRODUCTION: Non-cigarette tobacco (NCT) represents a form of tobacco use with a misperceived significance in chronic disease events. Whether NCT use is sufficient to promote stroke events, especially among Africans, is yet to be understood. This study assessed the relationship between NCT use and stroke among indigenous Africans. METHODS: A total of 7,617 respondents (NCT users: 41 vs. non-NCT: 7576) from the Stroke Investigation Research and Educational Network study were included in the current analysis. NCT use was defined as self-reported use of smoked (cigars or piper) or smokeless (snuff or chewed) tobacco in the past year preceding stroke events. Stroke was defined based on clinical presentation and confirmed with a cranial CT/MRI. Multivariable-adjusted logistic regression was applied to estimate the odds ratio (OR) and 95% confidence interval (CI) for the relationship between NCT and stroke at p<0.05. RESULTS: Out of the 41 (0.54%) who reported NCT use, 27 (65.9%) reported using smokeless NCT. NCT users were older than non-smokers (62.8±15.7 vs 57.7±14.8 years). Overall, NCT use was associated with first-ever stroke (OR: 2.08; 95%CI: 1.02, 4.23) in the entire sample. Notably, smokeless NCT use was independently associated with higher odds of stroke (OR: 2.74; 95%CI: 1.15, 6.54), but smoked NCT use (OR: 0.16; 95%CI: 0.02, 1.63) presented a statistically insignificant association after adjusting for hypertension and other covariates. CONCLUSIONS: NCT use was associated with higher odds of stroke, and public health interventions targeting NCT use might be promising in reducing the burden of stroke among indigenous Africans. IMPLICATIONS: A detailed understanding of the relationship between NCT use and stroke will likely inform well-articulated policy guidance to promote evidence-based recommendations for public health prevention and management of stroke on the African continent.

2.
J Stroke Cerebrovasc Dis ; 32(3): 106978, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36634397

RESUMO

OBJECTIVE: This study explored perceptions, preferences and attitudes towards disclosure of genetic testing results for stroke among stroke-free controls (and their family members) in the SIREN-SIBS Genomics Study, healthcare providers and policymakers. MATERIALS AND METHODS: We conducted a qualitative thematic analysis of key informant interviews with 61 participants recruited from community advisory boards (30) and health care providers (31) across seven sites in Nigeria and Ghana. RESULTS: Major findings illustrate differences in the knowledge of genetic testing with superior knowledge among health care professionals. Relatives and religious leaders were opined as the best to receive the disclosure as they would be able to break the news to the patient in a culturally sensitive manner to reduce the likely resultant emotional outburst. Poor level of awareness of national guidelines for disclosing genetic results exist. Key facilitating factors for disclosure are education, enabling environment, involvement of religious and community leaders, campaigns, and possible treatment options. Disclosure inhibitors include inadequate information, fear of marital break-up or family displacement, fear of stigmatization, fear of isolation, religious beliefs, health worker attitude, and lack of preparedness to accept results. CONCLUSIONS: These necessitate culturally sensitive interventions for continuing education, increased awareness and sustained engagement to equip all stakeholders in genetic testing disclosure process.


Assuntos
Revelação , Pessoal de Saúde , Humanos , Pesquisa Qualitativa , Pessoal de Saúde/psicologia , Testes Genéticos , Família
3.
Stroke ; 53(1): 134-144, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34587795

RESUMO

BACKGROUND AND PURPOSE: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. METHODS: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. RESULTS: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91-15.45); dyslipidemia, 5.16 (3.78-7.03); diabetes, 3.44 (2.60-4.56); low green vegetable consumption, 1.89 (1.45-2.46); red meat consumption, 1.89 (1.45-2.46); cardiac disease, 1.88 (1.22-2.90); monthly income $100 or more, 1.72 (1.24-2.39); and psychosocial stress, 1.62 (1.18-2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively (P<0.0001). CONCLUSIONS: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.


Assuntos
AVC Isquêmico/etnologia , AVC Isquêmico/fisiopatologia , África Ocidental/etnologia , Idoso , Estudos de Casos e Controles , Diabetes Mellitus/etnologia , Diabetes Mellitus/fisiopatologia , Diabetes Mellitus/prevenção & controle , Dislipidemias/etnologia , Dislipidemias/fisiopatologia , Dislipidemias/prevenção & controle , Feminino , Gana/etnologia , Humanos , Hipertensão/etnologia , Hipertensão/fisiopatologia , Hipertensão/prevenção & controle , AVC Isquêmico/prevenção & controle , Masculino , Pessoa de Meia-Idade , Nigéria/etnologia , Obesidade/etnologia , Obesidade/fisiopatologia , Obesidade/prevenção & controle , Fatores de Risco
4.
Neurol Sci ; 43(9): 5451-5457, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35729440

RESUMO

OBJECTIVE: Now is the time to reflect on the situation of neuro-endovascular interventions (NEVT) in Africa, particularly Ghana, and to renew our commitment to provide high-quality health care to our people. This evaluation is significant because it seeks to assess progress toward our goals and identify potential obstacles for remedial action and to highlight the challenges of NEVT in Ghana. METHODS: Retrospective review of all endovascular treatments performed between January 1, 2019, and December 31, 2021, at two Ghanaian hospitals. A descriptive analysis was done having entered data in Microsoft Excel utilizing frequencies and percentages. Four experienced specialist radiologists discussed NEVT issues in Ghana. The fishbone diagram was used to depict the challenges and problems of NEVT practices in Ghana. RESULTS: From January 2019 to December 2021, 278 patients' records were analyzed at two Ghanaian hospitals. The majority of patients (71.9%) had digital subtraction angiography of the head and neck. The high cost of medical supplies, lack of vendor interest, and limited awareness of symptoms by general practitioners were noted as obstacles associated with neuro-endovascular treatment in Ghana. CONCLUSION: Although the future of NEVT is bright, Interventional Neuroradiologists and other stakeholder need to make conscious effort to improve quality, accessibility, and cost of NEVT in Ghana.


Assuntos
Hospitais , Gana , Humanos , Inquéritos e Questionários
5.
Medicina (Kaunas) ; 55(9)2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31470666

RESUMO

Background and objectives: Imbalance of calcium/magnesium ratio could lead to clinical complications in sickle cell disease (SCD). Low levels of magnesium have been associated with sickling, increased polymerization and vaso-occlusion (VOC) in sickle cell due to cell dehydration. The K-Cl cotransport plays a very important role in sickle cell dehydration and is inhibited by significantly increasing levels of magnesium. The study evaluated total serum magnesium levels and computed calcium/magnesium ratio in SCD patients and "healthy" controls. Materials and methods: The study was a case-control cross-sectional one, involving 120 SCD patients (79 Haemoglobin SS (HbSS)and 41 Haemoglobin SC (HbSC)) at the steady state and 48 "healthy" controls. Sera were prepared from whole blood samples (n = 168) and total magnesium and calcium measured using a Flame Atomic Absorption Spectrometer (Variant 240FS manufactured by VARIAN Australia Pty Ltd., Melbourne, VIC, Australia). Calcium/magnesium ratios were calculated in patients and the controls. Results: The prevalence of hypomagnesemia and hypocalcaemia among the SCD patients was observed to be 39.17% and 52.50% respectively, higher than the controls (4.17% and 22.92%, for hypomagnesemia and hypocalcaemia, respectively). Level of magnesium was significantly lower in the SCD patients compared to their healthy counterparts (p = 0.002). The magnesium level was further reduced in the HbSS patients but not significantly different from the HbSC patients (p = 0.584). calcium/magnesium ratio was significantly higher in the SCD patients (p = 0.031). Although calcium/magnesium ratio was higher in the HbSC patients compared to those with the HbSS genotype, the difference was not significant (p = 0.101). Conclusion: The study shows that magnesium homeostasis are altered in SCD patients, and their levels are lower in HbSS patients. Although calcium/magnesium ratio is significantly higher in SCD patients compared with controls, there is no significant difference between patients with HbSS and HbSC genotypes. Magnesium supplementation may be required in sickle cell patients.


Assuntos
Anemia Falciforme/sangue , Cálcio/sangue , Magnésio/sangue , Adulto , Análise de Variância , Estudos de Casos e Controles , Estudos Transversais , Feminino , Genótipo , Doença da Hemoglobina SC/sangue , Hemoglobina Falciforme , Homeostase , Humanos , Masculino , Valores de Referência
6.
J Stroke Cerebrovasc Dis ; 26(11): 2662-2670, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28760409

RESUMO

BACKGROUND: Annotation and Image Markup on ClearCanvas Enriched Stroke-phenotyping Software (ACCESS) is a novel stand-alone computer software application that allows the creation of simple standardized annotations for reporting brain images of all stroke types. We developed the ACCESS application and determined its inter-rater and intra-rater reliability in the Stroke Investigative Research and Educational Network (SIREN) study to assess its suitability for multicenter studies. METHODS: One hundred randomly selected stroke imaging reports from 5 SIREN sites were re-evaluated by 4 trained independent raters to determine the inter-rater reliability of the ACCESS (version 12.0) software for stroke phenotyping. To determine intra-rater reliability, 6 raters reviewed the same cases previously reported by them after a month of interval. Ischemic stroke was classified using the Oxfordshire Community Stroke Project (OCSP), Trial of Org 10172 in Acute Stroke Treatment (TOAST), and Atherosclerosis, Small-vessel disease, Cardiac source, Other cause (ASCO) protocols, while hemorrhagic stroke was classified using the Structural lesion, Medication, Amyloid angiopathy, Systemic disease, Hypertensive angiopathy and Undetermined (SMASH-U) protocol in ACCESS. Agreement among raters was measured with Cohen's kappa statistics. RESULTS: For primary stroke type, inter-rater agreement was .98 (95% confidence interval [CI], .94-1.00), while intra-rater agreement was 1.00 (95% CI, 1.00). For OCSP subtypes, inter-rater agreement was .97 (95% CI, .92-1.00) for the partial anterior circulation infarcts, .92 (95% CI, .76-1.00) for the total anterior circulation infarcts, and excellent for both lacunar infarcts and posterior circulation infarcts. Intra-rater agreement was .97 (.90-1.00), while inter-rater agreement was .93 (95% CI, .84-1.00) for TOAST subtypes. Inter-rater agreement ranged between .78 (cardioembolic) and .91 (large artery atherosclerotic) for ASCO subtypes and was .80 (95% CI, .56-1.00) for SMASH-U subtypes. CONCLUSION: The ACCESS application facilitates a concordant and reproducible classification of stroke subtypes by multiple investigators, making it suitable for clinical use and multicenter research.


Assuntos
Encéfalo/diagnóstico por imagem , Hemorragia/diagnóstico , Fenótipo , Acidente Vascular Cerebral/diagnóstico , Isquemia Encefálica/complicações , Eletrocardiografia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Distribuição Aleatória , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/etiologia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler
7.
Stroke ; 47(1): 167-72, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26578660

RESUMO

BACKGROUND AND PURPOSE: The Questionnaire for Verifying Stroke-Free Status (QVSFS), a method for verifying stroke-free status in participants of clinical, epidemiological, and genetic studies, has not been validated in low-income settings where populations have limited knowledge of stroke symptoms. We aimed to validate QVSFS in 3 languages, Yoruba, Hausa and Akan, for ascertainment of stroke-free status of control subjects enrolled in an on-going stroke epidemiological study in West Africa. METHODS: Data were collected using a cross-sectional study design where 384 participants were consecutively recruited from neurology and general medicine clinics of 5 tertiary referral hospitals in Nigeria and Ghana. Ascertainment of stroke status was by neurologists using structured neurological examination, review of case records, and neuroimaging (gold standard). Relative performance of QVSFS without and with pictures of stroke symptoms (pictograms) was assessed using sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: The overall median age of the study participants was 54 years and 48.4% were males. Of 165 stroke cases identified by gold standard, 98% were determined to have had stroke, whereas of 219 without stroke 87% were determined to be stroke-free by QVSFS. Negative predictive value of the QVSFS across the 3 languages was 0.97 (range, 0.93-1.00), sensitivity, specificity, and positive predictive value were 0.98, 0.82, and 0.80, respectively. Agreement between the questionnaire with and without the pictogram was excellent/strong with Cohen k=0.92. CONCLUSIONS: QVSFS is a valid tool for verifying stroke-free status across culturally diverse populations in West Africa.


Assuntos
Multilinguismo , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etnologia , Inquéritos e Questionários/normas , Adulto , África Ocidental/etnologia , Estudos Transversais , Características Culturais , Feminino , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade
8.
Neuroepidemiology ; 45(2): 73-82, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26304844

RESUMO

BACKGROUND: As the second leading cause of death and the leading cause of adult-onset disability, stroke is a major public health concern particularly pertinent in Sub-Saharan Africa (SSA), where nearly 80% of all global stroke mortalities occur, and stroke burden is projected to increase in the coming decades. However, traditional and emerging risk factors for stroke in SSA have not been well characterized, thus limiting efforts at curbing its devastating toll. The Stroke Investigative Research and Education Network (SIREN) project is aimed at comprehensively evaluating the key environmental and genomic risk factors for stroke (and its subtypes) in SSA while simultaneously building capacities in phenomics, biobanking, genomics, biostatistics, and bioinformatics for brain research. METHODS: SIREN is a transnational, multicentre, hospital and community-based study involving 3,000 cases and 3,000 controls recruited from 8 sites in Ghana and Nigeria. Cases will be hospital-based patients with first stroke within 10 days of onset in whom neurovascular imaging will be performed. Etiological and topographical stroke subtypes will be documented for all cases. Controls will be hospital- and community-based participants, matched to cases on the basis of gender, ethnicity, and age (±5 years). Information will be collected on known and proposed emerging risk factors for stroke. STUDY SIGNIFICANCE: SIREN is the largest study of stroke in Africa to date. It is anticipated that it will shed light on the phenotypic characteristics and risk factors of stroke and ultimately provide evidence base for strategic interventions to curtail the burgeoning burden of stroke on the sub-continent.


Assuntos
Fenótipo , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/etiologia , Adulto , Estudos de Casos e Controles , Protocolos Clínicos , Seguimentos , Gana/epidemiologia , Humanos , Nigéria/epidemiologia , Projetos de Pesquisa , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
9.
Ghana Med J ; 58(1): 109-114, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38957279

RESUMO

Introduction: Mucocoele of the appendix occurs in 0.2-0.7% of people in the world without any well-defined clinical symptoms. It occurs when there is an accumulation of mucous in the lumen of the appendix. Case Presentation: We present three cases: a 48-year-old male admitted to the emergency room with a one-day history of right iliac fossa pain. Abdominal examination was suggestive of acute appendicitis. The initial abdominal computerised tomography scan was reported as being unremarkable. At surgery, a firm tumour of the appendix was found, and a limited right hemicolectomy was done. Histopathology confirmed a mucocoele of the appendix with borderline mucinous histology.The second case is a 63-year-old man who presented with a one-year history of abdominal distension and weight loss. Previous abdominal ultrasound was suggestive of liver cirrhosis with significant ascitic fluid. Abdominal magnetic resonance imaging found an appendix mucocoele with infiltration of the omentum and scalloping of the liver surface suggestive of pseudomyxoma peritonei. A percutaneous biopsy of the omental mass confirmed metastatic mucinous adenocarcinoma of the appendix.The third case is a 68-year-old man who, during an annual medical check-up, had an incidental finding of a cystic right iliac fossa mass on ultrasound, confirmed on abdominopelvic computerised tomography scan to be an appendix mucocele. He had laparoscopic appendicectomy. The histopathological diagnosis confirmed a mucinous cystadenoma of the appendix. Conclusion: Preoperative diagnosis of appendiceal mucocoele is difficult and commonly discovered intraoperatively. The prognosis is good for the histologically benign type, but it is poor when malignant or peritoneal lesions are present. Funding: None declared.


Assuntos
Apêndice , Mucocele , Humanos , Masculino , Pessoa de Meia-Idade , Mucocele/cirurgia , Mucocele/diagnóstico por imagem , Mucocele/patologia , Apêndice/patologia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Idoso , Tomografia Computadorizada por Raios X , Neoplasias do Apêndice/cirurgia , Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/diagnóstico por imagem , Adenocarcinoma Mucinoso/cirurgia , Adenocarcinoma Mucinoso/patologia , Adenocarcinoma Mucinoso/diagnóstico por imagem , Apendicite/cirurgia , Apendicite/diagnóstico por imagem , Apendicectomia , Imageamento por Ressonância Magnética , Doenças do Ceco/cirurgia , Doenças do Ceco/patologia , Pseudomixoma Peritoneal/patologia , Pseudomixoma Peritoneal/cirurgia
10.
J Hypertens ; 42(4): 620-628, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38230616

RESUMO

BACKGROUND: The dietary factors associated with the high burden of hypertension among indigenous Africans remain poorly understood. We assessed the relationship between dietary patterns and hypertension among indigenous Africans. METHOD: In this study, 1550 participants with hypertension matched (for age: ±â€Š5 years, sex and ethnicity) with 1550 participants without hypertension were identified from the stroke-free population in the Stroke Investigative Research and Educational Network study in Ghana and Nigeria. Food consumption was assessed using a food frequency questionnaire, and dietary information was summarized using principal component analysis to identify seven dietary patterns. Conditional logistic regression was applied to compute the odds ratio (OR) and 95% confidence interval (CI) for the risk of hypertension by tertiles of dietary patterns adjusting for age, education, income, smoking, alcohol use, physical inactivity, family history of cardiovascular diseases, obesity and salt intake at a two-sided P less than 0.05. RESULTS: Multivariable-adjusted OR [95% confidence interval (CI)] for risk of hypertension by second and third tertiles [using the lowest (first) tertile as reference] of dietary patterns were 0.62 (0.48-0.80), 0.70 (0.54-0.90) for whole grains and fruit drinks; 0.87 (0.68-1.12), 0.83 (0.64-1.08) for fruits; 0.85 (0.65-1.10), 0.97 (0.75-1.26) for vegetables, legumes and potatoes; 0.78 (0.60-1.00), 0.84 (0.65-1.08) for fried foods and sweetened drinks; 1.13 (0.88-1.45), 0.80 (0.62-1.03) for poultry product and organ meat; 1.11 (0.86-1.43), 0.88 (0.68-1.14) for red meat; and 1.14 (0.88-1.48), 1.09 (0.84-1.43) for processed foods ( P  < 0.05). CONCLUSION: A higher adherence to dietary consumption of whole grains and fruits was inversely associated with low odds of hypertension in this population.


Assuntos
Hipertensão , Acidente Vascular Cerebral , Humanos , Padrões Dietéticos , Dieta/efeitos adversos , Verduras , Frutas , Acidente Vascular Cerebral/epidemiologia , Hipertensão/epidemiologia , Comportamento Alimentar , Fatores de Risco
11.
J Neurol Sci ; 459: 122968, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38518449

RESUMO

BACKGROUND: Hypertension is preeminent among the vascular risk factors for stroke occurrence. The wide gaps in awareness, detection, treatment, and control rates of hypertension are fueling an epidemic of stroke in sub-Saharan Africa. PURPOSE: To quantify the contribution of untreated, treated but uncontrolled, and controlled hypertension to stroke occurrence in Ghana and Nigeria. METHODS: The Stroke Investigative Research and Educational Network (SIREN) is a case-control study across 16 study sites in Ghana and Nigeria. Cases were acute stroke (n = 3684) with age- and sex-matched stroke-free controls (n = 3684). We evaluated the associations of untreated hypertension, treated but uncontrolled hypertension, and controlled hypertension at BP of <140/90 mmHg with risk of stroke occurrence. We assessed the adjusted odds ratio and population-attributable risk of hypertension treatment control status associated with stroke occurrence. RESULTS: The frequencies of no hypertension, untreated hypertension, treated but uncontrolled hypertension and controlled hypertension among stroke cases were 4.0%, 47.7%, 37.1%, and 9.2% vs 40.7%, 34.9%, 15.9%, and 7.7% respectively among stroke-free controls, p < 0.0001. The aOR and PAR (95% CI) for untreated hypertension were 6.58 (5.15-8.41) and 35.4% (33.4-37.4); treated but uncontrolled hypertension was 9.95 (7.60-13.02) and 35.9% (34.2-37.5); and controlled hypertension 5.37 (3.90-7.41) and 8.5% (7.6-9.5) respectively. Untreated hypertension contributed a PAR of 47.5% to the occurrence of intracerebral hemorrhage vs 29.5% for ischemic stroke. The aOR of untreated hypertension for stroke occurrence was 13.31 (7.64-23.19) for <50 years; 7.14 (4.51-11.31) for 50-64 years; and 3.48 (2.28-5.30) for 65 years or more. CONCLUSION: The contribution of untreated hypertension and treated but uncontrolled hypertension to stroke occurrence among indigenous Africans is substantial. Implementing targeted interventions that address gaps in hypertension prevention and treatment, involving the local population, healthcare providers, and policymakers, can potentially substantially reduce the escalating burden of strokes in Africa.


Assuntos
Hipertensão , Acidente Vascular Cerebral , Humanos , Gana/epidemiologia , Nigéria/epidemiologia , Estudos de Casos e Controles , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/etiologia , Fatores de Risco , Hipertensão/epidemiologia , Hipertensão/complicações
12.
Genome Med ; 16(1): 25, 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38317187

RESUMO

BACKGROUND: African ancestry populations have the highest burden of stroke worldwide, yet the genetic basis of stroke in these populations is obscure. The Stroke Investigative Research and Educational Network (SIREN) is a multicenter study involving 16 sites in West Africa. We conducted the first-ever genome-wide association study (GWAS) of stroke in indigenous Africans. METHODS: Cases were consecutively recruited consenting adults (aged > 18 years) with neuroimaging-confirmed ischemic stroke. Stroke-free controls were ascertained using a locally validated Questionnaire for Verifying Stroke-Free Status. DNA genotyping with the H3Africa array was performed, and following initial quality control, GWAS datasets were imputed into the NIH Trans-Omics for Precision Medicine (TOPMed) release2 from BioData Catalyst. Furthermore, we performed fine-mapping, trans-ethnic meta-analysis, and in silico functional characterization to identify likely causal variants with a functional interpretation. RESULTS: We observed genome-wide significant (P-value < 5.0E-8) SNPs associations near AADACL2 and miRNA (MIR5186) genes in chromosome 3 after adjusting for hypertension, diabetes, dyslipidemia, and cardiac status in the base model as covariates. SNPs near the miRNA (MIR4458) gene in chromosome 5 were also associated with stroke (P-value < 1.0E-6). The putative genes near AADACL2, MIR5186, and MIR4458 genes were protective and novel. SNPs associations with stroke in chromosome 2 were more than 77 kb from the closest gene LINC01854 and SNPs in chromosome 7 were more than 116 kb to the closest gene LINC01446 (P-value < 1.0E-6). In addition, we observed SNPs in genes STXBP5-AS1 (chromosome 6), GALTN9 (chromosome 12), FANCA (chromosome 16), and DLGAP1 (chromosome 18) (P-value < 1.0E-6). Both genomic regions near genes AADACL2 and MIR4458 remained significant following fine mapping. CONCLUSIONS: Our findings identify potential roles of regulatory miRNA, intergenic non-coding DNA, and intronic non-coding RNA in the biology of ischemic stroke. These findings reveal new molecular targets that promise to help close the current gaps in accurate African ancestry-based genetic stroke's risk prediction and development of new targeted interventions to prevent or treat stroke.


Assuntos
AVC Isquêmico , MicroRNAs , Acidente Vascular Cerebral , Adulto , Humanos , Estudo de Associação Genômica Ampla , AVC Isquêmico/complicações , Predisposição Genética para Doença , Acidente Vascular Cerebral/genética , Genômica , Polimorfismo de Nucleotídeo Único , DNA , Estudos Multicêntricos como Assunto
13.
Radiol Case Rep ; 18(4): 1466-1470, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36798073

RESUMO

Pericardial cysts are rare mediastinal masses commonly asymptomatic and incidentally found on chest radiographs. Pericardial cysts may be acquired/inflammatory in origin and may be symptomatic. We present a case of 65-year-old male who presented with symptoms of right heart failure. Diagnosis of a giant pericardial cyst was made using imaging modalities such as chest X-ray, computed tomography scan, and echocardiography. Percutaneous cyst aspiration was done under echocardiography guidance. Radiologists and cardiothoracic surgeons need to understand the pathology of inflammatory/acquired pericardial cysts to include in their differential diagnosis of mediastinal masses.

14.
Ghana Med J ; 57(3): 167-174, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38957673

RESUMO

Objective: The study sought to determine clinical characteristics and histologic subtypes of a cohort of lung cancer patients in a tertiary facility. Design: Retrospective review of the medical records of histology-confirmed lung cancer cases at the respiratory clinic over a 3-year period. Setting: Respiratory Clinic, Korle-Bu Teaching Hospital, Accra, Ghana. Participants: All adult patients with histologically diagnosed lung cancer were enrolled. Main outcome measures: Lung cancer histological types. Results: The proportion of lung cancer cases was 12.4%. The majority were women (57.8%) and the mean age at diagnosis was 55.8±16.0 years. The patients were predominantly non-smokers (61%). Common symptoms were chronic cough and chest pain. More than two-thirds of the cases presented in clinical stages III and IV with the predominant histological subtype being adenocarcinoma in smokers and non-smokers. Genetic testing for epidermal growth factor receptor (EGFR) and Anaplastic Lymphoma kinase (ALK) mutations were largely absent. Conclusions: The majority of lung cancer patients presented late with advanced disease. Adenocarcinoma was the predominant histological subtype in a predominantly non-smoking population, with an increased prevalence among women less than 60 years. This should encourage testing for genetic mutations to improve patient survival. Funding: None declared.


Assuntos
Neoplasias Pulmonares , Fumar , Centros de Atenção Terciária , Humanos , Neoplasias Pulmonares/epidemiologia , Feminino , Pessoa de Meia-Idade , Masculino , Estudos Retrospectivos , Idoso , Adulto , Gana/epidemiologia , Fumar/epidemiologia , Fumar/efeitos adversos , Adenocarcinoma/epidemiologia , Estadiamento de Neoplasias , Tosse/etiologia , Receptores ErbB/genética , Idoso de 80 Anos ou mais , Dor no Peito/etiologia
15.
Marit Stud ; 22(2): 15, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37073301

RESUMO

Small fish are an important part of the diet in Ghana, but malnutrition rates remain high. The nutritional quality of fish consumed in Ghana may be affected by food processing and cooking practices, but the extent to which these processes are practiced among poor Ghanaian households along the coastal belt is unknown. This study explored how poor Ghanaian households process, prepare, and cook meals containing small fish. This exploratory qualitative study used Attride-Stirling thematic network analysis. Respondents were purposively sampled from fishing communities in the coastal regions of Ghana. One-on-one interviews were performed by trained field assistants, audio recorded and videotaped, and transcribed for further data analysis. The most common small fish species identified were anchovies and herrings. Anchovies were fried and eaten whole. Herrings were eaten either smoked or fresh; for fresh herring, the head, fins, and viscera were removed before boiling. Herrings were smoked with the head and viscera; however, both the head and viscera were removed before being added to boiling soup and were not consumed. Anchovies were fried for 10 min, and herrings were boiled for 15-30 min. Processing methods and further meal preparation depend on the small fish species. Nutrient composition and contribution of small fish depend on the processing method, preparation method, and what tissues are eaten. Thus, these results will be of importance for sampling schemes for food composition tables and for the calculation of nutrient intake from small fish. Supplementary Information: The online version contains supplementary material available at 10.1007/s40152-023-00300-w.

16.
Clin Med Insights Endocrinol Diabetes ; 16: 11795514231218592, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38107873

RESUMO

Background: The rapidly rising cardiometabolic disease (CMD) burden in urbanizing sub-Saharan African populations and among sub-Saharan African migrants in Europe likely affects serum adiponectin and leptin levels, but this has not yet been quantified. Objectives: To compare the serum levels of adiponectin and leptin among migrant, and non-migrant (urban and rural) populations of Ghanaian descent. Methods: Cross-sectional analysis of serum leptin and adiponectin in the multi-centre Research on Obesity and Diabetes among African Migrants (RODAM) study. Logistic-regression models were used to examine the association between these adipocyte-derived hormones after stratification (sex, geographic area) and adjustments for potential confounders. Results: A total of 2518 Ghanaians were included. Rural participants had the highest serum adiponectin and lowest leptin levels compared to Amsterdam and urban Ghanaians (P < .001). In fully adjusted models, participants living in urban Ghana had significantly higher odds of hyperleptinemia compared to rural participants (women-odds ratio 2.88; 95% CI, 1.12-7.38, P = .028 and men 43.52, 95% CI, 4.84-391.25, P < .001). Urban Ghanaian men also had higher odds of elevated leptin: adiponectin ratio (6.29, 95% CI, 1.43-27.62, P = .015). The odds of hyperleptinemia were only higher in Amsterdam Ghanaian men (10.56; 95% CI, 1.11-100.85, P = .041), but not in women (0.85; 95% CI, 0.30-2.41, P = .759). There was no significant association between hypoadiponectinemia and geographical location in both sexes. Conclusion: Urbanization is associated with serum adiponectin and leptin levels after adjusting for confounding covariates in sub-Saharan Africans. These findings serve as a backdrop for further research on the role adipokines play in CMD epidemiology among Africans.

17.
Hypertension ; 80(12): 2581-2590, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37830199

RESUMO

BACKGROUND: This study aimed to develop a risk-scoring model for hypertension among Africans. METHODS: In this study, 4413 stroke-free controls were used to develop the risk-scoring model for hypertension. Logistic regression models were applied to 13 risk factors. We randomly split the dataset into training and testing data at a ratio of 80:20. Constant and standardized weights were assigned to factors significantly associated with hypertension in the regression model to develop a probability risk score on a scale of 0 to 1 using a logistic regression model. The model accuracy was assessed to estimate the cutoff score for discriminating hypertensives. RESULTS: Mean age was 59.9±13.3 years, 56.0% were hypertensives, and 8 factors, including diabetes, age ≥65 years, higher waist circumference, (BMI) ≥30 kg/m2, lack of formal education, living in urban residence, family history of cardiovascular diseases, and dyslipidemia use were associated with hypertension. Cohen κ was maximal at ≥0.28, and a total probability risk score of ≥0.60 was adopted for both statistical weighting for risk quantification of hypertension in both datasets. The probability risk score presented a good performance-receiver operating characteristic: 64% (95% CI, 61.0-68.0), a sensitivity of 55.1%, specificity of 71.5%, positive predicted value of 70.9%, and negative predicted value of 55.8%, in the test dataset. Similarly, decision tree had a predictive accuracy of 67.7% (95% CI, 66.1-69.3) for the training set and 64.6% (95% CI, 61.0-68.0) for the testing dataset. CONCLUSIONS: The novel risk-scoring model discriminated hypertensives with good accuracy and will be helpful in the early identification of community-based Africans vulnerable to hypertension for its primary prevention.


Assuntos
Doenças Cardiovasculares , Hipertensão , Humanos , Pessoa de Meia-Idade , Idoso , População Africana , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Fatores de Risco , Medição de Risco
18.
J Am Heart Assoc ; 12(12): e027888, 2023 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-37301737

RESUMO

Background Baseline stroke severity is probably partly responsible for poor stroke outcomes in sub-Saharan Africa. However, there is a paucity of information on determinants of stroke severity among indigenous Africans. We sought to identify the factors associated with stroke severity among West Africans in the SIREN (Stroke Investigative Research and Educational Networks) study. Methods and Results Stroke was diagnosed clinically and confirmed with brain neuroimaging. Severe stroke was defined as a Stroke Levity Scale score of ≤5. A multivariate logistic regression model was constructed to identify factors associated with stroke severity at 95% CI and a nominal cutoff of 5% type 1 error. A total of 3660 stroke cases were included. Overall, 50.7%% had severe stroke, including 47.6% of all ischemic strokes and 56.1% of intracerebral hemorrhage. Factors independently associated with severe stroke were meat consumption (adjusted odds ratio [aOR], 1.97 [95% CI, 1.43-2.73]), low vegetable consumption (aOR, 2.45 [95% CI, 1.93-3.12]), and lesion volume, with an aOR of 1.67 (95% CI, 1.03-2.72) for lesion volume of 10 to 30 cm3 and aOR of 3.88 (95% CI, 1.93-7.81) for lesion volume >30 cm3. Severe ischemic stroke was independently associated with total anterior circulation infarction (aOR, 3.1 [95% CI, 1.5-6.9]), posterior circulation infarction (aOR, 2.2 [95% CI, 1.1-4.2]), and partial anterior circulation infarction (aOR, 2.0 [95% CI, 1.2-3.3]) compared with lacunar stroke. Increasing age (aOR, 2.6 [95% CI, 1.3-5.2]) and lesion volume >30 cm3 (aOR, 6.2 [95% CI, 2.0-19.3]) were independently associated with severe intracerebral hemorrhage. Conclusions Severe stroke is common among indigenous West Africans, where modifiable dietary factors are independently associated with it. These factors could be targeted to reduce the burden of severe stroke.


Assuntos
AVC Isquêmico , Acidente Vascular Cerebral , Humanos , População Africana , Acidente Vascular Cerebral/epidemiologia , Encéfalo , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Infarto , Fatores de Risco
19.
Lancet Glob Health ; 11(4): e575-e585, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36805867

RESUMO

BACKGROUND: Every minute, six indigenous Africans develop new strokes. Patient-level and system-level contributors to early stroke fatality in this region are yet to be delineated. We aimed to identify and quantify the contributions of patient-level and system-level determinants of inpatient stroke fatality across 16 hospitals in Ghana and Nigeria. METHODS: The Stroke Investigative Research and Educational Network (SIREN) is a multicentre study involving 16 sites in Ghana and Nigeria. Cases include adults (aged ≥18 years) with clinical and radiological evidence of an acute stroke. Data on stroke services and resources available at each study site were collected and analysed as system-level factors. A host of demographic and clinical variables of cases were analysed as patient-level factors. A mixed effect log-binomial model including both patient-level and system-level covariates was fitted. Results are presented as adjusted risk ratios (aRRs) with respective 95% CIs. FINDINGS: Overall, 814 (21·8%) of the 3739 patients admitted with stroke died as inpatients: 476 (18·1%) of 2635 with ischaemic stroke and 338 (30·6%) of 1104 with intracerebral haemorrhage. The variability in the odds of stroke fatality that could be attributed to the system-level factors across study sites assessed using model intracluster correlation coefficient was substantial at 7·3% (above a 5% threshold). Stroke units were available at only five of 16 centres. The aRRs of six patient-level factors associated with stroke fatality were: low vegetable consumption, 1·19 (95% CI 1·07-1·33); systolic blood pressure, 1·02 (1·01-1·04) for each 10 mm Hg rise; stroke lesion volume more than 30 cm3, 1·48 (1·22-1·79); National Institutes of Health Stroke Scale (NIHSS) score, 1·20 (1·13-1·26) for each 5-unit rise; elevated intracranial pressure, 1·75 (1·31-2·33); and aspiration pneumonia, 1·79 (1·16-2·77). INTERPRETATION: Studies are needed to assess the efficacy of interventions targeting patient-level factors such as aspiration pneumonia in reducing acute stroke fatality in this region. Policy directives to improve stroke unit access are warranted. FUNDING: US National Institutes of Health. TRANSLATIONS: For the Twi, Yoruba and Hausa translations of the abstract see Supplementary Materials section.


Assuntos
Isquemia Encefálica , Pneumonia Aspirativa , Acidente Vascular Cerebral , Adulto , Humanos , Adolescente , Estudos Prospectivos , Nigéria/epidemiologia , Gana/epidemiologia , Hospitais , Pneumonia Aspirativa/complicações
20.
Ghana Med J ; 56(4): 295-302, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37575625

RESUMO

Objectives: To review the Computed Tomography( CT )features of pediatric oncological patients with abdominal and pelvic tumours and correlate these findings with their histopathological diagnosis. Design: This was a retrospective cross-sectional facility-based study. Setting: This study was conducted in the Pediatric Oncology Unit and Radiology Department of the Korle Bu Teaching Hospital. Participants: Fifty-six pediatric oncology patients with contrast-enhanced abdominal and pelvic CT scans. Data Collection: The abdominal and pelvic CT scans findings, patient biodata, and histopathology reports of oncology patients over four years were reviewed. Statistical analysis: Simple descriptive statistics using frequency distribution, percentages, means, and standard deviation were used to describe the various variables and presented tables. Results: The four commonest tumours were nephroblastoma, neuroblastoma, lymphoma, and hepatoblastoma. The mean age at diagnosis was 4.8 years, with a slightly higher male predominance. The majority of the tumours were extremely large at presentation. Overall, the CT - histopathology concordance was 79.2%. Conclusion: Abdominal and pelvic CT scans play an important role in the diagnostic workup of pediatric malignancies by ensuring early and accurate diagnosis of these tumours. Funding: None declared.


Assuntos
Neoplasias Pélvicas , Criança , Humanos , Masculino , Pré-Escolar , Feminino , Gana , Neoplasias Pélvicas/diagnóstico por imagem , Estudos Retrospectivos , Estudos Transversais , Hospitais de Ensino , Tomografia Computadorizada por Raios X/métodos , Tomografia
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