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1.
J Stroke Cerebrovasc Dis ; 32(9): 107239, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37480805

RESUMO

BACKGROUND: While additional folic acid (FA) treatment has a neutral effect on lowering overall vascular risk in countries that mandate FA fortification of food, meta-analytic data suggest that folate supplementation reduces stroke risk in certain patient subgroups, and among people living in countries without mandatory folate food fortification. However, the burden of folate deficiency among adults with stroke in the world's poorest continent is unknown. PURPOSE: To assess the prevalence and predictors of folate deficiency among recent ischemic stroke survivors. METHODS: We analyzed data among consecutively encountered ischemic stroke patients aged ≥18 years at a tertiary medical center in Kumasi, Ghana between 10/2020 - 08/2021. We identified a modest sample of stroke free adults to serve as a comparator group. Fasting serum folate was measured using a radioimmunoassay and a cut-off of 4ng/mL used to define folate deficiency. Factors associated with serum folate concentration were assessed using a multilinear regression model. RESULTS: Comparing stroke cases (n = 116) with stroke-free comparators (n = 20), mean folate concentration was lower among stroke cases (7 ng/ml vs. 10.2 ng/ml, p = 0.004). Frequency of folate deficiency was higher among stroke cases vs. stroke-free controls (31% vs 5%, p = 0.02). Male sex (beta coefficient of -2.6 (95% CI: -4.2, -0.9) and LDL (ß: -0.76; -1.4, -0.07) were significantly associated with serum folate concentration. CONCLUSION: Almost one in three ischemic stroke survivors have folate deficiency potentially accentuating their risk for further adverse atherosclerotic events in a setting without folate fortification. A clinical trial of folate supplementation among stroke survivors is warranted.


Assuntos
Ácido Fólico , AVC Isquêmico , Adulto , Humanos , Masculino , Ácido Fólico/sangue , Alimentos Fortificados , Gana/epidemiologia , AVC Isquêmico/diagnóstico , AVC Isquêmico/epidemiologia , Prevalência , Sobreviventes , Feminino
2.
J Neurol Sci ; 427: 117540, 2021 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-34139450

RESUMO

BACKGROUND: Herbal medicines are not regulated by regulatory authorities and are often not of proven safety and efficacy. Anecdotal reports suggest widespread use of traditional herbal medicine (THM) for treatment of stroke in Africa, but verifiable data are limited in published literature. OBJECTIVE: To assess the frequency and reasons for THM use among Ghanaian stroke survivors. METHODS: We conducted a cross-sectional survey of 106 consecutive stroke survivors presenting for care at a tertiary medical center in Kumasi, Ghana between June and October 2020. Information on demographic, clinical, vascular risk factors and use of THM were collected in a non-judgmental manner and analyzed. RESULTS: Among the cohort, 46 (43.4%) reported use of any THM for their stroke management. There was a trend towards fewer women who reported use of THM 34.8% vs 53.3%, p = 0.06. Of those reporting use of THM, 78% had blood pressure > 140/90 mmHg vs. 56% among those not exposed to THM (p = 0.02). Top reasons proffered for use of THM were: expecting them to aid faster recovery from stroke (n = 30), expecting them to cure stroke (n = 18), and expecting them to be of superior effectiveness compared to approved conventional medications of proven efficacy/safety (n = 1). CONCLUSION: Almost half the individuals in this contemporary sample of Ghanaian stroke survivors reported use of THM with expectations for improved outcomes. More counseling is required to inform patients about potential safety issues with THM use, and more research is needed to explore risk/benefit of promising THMs to improve stroke outcomes.


Assuntos
Acidente Vascular Cerebral , Pressão Sanguínea , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Sobreviventes
3.
J Stroke Cerebrovasc Dis ; 30(6): 105735, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33744720

RESUMO

BACKGROUND: Multivitamins are commonly used supplements in high income countries, but their net benefit-risk, remains inconclusive. Little is known about the prevalence and predictors of multivitamin supplementation among individual with chronic illnesses in sub-Saharan Africa, especially stroke. PURPOSE: To assess the frequency and factors associated with of use of multivitamin supplement among stroke survivors in Ghana. METHODS: We analyzed prospectively collected data on consecutively encountered stroke survivors seen at an out-patient clinic in Ghana between January 2018 and March 2020. We collected baseline demographic and clinical details, and use of multivitamins among other secondary prevention medications prescribed. We assessed factors associated with multivitamin supplementation using a multivariable logistic regression analysis. RESULTS: Among 1,101 stroke survivors, 324 (29.4%) were on multivitamin supplements. Factors independently associated with multivitamin use were being divorced (OR 2.88; 95% CI: 1.52-5.47), time since diagnosis of index per each month increase (OR 0.99; 95% CI: 0.99-1.00), and number of prescribed classes of antihypertensive medications (OR 0.81; 95% CI: 0.72-0.92). CONCLUSION: Nearly a third of stroke survivors in this Ghanaian sample were on multivitamin supplementation, with select socio-clinical factors being linked to this practice. Future studies should examine how/if this practice is interfering with optimal stroke outcomes.


Assuntos
Suplementos Nutricionais , Padrões de Prática Médica , Acidente Vascular Cerebral/tratamento farmacológico , Vitaminas/uso terapêutico , Adulto , Idoso , Estudos Transversais , Combinação de Medicamentos , Uso de Medicamentos , Feminino , Gana/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Prevenção Secundária , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Resultado do Tratamento
4.
J Clin Hypertens (Greenwich) ; 21(10): 1542-1550, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31465141

RESUMO

The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astronomical increases in key risk factors including hypertension and diabetes. We sought to assess the burden and predictors of CKD among Ghanaians with hypertension and/or diabetes mellitus in a multicenter hospital-based study. We conducted a cross-sectional study in the Ghana Access and Affordability Program (GAAP) involving adults with hypertension only (HPT), hypertension with diabetes mellitus (HPT + DM), and diabetes mellitus only (DM) in 5 health facilities in Ghana. A structured questionnaire was administered to collect data on demographic variables, medical history, and clinical examination. Serum creatinine and proteinuria were measured, and estimated glomerular filtration rate derived using the CKD-EPI formula. A multivariable logistic regression model was used to identify factors associated with CKD. A total of 2781 (84.4%) of 3294 participants had serum creatinine and proteinuria data available for analysis. The prevalence of CKD was 242 (28.5%) among participants with both DM and HPT, 417 (26.3%) among participants with HPT, and 56 (16.1%) among those with DM alone. Predictors of CKD were increasing age aOR 1.26 (1.17-1.36), low educational level aOR 1.7 (1.23-2.35), duration of HPT OR, 1.02 (1.01-1.04), and use of herbal medications aOR 1.39 (1.10-1.75). Female gender was protective of CKD aOR 0.75 (0.62-0.92). Among patients with DM, increasing age and systolic blood pressure were associated with CKD. There is high prevalence of CKD among DM and hypertension patients in Ghana. Optimizing blood pressure control and limiting the use of herbal preparations may mitigate CKD occurrence in high cardiovascular risk populations in developing countries.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/epidemiologia , Medicina Herbária/estatística & dados numéricos , Hipertensão/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Adulto , Idoso , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/epidemiologia , Regras de Decisão Clínica , Creatinina/sangue , Estudos Transversais , Feminino , Gana/epidemiologia , Carga Global da Doença/estatística & dados numéricos , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Proteinúria/diagnóstico , Proteinúria/etiologia , Insuficiência Renal Crônica/etiologia , Fatores de Risco , Inquéritos e Questionários
5.
BMC Public Health ; 16: 563, 2016 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-27412114

RESUMO

BACKGROUND: The purpose of this study is to propose the Least Absolute Shrinkage and Selection Operators procedure (LASSO) as an alternative to conventional variable selection models, as it allows for easy interpretation and handles multicollinearities. We developed a model on the basis of LASSO-selected parameters in order to link associated demographical, socio-economical, clinical and immunological factors to performing tuberculosis screening in HIV-positive patients in Ghana. METHODS: Applying the LASSO method and multivariate logistic regression analysis on a large public health data set, we selected relevant predictors related to tuberculosis screening. RESULTS: One Thousand Ninety Five patients infected with HIV were enrolled into this study with 691 (63.2 %) of them having tuberculosis screening documented in their patient folders. Predictors found to be significantly associated with performance of tuberculosis screening can be classified into factors related to the clinician's perception of the clinical state, as well as those related to PLHIV's awareness. These factors include newly diagnosed HIV infections (n = 354 (32.42 %), aOR 1.84), current CD4+ T cell count (aOR 0.92), non-availability of HIV type (n = 787 (72.07 %), aOR 0.56), chronic cough (n = 32 (2.93 %), aOR 5.07), intake of co-trimoxazole (n = 271 (24.82 %), aOR 2.31), vitamin supplementation (n = 220 (20.15 %), aOR 2.64) as well as the use of mosquito bed nets (n = 613 (56.14 %), aOR 1.53). CONCLUSIONS: Accelerated TB screening among newly diagnosed HIV-patients indicates that application of the WHO screening form for intensifying tuberculosis case finding among HIV-positive individuals in resource-limited settings is increasingly adopted. However, screening for TB in PLHIV is still impacted by clinician's perception of patient's health state and PLHIV's health awareness. Education of staff, counselling of PLHIV and sufficient financing are needed for further improvement in implementation of TB screening for all PLHIV. The LASSO approach proved a convenient method for automatic variable selection in a large public health data set that requires efficient and fast algorithms. TRIALS REGISTRATION: ClinicalTrials.gov NCT01897909 (July 5, 2013).


Assuntos
Algoritmos , Infecções por HIV/complicações , Programas de Rastreamento/estatística & dados numéricos , Vigilância da População , Tuberculose/diagnóstico , Adulto , Linfócitos T CD4-Positivos , Feminino , Gana , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Análise Multivariada , Saúde Pública/estatística & dados numéricos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Tuberculose/prevenção & controle
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