Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE) / 대한뇌졸중학회지

Background@#and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes. @*Methods@#Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH). @*Results@#Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P<0.0001). @*Conclusions@#The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.

Relationship between Demographic, Clinical, Psychosocial Factors and Health-related Quality of Life among Persons with Epilepsy in Zaria Northern Nigeria

Introduction:Thereisagrowingglobalinterestontheeffectofepilepsyonthesubjectivehealth-relatedqualityoflife(HRQoL)ofthesufferers.Severaldemographic,clinical,andpsychosocialfactorshavebeenattributedascontributorytothepoorHRQoLinpatients(persons)withepilepsy(PWE).Aim:Thisstudyevaluatedtherelationshipbetweendemographic,clinicalandpsychosocialcharacteristicsofPWEandtheirHRQoL StudyDesign:Across-sectionalstudy.PlaceandDurationofStudy:StudycarriedoutatNeurologyclinicofAhmaduBelloUniversityTeachingHospitalKadunaState,NigeriafromSeptember2013toDecember2014.Methodology:ConsecutivelypresentingPWEonfollow-upforatleast1year,18yearsandabovewererecruitedafterobtainingethicalapprovalandinformedconsent.StructuredquestionnaireandtheWorldHealthOrganizationQualityof Life(WHOQOL-Bref)instrumentwereutilizedforthestudy.ThedatawasanalyzedusingSPSSversion17withp-valuesetatlessthan0.05.Results:Theparticipantswereonehundredwithmedianageof29years.ThefactorsfoundtohavesignificantrelationshipwithHRQoLweredemographicvariableslikemaritalstatus(F=3.250,p=0.025)andmonthlyincome(t=-2.883;p=0.005);psychosocialfactorslikepresenceofperceivedstigmaordiscrimination(χ2=2.427,p=0.017),presenceofdepressivesymptomintheprecedingmonth(χ2=3.164,p=0.002)andavailabilityofsocialsupport(χ2=3.328,P=0.001).TherewasnosignificantrelationshipfoundbetweenclinicalfactorsandHRQoLofPWE(p>0.05).Conclusion:Thedemographicfactors(maritalstatusandmonthlyincome)andpsychosocialfactors(stigma,depressionandsocialsupport)hadasignificantrelationshipwithHRQoLinPWE.Thereisaneedtoofferevidence-basedandfocusedcaretothesufferersofthisillness

Falls and Their Associated Risks in Parkinson’s Disease Patients in Nigeria

OBJECTIVE: Falls are a devastating consequence of Parkinson's disease (PD) and are due to motor imbalance. However, the frequency of falls and their risk factors among Nigerians with PD is not known despite the significant increase in PD cases in the country. To assess fall risk factors and frequency in Nigerian PD patients. METHODS: Using an analytical design to compare falling versus non-falling patients, 81 PD patients were assessed for clinical factors, frequency of falls, and candidate risk factors for falls according to the Tinetti Balance and Gait, Unified Parkinson's Disease Rating Scale subsection 1, and Timed Up and Go Tests. Descriptive, bivariate, and multivariate analyses were performed at the 95% confidence level. RESULTS: The mean age of participants was 65.6 ± 9.7 years. Falls were about three times (p < 0.001) more common in PD patients. Of the falling patients, 67.7% sustained injuries, 67.7% had recurrent falls and 44.9% admitted to having a fear of falling. The independent statistical predictors of fall were fear of falling [odds ratio (OR): 3.86], disease severity (OR: 1.09) and disease duration (OR: 1.01). CONCLUSION: The frequency of falls in PD patients was significantly higher when compared with the healthy adult population, and the modifiable predictor was fear of falling with a potential to significantly reduce falls when strategically addressed.