Determinants of visit-to-visit systolic blood pressure variability among Ghanaians with hypertension and diabetes mellitus

Objective: To identify the determinants of systolic blood pressure variability (SBPV) among Ghanaians. Design: We undertook a secondary analysis of data collected in a prospective study Setting: The study involved patients with hypertension and or diabetes receiving care in five hospitals in Ghana Main outcome measures: We assessed determinants of SBPV among 2,785 Ghanaian patients. We calculated the standard deviation (SD) of systolic BP recordings of 3 to 10 visits per patient over 18 months as a measure of SBPV. A multivariate linear regression analysis was fitted to identify factors independently associated with risk visit-to-visit SBP standard deviation. Results: The mean SD of individual patient visit-to-visit SBP overall was 14.8±6.3 mm Hg. Those with hypertension and diabetes had the highest SD of 15.4 ±6.2 mm Hg followed by 15.2 ±6.5 mm Hg among those with hypertension only and then 12.0 ± 5.2 mm Hg among those with diabetes only, p<0.0001. Factors independently associated with SBPV with adjusted ß coefficients (95% CI) included age: 0.06 (0.03 ­ 0.08) for each year rise in age, eGFR -0.03 (-0.05 - -0.02) for each ml/min rise, low monthly income of <210 Ghana cedis 1.45 (0.43-2.46), and secondary level of education -1.10 (-1.69, -0.50). Antihypertensive classes were associated with SBPV, the strongest associations being hydralazine 2.35 (0.03 ­ 4.68) and Methyldopa 3.08 (2.39 ­ 3.77). Conclusion: Several socio-demographic and clinical factors are associated with SBPV. Future studies should assess the contribution of SBPV to CVD outcomes among indigenous Africans and identify actionable targets.

Facteurs de risque et étiologies des AVC de l'adulte jeune au CHU de Bogodogo à Ouagadougou / Risk factors and etiologies of stroke in young adults in Bogodogo university hospital, Ouagadougou

Introduction: Les accidents vasculaires cérébraux (AVC) sont des pathologies graves survenant le plus souvent chez le sujet âgé. Le but de ce travail était d'étudier les facteurs de risque et les étiologies de l'AVC de l'adulte jeune. Patients et méthodes : Il s'est agi d'une étude transversale et rétrospective incluant tous les sujets d'âge compris entre 15 et 45 ans, hospitalisés pour AVC dans le service de neurologie du CHU de Bogodogo entre le 1er Avril 2017 et le 31 Mars 2019 et ayant un dossier complet. Résultats : Quarante-quatre cas d'AVC concernaient les sujets jeunes, soit 8,46% de l'ensemble des AVC. On notait 59,1% d'AVC ischémique et 40,9% d'AVC hémorragique. L'âge moyen était de37,45± 5,94 ans. Le sex-ratio était 2,14. La sédentarité (72,22%), l'HTA (59,09%) et le diabète (25%) étaient les principaux facteurs de risque. L'étiologie a été retrouvée chez 77,27% des patients. Il s'agissait principalement de l'athérosclérose et les cardiopathies emboligènes pour l'AVC ischémique et de l'HTA pour l'AVC hémorragique. Conclusion: Les AVC du sujet jeune sont relativement peu fréquents au CHU de Bogodogo. Une prévention des facteurs de risque vasculaire permettrait d'éviter une augmentation de leur fréquence

Introduction: Stroke is a common and serious disease occurring most often in the elderly. The aim if our study was to describe risk factors and causes of stroke in young adults. Patients and methods: This were a retrospective study including patients whose age was between 15 and 45 years, hospitalized in the neurology department of the Bogodogo University Hospital for stroke between April 1, 2017, and March 31, 2019. Results: Forty-four stroke cases involved young adults, it represented 8.46% of total stroke. Among those cases, 59,1% was ischemic stroke and 40,9% was hemorrhagic stroke. The Mean age was37,45± 5,94 years. The sex-ratio was 2,14. Physical inactivity (72,22%), high blood pressure (59,09%) and diabetes (25%) were the main risk factors. etiologies were found in 77,27% of cases. They were dominated by atherosclerosis and cardio embolism in ischemic stroke, and by high blood pressure in hemorrhagic stroke. Conclusion: Stroke in young adults at Bogodogo University Hospital is relatively infrequent. Prevention of risk factors would prevent an increase in its frequency

Role of Serum Uric Acid in the Assessment of Stroke.

Hyperuricaemia may be associated with an increased risk of stroke, but updated results from several studies have been inconsistent. The present study aimed to evaluate the relationship between hyperuricaemia & risk of stroke.METHODSThis cross-sectional study was conducted in the Department of General Medicine, GSL Medical College and General Hospital, Rajamahendravaram, with a total of 144 stroke patients. Other risk factors were also noted and serum uric acid (SUA) levels were determined.RESULTSThere was a significant (p<0.05) difference in the mean levels of different categories of age and increased levels of SUA levels in both males and females. There was a significant association between hypertension, diabetes mellitus, dyslipidaemia, CAD, but no significant relationship with (p>0.05) history of cerebrovascular accident (CVA), smoking and alcohol consumption. There was a significant association (p<0.05) between stratified SUA levels (normal and hyperuricaemia) and hypertension, diabetes mellitus, dyslipidaemia, coronary artery disease (CAD) and age, but no significant (p>0.05) association with history of CVA, smoking and alcohol consumption.CONCLUSIONSElevated SUA level is a significant risk factor for stroke. elevated serum uric acid level needs to be interpreted carefully in patients with risk factors for vascular events like hypertension, diabetes mellitus, dyslipidaemia and a history of prior vascular events. The prevalence of hyperuricaemia was found to be high especially in patients in their seventh decade of life and later.

Tamaño del infarto cerebral aterotrombótico del territorio carotídeo según sus factores de riesgo / Size of the atherothrombotic cerebral infarction from carotid territory according to its risk factors

Introducción: La mayoría de los infartos cerebrales aterotrombóticos son debidos a aterosclerosis extracraneal y a los factores de riesgo que lo condicionan. Objetivo: Caracterizar a pacientes con ictus aterotrombótico de territorio anterior según tamaño, sexo y factores de riesgo aterotrombótico. Métodos: Se realizó un estudio transversal a 63 pacientes que acudieron al Hospital Militar Central "Dr. Carlos J. Finlay" con diagnóstico de infarto cerebral aterotrombótico reciente de territorio carotídeo, a los que se les realizó tomografía de cráneo simple, entre los años 2011 y 2013. Resultados: Predominaron los infartos grandes (57,1 por ciento) en hombres (80,6 por ciento) y de forma general también fue el sexo masculino el más afectado (68,3 por ciento). La mayoría de los pacientes que tuvieron tanto infartos medianos (59,3 por ciento) como infartos grandes (58,3 por ciento), refirieron de 3 a 4 factores de riesgo aterotrombótico (58,7 por ciento). Prevaleció la hipertensión arterial (82,5 por ciento), con mayor coincidencia con los infartos medianos (88,9 por ciento), que con los infartos grandes (77,8 por ciento). Conclusiones: El ictus aterotrombótico reciente de territorio de irrigación carotídeo se caracterizó en esta serie, por infartos grandes y mayor afectación de adultos mayores, hipertensos, del sexo masculino. La existencia de 3 a 4 factores de riesgo en cada paciente prevalece tanto en los que presentan infarto cerebral mediano como grande(AU)

Introduction: Most of atherothrombotic cerebral infarctions are due to extracranial atherosclerosis and the risk factors that condition it. Objective: To characterize patients with atherothrombotic stroke of the anterior territory according to size, sex and atherothrombotic risk factors. Method: A cross-sectional study was performed on 63 patients attended at the "Dr. Carlos J. Finlay" hospital with a diagnosis of recent atherothrombotic cerebral infarction of the carotid territory, who underwent simple skull tomography, between 2011 and 2013. Results: Large infarcts predominated (57.1 percent) in men (80.6 percent) and in general, male sex was also the most affected (68.3 percent). Most of patients who had both moderate infarcts (59.3 percent) and large infarcts (58.3 percent), reported 3 to 4 atherothrombotic risk factors (58.7 percent). Prevalence of arterial hypertension (82.5 percent), with greater coincidence with medium infarcts (88.9 percent), than with large infarcts (77.8 percent). Conclusions: The recent atherothrombotic stroke of the carotid irrigation area was characterized in this series, due to large infarcts and greater involvement of elderly, hypertensive males. The existence of 3 to 4 risk factors in each patient prevails both in those with medium cerebral infarction and large ones(AU)

Avaliação do perfil dos fatores de risco para Acidente Vascular Cerebral: estudo observacional / Evaluation of the profile of risk factors for stroke: observational study

INTRODUÇÃO: Observa-se um crescimento significativo na incidência de casos de Acidente Vascular Cerebral (AVC). Isto deve-se ao aumento da longevidade estando a idade entre um dos fatores mais relevantes ao desenvolvimento da doença. OBJETIVO: Identificar o perfil dos fatores de risco que predispõe o surgimento do Acidente Vascular Cerebral em frequentadores de um parque em Teresina-PI. MATERIAIS E MÉTODOS: Trata-se de um estudo observacional do tipo transversal realizado com 117 pessoas frequentadores de um parque localizado em Teresina-PI, estipulando os seguintes critérios de inclusão: ter idade igual ou maior a 18 anos; assinar o Termo de Consentimento Livre e Esclarecido e frequentarem as atividades desse espaço recreativo. A coleta de dados deu-se através de questionário com 18 questões objetivas fechadas sobre os fatores de risco predisponentes ao surgimento de AVC incluindo informações sobre o conhecimento desses fatores e ainda, peso, altura, idade, Índice de Massa Corporal (IMC) e Pressão Arterial (PA) dos participantes. RESULTADOS: O estudo evidenciou um perfil de pessoas com idade de 18 a 30 anos, sexo feminino com IMC normal, que prevalecem os fatores de risco como estresse (49%), sedentarismo (44%), sexo (43%), consumo de álcool (40%), dislipidemia (12%), obesidade (10%), hipertensão arterial (8%), cardiopatia (6%), diabetes (3%) e o tabagismo (2%). CONCLUSÃO: Observouse um perfil de pessoas com faixa etária de 18 a 30 anos, do sexo feminino e com IMC normal que apresentam fatores de risco vasculares modificáveis que podem estar associados a maus hábitos e falta de informações relacionadas a esses problemas de saúde. Dessa forma, tornam-se necessárias medidas preventivas com o intuito de promover ou intensificar a promoção de saúde visando à informação, o acompanhamento e o controle desses fatores, proporcionando a população em geral um envelhecimento saudável.

INTRODUCTION: There is a significant increase in the incidence of stroke (AVC) cases, due to the increase in longevity, with age being one of the factors most relevant to the development of the disease. OBJECTIVE: To identify the profile of risk factors that predisposes the appearance of stroke in visitors of a park in Teresina-PI. MATERIALS AND METHODS: This is an observational cross-sectional study carried out with 117 people attending a park located in Teresina-PI, stipulating the following inclusion criteria: being 18 years or older; sign the Free and Informed Consent Form and attend the activities of this recreational space. Data were collected through a questionnaire with 18 closed objective questions about risk factors predisposing to the onset of stroke including information on the knowledge of these factors and also, weight, height, age, Body Mass Index (BMI) and Pressure Arterial (PA) of the participants. RESULTS: The study showed a profile of people aged 18 to 30 years, female with normal BMI, which prevails risk factors such as stress (49%), sedentarism (44%), sex (43%), consumption of alcohol consumption (40%), dyslipidemia (12%), obesity (10%), hypertension (8%), heart disease (6%), diabetes (3%) and smoking (2%). CONCLUSION: We observed a profile of people with ages ranging from 18 to 30 years, female and with normal BMI presenting modifiable vascular risk factors that may be associated with poor habits and lack of information related to these health problems. Thus, preventive measures are necessary in order to promote or intensify health promotion aimed at information, monitoring and control of these factors, providing the general population with a healthy aging.

Survey of Knowledge about Stroke and Rehabilitation in Stroke Patients / 中国康复理论与实践

@#Objective To investigate the knowledge of stroke risk factors, early symptoms, and rehabilitation in stroke patients. Methods 1043 cases with stroke were stratified randomly sampled from 10 hospitals at different levels in Gansu, and were surveyed with self-designed questionnaire. Results For risk factors for stroke, hypertension was the most aware (61.55%), 6.42% knew all the factors. For the prevention and treatment, reasonable diet was the most aware (56.18%), followed with giving up smoking and drinking (52.92%). For the early symptoms, dysaesthesia of one side body was the most aware (53.88%), and then the headache and dizzy (50.14%). It was less than 30% to know the blurring, nausea and vomiting, and stiff tongue, etc. as the early symptoms. 60% of the patients did not know any about the rehabilitation, 22% did not know if rehabilitation be needed. 80% of the patients with stroke chose medication regardless of family income, and rehabilitation was chosen less than 30%. Conclusion It is important to popularize the knowledge of risk factors, early symptoms, and rehabilitation of stroke.

National Stroke Registry (NSR): Terengganu and Seberang Jaya Experience

The National Stroke Registry (NSR) was established in 2009 under National Neurology Registry (NNeuR) . The main objectives of NSR were to describe the demographic and disease pattern of stroke patients in Malaysia, to examine the risk factors and evaluate the specified treatment and outcomes. This prospective observational study was carried out from August 2009 until December 2010 using a standardized case report form which involved two participating hospital, namely Hospital Sultanah Nur Zahirah, Kuala Terengganu and Hospital Seberang Jaya, Pulau Pinang. There were 1018 patients registered. Ischemic stroke accounted for the majority of cases (73.3%). The most common risk factor was hypertension (75.5 %), followed by diabetes mellitus, previous stroke or Transient Ischemic Attack (TIA), hyperlipidemia and active smoker: 45.6%, 25.1%, 22.4%, and 19.4%, respectively. Overall, our stroke management, based on nine stroke key performance indicators (KPI) still needs to be improved. There was a total of 121 mortality cases with the main contributing factor was massive cerebral bleed (21.6%). In conclusion, the findings highlight the important of primary and secondary stroke management. Further and continuous observation with more site date provider (SDP) involvement is needed to get a more comprehensive data on stroke in Malaysia.

The association of plasminogen activator inhibitor-1 level with ischemic stroke (preliminary study).

Aim Recently, increased plasminogen activator inhibitor-1 (PAI-1) has been known a risk factor for ischemic heart disease. However, the association of increased PAI-1 level with ischemic stroke remains unclear. The aim of this study was to analyze the association of PAI-1 level with ischemic stroke. Methods By case control design we involved 38 ischemic stroke and 38 risky-matched control subjects who fulfilled the criteria. The PAI-1 level was determined by ELISA method using Asserachrom PAI-1 from Stago. Results High PAI-1 level was found more frequent in ischemic stroke subjects than in control subjects (21.1% vs. 7.9 % with OR 3.1; 95 % CI 0.757 – 12.790). The analysis of all studied subjects showed that there was a weak negative correlation between PAI-1 level and age (r = -0.4; P = 0.000). High PAI-1 level was found more frequent in younger (40 – 58 years old) than in the older subjects (60 – 84 years old) (20% vs. 9.8 %) (p=0.004). Conclusion The result of this preliminary study suggested an association between PAI-1 level and ischemic stroke in younger age. Further study with larger subjects is recommended to confirm this association.

Incidence and Risk Factors of Cerebral Microbleeds in Patients with Ischemic Stroke / 中国康复理论与实践

@#Objective To investigate the incidence and risk factors of cerebral microbleeds(CMB) in ischemic stroke patients.Methods Patients with cerebral infarction for 1～6 months were recruited.Clinical data were recorded.MRI was reviewed blindly to determine the number of CMB and lacunar infarcts and the white matter lesions(WML).The independent risk factors of CMB were analyzed with the Logistic multivariable regression.Results 636 subjects were included.CMB were found in 250 cases(39.3%).The incidence of CMB in patients of ≤50,50～65 and >65 years old were 27.2%,38.1% and 47.6% respectively(P<0.05).CMB was more frequent in patients with more lacunar infarcts(P<0.05).The incidence of CMB in patients with negative,mild,moderate and severe WML were 21.9%,33.8%,46.9%and 63.1% respectively(P<0.05).Logistic regression analysis showed that history of hypertension(OR=1.523,95% CI 1.019～2.276),severity of WML(OR=1.535,95% CI 1.258～1.874) and lacunar infarcts(OR=1.517,95% CI 1.087～2.118) were the independent risk factors for presence of CMB.Conclusion CMB was frequent in ischemic stroke.The frequency of CMB increased with aging,grade of lacunar infarcts and WML.History of hypertension,severity of WML and lacunar infarcts were the independent risk factors for CMB presence.

Risk factors in ischemic stroke following total hip replacement / 中国康复理论与实践

@#ObjectiveTo investigate the risk factors in ischemic stroke following total hip replacement. MethodsThe clinical data of 18 patients who suffered ischemic stroke following total hip replacement were compared with other 142 patients without ischemic stroke following total hip replacement who were randomly selected as control. ResultsThe incidence rate of ischemic stroke following total hip replacement in our hospital was 1.8%. Age,hypertension, history of stroke,falling of systolic pressure and diastolic pressure during opereration were significantly different between patients and controls(P<0.05).There was no significantly different in sex,previous cardiac diseases, diabetes, hyperlipemia,and the bleeding in operation between patients and controls(P>0.05).ConclusionAge,hypertension, history of cerebrovascular disease,falling of systolic pressure and diastolic pressure during opereration are the important risk factors of ischemic stroke following total hip replacement.

Analysis of risk factors for young adult stroke / 中国康复理论与实践

@# ObjectiveTo evaluate the risk factors of young adult stroke.MethodsTo analyze the risk factors of 203 young adult stroke. The risk factors included hypertension, lipidemia, diabetes, heart disease, TIA, family history, tobacco and/or alcohol use.ResultsHypertension was still the most frequent risk factor. Diabetes, heart disease and TIA were not much more important in young adult with stroke. Almost half of the young adult stroke had family history and hobbies of smoking and drinking.ConclusionsHypertension is an important risk factor in young adult stroke. Other risk factors such as low level of HDL, smoking, drinking and family histories still contribute to the causes of young adult stroke.