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Background@#and Purpose Intracranial arterial stenosis (ICAS)-related stroke occurs due to three primary mechanisms with distinct infarct patterns: (1) borderzone infarcts (BZI) due to impaired distal perfusion, (2) territorial infarcts due to distal plaque/thrombus embolization, and (3) plaque progression occluding perforators. The objective of the systematic review is to determine whether BZI secondary to ICAS is associated with a higher risk of recurrent stroke or neurological deterioration. @*Methods@#As part of this registered systematic review (CRD42021265230), a comprehensive search was performed to identify relevant papers and conference abstracts (with ≥20 patients) reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAS. Subgroup analyses were performed for studies including any BZI versus isolated BZI and those excluding posterior circulation stroke. The study outcome included neurological deterioration or recurrent stroke during follow-up. For all outcome events, corresponding risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated. @*Results@#A literature search yielded 4,478 records with 32 selected during the title/abstract triage for full text; 11 met inclusion criteria and 8 studies were included in the analysis (n=1,219 patients; 341 with BZI). The meta-analysis demonstrated that the RR of outcome in the BZI group compared to the no BZI group was 2.10 (95% CI 1.52–2.90). Limiting the analysis to studies including any BZI, the RR was 2.10 (95% CI 1.38–3.18). For isolated BZI, RR was 2.59 (95% CI 1.24–5.41). RR was 2.96 (95% CI 1.71–5.12) for studies only including anterior circulation stroke patients. @*Conclusion@#This systematic review and meta-analysis suggests that the presence of BZI secondary to ICAS may be an imaging biomarker that predicts neurological deterioration and/or stroke recurrence.
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Background & Aim: Maternal mortality ratio for sub-Saharan Africa in 2010 was estimated to be about 600 per 100,000 live births, which is approximately higher than what is obtainable in advanced countries. Tothis end, several community-based interventions have been put in place by governments and developmental partners in the region to address the situation. This review aimed to seek evidence from existing literature on the level of effectiveness of these interventions in improving maternal health outcomes in the region. The literature search process resulted in retrieval of six full text studies that were written in English, published between 2000 and 2019 and were focused on intervention based at the community level which resulted in the reduction of maternal deaths in some sub-Saharan African countries. The Critical Appraisal Skills Programme (CASP) tool was used to critically review retrieved literature.Findings: Findings from the articles reviewed show that community based interventions with direct reduction on maternal mortality were implemented in Ethiopia and Nigeria and were effective since maternal mortality declined by 64% and 43.5% respectively. Other community based interventions did not directly address reduction in maternal mortality but rather addressed leading causes of maternal mortality such as home and unskilled birth attendance, low Ante-Natal Care (ANC) & Post-Natal Care (PNC) services utilization,Eclampsia, delay in accessing care and Postpartum Hemorrhage (PPH). Such interventions were implemented in Nigeria, Zambia, Tanzania and the Democratic Republic of Congo and were proved to be effective in reducing maternal mortality.Conclusions and Recommendations: Based on the literatures reviewed, it was concluded that community based interventions were effective in reducing maternal mortality in Sub-Saharan Africa. The following recommendations were made based on gaps observed in the implementation ofsome interventions. Introduction of emergency transport scheme in countries where they do not exist as despite the existence of maternity waiting homes and dedicated maternity ambulances in Zambia, many expectant mothers still had difficulty reaching the health facilities in time to deliver, Engagement and training of more health workers so as to avoid human resources challenges that may be associated with increased demand for health facility deliveries
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Current available treatment options for erectile dysfunction (ED) are effective but not without failure and/or side effects. Although the development of phosphodiesterase type 5 (PDE5) inhibitors (i.e. sildenafil, tadalafil and vardenafil) has revolutionized the treatment of ED, these oral medications require on-demand access and are not as effective in treating ED related to diabetic, post-prostatectomy and severe veno-occlusive disease states. Improvement in the treatment of ED is dependent on understanding the regulation of human corporal smooth muscle tone and on the identification of relevant molecular targets. Future ED therapies might consider the application of molecular technologies such as gene therapy. As a potential therapeutic tool, gene therapy might provide an effective and specific means for altering intracavernous pressure "on demand" without affecting resting penile function. However, the safety of gene therapy remains a major hurdle to overcome before being accepted as a mainstream treatment for ED. Gene therapy aims to cure the underlying conditions in ED, including fibrosis. Furthermore, gene therapy might help prolong the efficacy of the PDE5 inhibitors by improving penile nitric oxide bioactivity. It is feasible to apply gene therapy to the penis because of its location and accessibility, low penile circulatory flow in the flaccid state and the presence of endothelial lined (lacunar) spaces. This review provides a brief insight of the current role of gene therapy in the management of ED.