Unraveling the risk factors for spontaneous intracerebral hemorrhage among West Africans.

OBJECTIVE: To characterize risk factors for spontaneous intracerebral hemorrhage (sICH) occurrence and severity among West Africans. METHODS: The Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case-control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT-confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors. RESULTS: Of 2,944 adjudicated stroke cases, 854 were intracerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were nonlobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78-213.72); dyslipidemia, 2.95 (1.84-4.74); meat consumption, 1.55 (1.01-2.38); family history of CVD, 2.22 (1.41-3.50); nonconsumption of green vegetables, 3.61 (2.07-6.31); diabetes mellitus, 2.11 (1.29-3.46); stress, 1.68 (1.03-2.77); and current tobacco use, 14.27 (2.09-97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were nonconsumption of leafy green vegetables, 2.03 (1.43-2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00-1.01); presence of midline shift, 1.54 (1.11-2.13); lobar ICH, 1.72 (1.16-2.55); and supratentorial bleeds, 2.17 (1.06-4.46). CONCLUSIONS: Population-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.

Beta-cell dysfunction and abnormal glucose metabolism among non-diabetic women with recurrent miscarriages.

BACKGROUND: Subclinical beta-cell (ß-cell) dysfunction is an endocrine abnormality and its association with recurrent miscarriages (RM) has not been extensively studied. OBJECTIVE: This study aimed to determine the prevalence of ß-cell dysfunction and abnormal glucose metabolism [fasting blood glucose (FBG) ≥ 5.1 mmol/L] among non-diabetic women with recurrent miscarriages and to establish if there was an association between RM and ß-cell dysfunction and FBG ≥ 5.1 mmol/L. METHODOLOGY: This was a cross-sectional study involving 80 women with miscarriages at ≤ 13 weeks gestation and 80 women with normal pregnancies at ≤ 13 weeks of gestation with at least one successful live-birth and no history of miscarriage (comparison group). Interviewer-administered questionnaire was used to obtain relevant information. From each participant, FBG and fasting insulin were assayed. ß-Cell function was computed. The data obtained was analysed using IBM-SPSS version 22.0. RESULTS: A significantly higher prevalence of ß-cell dysfunction and abnormal glucose metabolism were observed among non-diabetic women with RM compared to age-matched controls (38.8% vs 10.0%, P < 0.001) and (27.5% vs 6.3%, P = 0.005) respectively. The mean ß-cell function of the cases was 59.0% of the controls (264.41 ± 105.13 vs 447.82 ± 181.24, P < 0.001). Mean FBG was significantly higher in the case-group compared to the controls (4.77 ± 1.14 mmol/L vs 3.58 ± 0.78 mmol/L, P < 0.001). There was a significant association between RM and FBG ≥ 5.1 mmol/L and low ß-cell function (P < 0.001). CONCLUSION: This study suggests that women with recurrent miscarriages are more likely to have impaired ß-cell function and abnormal glucose metabolism (FBG ≥ 5.1 mmol/L).