Diabetes, hypertension, smoking, and hyperlipidemia as risk factors for spontaneous cervical artery dissection: Meta-analysis of case-control studies.

Background: Spontaneous cervical artery dissection (sCeAD) is an important cause of ischemic stroke in the young population and has a different cardiovascular risk profile from other causes of ischemic stroke. No study provided a comprehensive evidence for cardiovascular risk factors of sCeAD. Methods: We searched PubMed, MEDLINE, and Embase without date or language restrictions for relevant studies. Bibliographies of included studies were also searched. We included case-control studies where patients with sCeAD were on one arm, and controls were on the other arm. The investigated risk factors were diabetes, hypertension, smoking, and hyperlipidemia. Data extraction and quality assessment were performed independently by two reviewers. Results: Seventeen qualifying case-control studies were identified, comparing 2185 patients with sCeAD and 3185 healthy control subjects. Heterogeneity was low for diabetes, moderate for hypertension and hyperlipidemia, and high for smoking. The meta-analysis showed a significant association between hypertension and sCeAD [pooled odds ratio (OR) = 1.70, 95% confidence interval (CI): 1.40-2.07, P < 0.001]. There was no association between sCeAD and diabetes (pooled OR = 0.71, 95% CI: 0.50-1.01, P = 0.060) or smoking (pooled OR = 0.90, 95% CI: 0.68-1.20, P = 0.480). Hyperlipidemia was negatively-associated with sCeAD (OR = 0.65, 95% CI: 0.48-0.89, P = 0.007), but with sensitivity analysis, there was no association (OR = 0.72, 95% CI: 0.44-1.19, P = 0.200). Conclusion: The meta-analysis reveals that sCeAD has a significant association with hypertension and no association with smoking, diabetes, or hyperlipidemia. These results should direct future research towards exploring biological mechanism of hypertension-induced arterial dissection.

The five-year survival rate of breast cancer at Radiation and Isotopes Centre Khartoum, Sudan.

BACKGROUND: The Radiation and Isotopes Centre Khartoum (RICK) is the largest public cancer centre in Sudan. The most common cancer in Sudan (and RICK) is breast cancer. The study aims to determine the five year survival of breast cancer as well as factors influencing this survivorship. METHODS: This retrospective facility-based study was conducted on patients diagnosed as having breast cancer at RICK during the year 2013. At 305 patients, the population under study was totally covered. Data analysis was conducted using SPSS version 23. Kaplan-Meier method was used to estimate survival, and to further plot it against specific variables. RESULTS: The five-year survival was found to be 79%. Lymph nodes were involved in 70.5% of the cases. The mean time between patients' first discovery of symptoms and diagnosis at RICK was 13.03 months. Presence of comorbid diabetes and hypertension significantly increased breast cancer mortality. CONCLUSIONS: Breast cancer in Sudan is characterized by younger age, delayed diagnosis and advanced staging at presentation, as well as lower five-year breast cancer survival in comparison to developed countries.