Stroke Subtypes, Risk Factors and Treatment Outcomes at A Tertiary Hospital Situated in Rural Southwestern Nigeria: A Five- Year Restrospective Observational Study

Introduction: Despite the high burden of stroke globally, there is an observed paucity of data regarding its subtypes, risk factors and treatment outcomes in rural Southwestern Nigeria. The study ascertained the subtypes, risk factors and treatment outcomes of stroke at the adult Accident and Emergency Department of a tertiary hospital in a rural Southwestern Nigeria. Materials and methods: A retrospective survey using data form and standardized questionnaire was used to review the patients admitted for stroke between January 2015 and December 2019. The data were analyzed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. Results: In this study, 276 stroke patients comprised Ischemic (60.1%) vs Hemorrhagic (39.9%) strokes were studied. The mean age of the patients was 67.3±11.1 years. The majority were males and were older than 65 years. The independent predictors of stroke admissions were Informal education [(AOR = 0.288; 95% CI: (0.120-0.691), p = 0.005)], low income earners [(AOR = 0.452; 95% CI: (0.230-0.888), p = 0.021)], obesity [(AOR = 0.080; 95% CI: (0.019-0.347), p= 0.001)], heart failure [(AOR= 9.152; 95% CI: (2.325-41.266), p < 0.001)], atrial fibrillation [(AOR = 0.136; 95% CI: (0.068-0.891),p = 0.001)], tobacco smoking [(AOR = 0.350; 95% CI: (0.137-0.891), p = 0.028)], and poorly controlled blood pressure [(AOR = 0.107; 95% CI: (0.033-0.348), p <0.001)]. The mortality rate was 10.1%. Conclusion: The results of this study further support the argument on the higher prevalence of stroke admission in rural areas of Southwestern Nigeria. There may be need for public awareness on primary stroke prevention and early identification of the risk factors in order to reduce the prevalence and mortality of stroke in the rural Southwestern Nigeria

Stroke Subtypes, Risk Factors and Treatment Outcomes at A Tertiary Hospital Situated in Rural Southwestern Nigeria: A Five- Year Restrospective Observational Study

Introduction: Despite the high burden of stroke globally, there is an observed paucity of data regarding its subtypes, risk factors and treatment outcomes in rural Southwestern Nigeria. The study ascertained the subtypes, risk factors and treatment outcomes of stroke at the adult Accident and Emergency Department of a tertiary hospital in a rural Southwestern Nigeria. Materials and methods: A retrospective survey using data form and standardized questionnaire was used to review the patients admitted for stroke between January 2015 and December 2019. The data were analyzed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. Results: In this study, 276 stroke patients comprised Ischemic (60.1%) vs Hemorrhagic (39.9%) strokes were studied. The mean age of the patients was 67.3±11.1 years. The majority were males and were older than 65 years. The independent predictors of stroke admissions were Informal education [(AOR = 0.288; 95% CI: (0.120-0.691), p = 0.005)], low income earners [(AOR = 0.452; 95% CI: (0.230-0.888), p = 0.021)], obesity [(AOR = 0.080; 95% CI: (0.019-0.347), p= 0.001)], heart failure [(AOR= 9.152; 95% CI: (2.325-41.266), p < 0.001)], atrial fibrillation [(AOR = 0.136; 95% CI: (0.068-0.891),p = 0.001)], tobacco smoking [(AOR = 0.350; 95% CI: (0.137-0.891), p = 0.028)], and poorly controlled blood pressure [(AOR = 0.107; 95% CI: (0.033-0.348), p <0.001)]. The mortality rate was 10.1%. Conclusion: The results of this study further support the argument on the higher prevalence of stroke admission in rural areas of Southwestern Nigeria. There may be need for public awareness on primary stroke prevention and early identification of the risk factors in order to reduce the prevalence and mortality of stroke in the rural Southwestern Nigeria

Interleukin-6 (\u3cem\u3eIL-6\u3c/em\u3e) rs1800796 and Cyclin Dependent Kinase Inhibitor (\u3cem\u3eCDKN2A/CDKN2B\u3c/em\u3e) rs2383207 Are Associated with Ischemic Stroke in Indigenous West African Men

Background—Inherited genetic variations offer a possible explanation for the observed peculiarities of stroke in sub – Saharan African populations. Interleukin–6 polymorphisms have been previously associated with ischemic stroke in some non-African populations. Aim—Herein we investigated, for the first time, the association of genetic polymorphisms of IL-6 and CDKN2A- CDKN2B and other genes with ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study. Methods—Twenty-three previously identified single nucleotide polymorphisms (SNPs) in 14 genes of relevance to the neurobiology of ischemic stroke were investigated. Logistic regression models adjusting for known cardiovascular disease risk factors were constructed to assess the associations of the 24 SNPs in rigorously phenotyped cases (N=429) of ischemic stroke (Men = 198; Women = 231) and stroke– free (N=483) controls (Men = 236; Women = 247). Results—Interleukin-6 (IL6) rs1800796 (C minor allele; frequency: West Africans = 8.6%) was significantly associated with ischemic stroke in men (OR = 2.006, 95% CI = [1.065, 3.777], p = 0.031) with hypertension in the model but not in women. In addition, rs2383207 in CDKN2A/CDKN2B (minor allele A with frequency: West Africans = 1.7%) was also associated with ischemic stroke in men (OR = 2.550, 95% CI = [1.027, 6.331], p = 0.044) with primary covariates in the model, but not in women. Polymorphisms in other genes did not show significant association with ischemic stroke. Conclusion—Polymorphisms rs1800796 in IL6 gene and rs2383207 in CDKN2A/CDKN2B gene have significant associations with ischemic stroke in indigenous West African men. CDKN2A/CDKN2B SNP rs2383207 is independently associated with ischemic stroke in indigenous West African men. Further research should focus on the contributions of inflammatory genes and other genetic polymorphisms, as well as the influence of sex on the neurobiology of stroke in people of African ancestry

Removal of an Impacted Foreign Body from The Upper Airway with a Gastroscope in a Tertiary Hospital in South-West Nigeria – A Case Report

Foreign body ingestion and food bolus impaction are encountered commonly in clinical practice and are a common endoscopic emergency. A wide variety of objects could be ingested which could get impacted, and the site of impaction is commonly the oesophagus but can also be the airway depending on the nature of the substance ingested, the age of the patient and the presence of a neurologic disorder. The predominant clinical features of a patient will depend on the site of impaction of the foreign body; the airway or the oesophagus. Endoscopy remains the gold standard for the diagnosis and management of foreign body ingestion of which there are different modalities and equipment types. For foreign body in the airway laryngoscopy, tracheoscopy and bronchoscopy are the modalities indicated and there are also different types of retrieval devices some of which include standard biopsy forceps, retrieval graspers, retrieval forceps and polypectomy snares. The management of foreign body ingestion cuts across different specialties including Pulmonology, Otorhinolaryngology, General surgery, Cardiothoracic surgery and Gastroenterology all of which are involved in various different endoscopic procedures and their endoscopy equipment have a lot of similarities and in certain instances they can be adapted to perform varying roles. Foreign bodies in the airway require urgent endoscopic removal because it can become rapidly life threatening with associated high morbidity and mortality, therefore the available equipment should be immediately deployed to save lives. We present a case of foreign body impaction in the upper airway (larynx) that was removed with a flexible video Gastroscope using a polypectomy snare

Priorities to reduce the burden of hypertension in Africa through ACHIEVE

No abstract availabl

Understanding and controlling the increasing burden of cardiovascular diseases in Africa

No abstract available

Five-year analysis of clinical presentations and predictors of stroke mortality in rural Southwestern Nigeria: A retrospective observational study

Introduction: Stroke mortality and its predictors are important outcome measures in stroke epidemiological studies and clinical trials. There is an observed paucity of data regarding the clinical presentations and predictors of stroke mortality in Southwestern Nigeria. Few available related studies have centred on hospitals in the urban and sub-urban areas; however, none in the rural settings. This study, therefore, focuses on the clinical presentations and predictors of stroke mortality at the adult Emergency Centre of a tertiary hospital situated in rural Southwestern Nigeria. Methods: A retrospective survey, using data form and standardized questionnaire, was used to study the patients admitted for stroke between January 2015 and December 2019. The data were analysed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. Results: A total of 276 patients were studied. Their mean age was 67.3 ± 11.1 years. The most common clinical presentations were hemiparesis and cranial nerve deficit. The case of fatality was 10.1%. The predictors of stroke mortality were age ≥65 years [(AOR = 12.752; 95% CI: (1.022–159.190), p = 0.048)], Glascow coma score <8 [(AOR = 50.348; 95% CI: (7.779–325.866), p < 0.001)], uncontrolled blood pressure [(AOR = 23.321; 95% CI: (2.449–221.927), p = 0.006)], presence of atrial fibrillation [(AOR = 16.456; 95% CI: (2.169–169.336), p = 0.009)], convulsion [(AOR = 25.889; 95% CI: (2.374–282.296), p = 0.008)], heart failure [(AOR = 30.284; 95% CI: (3.265–256.347), p < 0.001)], and a repeat stroke [(AOR = 32.617; 95% CI: (2.410–441.381), p = 0.009)]. Conclusion: The 7-day fatality was 10.1%. The predictors of stroke mortality were poor Glascow coma score, uncontrolled blood pressure, atrial fibrillation, heart failure, convulsion and a repeat stroke. This study strengthens the argument on the higher prevalence of stroke and its mortality in rural Southwestern Nigeria. Our findings may provide an impetus for prospective research on this outcome

Strategies for reducing non-communicable diseases in Africa

No abstract available

Relationship between the Level of Spirituality and Blood Pressure Control among Adult Hypertensive Patients in a Southwestern Community in Nigeria

Background: Spirituality has been strongly associated with good blood pressure control as it forms a strong coping mechanism in hypertensive patients. This hospital-based cross-sectional study was done to determine the relationship between spirituality and blood pressure control among adult hypertensive patients in rural Southwestern Nigeria to achieve good blood pressure control.Method: The selection was done by systematic random sampling technique. Socio-demographic and clinical information were obtained through semi-structured interviewer-administered questionnaires. The level of spirituality was assessed using the Spiritual Perspective Scale. Data were analysed using the Statistical Package for Social Sciences version 20.0. Statistical significance was set at p &le; 0.05.Results: The mean age of the respondents was 61.1 &plusmn; 11.1 years. More than half (52.6%) had a high level of spirituality and more than two-thirds (67.1%) of respondents had controlled blood pressure. Respondents with a high level of spirituality were 4.76 times more likely to have good blood pressure control {p &lt; 0.001, 95% CI (1.05-14.99)} than those with a low level of spirituality.&nbsp;Conclusion: Proper understanding and effective utilization of this relationship will assist health professionals and researchers in the appropriate integration of this concept into patients&rsquo; holistic care with the aim of achieving better blood pressure control among hypertensive patients

ACHIEVE conference proceedings: implementing action plans to reduce and control hypertension burden in Africa

The prevalence of hypertension, the commonest risk factor for preventable disability and premature deaths, is rapidly increasing in Africa. The African Control of Hypertension through Innovative Epidemiology, and a Vibrant Ecosystem [ACHIEVE] conference was convened to discuss and initiate the co-implementation of the strategic solutions to tame this burden toward achieving a target of 80% for awareness, treatment, and control by the year 2030. Experts, including the academia, policymakers, patients, the WHO, and representatives of various hypertension and cardiology societies generated a 12-item communique for implementation by the stakeholders of the ACHIEVE ecosystem at the continental, national, sub-national, and local (primary) healthcare levels