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Ceasovschih A, Șorodoc V, Covantsev S, Balta A, Uzokov J, Kaiser SE, Almaghraby A, Lionte C, Stătescu C, Sascău RA, Onofrei V, Haliga RE, Stoica A, Bologa C, Ailoaei Ș, Şener YZ, Kounis NG, Șorodoc L. Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects. J Multidiscip Healthc 2024; 17:1695-1719. [PMID: 38659633 PMCID: PMC11041971 DOI: 10.2147/jmdh.s445549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy.
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Affiliation(s)
- Alexandr Ceasovschih
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Victorița Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Serghei Covantsev
- Department of Research and Clinical Development, Botkin Hospital, Moscow, Russia
| | - Anastasia Balta
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Jamol Uzokov
- Department of Cardiology, Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | - Sergio E Kaiser
- Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Abdallah Almaghraby
- Department of Cardiology, Ibrahim Bin Hamad Obaidallah Hospital, Ras Al Khaimah, United Arab Emirates
| | - Cătălina Lionte
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristian Stătescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Radu A Sascău
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Viviana Onofrei
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Raluca Ecaterina Haliga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Alexandra Stoica
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristina Bologa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Ștefan Ailoaei
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Yusuf Ziya Şener
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Nicholas G Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece
| | - Laurențiu Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
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Silva LHL, Andrade JBCD, Majdoub AAE, Miranda-Alves M, Valiente RA, Rodrigues DLG, Silva GS. A Brazilian series utilizing the SMASH-U system for etiologic classification of intracerebral hemorrhage. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-7. [PMID: 38316424 PMCID: PMC10843916 DOI: 10.1055/s-0044-1779505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/07/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Understanding the causes of intracerebral hemorrhage (ICH) is crucial for effective treatment and preventing recurrences. The SMASH-U scale is a suggested method for classifying and predicting the outcomes of ICH. OBJECTIVE To describe the SMASH-U classification and outcomes by etiology in patients admitted to a comprehensive stroke center in São Paulo, Brazil. METHODS A retrospective analysis was conducted on patients admitted to the hospital or outpatient clinic between April 2015 and January 2018. Two stroke neurologists evaluated the SMASH-U classification, and patients with incomplete medical records were excluded. RESULTS Out of the 2000 patients with a stroke diagnosis evaluated, 140 were included in the final analysis. The mean age was 57.9 (± 15.5) years, and 54.3% were male. Hypertension was the most frequent etiology, accounting for 41.4% of cases, followed by amyloid angiopathy (18.5%) and structural lesions (14.1%). Structural lesions were more common among women and patients under 45 years old. Favorable outcomes were observed in 61% of patients with structural lesions, compared to 10% of patients with medication-related etiologies. CONCLUSION This study provides important evidence regarding the etiological classification of Brazilian patients with ICH. Hypertension and amyloid angiopathy were the most frequent causes, while structural lesions and systemic diseases were more common in younger patients.
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Affiliation(s)
| | | | | | | | | | | | - Gisele Sampaio Silva
- Universidade Federal de São Paulo, São Paulo SP, Brazil.
- Hospital Israelita Albert Einstein, São Paulo SP, Brazil.
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Ovbiagele B. The p-value framework for building and sustaining a stroke research enterprise in a high-risk and low-income region. J Neurol Sci 2023; 455:122800. [PMID: 37995460 DOI: 10.1016/j.jns.2023.122800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023]
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Idro R, Boehme AK, Kawooya M, Lubowa SK, Munube D, Bangirana P, Opoka R, Mupere E, Lignelli A, Kasirye P, Green NS, Minja FJ. Brain Magnetic Resonance Imaging and Angiography in Children with Sickle Cell Anaemia in Uganda in a Cross-Sectional Sample. J Stroke Cerebrovasc Dis 2022; 31:106343. [PMID: 35158150 PMCID: PMC9004405 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Children with sickle cell anaemia (SCA) are highly susceptible to cerebrovascular injury. We performed brain magnetic resonance imaging and angiography (MRI-MRA) in Ugandan children with SCA to identify structural cerebrovascular abnormalities and examine their relationship to standardized clinical assessments. METHODS A sub-sample (n=81) was selected from a cross-sectional study of children attending SCA clinic, including 52 (64.2%) with and 29 (35.8%) without clinically detected abnormalities. Clinical evaluation included assessment for prior stroke, cognitive testing and cerebral arterial transcranial doppler (TCD) flow velocity. MRI-MRA scans were interpreted by at least two neuroradiologists. RESULTS Mean age was 6.5±2.7 years, with 39 (48.1%) female. Mean haemoglobin was 7.3±0.9 g/dl. Overall, 13 (16.0%) were malnourished. Infarcts and/or stenoses were detected in 55 (67.9%) participants, with stenoses primarily in the anterior circulation. Infarcts were seen in those with normal 17/29 (58.6%) or abnormal 34/52 (65.4%) clinical testing (p=0.181). Neither abnormal MRI nor MRA was associated with age, sex, haemoglobin, or malnutrition. Abnormal MRA was highly associated with infarcts (p<0.0001). Participants with abnormal imaging had two-fold higher proportion of stroke on exam and/or impaired cognition. Stroke on exam was strongly associated with an imaging abnormality after adjusting for age, sex, malnutrition, and haemoglobin (OR 11.8, 95%CI 1.87-74.2). CONCLUSION Over half of these SCA children had cerebrovascular infarcts and/or arterial stenoses. Cerebrovascular disease was frequently undetectable by clinical assessments. While rarely available in under-resourced settings, MRI-MRA brain imaging is an important tool for defining SCA cerebrovascular disease and for assessing impact of clinical intervention trials.
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Affiliation(s)
| | | | - Michael Kawooya
- Radiology, Makerere University College of Health Sciences, Kampala, Uganda; Ernest Cook Ultrasound Research and Education Institute (ECUREI) Mengo Hospital, Kampala, Uganda
| | - Samson K Lubowa
- Radiology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | | | - Angela Lignelli
- Radiology, Columbia University Irving Medical Center, NY, USA
| | | | | | - Frank J Minja
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Mao J, Xu Z, Sun Z, Xu M, Zhao B, Wei J, Guo H, Li Y. The Effect Of Small Bone Window Craniotomy Removal on Lactic Acid and CRP in Patients with Hypertensive Intracerebral Hemorrhage in the Basal Ganglia. Neurol India 2022; 70:2047-2052. [DOI: 10.4103/0028-3886.359215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Popoola O, Ovbiagele B, Arulogun O, Akinyemi J, Akinyemi R, Uvere E, Akpa O, Salami A, Taiwo O, Olaniyan L, Walker R, Jenkins C, Owolabi M. African Rigorous Innovative Stroke Epidemiological Surveillance: Protocol for a Community-Based Mobile-Health Study. Neuroepidemiology 2022; 56:17-24. [PMID: 34903691 PMCID: PMC9840813 DOI: 10.1159/000518885] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/30/2021] [Indexed: 01/18/2023] Open
Abstract
Despite projections of stroke being a leading cause of mortality in Africa, reliable estimates of stroke burden on the continent using rigorous methods are not available. We aimed to implement a mobile-Health community-based interactive Stroke Information and Surveillance System to sustainably measure stroke burden and improve stroke health literacy and outcomes in urban and rural sites in Nigeria. African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) is an observational cohort study, which will be conducted in urban (Ibadan North LGA Ward 3) and rural (Ibarapa Central LGA) sites with a combined base population of over 80,000 people. The study will use a consultative approach to establish an mHealth-based Stroke Information and Surveillance System comprising a Stroke Alert System and a Stroke Finding System. These systems will enable the community to report stroke events and the research team/health workers find stroke cases using phone calls, short message service, and Voice Over Internet Protocols (VoIP). We will update community household data and geo-locate all households. Over the 5 years of the study, the system will collect information on stroke events and educate the community about this disease. Reported stroke cases will be clinically adjudicated at home and in prespecified health facilities. Baseline and endline community surveys will be conducted to assess stroke occurrence and other important study variables. The proportion of strokes alerted and found will be determined over the study period. Focus group discussions and key informant interviews will be conducted to understand community stroke literacy and perspectives. The study will also assess any impact of these efforts on time from stroke onset to referral, community uptake of orthodox health services for stroke patients. ARISES is anticipated to establish proof of concept about using mHealth for stroke surveillance in Africa. The potential impact of the SISS on improving patient outcomes will also be determined.
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Affiliation(s)
- Oluwafemi Popoola
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, University of California San-Francisco, USA
| | - Oyedunni Arulogun
- Department of Health Promotion, College of Medicine, University of Ibadan, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Statistics, College of Medicine, University of Ibadan
| | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, IAMRAT, College of Medicine, University of Ibadan, Nigeria,Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Ezinne Uvere
- Department of Medicine, Newcastle University, United Kingdom
| | - Onoja Akpa
- Department of Epidemiology and Statistics, College of Medicine, University of Ibadan
| | - Ayodeji Salami
- Department of Pathology, College of Medicine, University of Ibadan, Nigeria
| | - Olalekan Taiwo
- Department of Geography, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Lanre Olaniyan
- Department of Economics, Faculty of Social Sciences, University of Ibadan, Nigeria
| | - Richard Walker
- College of Nursing, Medical University of South Carolina, Charleston, USA
| | - Carolyn Jenkins
- Department of Medicine, Newcastle University, United Kingdom
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria,Department of Medicine, College of Medicine, University of Ibadan, Nigeria
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Akpalu A, Adjei P, Nkromah K, Poku FO, Sarfo FS. Neurological disorders encountered at an out-patient clinic in Ghana's largest medical center: A 16-year review. eNeurologicalSci 2021; 24:100361. [PMID: 34377844 PMCID: PMC8327338 DOI: 10.1016/j.ensci.2021.100361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/08/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022] Open
Abstract
Background With a rising age of its population, sub-Saharan Africa(SSA) is currently experiencing an unprecedented rise in burden of neurological disorders. There is limited data on the demographic profile of neurological diseases in SSA. Objective To describe the spectrum of neurological disorders at the adult neurology clinic at Ghana's leading medical center. Methods This retrospective study was conducted at the adult neurology clinic at the Korle Bu Teaching Hospital between 2003 and 2019. We retrospectively reviewed charts of all cases seen at the clinic over the period to document main neurological diagnosis, and captured age and sex of participants. Neurologic diseases were classified using the revised International Statistical Classification of Diseases and Related Health Problems ICD 11 tool. Results There were 7950 patients sought consultation over the period with 7076 having a primary neurological disorder. The mean age ± SD of patients included in the analysis was 43.0 ± 19.8 years with 3777 (53.4%) being males. The frequencies of the top 5 neurological disorders were epilepsy (23.0%), peripheral neuropathies (19.6%), movement disorders (14.7%), cerebrovascular diseases (11.1%) and headache disorders (7.7%). Neurocognitive disorders, autoimmune demyelinating disorders of the nervous system, and motor neuron disorders were infrequently observed. Conclusion A wide spectrum of neurological disorders were encountered in this clinic, similar to previous report from other centers in SSA. There is an urgent need to build local capacity to provide optimal care to meet the demand of the rising burden of neurological diseases in Ghana.
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Affiliation(s)
- Albert Akpalu
- University of Ghana Medical School, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | - Patrick Adjei
- University of Ghana Medical School, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Foster Osei Poku
- Korle Bu Teaching Hospital, Accra, Ghana.,Akwatia Hospital, Ghana
| | - Fred Stephen Sarfo
- Kwame Nkrumah University of Science and Technology, School of Medical Sciences, Kumasi, Ghana
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Thomas SM, Delanni E, Christophe B, Connolly ES. Systematic review of novel technology-based interventions for ischemic stroke. Neurol Sci 2021; 42:1705-1717. [PMID: 33604762 DOI: 10.1007/s10072-021-05126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify novel technologies pertinent to the prevention, diagnosis, treatment, and rehabilitation of ischemic stroke, and recommend the technologies that show the most promise in advancing ischemic stroke care. METHOD A systematic literature search on PubMed and Medscape was performed. Articles were assessed based on pre-determined criteria. Included journal articles were evaluated for specific characteristics and reviewed according to a structured paradigm. A search on www.clinicaltrials.gov was performed to identify pre-clinical ischemic stroke technological interventions. All clinical trial results were included. An additional search on PubMed was conducted to identify studies on robotic neuroendovascular procedures. RESULTS Thirty journal articles and five clinical trials were analyzed. Articles were categorized as follows: six studies pertinent to pre-morbidity and prevention of ischemic stroke, three studies relevant to the diagnosis of ischemic stroke, 16 studies about post-ischemic stroke rehabilitation, and five studies on robotic neuroendovascular interventions. CONCLUSIONS Novel technologies across the spectrum of ischemic stroke care were identified, and the ones that appear to have the most clinical utility are recommended. Future investigation of the feasibility and long-term efficacy of the recommended technologies in clinical settings is warranted.
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Affiliation(s)
- Steven Mulackal Thomas
- Department of Neurological Surgery, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Ellie Delanni
- Department of Neurological Surgery, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Brandon Christophe
- Department of Neurological Surgery, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Edward Sander Connolly
- Department of Neurological Surgery, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
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Abstract
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
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Owolabi M, Sarfo FS, Akinyemi R, Gebreyohanns M, Ovbiagele B. The Sub-Saharan Africa Conference on Stroke (SSACS): An idea whose time has come. J Neurol Sci 2019; 400:194-198. [PMID: 30991160 DOI: 10.1016/j.jns.2019.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/28/2019] [Indexed: 12/19/2022]
Abstract
Stroke is a leading cause of global morbidity and mortality. Sub-Saharan Africa (SSA), where an unprecedented rise in stroke burden is currently raging, has the highest age-standardized stroke incidence, stroke prevalence, and stroke mortality rates. This is in sharp contrast to the relative decline in stroke incidence in high-income countries over the past four decades through better awareness and control of vascular risk factors. Compared to other groups, Africans tend to have a higher risk of stroke, higher percentage of the hemorrhagic type and much poorer outcomes. Indeed, stroke levies a heavy toll on the developing SSA economy by affecting a relatively younger age group. In this commentary, we examine the disproportionately high burden of stroke in the setting of grossly inadequate resources and evidence-based interventions. We propose an annual pan-regional stroke conference (starting in 2020) to harness global resources and local talent with the goal of galvanizing action to tackle this escalating burden. We anticipate that a successful conference series could become a rallying point for the eventual establishment of an African Stroke Organization.
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Affiliation(s)
- Mayowa Owolabi
- Department of Medicine, University of Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, University of Ibadan, Ibadan, Nigeria.
| | | | - Rufus Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
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Azarpazhooh MR, Mandzia JL, Thrift AG, Sposato LA, Morovatdar N, Amiri A, Kapral MK, Yassi N, Bahit C, Kaul S, Alladi S, Nilanont Y, Coppola M, Nucera A, Silver B, Werring D, Simister R, Swartz RH, Owolabi MO, Ovbiagele B, Hachinski V. Age, sex, and setting in the etiology of stroke study (ASSESS): Study design and protocol. J Neurol Sci 2019; 399:209-213. [PMID: 30851659 DOI: 10.1016/j.jns.2019.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/21/2019] [Accepted: 02/13/2019] [Indexed: 12/01/2022]
Abstract
RATIONALE Stroke etiology and risk factors vary by age, sex, setting (hospital or community-based) and by region. Identifying these differences would improve our understanding of stroke etiology, diagnosis, and treatment. AIM The Age, Sex and Setting in the Etiology of Stroke Study (ASSESS) is a multicenter cohort study to assess differences in stroke etiology. METHODS AND DESIGN Data from all centers will be categorized according to age, sex, setting, stroke subtypes. Centers with extensive hospital- or community-based data regarding stroke from Argentina, Australia, Canada, India, Iran, Italy, Ghana, Nigeria, Thailand, the United Kingdom and the United States have agreed to participate so far. STUDY OUTCOMES The primary outcome includes differences in stroke etiology in study centers. The secondary outcomes include stroke incidence, risk factors, preventive strategies, and short- and long-term outcomes. CONCLUSION ASSESS will enable comparisons of data from different regions to determine the age and sex distribution of the most common causes of stroke in each setting. This will help clinicians to tailor the assessment and treatment of stroke patients on the basis of their specific local characteristics. It will also empower stroke epidemiologists to design preventive measures by targeting the specific characteristics of each population.
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Affiliation(s)
- Mahmoud Reza Azarpazhooh
- Department of Neurology, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Center, Western University, ON, Canada; Department of Epidemiology and Biostatistics, Western University, ON, Canada
| | - Jennifer L Mandzia
- Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Center, Western University, ON, Canada
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Center, Western University, ON, Canada; Department of Epidemiology and Biostatistics, Western University, ON, Canada; Department of Anatomy and Cell Biology, Western University, ON, Canada; Stroke, Dementia, and Heart Disease Lab, Western University, ON, Canada
| | - Negar Morovatdar
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Amiri
- Department of Neurology, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Moira K Kapral
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Nawaf Yassi
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Cecilia Bahit
- Cardiology Department, INECO Neurociencias Oroño, Rosario, Santa Fe, Argentina
| | - Subhash Kaul
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Suvarna Alladi
- National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Yongchai Nilanont
- Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Antonia Nucera
- Department of Neurology, Saint Andrea Hospital, Stroke Unit, La Spezia, Italy
| | - Brian Silver
- Department of Neurology, The University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA, United States
| | - David Werring
- Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom
| | - Robert Simister
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Richard H Swartz
- Department of Medicine, Division of Neurology, Sunnybrook HSC, University of Toronto, Toronto, Canada
| | - Mayowa O Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Center, Western University, ON, Canada; Department of Epidemiology and Biostatistics, Western University, ON, Canada.
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Akinyemi RO, Akinwande K, Diala S, Adeleye O, Ajose A, Issa K, Owusu D, Boamah I, Yahaya IS, Jimoh AO, Imoh L, Fakunle G, Akpalu A, Sarfo F, Wahab K, Sanya E, Owolabi L, Obiako R, Osaigbovo G, Komolafe M, Fawale M, Adebayo P, Olowoyo P, Obiabo Y, Sunmonu T, Chukwuonye I, Balogun O, Adeoye B, Oladele F, Olowoniyi P, Adeyemi F, Lezzi A, Falayi AT, Fasanya M, Ogunwale K, Adeola O, Olomu O, Aridegbe O, Laryea R, Uvere E, Faniyan M, Melikam E, Tagge R, Akpa O, Akinyemi J, Arulogun O, Tiwari HK, Ovbiagele B, Owolabi MO. Biobanking in a Challenging African Environment: Unique Experience from the SIREN Project. Biopreserv Biobank 2018; 16:217-232. [PMID: 29733683 PMCID: PMC5995267 DOI: 10.1089/bio.2017.0113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Africa was previously insufficiently represented in the emerging discipline of biobanking despite commendable early efforts. However, with the Human, Heredity, and Health in Africa (H3Africa) initiative, biorepository science has been bolstered, regional biobanks are springing up, and awareness about biobanks is growing on the continent. The Stroke Investigative Research and Educational Network (SIREN) project is a transnational, multicenter, hospital and community-based study involving over 3000 cases and 3000 controls recruited from 16 sites in Ghana and Nigeria. SIREN aims to explore and unravel the genetic and environmental factors that interact to produce the peculiar phenotypic and clinical characteristics of stroke as seen in people of African ancestry and facilitate the development of new diagnostics, therapeutics, and preventative strategies. The aim of this article is to describe our experience with the development of the procedure for collection, processing, storage, and shipment of biological samples (blood, serum, plasma, buffy coat, red cell concentrates, and DNA) and brain imaging across coordinating and participating sites within the SIREN Project. The SIREN network was initiated in 2014 with support and funding from the H3Africa Initiative. The SIREN Biobank currently has 3015 brain images, 92,950 blood fractions (serum, plasma, red cell concentrates, and buffy coat) accrued from 8450 recruited subjects, and quantified and aliquoted good-quality DNA extracts from 6150 study subjects. This represents an invaluable resource for future research with expanding genomic and trans-omic technologies. This will facilitate the involvement of indigenous African samples in cutting-edge stroke genomics and trans-omics research. It is, however, critical to effectively engage African stroke patients and community members who have contributed precious biological materials to the SIREN Biobank to generate appropriate evidence base for dealing with ethical, legal, and social issues of privacy, autonomy, identifiability, biorights, governance issues, and public understanding of stroke biobanking in the context of unique African culture, language, and belief systems.
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Affiliation(s)
- Rufus O. Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Pathology Department, Federal Medical Centre, Abeokuta, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | | | - Samuel Diala
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Osi Adeleye
- Pathology Department, Federal Medical Centre, Abeokuta, Nigeria
| | - Abiodun Ajose
- Neurology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Kehinde Issa
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Dorcas Owusu
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Isaac Boamah
- Neurology Unit, Department of Medicine, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | | | - Lucius Imoh
- Neurology Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Gregory Fakunle
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Albert Akpalu
- Neurology Unit, Department of Medicine, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Fred Sarfo
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Kolawole Wahab
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Emmanuel Sanya
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Lukman Owolabi
- Neurology Unit, Department of Medicine, Bayero University, Kano, Nigeria
| | - Reginald Obiako
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Godwin Osaigbovo
- Neurology Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Morenikeji Komolafe
- Neurology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Michael Fawale
- Neurology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Philip Adebayo
- Neurology Unit, Department of Medicine, Ladoke Akintola University Teaching Hospital, Ogbomoso, Nigeria
| | - Paul Olowoyo
- Neurology Unit, Department of Medicine, Federal University Teaching Hospital, Ido Ekiti, Nigeria
| | - Yahaya Obiabo
- Neurology Unit, Department of Medicine, Delta State University Teaching Hospital, Igharra, Nigeria
| | - Taofiki Sunmonu
- Neurology Unit, Department of Medicine, Federal Medical Center, Owo, Nigeria
| | - Ijezie Chukwuonye
- Neurology Unit, Department of Medicine, Federal Medical Center, Umuahia, Nigeria
| | - Olayemi Balogun
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Basirat Adeoye
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Florence Oladele
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Peter Olowoniyi
- Neurology Unit, Department of Medicine, Federal Medical Center, Umuahia, Nigeria
| | - Frederick Adeyemi
- Neurology Unit, Department of Medicine, Federal Medical Center, Owo, Nigeria
| | - Arthur Lezzi
- Neurology Unit, Department of Medicine, Delta State University Teaching Hospital, Igharra, Nigeria
| | - Ajibola Tunde Falayi
- Neurology Unit, Department of Medicine, Federal University Teaching Hospital, Ido Ekiti, Nigeria
| | - Michael Fasanya
- Neurology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Kolawole Ogunwale
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olabisi Adeola
- Pathology Department, Federal Medical Centre, Abeokuta, Nigeria
| | - Omolara Olomu
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | | | - Ruth Laryea
- Neurology Unit, Department of Medicine, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ezinne Uvere
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Moyinoluwalogo Faniyan
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Ezinne Melikam
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Raelle Tagge
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Onoja Akpa
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joshua Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oyedunni Arulogun
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hemant K. Tiwari
- School of Public Health, University of Alabama, Birmingham, Alabama
| | - Bruce Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Mayowa O. Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
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Akinyemi R, Tiwari HK, Arnett DK, Ovbiagele B, Irvin MR, Wahab K, Sarfo F, Srinivasasainagendra V, Adeoye A, Perry RT, Akpalu A, Jenkins C, Arulogun O, Gebregziabher M, Owolabi L, Obiako R, Sanya E, Komolafe M, Fawale M, Adebayo P, Osaigbovo G, Sunmonu T, Olowoyo P, Chukwuonye I, Obiabo Y, Onoja A, Akinyemi J, Ogbole G, Melikam S, Saulson R, Owolabi M. APOL1, CDKN2A/CDKN2B, and HDAC9 polymorphisms and small vessel ischemic stroke. Acta Neurol Scand 2018; 137:133-141. [PMID: 28975602 DOI: 10.1111/ane.12847] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Worldwide, the highest frequencies of APOL1-associated kidney variants are found in indigenous West Africans among whom small vessel disease (SVD) ischemic stroke is the most common stroke phenotype. The objective of this study was to investigate the association and effect sizes of 23 selected SNPs in 14 genes of relevance, including the APOL1 G1 variants, with the occurrence of SVD ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study. MATERIALS AND METHODS Cases were consecutively recruited consenting adults (aged 18 years or older) with neuroimaging-confirmed first clinical stroke. Stroke-free controls were ascertained using a locally validated version of the Questionnaire for Verifying Stroke-Free Status (QVSFS). Logistic regression models adjusting for known vascular risk factors were fitted to assess the associations of the 23 SNPs in rigorously phenotyped cases (N = 154) of SVD ischemic stroke and stroke-free (N = 483) controls. RESULTS Apolipoprotein L1 (APOL1) rs73885319 (OR = 1.52; CI: 1.09-2.13, P-value = .013), rs2383207 in CDKN2A/CDKN2B (OR = 3.08; CI: 1.15-8.26, P -value = .026) and rs2107595 (OR = 1.70; CI: 1.12-2.60, P-value = .014) and rs28688791 (OR = 1.52; CI: 1.03-2.26, P-value = .036) in HDAC9 gene were associated with SVD stroke at 0.05 significance level. Polymorphisms in other genes did not show significant associations. CONCLUSION This is the first report of a specific association of APOL1 with a stroke subtype. Further research is needed to confirm these initial findings and deepen understanding of the genetics of stroke in people of African ancestry with possible implications for other ancestries as all humans originated from Africa.
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Affiliation(s)
- R. Akinyemi
- Center for Genomic and Precision Medicine; University of Ibadan; Ibadan Nigeria
- Federal Medical Centre Abeokuta; Ibadan Nigeria
| | - H. K. Tiwari
- University of Alabama at Birmingham; Birmingham AL USA
| | | | - B. Ovbiagele
- Medical University of South Carolina; South Carolina SC USA
| | - M. R. Irvin
- University of Alabama at Birmingham; Birmingham AL USA
| | - K. Wahab
- University of Ilorin Teaching Hospital; Ilorin Nigeria
| | - F. Sarfo
- Kwame Nkrumah University of Science and Technology; Kumasi Ghana
| | | | - A. Adeoye
- Center for Genomic and Precision Medicine; University of Ibadan; Ibadan Nigeria
| | - R. T. Perry
- University of Alabama at Birmingham; Birmingham AL USA
| | - A. Akpalu
- University of Ghana Medical School; Accra Ghana
| | - C. Jenkins
- Medical University of South Carolina; South Carolina SC USA
| | - O. Arulogun
- Center for Genomic and Precision Medicine; University of Ibadan; Ibadan Nigeria
| | | | - L. Owolabi
- Aminu Kano University Teaching Hospital; Kano Nigeria
| | - R. Obiako
- Ahmadu Bello University; Zaria Nigeria
| | - E. Sanya
- University of Ilorin Teaching Hospital; Ilorin Nigeria
| | | | - M. Fawale
- Obafemi Awolowo University; Ile-Ife Nigeria
| | - P. Adebayo
- Ladoke Akintola University of Technology; Ogbomosho Nigeria
| | | | | | - P. Olowoyo
- Federal University Teaching Hospital; Ido-Ekiti Nigeria
| | | | - Y. Obiabo
- Delta State University Teaching Hospital; Oghara Nigeria
| | - A. Onoja
- Department of Epidemiology and Medical Statistics; University of Ibadan; Ibadan Nigeria
| | - J. Akinyemi
- Department of Epidemiology and Medical Statistics; University of Ibadan; Ibadan Nigeria
| | - G. Ogbole
- Department of Radiology; University of Ibadan; Ibadan Nigeria
| | - S. Melikam
- Center for Genomic and Precision Medicine; University of Ibadan; Ibadan Nigeria
| | - R. Saulson
- Medical University of South Carolina; South Carolina SC USA
| | - M. Owolabi
- Center for Genomic and Precision Medicine; University of Ibadan; Ibadan Nigeria
- WFNR-Blossom Specialist Medical Center; Ibadan Nigeria
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14
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Owolabi M, Peprah E, Xu H, Akinyemi R, Tiwari HK, Irvin MR, Wahab KW, Arnett DK, Ovbiagele B. Advancing stroke genomic research in the age of Trans-Omics big data science: Emerging priorities and opportunities. J Neurol Sci 2017; 382:18-28. [PMID: 29111012 DOI: 10.1016/j.jns.2017.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/19/2017] [Accepted: 09/15/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND We systematically reviewed the genetic variants associated with stroke in genome-wide association studies (GWAS) and examined the emerging priorities and opportunities for rapidly advancing stroke research in the era of Trans-Omics science. METHODS Using the PRISMA guideline, we searched PubMed and NHGRI- EBI GWAS catalog for stroke studies from 2007 till May 2017. RESULTS We included 31 studies. The major challenge is that the few validated variants could not account for the full genetic risk of stroke and have not been translated for clinical use. None of the studies included continental Africans. Genomic study of stroke among Africans presents a unique opportunity for the discovery, validation, functional annotation, Trans-Omics study and translation of genomic determinants of stroke with implications for global populations. This is because all humans originated from Africa, a continent with a unique genomic architecture and a distinctive epidemiology of stroke; as well as substantially higher heritability and resolution of fine mapping of stroke genes. CONCLUSION Understanding the genomic determinants of stroke and the corresponding molecular mechanisms will revolutionize the development of a new set of precise biomarkers for stroke prediction, diagnosis and prognostic estimates as well as personalized interventions for reducing the global burden of stroke.
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Affiliation(s)
- Mayowa Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Emmanuel Peprah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Huichun Xu
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rufus Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hemant K Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
| | - Kolawole Wasiu Wahab
- Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Donna K Arnett
- College of Public Health, University of Kentucky at Lexington, USA
| | - Bruce Ovbiagele
- Department of Neurology, Medical University of South Carolina, Charleston, USA
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