As the second leading cause of death and the leading cause of adult-onset disability, stroke is a major public health concern particularly pertinent in Sub-Saharan Africa (SSA), where nearly 80% of ...all global stroke mortalities occur, and stroke burden is projected to increase in the coming decades. However, traditional and emerging risk factors for stroke in SSA have not been well characterized, thus limiting efforts at curbing its devastating toll. The Stroke Investigative Research and Education Network (SIREN) project is aimed at comprehensively evaluating the key environmental and genomic risk factors for stroke (and its subtypes) in SSA while simultaneously building capacities in phenomics, biobanking, genomics, biostatistics, and bioinformatics for brain research.
SIREN is a transnational, multicentre, hospital and community-based study involving 3,000 cases and 3,000 controls recruited from 8 sites in Ghana and Nigeria. Cases will be hospital-based patients with first stroke within 10 days of onset in whom neurovascular imaging will be performed. Etiological and topographical stroke subtypes will be documented for all cases. Controls will be hospital- and community-based participants, matched to cases on the basis of gender, ethnicity, and age (±5 years). Information will be collected on known and proposed emerging risk factors for stroke. STUDY SIGNIFICANCE: SIREN is the largest study of stroke in Africa to date. It is anticipated that it will shed light on the phenotypic characteristics and risk factors of stroke and ultimately provide evidence base for strategic interventions to curtail the burgeoning burden of stroke on the sub-continent.
OBJECTIVE:To analyze the athleteʼs heart of adult and adolescent elite male soccer players by electrocardiography (ECG) and echocardiography (ECHO) and to describe typical ECG and ECHO findings in ...this cohort (West African elite soccer players).
DESIGN:A cross-sectional study of ECGs and ECHOs conducted as part of precompetition medical assessment for national male soccer teams preparing for various Fédération Internationale de Football Association (FIFA) tournaments in 2016 and 2017.
SETTING:Ghana National Football Association.
PARTICIPANTS:One hundred fifty-nine players playing for the National male soccer teams preparing for tournaments in 2016 and 2017.
INTERVENTIONS:Precompetition medical assessment using ECGs and ECHOs.
MAIN OUTCOME MEASURES:Number of athletes with abnormal ECGs and ECHO findings.
RESULTS:Twenty-three percent of the players had abnormal ECGs. Nine percent of the participants had T-wave inversions in lateral leads (V5–V6). Sokolow–Lyon criteria for left ventricular hypertrophy were present in 64% of participants. Thirty-six (23%) players had left ventricular wall thickness (LVWT) ≥13 mm, with no player exceeding 16 mm. Four percent of players had left ventricular cavity dimension greater than 60 mm. Relative wall thickness >0.42 was present in 44% of the players.
CONCLUSIONS:Uncommon ECG changes seem to be more common in elite Ghanaian soccer players compared with previously reported results for Caucasians and even mixed populations of black athletes. Although ST elevation, T-wave inversions, and LVWT up to 15 mm are common, ST depression, deep T-waves in lateral leads, and LVWT ≥16 mm always warrant further clinical and scientific investigations.
OBJECTIVE:To examine the heart of Ghanaian adult and adolescent female soccer players using electrocardiography (ECG) and echocardiography (ECHO), and to describe typical ECG and ECHO findings in a ...cohort of west African female soccer players.
DESIGN:Cross-sectional study of ECG and ECHO performed as part of precompetition medical assessment for 3 national female football teams preparing for various Fédération Internationale de Football Association (FIFA) tournaments in 2016.
SETTING:Ghana National Football Association.
PARTICIPANTS:Seventy-five female players playing for the National female football teams preparing for FIFA tournaments in 2016.
INTERVENTIONS:Precompetition medical assessment using ECGs and ECHOs.
MAIN OUTCOME MEASURE:Number of athletes with abnormal ECG and ECHO findings using the International ECG Interpretation criteria.
RESULTS:Eight percent of the participants had T-wave inversions in lateral leads (V5–V6). Voltage criteria for left ventricular hypertrophy (LVH) were present in 35% of participants. A total of 2.7% of the players had LV wall thickness (LVWT) ≥12 mm with no player exceeding 13 mm. No player had LV cavity dimension greater than 60 mm.
CONCLUSION:Ghanaian female soccer players seem to have a high prevalence of LVH and repolarization change. Although LVWT up to 12 mm might be normal in this cohort, deep T-wave inversions and LVWT ≥13 mm should always be further investigated and/or undergo a long-term follow.
Objective: To determine the angiographic severity of coronary artery disease (CAD) and assess the influence of major cardiovascular risk factors (CVRF).Study design: a cross-sectional, hospital-based ...study.Setting: the catheterisation laboratory of the National Cardiothoracic Centre, Accra, Ghana.Participants: for 12 months, consecutive patients admitted for coronary angiography were assessed for the presence of CVRFs. Those with significant CAD after angiography were recruited into the study.Intervention: The patient’s angiograms were analysed, and the CAD severity was obtained using the SYNTAX scoring criteria.Main outcome measure: The lesion overall severity (SYNTAX) score and the relationship with CVRFs present.Results: out of the 169 patients that had coronary angiography, 78 had significant CAD. The mean SYNTAX score was 20.18 (SD= 10.68), with a significantly higher value in dyslipidaemic patients (p < 0.001). Pearson’s correlation between the score and BMI was weak (r= 0.256, p= 0.034). The occurrence of high SYNTAX score lesions in about 18% of the population was significantly associated with hypertension (OR= 1.304, 95% CI 1.13-1.50; p= 0.017) dyslipidaemia (OR= 5.636, 95% CI 1.17-27.23; p= 0.019), and obesity (OR= 3.960, 95% CI 1.18-13.34; p= 0.021). However, after adjusting for confounding factors, only dyslipidaemia significantly influenced its occurrence (aOR= 5.256, 95% CI 1.03-26.96; p= 0.047).Conclusion: Even though the most severe form of CAD was found in about one-fifth of the study population, its occurrence was strongly influenced by the presence of dyslipidaemia.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background. Abnormalities in lung function tests have been shown to commonly occur in a majority of patients with sickle cell disease (SCD) even at steady state. The prevalence and pattern of these ...lung function abnormalities have been described in other populations but this is unknown among our sickle cell cohort. There is generally little information available on risk factors associated with the lung function abnormalities and its relevance in patient care. Method. This was an analytical cross-sectional study involving 76 clinically stable, hydroxyurea-naive adult Hb-SS participants and 76 nonsickle cell disease (non-SCD) controls. A structured questionnaire was used to obtain sociodemographic data and clinical history of the participants. Investigations performed included spirometry, pulse oximetry, tricuspid regurgitant jet velocity (TRV) measurements via echocardiogram, complete blood counts, free plasma haemoglobin, serum urea, and creatinine. Results. Weight, BMI, mean FVC, and FEV1% predicted values were comparatively lower among the Hb-SS patients (p < 0.001). Abnormal spirometry outcome occurred in 70.4% of Hb-SS patients, predominantly restrictive defects (p < 0.001), and showed no significant association with steady-state Hb, WBC count, free plasma haemoglobin, frequency of sickling crisis, chronic leg ulcers, and TRV measurements (p > 0.05). The mean oxygen saturation was comparatively lower among Hb-SS patients (p < 0.001). Conclusion. Measured lung volumes were significantly lower in Hb-SS patients when compared to non-SCD controls and this difference was not influenced by anthropometric variance. Lung function abnormalities, particularly restrictive defects, are prevalent in Hb-SS patients but showed no significant association with recognized markers of disease severity.
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Introduction: Chronic pulmonary complications in sickle cell disease (SCD) are major causes of morbidity and mortality, particularly among those with sickle cell anemia (SCA), and accounts for ...20-30% of all sickle cell deaths (Gray et. al. J Clin Pathol 1991; Thomas et. al. BMJ 1982).
These complications include abnormalities in pulmonary function, interstitial lung disease and pulmonary hypertension (PH) in its severest form. An elevated tricuspid regurgitant jet velocity (TRV) obtained via doppler echocardiography, is a validated non-invasive screening tool for possible PH and an independent risk factor for early death among patients with SCD (Gladwin et. al. N Engl J Med 2004; Mehari et. al. JAMA 2012). It has been shown that measured TRV ≥ 2.5m/s is associated with decreased survival, estimated to be 40% at 40 months (Castro et. al. Blood 2003). The prevalence of PH determined by echocardiography is between 25-30% in SCA patients (Aliyu et. al. Am J Hematol 2008).
Though the burden of SCD in Sub-Saharan Africa is high, there is paucity of research into chronic lung complications, particularly pulmonary hypertension in this special population. Ghana, a West African country, has a high burden of SCD with over 16,000 babies born annually with the disease. This study therefore determined the prevalence of pulmonary hypertension and its associated risk factors.
Methods
This was a cross-sectional study involving 76 clinically stable SCA patients aged 18 years and above. A structured and pre-tested questionnaire was used to obtain socio-demographic and clinical information. The cardiopulmonary system of participants was thoroughly examined and a modified version of St George's questionnaire was used to screen and exclude those with chronic lung disease. Doppler echocardiography was used to measure TRV. The participants underwent spirometry testing, pulse oximetry measurement, and laboratory investigations including a complete blood count, free plasma hemoglobin, blood urea and creatinine.
Results
Twenty-five (32.9%) of the SCA participants had elevated TRV (≥ 2.5m/s), which was suggestive of pulmonary hypertension. Nineteen (76%) had values between 2.5m/s - 2.9m/s, representing mild pulmonary hypertension and Six (24%) had values ≥ 3.0m/s suggestive of moderate-severe pulmonary hypertension.
A negative correlation between TRV and steady-state haemoglobin (Hb) was observed (R= - 0.456, p < 0.001). Those with elevated TRV had a mean Hb of 6.9g/dl compared to 8.6g/dl in those with TRV < 2.5m/s. Further analysis showed that 6 of the SCA participants with TRV ≥ 3.0m/s had a much lower mean Hb (5.8g/dl). There was also an association between TRV and blood urea level (p = 0.030), but not with serum creatinine (p < 0.088). Oxygen saturation was significantly associated with measured TRV (p < 0.001) values. The proportion of SCA with abnormal spirometry (restrictive, obstructive and mixed defects) was 70.4% but this was however not significantly associated with measured TRV values.
Conclusion
Pulmonary hypertension occurred in about a third of the SCA participants, the presence of which was significantly associated with steady state hemoglobin, oxygen saturation and blood urea level. Early screening and identification of risk factors for PH is therefore recommended to reduce morbidity and mortality.
No relevant conflicts of interest to declare.
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