Background: Stroke is the second leading cause of death worldwide. The prevalence of hypertension (the major risk factor for stroke) in Mozambique increased from 33.1% in 2005 to 38.9% in 2014/2015, although awareness and control remained at very low levels (15% and 3%, respectively). The aim of this study is to characterize the demographic and clinical pattern of stroke in Maputo Central Hospital (MCH), Mozambique. Methods: A cross-sectional hospital-based study was carried out in MCH, collecting secondary data from hospitalized patients with stroke. Using systematic probabilistic sampling, clinical records were used to analyze data for the period 2014-18. Results: Of the 402 clinical records, 53.5% were female. The mean age was 60.68 years (13.98 SD). Around 96% was an acute stroke event, and 91% was first-ever episode. Thirty one percent did not receive a CT scan for confirmation. Of the 247 CT scanned patients, 50.2% were ischemic. The area of middle cerebral artery was affected in 83.4% patients. The most common co-morbidity was hypertension (87.1%). Near 96% of hemorrhagic stroke were associated with hypertension (Ischemic = 78.7%, p < 0.001). The overall case-fatality was 22.9%. Confirmed hemorrhagic stroke patients were 6.47 years younger than ischemic (56.40 vs 62.87 years; p < 0.001). Younger ages and female were associated with clinical improvement (aOR = 0.964; p = 0.002 and aOR = 1.890; p = 0.044, respectively). Hemorrhagic stroke were 56.8 percent points more likely associated with death (aOR = 0.432; p = 0.010). The likelihood of clinical improvement was 20.5 percent points better over the years (aOR = 1.205; p = 0.086) Conclusions: Stroke associated with hypertension is common in MCH, mostly likely due to an increase in hypertension prevalence and extremely low awareness and control. Favorable clinical outcome improved over the years. Efforts for CT scan to all stroke episodes should be emphasized by MCH managers.
BackgroundCaveolin-1 (Cav-1) plays an important role in the development of various human cancers. We investigated the relationship between Cav-1 expression and non-small cell lung cancer (NSCLC) progression in the context of brain metastasis (BM).
MethodsCav-1 expression was investigated in a series of 102 BM samples and 49 paired primary NSCLC samples, as well as 162 unpaired primary NSCLC samples with (63 cases) or without (99 cases) metastasis to distant organs. Human lung cancer cell lines were used for in vitro functional analysis.
ResultsHigh Cav-1 expression in tumor cells was observed in 52% (38/73) of squamous cell carcinomas (SQCs) and 33% (45/138) of non-SQCs. In SQC, high Cav-1 expression was increased after BM in both paired and unpaired samples of lung primary tumors and BM (53% vs. 84% in paired samples, P = 0.034; 52% vs. 78% in unpaired samples, P = 0.020). Although the difference in median overall survival in patients NSCLC was not statistically significant, high Cav-1 expression in tumor cells (P = 0.005, hazard ratio 1.715, 95% confidence index 1.175-2.502) was independent prognostic factors of overall survival on multivariate Cox regression analyses, in addition to the presence of BM and non-SQC type. In vitro assays revealed that Cav-1 knockdown inhibited the invasion and migration of lung cancer cells. Genetic modulation of Cav-1 was consistently associated with SNAIL up-and down-regulation.
ConclusionsCav-1 plays an important role in the BM of NSCLC, especially in SQC. The mechanism may be linked to SNAIL regulation.
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