Insights in the pathophysiology of haemorrhagic strokes in a sub‐Sahara African country, an epidemiological and MRI study

Abstract

Objective Intra‐cerebral Haemorrhage (ICH) seems more prevalent in sub‐Saharan Africa (SSA) than in High‐Income Countries (HIC) with poorer clinical outcome. Higher impact of hypertension and/or amyloid angiopathy could account for this disproportion. Here, we sought to (i) retrospectively compare ICH clinical and imaging patterns in Belgium and Guinea and in a subsequent cohort (ii) prospectively compare brain MRI characteristics to seek evidence for a different proportion of amyloid angiopathy patterns. Methods Ninety one consecutive patients admitted for spontaneous ICH at Brussels Erasme‐ULB Hospital and at Conakry Ignace Deen‐UGANC were retrospectively compared in terms of ICH volume estimated with the ABC/2 method, clinical characteristics and modified ranking (mRS) score at 30 days. mRS was dichotomised as good outcomes (≤3) and poor outcomes (>3). A prospective cohort of 30 consecutive patients with ICH admitted at CHU Conakry Ignace Deen‐UGANC was prospectively included to undergo brain MRI. Results of the Guinean MRI were compared to 30 patients randomly selected from Brussels’ initial cohort. Paired Student’s t‐test and Mann–Whitney u‐test were used for group comparisons. Results Age of ICH onset was higher in Belgium (68 ± 17 years vs. 56 ± 14 years, P < 0.01) while ICH volume and 30‐day mortality rate were higher in Guinea (20 ml vs. 11 ml, P < 0.01 and mortality 33% vs. 10 %, P < 0.01). ICH burden in survivors in Conakry and Brussels showed respectively good outcomes in 56.7% and 60.4% (P = 0.09) and poor outcomes in 10.3% vs. 29.6% (P < 0.001). MRI analysis of the prospective cohort failed to disclose significant differences regarding brain MRI characteristics. Conclusions Intra‐cerebral Haemorrhage affected patients 15 years younger in Guinea with larger haematoma volumes and higher mortality than in Belgium. MRI findings did not show more prevalent amyloid angiopathy pathology suggesting that better primary prevention of hypertension could positively impact ICH epidemiology in Guinea.

IGFBP‑rP1 affects the proliferation, apoptosis and macrophage polarization of endometrial cancer cells by regulating the PI3K/AKT pathway

“…Inhibition of PI3Kγ has been proposed as a macrophage-based cancer treatment strategy ( 27 ). Additionally, changes in AKT isoforms or AKT activity levels in macrophages determine the viability of monocytes/macrophages ( 28 , 29 ). The present study showed that overexpression of AKT in EC cells abolished the effect of overexpression of IGFBP-rP1 on M2 polarization, indicating that this regulation was dependent on the PI3K/AKT pathway.…”

The Epidemiological Pattern of Factors Associated With Ischemic Stroke in Patients Under 50 Years of Age: A Cross-Sectional Study

“…Hemorrhagic stroke can be classified as intracerebral hemorrhage or subarachnoid hemorrhage based on the site of the hemorrhage. With regard to ischemic stroke, a blood vessel is blocked, leading to sudden loss of blood flow, local cerebral ischemia, and cell death [9,10]. The global prevalence of ischemic stroke is twice as high as that of stroke [11]; however, ischemic stroke accounts for about 85% of all strokes in high-income countries [12].…”