Predictors and prognoses of new onset post-stroke anxiety at one year in black Africans

Ojagbemi, Akin; Akinyemi, Joshua; Owolabi, Mayowa; Akinyemi, Rufus; Arulogun, Oyedunni; Gebregziabher, Mulugeta; Akpa, Onoja Matthew; Olaniyan, Olanrewaju; Bl, Salako; Ovbiagele, Bruce

doi:10.1016/j.jstrokecerebrovasdis.2020.105082

Cited by 12 publications

(9 citation statements)

References 31 publications

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“…Most data on stroke complications in Africa come from hospital-based studies and suggest that some form of complication occurs in >80% of inpatients with stroke (Table 2 ). Stroke complications in Africa include delirium 159 – 161 , post-stroke aspiration pneumonia 85 , 86 , 162 – 166 , bacteriuria and urinary tract infection 167 – 169 , aphasia and deglutition disorders 170 , anxiety 99 , 171 – 173 , fatigue 174 – 176 , sexual dysfunction 177 – 179 , pain (central post-stroke pain syndrome) 180 – 183 , depressive illness 184 – 193 and cognitive impairment that often leads to dementia 194 – 197 .…”

Section: Stroke Phenotypes In Africamentioning

confidence: 99%

Stroke in Africa: profile, progress, prospects and priorities

et al. 2021

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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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Section: Stroke Phenotypes In Africamentioning

confidence: 99%

Stroke in Africa: profile, progress, prospects and priorities

et al. 2021

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“…Likewise, there should be increased vigilance for poststroke depression among clinicians as it may occur in more than one third of stroke cases [ 80 ]. The need to integrate this in clinical guidelines could not be overemphasized especially in low-income to middle-income countries due to its increasing prevalence [ 81 , 82 ]. Moreover, its impact on the disability-adjusted life-years lost is significantly greater in than in high-income countries [ 82 ].…”

Section: Resultsmentioning

confidence: 99%

Systematic Review of Existing Stroke Guidelines: Case for a Change

Wijeratne

Sales

Wijeratne

et al. 2022

BioMed Research International

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Background and Purpose. Stroke represents one of the most important causes of morbidity (Just over hundred million patients with disabling of ongoing effects of stroke at a given time, globally) and mortality (the second leading cause of death) worldwide. Innovative system biology-based approach is likely to increase the understanding of the underpinning of acute stroke promise to enhance stroke prevention, acute treatment, and neurorehabilitation. Recent growing body of evidence with shared pathobiology with COVID-19 and the critically important role of inflammation in the context of stroke points to far-reaching consequences of acute stroke, just as in the case of COVID-19 (postacute event issues as well as long term issues). So far, stroke is typically defined by late-appearing disease manifestation by the range of stroke subtypes as defined by the WHO or American Stroke Association. This definition neglects the underlying pathobiological mechanisms such as low-grade chronic inflammation and already compromised vascular system. Diseases such as stroke are hardly a simple result of a single problem but rather a complex cascade of pathobiological processes and interactions in a complex biochemical environment. The evidence of changes in innate immunity and adaptive immunity during the index event of acute stroke and recovery over next 3-12 months can be easily elicited with simple bedside blood tests such as neutrophil-lymphocyte ratio (NLR) with well over 300 published papers including several systematic reviews and meta-analyses confirming this. Global standard operating procedures (SOP) of stroke care are dictated by the national and international stroke guidelines at present. It is imperative to explore the evidence of system biology approach in current stroke guidelines. This is likely to be a key turning point in managing stroke across the continuum (prevention, management of acute event, and rehabilitation). Methods. We systematically searched for guideline recommendation on the day-to-day use of peripheral inflammatory markers such as NLR published in the English language between January 1, 2005, and October 2020. Any other evidence of system biology-based approach or recommendation was explored within the selected guidelines for this scoping review. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 4 authors to determine clinical scenarios explained/given, scientific evidence used, and recommendations presented in the context of system biology. Results. The scoping review found 2,911 titles at the beginning of the search. Final review included with 15 guidelines. Stroke-related organizations wrote sixty-five percent of the guidelines while national ministries wrote a fewer number of guidelines. We were primarily interested in recommendations for acute management in AIS published in the English language. Fifteen eligible guidelines were identified from 15 different countries/regions. None of the guidelines recommended the routine use of peripheral markers of inflammation, such as NLR, among their acute assessment and management recommendations. None of the existing guidelines explored the system biology approach to one of the most complex diseases affecting the human brain, stroke. Conclusions. This systematic review has identified a significant evidence-practice gap in all existing national stroke guidelines published in English medium as of October 2020. These guidelines included the only current “living stroke guidelines,” stroke guidelines from Australia with a real opportunity to modernize the living stroke guidelines with systems biology approach, and provide 2020 vision towards better stroke care globally. Investigation of complex disease such as stroke is best served through a systems biology approach. One of the easiest places to start is simple blood tests such as total white cell count and NLR. Systems biology approach point us towards simple tools such immune-inflammatory index (SII) and serial systemic immune inflammatory indices (SSIIi) which should pave the way for the stroke physician community address the challenges in systems biology approach in stroke care. These challenges include translating bench research to the bedside, managing big data (continuous pulse, blood pressure, sleep, oxygen saturation, progressive changes in NLR, SII, SSIIi, etc.). Working with an interdisciplinary team also provides a distinct advantage. Recent adoption of historic WHO-IGAP calls for immediate action. The 2022 World Brain Day campaign on Brain Health for All is the perfect opportunity to raise awareness and start the process.

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“…The need to integrate this in clinical guidelines could not be over-emphasized especially in low-income to middle income countries due to its increasing prevalence (92, 93). Moreover, its impact on the disability-adjusted life-years lost is significantly greater in than in high income countries (94, 95)…”

Section: Resultsmentioning

confidence: 99%

Scoping Review of Existing Stroke Guidelines; Argument for a Value-Added Change

Wijeratne

Sales

Jakovljević

et al. 2021

Preprint

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Background and Purpose: Stroke represents one of the most important causes of morbidity (eighty million patients with disabling of ongoing effects of stroke at a given time, globally) and mortality (the second leading cause of death) worldwide. Innovative systems biology-based approach is likely to increase the understanding of the underpinning of acute stroke promise to enhance stroke prevention, acute treatment, and neurorehabilitation. Recent growing body of evidence with shared pathobiology with COVID-19 and the critically important role of inflammation in the context of stroke points to far-reaching consequences of acute stroke, just as in the case of COVID-19 ( post-acute event issues as well as long term issues ). So far, stroke typically defined by late-appearing disease manifestation by the range of stroke subtypes as defined by the WHO or American Stroke Association. This definition neglects the underlying pathobiological mechanisms such as low-grade chronic inflammation and already compromised vascular system. Diseases such as stroke is hardly a simple result of a single problem, but rather a complex cascade of pathobiological processes and interactions in a complex biochemical environment. The evidence of changes in innate immunity and adaptive immunity during the index event of acute stroke and recovery over next 3-12 months can be easily elicited with simple bedside blood tests such as neutrophil-lymphocyte ratio (NLR) with well over 300 published papers including several systematic reviews and meta-analyses confirming this. Global standard operating procedures (SOP) of stroke care dictated by the national and international stroke guidelines at present. It is imperative to explore the evidence of systems biology approach in current stroke guidelines. This is likely to be a key turning point in managing stroke across the continuum (prevention, management of acute event and rehabilitation). Methods: We systematically searched for guideline recommendation on the day-to-day use of peripheral inflammatory markers such as NLR published in the English language between January 1, 2005, and December 2020. Any other evidence of systems biology-based approach or recommendation was explored within the selected guidelines for this scoping review. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 4 authors to determine clinical scenarios explained/given, scientific evidence used, and recommendations presented in the context of systems biology. Results: The scoping review found 3,830 (3830) titles with 119 guidelines from 46 countries included for this review (Figure 1; PRISMA diagram). Stroke-related organizations wrote Sixty-five per cent of the guidelines while national ministries wrote a fewer number of guidelines. We were primarily interested in recommendations for acute management in AIS published in the English language. Fifteen eligible guidelines were identified from 15 different countries/regions. None of the guidelines recommended the routine use of peripheral markers of inflammation, such as NLR, among their acute assessment and management recommendations. None of the existing guidelines explored the systems biology approach to one of the most complex diseases affecting the human brain, stroke. Conclusions: This systematic review has identified a significant evidence-practice gap in all existing national stroke guidelines published in English medium as of October 2020. These guidelines included the only current living stroke guidelines, Stroke Guidelines from Australia with a real opportunity to modernize the living stroke guidelines with systems biology approach and provide 2020 vision towards better stroke care globally. Investigation of complex disease such as stroke is best served through a systems biology approach. One of the easiest places to start is simple blood tests such as total white cell count and NLR. Systems biology approach point us towards simple tools such immune-inflammatory index (SII), Sunshine Prognostic Score (SPS) which should pave the way for the stroke physician community address the challenges in systems biology approach in stroke care. These challenges include translating bench research to the bedside, managing big data ( continuous pulse, blood pressure, sleep, Oxygen saturation, progressive changes in NLR, SII, SPS, etc.). Working with an interdisciplinary team is also provide a distinct advantage.

show abstract

Predictors and prognoses of new onset post-stroke anxiety at one year in black Africans

Cited by 12 publications

References 31 publications

Stroke in Africa: profile, progress, prospects and priorities

Stroke in Africa: profile, progress, prospects and priorities

Systematic Review of Existing Stroke Guidelines: Case for a Change

Scoping Review of Existing Stroke Guidelines; Argument for a Value-Added Change

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