Mayowa Owolabi

What Are the Consistent Predictors of Generic and Specific Post-Stroke Health-Related Quality of Life?

Background: In order to improve post-stroke health-related quality of life (HRQOL), it is crucial to focus scarce health care and research resources towards its consistent determinants. Disparities in reported determinants of post-stroke HRQOL may be due to the use of different instruments (generic or specific) in different populations. This is the first study to identify factors which consistently influenced both generic and specific post-stroke HRQOL in the same study population. Methods: One hundred consecutive consenting stroke survivors were assessed using the stroke levity scale (SLS), modified Rankin scale (mRS), SF-36 and HRQOL in stroke patients (HRQOLISP) measure. Employing multiple regression analysis (R2 = 0.63), potential predictors were sought among age, gender, socioeconomic class (SEC), aphasia, post-stroke duration, side, type and number of strokes, SLS, mRS, social support and Likert scale-graded responses to laughter and negative-feeling frequency. Results: Gender, SEC and stroke type had no significant impact on HRQOL. The consistent independent statistical predictors of several facets of generic and stroke-specific HRQOL were stroke severity, disability, laughter and negative-feeling frequencies. Conclusions: While stroke severity, a component of physical health, impaired psychological health, psychological dysfunction in turn negatively influenced physical and other domains of health, thereby creating a vicious cycle. These multidirectional interactions may involve neural, social and existential mechanisms which remain to be confirmed, elucidated and exploited.

Which Is More Valid for Stroke Patients: Generic or Stroke-Specific Quality of Life Measures?

Background: It remains unclear whether a generic or specific health-related quality of life (HRQOL) measure is more valid for stroke. Aim: The aim of this study is to compare the validity of SF-36, a generic measure, and HRQOL in stroke patients (HRQOLISP), a stroke-specific measure, for assessing post-stroke HRQOL. Methods: The validity of HRQOLISP and SF-36 was compared in a cross-sectional study of 100 stroke survivors. The Stroke Levity Scale and modified Rankin Scale were applied to measure stroke severity and disability, respectively. Results: Both measures exhibited adequate ‘known-groups’ and construct validity. However, the SF-36 lacked content validity for the cognitive domain and personal constructs including spiritual functioning. Most SF-36 subscales had substantial floor or ceiling effects. The HRQOLISP demonstrated better content and internal consistency validity and no significant floor or ceiling effect. Conclusions: Like other stroke-specific measures, HRQOLISP was better than SF-36 in most parameters of validity considered. The SF-36 is designed for comparison among different diseases and may not be suitable for clinical trials or studies of internal adaptation, cognitive or spiritual functioning in stroke. This is because it lacks content validity for these domains and may underestimate health changes in most subscales.

Cognitive dysfunction in Nigerians with Parkinson's disease.

Despite the original description of Parkinsons disease (PD) as a disorder in which “the senses and intellect remain uninjured,” there is now sufficient evidence that cognitive dysfunction does occur. This research determined the frequency, pattern, and predictors of cognitive dysfunction among 51 Nigerian patients with PD compared with 50 demographically matched controls using the modified Community Screening Instrument for Dementia (CSI‘D’) and selected items from the Ibadan Neuropsychological Battery (I‐NB). In all, 21.6% patients with PD (4% of controls) exhibited cognitive impairment (P = 0.008) defined, for the purposes of this study, as total modified CSI‘D’ score below 2 SD of the mean score of the control group. Cognitive dysfunction in patients with PD encompassed memory, language, and executive dysfunction. Correlates of cognitive dysfunction included older age at PD onset (P = 0.001), older current age (P < 0.001), and higher UPDRS motor score (P = 0.005). After logistic regression, older age at onset of PD was the only independent predictor of cognitive dysfunction. (O.R = 1.29; 95% CI = 1.08–1.57, P = 0.006). Cognitive dysfunction occurs more frequently in Nigerians with PD compared to controls. Older age at disease onset is an important determinant of cognitive dysfunction in PD.

Psychometric Properties of the HRQOLISP-40: A Novel, Shortened Multiculturally Valid Holistic Stroke Measure

Background. A recent review showed that no existing instrument measured the entire spectrum of health-related quality of life (HRQOL) in stroke patients. However, the HRQOL in stroke patients (HRQOLISP) questionnaire is valid and exceptionally comprehensive. Founded on a holistic model of human life, it comprises both physical and spiritual spheres. However, its 102-item length may discourage routine use. Therefore, the aim was to determine the psychometric attributes of a shortened version based on a multicultural transnational study. Methods. HRQOLISP was administered to 100 stroke patients in Ibadan, 103 in Berlin, and control groups of 100 apparently healthy adults in Ibadan and 50 in Berlin. Analyzing data from both cities, items were reduced to 40. Construct validity of the resulting HRQOLISP-40 was assessed by comparison with the National Institutes of Health Stroke Scale (NIHSS), Stroke Levity Scale (SLS), modified Rankin Scale (mRS), and Short Form 36 (SF-36) Health Survey. Results. In multicultu...

Post-stroke depression in Ghana: Characteristics and correlates

BACKGROUND Poststroke depression (PSD) is prevalent and is an important determinant of functional recovery, quality of life and mortality after stroke. Scanty data on the nature of PSD among stroke survivors in sub-Saharan Africa prompted this study. OBJECTIVE To assess the prevalence and predictors of depression in a convenience sample of Ghanaian stroke survivors. METHODS We evaluated consecutive stroke survivors encountered at a comprehensive neurology clinic in a tertiary medical center in Ghana. The Center for Epidemiologic Studies Depression Scale (CES-D) and Geriatric Depression Scale (GDS) were both used to screen for depressive symptoms and subjects were considered as depressed if they scored ≥16 on the CES-D scale and >5 on the GDS. Demographic and clinical data on stroke type and severity as well as health-related quality of life indicators were collected. Predictors of stroke-related depression were assessed using a logistic regression model. RESULTS Of 200 stroke survivors, mean±SD age was 62.0±14.4years, and 105 (52.5%) patients were men. Among the cohort 78.5% were classified as being depressed by CES-D, 42.5% by GDS, and 36.5% on both CES-D and GDS. In multivariable analyses, for each unit increase on the Modified Rankin scale (i.e. worsening disability), there were higher odds of depression (adjusted OR 1.85; 1.28-2.69, p=0.001), and being divorced (vs. being married) was linked to depression (adjusted 2.82; 1.18-6.71, p=0.02). Stroke survivors with depression demonstrated profound diminutions in the physical, psycho-social, cognitive and eco-social domains of quality of life compared with those without depression (p<0.05). CONCLUSION Almost 4 out of 10 stroke survivors in this Ghanaian cohort displayed clinically significant depression. Prospective interventional studies are urgently needed to provide solid evidence-based and culturally tailored interventions to address post-stroke depression particularly in LMICs.

Cervical spine tuberculosis and retropharyngeal abscess in an adult Nigerian

Globally, there has been an increase in the incidence of tuberculosis by 2.2 million from 1997 to 2005 and 95% of this is occurring in developing countries. Tuberculosis of the cervical spine is rare. To present our experience with a case of cervical spine tuberculosis. We present a case report of tuberculosis of the C3/C4 cervical spine associated with retropharyngeal abscess in a 36-year-old Nigerian woman. The disease was also associated with pulmonary tuberculosis. Neck pain, neck stiffness, radicular pain, especially to the left shoulder and wasting of the muscles of the hand, were the main features. Our patient improved on anti-tuberculous therapy and conservative supportive care. This case stresses the usefulness of simple pain cervical X-radiograph, especially in environments like ours where sophisticated investigations are either not available or beyond the reach of most patients. Conservative management in our patient resulted in remarkable improvement.

Aggregate Cardiovascular Risk Is a Stronger Statistical Correlate of Clinically Evident Diabetic Peripheral Neuropathy Than HbA1c Alone

BACKGROUND Apart from chronic hyperglycemia measured by hemoglobin A1c (HbA1c), other vascular risk factors contribute to the development of diabetic neuropathy. Even though these factors are synergistic, no study has measured the relative effect of aggregate cardiovascular risk load compared with chronic hyperglycemia alone on the risk of clinically evident diabetic peripheral neuropathy. OBJECTIVE To compare the effects of aggregate cardiovascular risk load and HbA1c on clinically evident diabetic peripheral neuropathy. METHODS We studied 277 consecutive and consenting type 2 diabetic outpatients attending the University College Hospital, Ibadan, Nigeria. Neuropathy was defined operationally as at least 7 positive responses on the Michigan Neuropathy Screening Instrument (MNSI) questionnaire or a score greater than 2.0 on the MNSI examination: thresholds defined by prior validation studies. Patients with nondiabetic causes of neuropathy were excluded. We determined the HbA1c using the ionic exchange chromatographic method and later computed the Diabetes Control Complications Trial referenced values. Aggregate cardiovascular risk load was determined using the UK Prospective Diabetes Study risk engines. RESULTS One hundred ninety-seven (71.1%) patients had clinically evident diabetic peripheral neuropathy. The mean HbA1c value was 6.9%. HbA1c correlated significantly with the average fasting plasma glucose (r = 0.36) but did not correlate significantly with the development of clinically evident diabetic peripheral neuropathy (p = .465, p = -0.045). Aggregate cardiovascular risk load had the strongest significant correlation with clinically evident diabetic peripheral neuropathy (p = .002, p = 0.186, odds ratio, 2.3 for score > 5). In the regression analysis, aggregate cardiovascular risk load was a stronger predictor of clinically evident diabetic peripheral neuropathy than HbA1c. CONCLUSIONS Aggregate cardiovascular risk load was a stronger statistical correlate and predictor of clinically evident diabetic peripheral neuropathy than HbA1c. This may have implications for prevention and monitoring of clinically evident diabetic peripheral neuropathy.

The epidemiology of stroke in Africa: A systematic review of existing methods and new approaches

Accurate epidemiological surveillance of the burden of stroke is direly needed to facilitate the development and evaluation of effective interventions in Africa. The authors therefore conducted a systematic review of the methodology of stroke epidemiological studies conducted in Africa from 1970 to 2017 using gold standard criteria obtained from landmark epidemiological publications. Of 1330 articles extracted, only 50 articles were eligible for review grouped under incidence, prevalence, case‐fatality, health‐related quality of life, and disability‐adjusted life‐years studies. Because of various challenges, no study fulfilled the criteria for an excellent stroke incidence study. The relatively few stroke epidemiology studies in Africa have significant methodological flaws. Innovative approaches leveraging available information and communication technology infrastructure are recommended to facilitate rigorous epidemiological studies for accurate stroke surveillance in Africa.

EMG indications and findings in a sub-Saharan African neurorehabilitation center

Highlights • Little is published about the usage of electro-diagnostic procedures in sub Saharan Africa.• We report the indications and findings in a sub-Saharan African neurorehabilitation center.• Polyneuropathy and entrapment neuropathy were the most common reasons for electrodiagnostic requests.

Short term stroke outcome is worse among individuals with sickle cell trait

Background Most (86%) of the global stroke mortality are from low- and middle-income countries (LMIC) including African countries which have the highest prevalence of the sickle cell trait (Hb AS). The effects of this trait on stroke occurrence and outcome are poorly understood. We aimed to investigate the effects of the sickle cell trait on the 30-day stroke mortality in Nigerian-Africans. Method This was a prospective study of 35 stroke patients with sickle cell trait (Haemoglobin AS) and 35 age and sex-matched controls without haemoglobinopathy (Haemoglobin AA). Haemoglobin electrophoresis was performed for all before recruitment and they all had neuroimaging done. Patients with haemoglobin AS were used as cases and those with haemoglobin AA as controls. The National Institute of Health Stroke Scale (NIHSS) was used to assess the severity of stroke at presentation and the Modified Rankin Scale for 30-day stroke outcome. Result There was no significant difference in the baseline stroke severity between the two groups (p = 0.21). Univariate analysis of the factors predicting the 30-day stroke outcome revealed that NIHSS score > 20 (p < 0.001), haemorrhagic stroke (p = 0.01) and the presence of Hb AS (p < 0.001) were significantly associated with 30-day mortality. Haemorrhagic stroke type was strongly associated with HbAS (OR = 2.9, 95% CI = 1.10–7.99, p-value = 0.02). With multiple logistic regression model, the presence of Hb AS (p = 0.01) and NIHSS score > 20 (p = 0.05) emerged as independent risk factors for 30-day mortality. The cases had worse stroke outcome at 30 days. Conclusion Stroke had1 a worse 30-day mortality and outcome in patients with sickle cell trait (HbAS) than in patients with normal adult haemoglobin (HbAA).