Publications by authors named "Morenikeji Komolafe"

51 Publications

A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study.

J Stroke Cerebrovasc Dis 2021 Jul 28;30(10):106003. Epub 2021 Jul 28.

Medical University of South Carolina, SC, USA.

Background: Stroke risk can be quantified using risk factors whose effect sizes vary by geography and race. No stroke risk assessment tool exists to estimate aggregate stroke risk for indigenous African.

Objectives: To develop Afrocentric risk-scoring models for stroke occurrence.

Materials And Methods: We evaluated 3533 radiologically confirmed West African stroke cases paired 1:1 with age-, and sex-matched stroke-free controls in the SIREN study. The 7,066 subjects were randomly split into a training and testing set at the ratio of 85:15. Conditional logistic regression models were constructed by including 17 putative factors linked to stroke occurrence using the training set. Significant risk factors were assigned constant and standardized statistical weights based on regression coefficients (β) to develop an additive risk scoring system on a scale of 0-100%. Using the testing set, Receiver Operating Characteristics (ROC) curves were constructed to obtain a total score to serve as cut-off to discriminate between cases and controls. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at this cut-off.

Results: For stroke occurrence, we identified 15 traditional vascular factors. Cohen's kappa for validity was maximal at a total risk score of 56% using both statistical weighting approaches to risk quantification and in both datasets. The risk score had a predictive accuracy of 76% (95%CI: 74-79%), sensitivity of 80.3%, specificity of 63.0%, PPV of 68.5% and NPV of 76.2% in the test dataset. For ischemic strokes, 12 risk factors had predictive accuracy of 78% (95%CI: 74-81%). For hemorrhagic strokes, 7 factors had a predictive accuracy of 79% (95%CI: 73-84%).

Conclusions: The SIREN models quantify aggregate stroke risk in indigenous West Africans with good accuracy. Prospective studies are needed to validate this instrument for stroke prevention.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.106003DOI Listing
July 2021

Influence of age on links between major modifiable risk factors and stroke occurrence in West Africa.

J Neurol Sci 2021 Sep 9;428:117573. Epub 2021 Jul 9.

College of Medicine, University of Ibadan, Nigeria. Electronic address:

Background The burden of stroke in Africa is high. Understanding how age associates with major modifiable stroke risk factors could inform tailored demographic stroke prevention strategies. Purpose To quantify the magnitude and direction of the effect sizes of key modifiable stroke risk factors according to three age groups: <50 years (young), 50-65 years (middle age) and > 65 years (elderly) in West Africa. Methods This was a case-control study involving 15 sites in Ghana and Nigeria. Cases included adults aged ≥18 years with CT/MRI scan-typed stroke. Controls were age-and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle and psychosocial factors were performed. We estimated adjusted odds ratios (aOR) using conditional logistic regression and population attributable risk (PAR) with 95% Confidence Interval of vascular risk factors by age groups. Results Among 3553 stroke cases, 813 (22.9%) were young, 1441 (40.6%) were middle-aged and 1299 (36.6%) were elderly. Among the 5 co-shared risk factors, dyslipidemia with PAR and aOR (95%CI) of 62.20% (52.82-71.58) and 4.13 (2.64-6.46) was highest among the young age group; hypertension with PAR of 94.31% (91.82-96.80) and aOR of 28.93 (15.10-55.44) was highest among the middle-age group. Diabetes with PAR of 32.29%(27.52-37.05) and aOR of 3.49 (2.56-4.75); meat consumption with PAR of 42.34%(32.33-52.35) and aOR of 2.40 (1.76, 3.26); and non-consumption of green vegetables, PAR of 16.81%(12.02-21.60) and aOR of 2.23 (1.60-3.12) were highest among the elderly age group. However confidence intervals of risk estimates overlapped across age groups. Additionally, among the young age group cigarette smoking, psychosocial stress and cardiac disease were independently associated with stroke. Furthermore, education, stress, physical inactivity and salt intake were associated with stroke in the middle-age group while cardiac disease was associated with stroke in the elderly age group. Conclusion There is a differential influence of age on the associations of major risk factors with stroke in this West African cohort. Targeting modifiable factors predominant within an age group may be more effective as a stroke prevention strategy.
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http://dx.doi.org/10.1016/j.jns.2021.117573DOI Listing
September 2021

Epidemiology of Epilepsy in Nigeria: A Community-Based Study From 3 Sites.

Neurology 2021 08 12;97(7):e728-e738. Epub 2021 Jul 12.

From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands.

Background: We determined the prevalence, incidence, and risk factors for epilepsy in Nigeria.

Methods: We conducted a door-to-door survey to identify cases of epilepsy in 3 regions. We estimated age-standardized prevalence adjusted for nonresponse and sensitivity and the 1-year retrospective incidence for active epilepsy. To assess potential risk factors, we conducted a case-control study by collecting sociodemographic and risk factor data. We estimated odds ratios using logistic regression analysis and corresponding population attributable fractions (PAFs).

Results: We screened 42,427 persons (age ≥6 years), of whom 254 had confirmed active epilepsy. The pooled prevalence of active epilepsy per 1,000 was 9.8 (95% confidence interval [CI] 8.6-11.1), 17.7 (14.2-20.6) in Gwandu, 4.8 (3.4-6.6) in Afikpo, and 3.3 (2.0-5.1) in Ijebu-Jesa. The pooled incidence per 100,000 was 101.3 (95% CI 57.9-167.6), 201.2 (105.0-358.9) in Gwandu, 27.6 (3.3-128.0) in Afikpo, and 23.9 (3.2-157.0) in Ijebu-Jesa. Children's significant risk factors included febrile seizures, meningitis, poor perinatal care, open defecation, measles, and family history in first-degree relatives. In adults, head injury, poor perinatal care, febrile seizures, family history in second-degree relatives, and consanguinity were significant. Gwandu had more significant risk factors. The PAF for the important factors in children was 74.0% (71.0%-76.0%) and in adults was 79.0% (75.0%-81.0%).

Conclusion: This work suggests varied epidemiologic numbers, which may be explained by differences in risk factors and population structure in the different regions. These variations should differentially determine and drive prevention and health care responses.
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http://dx.doi.org/10.1212/WNL.0000000000012416DOI Listing
August 2021

Copy Number Variation in Parkinson's Disease: An Update from Sub-Saharan Africa.

Mov Disord 2021 Jul 6. Epub 2021 Jul 6.

Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

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http://dx.doi.org/10.1002/mds.28710DOI Listing
July 2021

Sleep medicine in Africa: past, present, and future.

J Clin Sleep Med 2021 06;17(6):1317-1321

Department of Mental Health, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria.

None: Interest in sleep and sleep disorders in Africa dates back thousands of years, influenced by various cultural and religious beliefs. However, the practice of sleep medicine as a specialty has been inadequate compared to other regions of the world. The objective of this study was to explore the current status of sleep medicine in Africa vis-à-vis education, professional societies, and facilities, and to identify challenges of the specialty in the region. A literature search of major electronic databases (PubMed, Google Scholar) was done. This revealed that there is a high prevalence of sleep disorders in Africa and a significant association with epilepsy, human African trypanosomiasis, human immunodeficiency virus, and other diseases. There are 6 sleep societies in Africa located in 4 countries. Forty-one sleep laboratories were identified located in 4 countries. The challenges hindering development of sleep medicine in Africa include lack of awareness, poor funding, lack of facilities, and inadequate training.
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http://dx.doi.org/10.5664/jcsm.9218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8314674PMC
June 2021

Factors associated with hypertension among stroke-free indigenous Africans: Findings from the SIREN study.

J Clin Hypertens (Greenwich) 2021 04 23;23(4):773-784. Epub 2021 Jan 23.

Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Hypertension is one of the most important risk factors for stroke and cardiovascular diseases (CVD) globally. Understanding risk factors for hypertension among individuals with matching characteristics with stroke patients may inform primordial/primary prevention of hypertension and stroke among them. This study identified the risk factors for hypertension among community-dwelling stroke-free population in Ghana and Nigeria. Data for 4267 community-dwelling stroke-free controls subjects in the Stroke Investigative Research and Education Network (SIREN) study in Nigeria and Ghana were used. Participants were comprehensively assessed for sociodemographic, lifestyle and metabolic factors using standard methods. Hypertension was defined as a previous diagnosis by a health professional or use of an anti-hypertensive drug or mean systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Logistic regression analysis was used to estimate adjusted odds ratios (aOR) of hypertension and their 95% confidence intervals (CI) at p < .05. Overall, 56.7% of the participants were hypertensive with a higher proportion among respondents aged ≥60 years (53.0%). Factors including physical inactivity (aOR: 9.09; 95% CI: 4.03 to 20.53, p < .0001), diabetes (aOR: 2.70; CI: 1.91 to 3.82, p < .0001), being ≥60 years (aOR: 2.22; 95% CI: 1.78 to 2.77, p < .0001), and family history of CVD (aOR 2.02; CI: 1.59 to 2.56, p < .0001) were associated with increased aOR of hypertension. Lifestyle factors were associated with hypertension in the current population of community-dwelling stroke-free controls in west Africa. Community-oriented interventions to address sedentary lifestyles may benefit this population and reduce/prevent hypertension and stroke among them.
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http://dx.doi.org/10.1111/jch.14183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263562PMC
April 2021

Translation and validation of an epilepsy-screening questionnaire in three Nigerian languages.

Epilepsy Behav 2021 01 30;114(Pt A):107604. Epub 2020 Nov 30.

NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, the Netherlands. Electronic address:

Objective: We describe the development, translation and validation of epilepsy-screening questionnaires in the three most popular Nigerian languages: Hausa, Igbo and Yoruba.

Methods: A 9-item epilepsy-screening questionnaire was developed by modifying previously validated English language questionnaires. Separate multilingual experts forward- and back-translated them to the three target languages. Translations were discussed with fieldworkers and community members for ethnolinguistic acceptability and comprehension. We used an unmatched affected-case versus unaffected-control design for the pilot study. Cases were people with epilepsy attending the tertiary hospitals where these languages are spoken. The controls were relatives of cases or people attending for other medical conditions. An affirmative response to any of the nine questions amounted to a positive screen for epilepsy.

Results: We recruited 153 (75 cases and 78 controls) people for the Hausa version, 106 (45 cases and 61 controls) for Igbo and 153 (66 cases and 87 controls) for the Yoruba. The sensitivity and specificity of the questionnaire were: Hausa (97.3% and 88.5%), Igbo (91.1% and 88.5%) and Yoruba (93.9% and 86.7%). The three versions reliably indicated epilepsy with positive predictive values of 85.9% (Hausa), 85.4% (Igbo) and 87.3% (Yoruba) and reliably excluded epilepsy with negative predictive values of 97.1% (Hausa), 93.1% (Igbo) and 95.1% (Yoruba). Positive likelihood ratios were all greater than one.

Conclusions: Validated epilepsy screening questionnaires are now available for the three languages to be used for community-based epilepsy survey in Nigeria. The translation and validation process are discussed to facilitate usage and development for other languages in sub-Saharan Africa.
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http://dx.doi.org/10.1016/j.yebeh.2020.107604DOI Listing
January 2021

Antecedent febrile illness and occurrence of stroke in West Africa: The SIREN study.

J Neurol Sci 2020 Nov 28;418:117158. Epub 2020 Sep 28.

Department of Medicine, University of Ibadan, Nigeria.

Background: Acute infections have been posited as potential precipitants or triggers of the occurrence of stroke among adults with traditional vascular risk factors. We evaluated associations between stroke occurrence and reported febrile illness within 4 weeks (potential antecedent infections) among West Africans.

Methods: The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with radiologically confirmed strokes. Controls were stroke-free adults matched with cased by age, gender and ethnicity. Detailed evaluations for vascular, lifestyle and psychosocial factors were performed. Participants were asked for evidence of any febrile illness within the past 4 weeks. We used conditional logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval.

Results: Among 3588 stroke cases recruited in Ghana and Nigeria between August 2014 and July 2018, 363 cases (10.1%) reported having a febrile illness within the 4 weeks prior to stroke occurrence. Having an antecedent infection was associated with stroke occurrence with an unadjusted OR of 1.19 (1.00-1.51) but aOR of 0.83 (0.59-1.17) upon adjusting for traditional vascular risk factors. Stress, aOR of 4.69 (2.59-8.50) and consumption of green vegetables 2.27 (1.35-2.85) were associated with antecedent febrile illness.

Conclusion: 1 in 10 stroke cases reported antecedent history of febrile illness prior to occurrence of stroke but no independent association was observed in this study. Infectious exposures may be important triggers of cardiovascular events requiring further exploratory studies to better understand the role of this emerging risk factor.
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http://dx.doi.org/10.1016/j.jns.2020.117158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006213PMC
November 2020

Parkinson's Disease Research on the African Continent: Obstacles and Opportunities.

Front Neurol 2020 19;11:512. Epub 2020 Jun 19.

Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.

The burden of Parkinson's disease (PD) is becoming increasingly important in the context of an aging African population. Although PD has been extensively investigated with respect to its environmental and genetic etiology in various populations across the globe, studies on the African continent remain limited. In this Perspective article, we review some of the obstacles that are limiting research and creating barriers for future studies. We summarize what research is being done in four sub-Saharan countries and what the key elements are that are needed to take research to the next level. We note that there is large variation in neurological and genetic research capacity across the continent, and many opportunities for unexplored areas in African PD research. Only a handful of countries possess appropriate infrastructure and personnel, whereas the majority have yet to develop such capacity. Resource-constrained environments strongly determines the possibilities of performing research locally, and unidirectional export of biological samples and genetic data remains a concern. Local-regional partnerships, in collaboration with global PD consortia, should form an ethically appropriate solution, which will lead to a reduction in inequality and promote capacity building on the African continent.
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http://dx.doi.org/10.3389/fneur.2020.00512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317302PMC
June 2020

The Nigeria Parkinson Disease Registry: Process, Profile, and Prospects of a Collaborative Project.

Mov Disord 2020 08 19;35(8):1315-1322. Epub 2020 Jun 19.

Muritala Muhammed Specialist Hospital, Kano, Kano State, Nigeria.

Background: Clinical disease registries are useful for quality improvement in care, benchmarking standards, and facilitating research. Collaborative networks established thence can enhance national and international studies by generating more robust samples and credible data and promote knowledge sharing and capacity building. This report describes the methodology, baseline data, and prospects of the Nigeria Parkinson Disease Registry.

Methods: This national registry was established in November 2016. Ethics approval was obtained for all sites. Basic anonymized data for consecutive cases fulfilling the United Kingdom Parkinson's Disease Brain Bank criteria (except the exclusion criterion of affected family members) are registered by participating neurologists via a secure registry website (www.parkinsonnigeria.com) using a minimal common data capture format.

Results: The registry had captured 578 participants from 5 of 6 geopolitical zones in Nigeria by July 2019 (72.5% men). Mean age at onset was 60.3 ± 10.7 years; median disease duration (interquartile range) was 36 months (18-60.5 months). Young-onset disease (<50 years) represented 15.2%. A family history was documented in 4.5% and 7.8% with age at onset <50 and ≥ 50, respectively. The most frequent initial symptom was tremor (45.3%). At inclusion, 93.4% were on treatment (54.5% on levodopa monotherapy). Per-capita direct cost for the registry was $3.37.

Conclusions: This is the first published national Parkinson's disease registry in sub-Saharan Africa. The registry will serve as a platform for development of multipronged evidence-based policies and initiatives to improve quality of care of Parkinson's disease and research engagement in Nigeria. © 2020 International Parkinson and Movement Disorder Society.
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http://dx.doi.org/10.1002/mds.28123DOI Listing
August 2020

The performance of a low-cost bio-amplifier on 3D human arm movement reconstruction.

Biomed Tech (Berl) 2020 Oct;65(5):577-585

Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria.

Objectives In this study, the performance of OpenBCI, a low-cost bio-amplifier, is assessed when used for 3D motion reconstruction. Methods Eleven scalp electrode locations from three subjects were used, with sampling rate of 125 Hz, subsequently band-pass filtered from 0.5 to 40 Hz. After segmentation into epochs, information-rich frequency ranges were determined using filter bank common spatial filter. Simultaneously, the actual hand motions of subjects were captured using a Microsoft Kinect sensor. Multimodal data streams were synchronized using the lab streaming layer (LSL) application. A modified version of an existing multiple linear regression models was employed to learn the relationship between the electroencephalography (EEG) feature input and the recorded kinematic data. To assess system performance with limited data, 10-fold cross validation was used. Results The most information-rich frequency bands for subjects were found to be in the ranges of 5 - 9 Hz and 33 - 37 Hz. Hand lateralization accuracy for the three subjects were 97.4, 78.7 and 96.9% respectively. 3D position reconstructed with an average correlation coefficient of 0.21, 0.47 and 0.38 respectively along three pre-defined axes, with the corresponding average correlation coefficients for velocity being 0.21, 0.36 and 0.25 respectively. The results compare favourably with a cross-section of existing results, while cost-per-electrode costs were 76% lower than the average per-electrode cost for similar systems and 44% lower than the cheapest previously-reported system. Conclusions This study has shown that low-cost bio-amplifiers such as the OpenBCI can be used for 3D motion reconstruction tasks.
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http://dx.doi.org/10.1515/bmt-2019-0085DOI Listing
October 2020

Sonographic soft tissue arthritic changes associated with post-stroke hemiplegic knee pain: utility of musculoskeletal ultrasound in a resource-limited setting.

Pol J Radiol 2020 27;85:e45-e52. Epub 2020 Jan 27.

Department of Radiology, Obafemi Awolowo University, Ile-Ife, Nigeria.

Purpose: Post-stroke arthritic changes that may compromise rehabilitation have been described in the upper and lower limbs. We aimed at evaluating the soft tissue arthritic changes associated with pain in hemiplegic knees of stroke patients in our environment.

Material And Methods: Hemiplegic and non-hemiplegic knees of 48 stroke patients as well as both knees of 26 apparently healthy controls were evaluated with a 7.5-12 MHz linear ultrasound probe. History of knee pain, and socio-demographic, laboratory, and clinical data were recorded for all study participants. Muscle tone and power as well as functional ambulatory category (FAC) were graded for the stroke patients. Data was analysed using SPSS version 20.

Results: Pain was reported more often in hemiplegic than non-hemiplegic knees ( = 16 vs. = 6, = 0.021). The frequencies of soft tissue arthritic changes found, which included reduced lateral and medial femoral cartilage thickness, suprapatellar effusion, and irregular cartilage-bone margin, were similar between hemiplegic and non-hemiplegic knees ( > 0.05). Suprapatellar effusion and reduced lateral femoral cartilage thickness were more prevalent in the hemiplegic knees compared to the healthy control knees ( < 0.05). Stroke patients with pes anserinus tendinosis had greater risk of hemiplegic knee pain (HKP) when compared to stroke patients without this lesion (OR = 10; 95% CI: 1.7-61). FAC, muscle tone, and power showed no association with HKP.

Conclusions: Soft tissue arthritic changes associated with knee pain are comparable between hemiplegic and non-hemiplegic knees of stroke patients. The risk of knee pain in stroke is higher in the presence of pes anserinus tendinosis.
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http://dx.doi.org/10.5114/pjr.2020.93149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064013PMC
January 2020

Effect of Health Education on Level of Awareness and Knowledge of Nigerian In-School adolescents on Stroke and Its Risk Factors.

J Stroke Cerebrovasc Dis 2020 May 12;29(5):104757. Epub 2020 Mar 12.

Department of Community Health, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

Background: Stroke education in adolescents has been established as an effective method of creating awareness about stroke, its warning signs and risk factors. It contributes to desired behavioural change in the adolescents as well as their parents. Thus, we aimed to determine the baseline knowledge of school attending adolescents about stroke and its risk factors as well as the effect of stroke education on their stroke awareness.

Methods: This study employed a quasi-experimental study design and was conducted in secondary schools in Ile-Ife, Osun State, Nigeria. The schools were divided into intervention and control groups. We assessed the baseline knowledge of the students on stroke, its risk factors, warning signs, and ways of preventing it using a pre-tested structured questionnaire in both intervention and control groups. In the intervention group, health talks on stroke consisting of oral presentation and distribution of fliers were presented for 30 minutes in each selected school. Each school was visited 2 weeks after the health education intervention to assess their knowledge on stroke, its risk factors, and ways of preventing it. The control group was also visited after 2 weeks for a re-assessment of their stroke knowledge and the conduct of heath talk on other aspects of neurology such as sleep, epilepsy, etc. Results: A total of 1259 adolescents were studied with 661 in the intervention group and 598 in the control group. The mean age of the respondents was 13.56 ± 2.87 the intervention group and 13.38 ± 2.06 in the control group. There were higher mean scores on knowledge of stroke and its risk factors among the intervention group than seen in the control group after the stroke education.

Conclusions: Stroke education is an effective way of creating and maintaining stroke awareness among school-attending adolescents.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104757DOI Listing
May 2020

Unraveling the risk factors for spontaneous intracerebral hemorrhage among West Africans.

Neurology 2020 03 19;94(10):e998-e1012. Epub 2020 Feb 19.

From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria.

Objective: To characterize risk factors for spontaneous intracerebral hemorrhage (sICH) occurrence and severity among West Africans.

Methods: The Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case-control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT-confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors.

Results: Of 2,944 adjudicated stroke cases, 854 were intracerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were nonlobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78-213.72); dyslipidemia, 2.95 (1.84-4.74); meat consumption, 1.55 (1.01-2.38); family history of CVD, 2.22 (1.41-3.50); nonconsumption of green vegetables, 3.61 (2.07-6.31); diabetes mellitus, 2.11 (1.29-3.46); stress, 1.68 (1.03-2.77); and current tobacco use, 14.27 (2.09-97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were nonconsumption of leafy green vegetables, 2.03 (1.43-2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00-1.01); presence of midline shift, 1.54 (1.11-2.13); lobar ICH, 1.72 (1.16-2.55); and supratentorial bleeds, 2.17 (1.06-4.46).

Conclusions: Population-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.
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http://dx.doi.org/10.1212/WNL.0000000000009056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238923PMC
March 2020

Targeted next-generation sequencing identifies novel variants in candidate genes for Parkinson's disease in Black South African and Nigerian patients.

BMC Med Genet 2020 02 4;21(1):23. Epub 2020 Feb 4.

Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.

Background: The prevalence of Parkinson's disease (PD) is increasing in sub-Saharan Africa, but little is known about the genetics of PD in these populations. Due to their unique ancestry and diversity, sub-Saharan African populations have the potential to reveal novel insights into the pathobiology of PD. In this study, we aimed to characterise the genetic variation in known and novel PD genes in a group of Black South African and Nigerian patients.

Methods: We recruited 33 Black South African and 14 Nigerian PD patients, and screened them for sequence variants in 751 genes using an Ion AmpliSeq™ Neurological Research panel. We used bcftools to filter variants and annovar software for the annotation. Rare variants were prioritised using MetaLR and MetaSVM prediction scores. The effect of a variant on ATP13A2's protein structure was investigated by molecular modelling.

Results: We identified 14,655 rare variants with a minor allele frequency ≤ 0.01, which included 2448 missense variants. Notably, no common pathogenic mutations were identified in these patients. Also, none of the known PD-associated mutations were found highlighting the need for more studies in African populations. Altogether, 54 rare variants in 42 genes were considered deleterious and were prioritized, based on MetaLR and MetaSVM scores, for follow-up studies. Protein modelling showed that the S1004R variant in ATP13A2 possibly alters the conformation of the protein.

Conclusions: We identified several rare variants predicted to be deleterious in sub-Saharan Africa PD patients; however, further studies are required to determine the biological effects of these variants and their possible role in PD. Studies such as these are important to elucidate the genetic aetiology of this disorder in patients of African ancestry.
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http://dx.doi.org/10.1186/s12881-020-0953-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001245PMC
February 2020

Echocardiographic Abnormalities and Determinants of 1-Month Outcome of Stroke Among West Africans in the SIREN Study.

J Am Heart Assoc 2019 06 30;8(11):e010814. Epub 2019 May 30.

1 Center for Genomic and Precision Medicine University of Ibadan Ibadan Nigeria.

Background Little is known about the relationship between echocardiographic abnormalities and outcome among patients with acute stroke. We investigated the pattern and association of baseline echocardiographic variables with 1-month disability and mortality among patients with stroke in the SIREN (Stroke Investigative Research and Education Network) study. Methods and Results We enrolled and followed up consecutive 1020 adult patients with acute stroke with baseline transthoracic echocardiography from west Africa. To explore the relationship between echocardiographic variables and 1-month disability (using modified Rankin scale >3) and fatality, regression models were fitted. Relative risks were computed with 95% CIs. The participants comprised 60% men with a mean age of 59.2±14.6 years. Ischemic stroke was associated with smaller aortic root diameter (30.2 versus 32.5, P=0.018) and septal (16.8 versus 19.1, P<0.001) and posterior wall thickness at systole (18.9 versus 21.5, P=0.004). Over 90% of patients with stroke had abnormal left ventricular (LV) geometry with eccentric hypertrophy predominating (56.1%). Of 13 candidate variables investigated, only baseline abnormal LV geometry (concentric hypertrophy) was weakly associated with 1-month disability (unadjusted relative risk, 1.80; 95% CI , 0.97-5.73). Severe LV systolic dysfunction was significantly associated with increased 1-month mortality (unadjusted relative risk, 3.05; 95% CI , 1.36-6.83). Conclusions Nine of 10 patients with acute stroke had abnormal LV geometry and a third had systolic dysfunction. Severe LV systolic dysfunction was significantly associated with 1 month mortality. Larger studies are required to establish the independent effect and unravel predictive accuracy of this association.
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http://dx.doi.org/10.1161/JAHA.118.010814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585359PMC
June 2019

Differential Impact of Risk Factors on Stroke Occurrence Among Men Versus Women in West Africa.

Stroke 2019 04;50(4):820-827

Centre for Genomic and Precision Medicine, University of Ibadan, Nigeria (R.A., A.A., M.O.).

Background and Purpose- The interplay between sex and the dominant risk factors for stroke occurrence in sub-Saharan Africa has not been clearly delineated. We compared the effect sizes of risk factors of stroke by sex among West Africans. Methods- SIREN study (Stroke Investigative Research and Educational Networks) is a case-control study conducted at 15 sites in Ghana and Nigeria. Cases were adults aged >18 years with computerized tomography/magnetic resonance imaging confirmed stroke, and controls were age- and sex-matched stroke-free adults. Comprehensive evaluation for vascular, lifestyle, and psychosocial factors was performed using validated tools. We used conditional logistic regression to estimate odds ratios and reported risk factor specific and composite population attributable risks with 95% CIs. Results- Of the 2118 stroke cases, 1193 (56.3%) were males. The mean±SD age of males was 58.1±13.2 versus 60.15±14.53 years among females. Shared modifiable risk factors for stroke with adjusted odds ratios (95% CI) among females versus males, respectively, were hypertension [29.95 (12.49-71.77) versus 16.1 0(9.19-28.19)], dyslipidemia [2.08 (1.42-3.06) versus 1.83 (1.29-2.59)], diabetes mellitus [3.18 (2.11-4.78) versus 2.19 (1.53-3.15)], stress [2.34 (1.48-3.67) versus 1.61 (1.07-2.43)], and low consumption of green leafy vegetables [2.92 (1.89-4.50) versus 2.00 (1.33-3.00)]. However, salt intake and income were significantly different between males and females. Six modifiable factors had a combined population attributable risk of 99.1% (98.3%-99.6%) among females with 9 factors accounting for 97.2% (94.9%-98.7%) among males. Hemorrhagic stroke was more common among males (36.0%) than among females (27.6%), but stroke was less severe among males than females. Conclusions- Overall, risk factors for stroke occurrence are commonly shared by both sexes in West Africa favoring concerted interventions for stroke prevention in the region.
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http://dx.doi.org/10.1161/STROKEAHA.118.022786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6433514PMC
April 2019

Parkinson's disease in Nigeria: A review of published studies and recommendations for future research.

Parkinsonism Relat Disord 2019 05 8;62:36-43. Epub 2018 Dec 8.

Neurology Unit, Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. Electronic address:

Parkinson's disease (PD) affects 1-2% of individuals above 60 years amounting to over 7 million people worldwide. Thus, PD has become an important contributor to the neurological disease burden. Nigeria is the most populous country in Africa, and alarmingly, approximately 5.25 million Nigerians are above 65 years and are therefore at risk for developing PD. We carried out a critical review of published literature on PD in Nigeria to summarize the findings and to evaluate gaps in knowledge. Seven electronic databases were searched for studies published in English before 18th July 2018. Search terms were ["Parkinson's disease" OR "Parkinson disease" OR "parkinsonian disorders" OR "Parkinsonism"] AND "Nigeria". A total of 44 articles (including eight reviews) published since 1969 were identified and reviewed. Amongst the original research articles, most (23) were on PD symptoms or prevalence. There were only two studies on genetics and two on environmental factors. The estimated crude prevalence of PD in Nigeria was lower (10-249/100 000) compared to studies published in Europe (65.6-12 500/100 000). Our findings suggest that PD is under-diagnosed in Nigeria. Possible environmental risk factors identified include blacksmithing and well-water contaminated with trace metals. Given the rising numbers of the ageing population in Nigeria, more studies to evaluate the prevalence and causes of PD in this country are urgently needed. To this end, more funding, resources and a workforce of well-trained neurologists and scientists are essential to manage the impending health burden of PD and related disorders in this country.
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http://dx.doi.org/10.1016/j.parkreldis.2018.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556138PMC
May 2019

Knowledge, attitudes and practices related to stroke in Ghana and Nigeria: A SIREN call to action.

PLoS One 2018 16;13(11):e0206548. Epub 2018 Nov 16.

University of Ghana Medical School, Accra, Ghana.

Introduction: Stroke is a prominent cause of death, disability, and dementia in sub-Saharan Africa (SSA). The Stroke Investigative Research and Education Network works collaboratively with stroke survivors and individuals serving as community controls to comprehensively characterize the genomic, sociocultural, economic and behavioral risk factors for stroke in SSA.

Purpose: In this paper, we aim to: i) explore the attitudes, beliefs, and practices related to stroke in Ghana and Nigeria using the process of qualitative description; and ii) propose actions for future research and community-based participation and education.

Methods: Stroke survivors, their caregivers, health care professionals, and community representatives and faith-based leaders participated in one of twenty-six focus groups, which qualitatively explored community beliefs, attitudes and practices related to stroke in Ghana and Nigeria. Arthur Kleinman's Explanatory Model of Illness and the Social Ecological Model guided the questions and/or thematic analysis of the qualitative data. We hereby describe our focus group methods and analyses of qualitative data, as well as the findings and suggestions for improving stroke outcomes.

Results And Discussion: The major findings illustrate the fears, causes, chief problems, treatment, and recommendations related to stroke through the views of the participants, as well as recommendations for working effectively with the SIREN communities. Findings are compared to SIREN quantitative data and other qualitative studies in Africa. As far as we are aware, this is the first paper to qualitatively explore and contrast community beliefs, attitudes, and practices among stroke survivors and their caregivers, community and faith-based leaders, and health professionals in multiple communities within Nigeria and Ghana.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206548PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6239297PMC
April 2019

Sleep pattern, socioenvironmental factors, and use of electronic devices among Nigerian school-attending adolescents.

Sleep Health 2018 12 23;4(6):551-557. Epub 2018 Oct 23.

Department of Community Medicine, Osun State University, Osogbo, Nigeria.

Objectives: To determine the sleep pattern among Nigerian school-attending adolescents and its association with socioenvironmental factors and the use of electronic devices.

Design: Descriptive cross-sectional survey.

Setting: Public and private secondary schools in Ile-Ife, Osun State, Nigeria.

Participants: Multistage sampling technique was used to select 346 school-attending adolescents aged 10-19 years.

Measurements: A modified version of the Adolescent Sleep Habits Survey Questionnaire was administered to respondents in the school setting using the facilitated self-administration method.

Results: Participants' mean age was 13.5±2.29 years, and the male-female ratio was 1:1.1. The mean total sleep duration on weekends of 9 hours (h) 08 minutes (min) ± 113 min was significantly higher than that of weekdays (7 h 15 min ± 86 min) (P < .001). About half of the respondents (48.7 %) had access to a computer. Majority of the respondents (80.9%) use one or more electronic device at bedtime, although cell phone was used by more than half (52.3%) of the respondents at bedtime. The proportion of adolescents with short sleep duration was 44.4% for weekdays and 5.5% for weekends. Lower social class and non-use of computers in the night time were independent predictors of adequate sleep duration on weekdays, whereas female sex, age (early adolescence), and polygamous family setting were independent predictors of sufficient sleep on weekends.

Conclusion: A high proportion of school-attending adolescents have insufficient sleep on weekdays and significantly sleep less during weekdays compared to weekends. There is a need to target adolescents, parents, and school authorities with education on sleep issues.
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http://dx.doi.org/10.1016/j.sleh.2018.09.002DOI Listing
December 2018

Knowledge, attitudes and practices of West Africans on genetic studies of stroke: Evidence from the SIREN Study.

Int J Stroke 2019 01 24;14(1):69-79. Epub 2018 Jul 24.

7 Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria.

Background: It is crucial to assess genomic literacy related to stroke among Africans in preparation for the ethical, legal and societal implications of the genetic revolution which has begun in Africa.

Objective: To assess the knowledge, attitudes and practices (KAP) of West Africans about stroke genetic studies.

Methods: A comparative cross-sectional study was conducted among stroke patients and stroke-free controls recruited across 15 sites in Ghana and Nigeria. Participants' knowledge of heritability of stroke, willingness to undergo genetic testing and perception of the potential benefits of stroke genetic research were assessed using interviewer-administered questionnaire. Descriptive, frequency distribution and multiple regression analyses were performed.

Results: Only 49% of 2029 stroke patients and 57% of 2603 stroke-free individuals knew that stroke was a heritable disorder. Among those who knew, 90% were willing to undergo genetic testing. Knowledge of stroke heritability was associated with having at least post-secondary education (OR 1.51, 1.25-1.81) and a family history of stroke (OR 1.20, 1.03-1.39) while Islamic religion (OR=0.82, CI: 0.72-0.94), being currently unmarried (OR = 0.81, CI: 0.70-0.92), and alcohol use (OR = 0.78, CI: 0.67-0.91) were associated with lower odds of awareness of stroke as a heritable disorder. Willingness to undergo genetic testing for stroke was associated with having a family history of stroke (OR 1.34, 1.03-1.74) but inversely associated with a medical history of high blood pressure (OR = 0.79, 0.65-0.96).

Conclusion: To further improve knowledge of stroke heritability and willingness to embrace genetic testing for stroke, individuals with less formal education, history of high blood pressure and no family history of stroke require targeted interventions.
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http://dx.doi.org/10.1177/1747493018790059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325169PMC
January 2019

Biobanking in a Challenging African Environment: Unique Experience from the SIREN Project.

Biopreserv Biobank 2018 Jun 7;16(3):217-232. Epub 2018 May 7.

Neurology Unit, Department of Medicine, Federal Medical Center, Umuahia, Nigeria.

Africa was previously insufficiently represented in the emerging discipline of biobanking despite commendable early efforts. However, with the Human, Heredity, and Health in Africa (H3Africa) initiative, biorepository science has been bolstered, regional biobanks are springing up, and awareness about biobanks is growing on the continent. The Stroke Investigative Research and Educational Network (SIREN) project is a transnational, multicenter, hospital and community-based study involving over 3000 cases and 3000 controls recruited from 16 sites in Ghana and Nigeria. SIREN aims to explore and unravel the genetic and environmental factors that interact to produce the peculiar phenotypic and clinical characteristics of stroke as seen in people of African ancestry and facilitate the development of new diagnostics, therapeutics, and preventative strategies. The aim of this article is to describe our experience with the development of the procedure for collection, processing, storage, and shipment of biological samples (blood, serum, plasma, buffy coat, red cell concentrates, and DNA) and brain imaging across coordinating and participating sites within the SIREN Project. The SIREN network was initiated in 2014 with support and funding from the H3Africa Initiative. The SIREN Biobank currently has 3015 brain images, 92,950 blood fractions (serum, plasma, red cell concentrates, and buffy coat) accrued from 8450 recruited subjects, and quantified and aliquoted good-quality DNA extracts from 6150 study subjects. This represents an invaluable resource for future research with expanding genomic and trans-omic technologies. This will facilitate the involvement of indigenous African samples in cutting-edge stroke genomics and trans-omics research. It is, however, critical to effectively engage African stroke patients and community members who have contributed precious biological materials to the SIREN Biobank to generate appropriate evidence base for dealing with ethical, legal, and social issues of privacy, autonomy, identifiability, biorights, governance issues, and public understanding of stroke biobanking in the context of unique African culture, language, and belief systems.
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http://dx.doi.org/10.1089/bio.2017.0113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995267PMC
June 2018

Cost burden of neuroimaging during one-time admission for first-ever acute stroke in Nigeria.

Neurosciences (Riyadh) 2018 Apr;23(2):122-128

Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.

Objective: To determine the cost burden of Neuroimaging and its contribution to direct total hospitalization costs (HCs) during one-time admission for first-ever stroke.

Methods: The clinical characteristics, direct itemised costs and total HCs for 170 consecutive patients with first-ever stroke, admitted at our public tertiary health facility over a 15-month period were evaluated.

Results: The records of 170 stroke subjects were reviewed. The median total HCs for one-time admission per stroke patient was $183.30 with a median daily cost of $15.86. Median cost of radiological investigations was the highest among the categorized hospital costs. Among the radiological investigations, neuroimaging accounted for at least 99% of cost to patients.

Conclusion: The financial burden of radiological investigations, particularly neuroimaging, is high during one-time admission of patients with first-ever stroke in our environment.
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http://dx.doi.org/10.17712/nsj.2018.2.20170404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015451PMC
April 2018

Association of traditional cardiovascular risk factors with carotid atherosclerosis among adults at a teaching hospital in south-western Nigeria.

Cardiovasc J Afr 2018 May/Jun 23;29(3):183-188. Epub 2018 Feb 28.

Department of Radiology, Obafemi Awolowo University teaching hospitals complex, Ile-Ife, Nigeria.

Background: Traditional cardiovascular risk factors (CVRFs), which include age, gender, hypertension, diabetes mellitus, dyslipidaemia, smoking, alcohol consumption, chronic kidney disease and obesity, have been shown to be associated with atherosclerosis. We aimed to evaluate the impact of traditional CVRFs on carotid atherosclerosis (CA) in a sample of Nigerian adults.

Methods: We examined 162 subjects with traditional CVRFs in a cross-sectional study. Demographic and clinical data, including history of hypertension, diabetes mellitus, smoking, alcohol intake and chronic kidney disease, as well as systolic and diastolic blood pressure, weight and height were collected. Serum creatinine, fasting blood glucose and lipid profiles were also determined. Carotid intima-media thickness (CIMT) and presence of carotid plaque (CP) were evaluated by high-frequency B-mode ultrasound. Chi-squared and regression analyses were carried out to determine associations between variables of CIMT and CVRF.

Results: Increased CIMT was associated with all CVRFs (p < 0.05) except gender (p > 0.05), while CP was associated with older age, obesity, hypertension and dyslipidaemia (p < 0.05). We found prevalence of increased CIMT was 53.7%, while that of CP was 16.1%. The prevalence of CA (increased CIMT and CP) also increased with increasing number of CVRFs in the subjects. Age ≥ 50 years, hypertension, dyslipidaemia, obesity and alcohol intake explained 78.7% of variance in CIMT, while age ≥ 50 years and hypertension explained 38.0% of variance in CP.

Conclusions: CA was associated with presence and increasing number of traditional CVRFs. A significant percentage of variance in CA was, however, unexplained by traditional CVRFs.
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http://dx.doi.org/10.5830/CVJA-2018-014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107829PMC
January 2019

Restless legs syndrome: a rarity in the Nigerian pregnant population?

Sleep Med 2018 03 31;43:47-53. Epub 2018 Jan 31.

Department of Chemical Pathology, Obafemi Awolowo University, Ile-Ife, Nigeria.

Objectives: The prevalence of RLS in pregnancy is higher when compared with the general population however it remains unknown among indigenous black Africans. Available data indicate that RLS is uncommon in sub-Saharan Africa. We embarked on this study to determine the prevalence and characteristics of RLS in an antenatal clinic sample of Nigerian pregnant women compared with a primary care sample of non-pregnant women.

Methods: A total of 310 pregnant women and non-pregnant women filled out a questionnaire which incorporated the 2014 minimal criteria of the International Restless Legs Syndrome Study Group. Demographic and clinical data, including sleep duration and samples for blood hemoglobin concentration and urinalysis were obtained.

Results: The mean ages of the pregnant and non-pregnant women were 24.9 ± 5.6 years and 23.6 + 5.4 years, respectively (p = 0.003). There was no case of RLS found among pregnant women while five (1.6%) of the non-pregnant women fulfilled the criteria for RLS. Overall, the prevalence report of RLS symptoms was associated with lower mean habitual nocturnal sleep duration (p < 0.05) coffee (p = 0.013) and kola nut (0.023) consumption, report of leg cramps (p < 0.001) and proteinuria (p = 0.047), Report of leg cramps and proteinuria were independently associated with RLS.

Conclusion: The prevalence of restless legs syndrome is low among women of child-bearing age in the Nigerian population and may be lower in pregnancy. Report of leg cramps and proteinuria are independently associated with RLS.
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http://dx.doi.org/10.1016/j.sleep.2018.01.002DOI Listing
March 2018

Sonographic detection of inferior subluxation in post-stroke hemiplegic shoulders.

J Ultrason 2017 Jun 30;17(69):106-112. Epub 2017 Jun 30.

Departments of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.

Aim Of The Study: To evaluate the usefulness of ultrasonographic acromion-greater tuberosity distance measurement and Shoulder ratio in detecting post-stroke inferior shoulder subluxation.

Material And Methods: Forty-five hemiplegic stroke patients and 45 controls underwent shoulder sonography to measure their acromion-greater tuberosity distance. Side-to-side acromion-greater tuberosity distance differences and Shoulder ratios were derived from the acromion-greater tuberosity distance values. The long head of biceps tendon, subscapularis tendon, supraspinatus tendon, and the infraspinatus tendon were also evaluated to exclude full thickness tendon tears. Data were analyzed using the Statistical Package for Social Sciences version 20.0 for windows. Normality of data distribution was checked using the Kolmogorov-Smirnov test. Mann-Whitney U test and Chi-square tests were utilized.

Results: Hemiplegic and control shoulders' acromion-greater tuberosity distance values were 2.8 ± 0.6 cm and 2.4 ± 0.4 cm, respectively ( = 0.001). Hemiplegic and control shoulder ratios were 1.3 ± 0.3 and 1.1 ± 0.1, respectively; < 0.001. Point biserial correlation showed that the presence of subluxation correlated moderately with higher shoulder ratios in all the hemiplegics (r = 0.520; < 0.001).

Conclusion: Our results suggest that acromion-greater tuberosity distance measurement is useful for detecting inferior shoulder subluxation. Shoulder ratio may be of complementary or supplemental value to acromion-greater tuberosity distance difference.
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http://dx.doi.org/10.15557/JoU.2017.0015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5516080PMC
June 2017

Development and Reliability of a User-Friendly Multicenter Phenotyping Application for Hemorrhagic and Ischemic Stroke.

J Stroke Cerebrovasc Dis 2017 Nov 29;26(11):2662-2670. Epub 2017 Jul 29.

University of Ghana Medical School, Accra, Ghana.

Background: Annotation and Image Markup on ClearCanvas Enriched Stroke-phenotyping Software (ACCESS) is a novel stand-alone computer software application that allows the creation of simple standardized annotations for reporting brain images of all stroke types. We developed the ACCESS application and determined its inter-rater and intra-rater reliability in the Stroke Investigative Research and Educational Network (SIREN) study to assess its suitability for multicenter studies.

Methods: One hundred randomly selected stroke imaging reports from 5 SIREN sites were re-evaluated by 4 trained independent raters to determine the inter-rater reliability of the ACCESS (version 12.0) software for stroke phenotyping. To determine intra-rater reliability, 6 raters reviewed the same cases previously reported by them after a month of interval. Ischemic stroke was classified using the Oxfordshire Community Stroke Project (OCSP), Trial of Org 10172 in Acute Stroke Treatment (TOAST), and Atherosclerosis, Small-vessel disease, Cardiac source, Other cause (ASCO) protocols, while hemorrhagic stroke was classified using the Structural lesion, Medication, Amyloid angiopathy, Systemic disease, Hypertensive angiopathy and Undetermined (SMASH-U) protocol in ACCESS. Agreement among raters was measured with Cohen's kappa statistics.

Results: For primary stroke type, inter-rater agreement was .98 (95% confidence interval [CI], .94-1.00), while intra-rater agreement was 1.00 (95% CI, 1.00). For OCSP subtypes, inter-rater agreement was .97 (95% CI, .92-1.00) for the partial anterior circulation infarcts, .92 (95% CI, .76-1.00) for the total anterior circulation infarcts, and excellent for both lacunar infarcts and posterior circulation infarcts. Intra-rater agreement was .97 (.90-1.00), while inter-rater agreement was .93 (95% CI, .84-1.00) for TOAST subtypes. Inter-rater agreement ranged between .78 (cardioembolic) and .91 (large artery atherosclerotic) for ASCO subtypes and was .80 (95% CI, .56-1.00) for SMASH-U subtypes.

Conclusion: The ACCESS application facilitates a concordant and reproducible classification of stroke subtypes by multiple investigators, making it suitable for clinical use and multicenter research.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.06.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624839PMC
November 2017

Interleukin-6 (IL-6) rs1800796 and cyclin dependent kinase inhibitor (CDKN2A/CDKN2B) rs2383207 are associated with ischemic stroke in indigenous West African Men.

J Neurol Sci 2017 Aug 23;379:229-235. Epub 2017 May 23.

University of Ibadan, Ibadan, Nigeria; WFNR-Blossom Specialist Medical Center Ibadan, Nigeria.

Background: Inherited genetic variations offer a possible explanation for the observed peculiarities of stroke in sub - Saharan African populations. Interleukin-6 polymorphisms have been previously associated with ischemic stroke in some non-African populations.

Aim: Herein we investigated, for the first time, the association of genetic polymorphisms of IL-6, CDKN2A- CDKN2B and other genes with ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study.

Methods: Twenty-three previously identified single nucleotide polymorphisms (SNPs) in 14 genes of relevance to the neurobiology of ischemic stroke were investigated. Logistic regression models adjusting for known cardiovascular disease risk factors were constructed to assess the associations of the 23 SNPs in rigorously phenotyped cases (N=429) of ischemic stroke (Men=198; Women=231) and stroke- free (N=483) controls (Men=236; Women=247).

Results: Interleukin-6 (IL6) rs1800796 (C minor allele; frequency: West Africans=8.6%) was significantly associated with ischemic stroke in men (OR=2.006, 95% CI=[1.065, 3.777], p=0.031) with hypertension in the model but not in women. In addition, rs2383207 in CDKN2A/CDKN2B (minor allele A with frequency: West Africans=1.7%) was also associated with ischemic stroke in men (OR=2.550, 95% CI=[1.027, 6.331], p=0.044) with primary covariates in the model, but not in women. Polymorphisms in other genes did not show significant association with ischemic stroke.

Conclusion: Polymorphisms rs1800796 in IL6 gene and rs2383207 in CDKN2A/CDKN2B gene have significant associations with ischemic stroke in indigenous West African men. CDKN2A/CDKN2B SNP rs2383207 is independently associated with ischemic stroke in indigenous West African men. Further research should focus on the contributions of inflammatory genes and other genetic polymorphisms, as well as the influence of sex on the neurobiology of stroke in people of African ancestry.
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http://dx.doi.org/10.1016/j.jns.2017.05.046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546618PMC
August 2017

Correlates of sleep quality and sleep duration in a sample of urban-dwelling elderly Nigerian women.

Sleep Health 2017 08 7;3(4):257-262. Epub 2017 Jun 7.

Department of Family Medicine, State Hospital, Ilesa, Nigeria; Department of Mental Health, State Specialist Hospital, Osogbo, Nigeria.

Objectives: Aging, female sex, and urbanization increase the risk of sleep impairment. Sleep in urban-dwelling elderly African women has been sparsely studied. We studied the characteristics and correlates of sleep quality and habitual sleep duration in a primary care population of urban-living Nigerian women.

Methods: Sleep quality and sleep duration over the previous 1 month were estimated using the Pittsburgh Sleep Quality Index (PSQI). Excessive daytime sleepiness, risk of obstructive sleep apnea (OSA), and depressive symptoms were also assessed.

Results: Of the 428 subjects included, 117 (27.3%) were poor sleepers endorsing PSQI scores >5, whereas 126 (29.4%) slept <7 hours. The poor sleepers were more likely to be obese (P = .022), to have a high risk for OSA (P = .013), and to have clinically significant depressive symptoms (P = .001) compared with the good sleepers. Habitual sleep duration of <7 hours was associated with past oral contraceptive use (P = .025) and a trend toward a higher likelihood of high risk for OSA (P = .05) and coffee consumption (P = .05). On regression, the odds of high risk for OSA were higher with poor sleep quality and sleep duration <7 hours, respectively, whereas the odds of coffee consumption were higher with sleep duration <7 hours.

Conclusions: Poor sleep quality and inadequate sleep are common in our population of elderly women. High risk for OSA independently predicts poor sleep quality and, along with report of coffee consumption, independently predicts habitual sleep duration of <7 hours.
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http://dx.doi.org/10.1016/j.sleh.2017.05.008DOI Listing
August 2017

Stroke in Indigenous Africans, African Americans, and European Americans: Interplay of Racial and Geographic Factors.

Stroke 2017 05 7;48(5):1169-1175. Epub 2017 Apr 7.

From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).

Background And Purpose: The relative contributions of racial and geographic factors to higher risk of stroke in people of African ancestry have not been unraveled. We compared stroke type and contributions of vascular risk factors among indigenous Africans (IA), African Americans (AA), and European Americans (EA).

Methods: SIREN (Stroke Investigative Research and Educational Network) is a large multinational case-control study in West Africa-the ancestral home of 71% AA-whereas REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a cohort study including AA and EA in the United States. Using harmonized assessments and standard definitions, we compared data on stroke type and established risk factors for stroke in acute stroke cases aged ≥55 years in both studies.

Results: There were 811 IA, 452 AA, and 665 EA stroke subjects, with mean age of 68.0±9.3, 73.0±8.3, and 76.0±8.3 years, respectively (<0.0001). Hemorrhagic stroke was more frequent among IA (27%) compared with AA (8%) and EA (5.4%; <0.001). Lacunar strokes were more prevalent in IA (47.1%), followed by AA (35.1%) and then EA (21.0%; <0.0001). The frequency of hypertension in decreasing order was IA (92.8%), followed by AA (82.5%) and then EA (64.2%; <0.0001) and similarly for diabetes mellitus IA (38.3%), AA (36.8%), and EA (21.0%; <0.0001). Premorbid sedentary lifestyle was similar in AA (37.7%) and EA (34.0%) but lower frequency in IA (8.0%).

Conclusions: Environmental risk factors such as sedentary lifestyle may contribute to the higher proportion of ischemic stroke in AA compared with IA, whereas racial factors may contribute to the higher proportion of hypertension and diabetes mellitus among stroke subjects of African ancestry.
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http://dx.doi.org/10.1161/STROKEAHA.116.015937DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404953PMC
May 2017
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