Articles

Genetic and Molecular Aspects of Ischemic Stroke

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Stroke remains a leading cause of disability and death worldwide, with significant public health implications. Ischemic stroke is classified into various subtypes based on etiology, including large-artery atherosclerosis, small-vessel occlusion, and cardioembolism. The middle cerebral artery is often the most affected. The concept of the ischemic core and penumbra is crucial in understanding stroke pathology, where the core suffers irreversible damage, and the penumbra is at high risk if reperfusion is not timely. Genetic predispositions play a significant role in ischemic stroke, with heritability estimates around 37.9%. Monogenic causes account for 1-5% of cases, while polygenic factors are more prevalent. Genome-wide association studies (GWAS) have identified numerous genetic loci associated with ischemic stroke, revealing the complex genetic architecture of the disease. Molecular pathways such as neuroinflammation, excitotoxicity, oxidative stress, apoptosis, and autophagy are involved in the pathophysiology of ischemic stroke. Understanding these pathways offers potential therapeutic targets. This review aims to synthesise recent genetic studies and provide insights into future directions for research and clinical practice in ischemic stroke, emphasising the importance of personalised medicine and targeted therapies.

Yoga as an Integrated Therapy for Stroke Rehabilitation – A Case Study

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Background and Purpose: A stroke (cerebrovascular accident) is damage to the brain cells from an interruption of their blood supply due to blockage or rupture of an artery to the brain. It is the second-leading cause of death and long-term disability worldwide. The present study is a case report investigating the effect of yoga therapy in addition to acupressure and physiotherapy on activities of daily living and the quality of life of patients after stroke.  

Subject and method:  It is a single case study of 38-year-old women diagnosed with acute ischemic stroke who have chief complaints of loss of function of the left upper and lower limbs, and hypertension. For better management of stroke and recovery, she was undergoing yoga, physiotherapy, and acupuncture treatment in the CAM department at DSVV. The primary outcome measures were activities of daily living by the Barthel index and quality of life by the stroke-specific quality of life scale. The subject received integrated treatment for 12 weeks consisting of 45-minute, 1-hour yoga sessions 6 days a week, regular physiotherapy in the subject’s home, and acupuncture every 2 weeks. The primary outcome data were collected before and after the treatment intervention phase. 

Result: The subject had improved Barthel’s activity and quality of life score. 

Discussion and Conclusion: The results suggest that yoga integrated with other complementary therapies may be beneficial to stroke survivors in rehabilitation.

Quality of Life and Lifestyle Factors among Stroke Survivors and People Living With Osteoarthritis in Port Harcourt Metropolis, Rivers State

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Background: Quality of life (QoL) and Lifestyle factors (LFs) are key determinants of health. Poor QoL and unhealthy lifestyles are global concerns and have been linked to stroke and osteoarthritis (OA).

Aim of the Study: This study determined and compared QoL between stroke survivors and People living with osteoarthritis (PLWOA), and also established association between selected LFs and QoL of the stroke survivors and PLWOA in Port Harcourt Metropolis, Rivers State.

Materials and Methods: The study adopted a comparative cross-sectional design. A multistage sampling technique was used to select 78 stroke survivors and 186 People Living with Osteoarthritis (PLWOA) from the two strata making up Port Harcourt Metropolis – Port Harcourt City Local Government Area (PHALGA) and Obio-Akpor Local Government Area (OBALGA). The World Health Organization Quality of Life Bref (WHOQoL-BREF) Scale was used to measure their current QoL while LFs (Smoking, Alcohol consumption, Physical activity, and Balanced Diet) were selected in line with WHO STEPS instrument for non-communicable diseases (NCDs) from June 2019 to January, 2000. Data were analyzed using the IBM SPSS version 24. Chi-square test statistic was used to compare the proportion of stroke survivors with very poor, poor and good QoL and that of PLWOA. Chi-square test of independence was used to determine association between LFs and QoL of the two groups, and where appropriate Fisher’s exact test. P-value ≤ 0.05 was considered statistically significant.

Results: Results revealed that the proportion of stroke survivors with very poor, poor and good QoL was 18 (23.16%), 53 (67.9%), and 7 (9.0%) compared to 16 (8.6%), 53 (67.9%), and 7 (9.0%) respectively of those of PLWOA. The difference observed between these proportions was statistically significant (Chi-square = 67.097, p-value <0.0001). For association between LFs and QoL, Smoking (Chi-square = 40.678, Fisher’s p-values <0.0001, <0.0001), Alcohol consumption (Chi-square = 26.541, Fisher’s p-values <0.0001, <0.0001), Physical activity (Chi-square = 13.679, Fisher’s p-values 0.001, 0.022), Balanced diet (Chi-square = 39.691, Fisher’s p-values < 0.0001, 0.002) were all associated for stroke survivors and PLWOA respectively.

Conclusion: Majority of stroke survivors and PLWOA had poor QoL. Association exists between LFs and QoL of stroke survivors and PLWOA in the study. There is need for government to collaborate and set up specialized healthcare facilities for stroke survivors and PLWOA in our communities.