EVALUATION OF SERUM LEVEL OF HOMOCYSTEINE, VITAMIN B12 AND ZINC IN PATIENTS WITH ACUTE ISCHAEMIC STROKE IN ZARIA


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TABLE OF CONTENTS

Title page
Abstract
Table of Contents
Abbreviation/Symbols used

CHAPTER ONE
1.0       INTRODUCTION
1.1       Background
1.2       Statement of problems
1.3       Justification
1.4       Aim and objectives of the study
1.4.1    Aim
1.4.2    Objectives
1.5       Research question/hypothesis

CHAPTER TWO
2.0       LITERATURE REVIEW
2.1       Stroke
2.1.1    Brief History
2.1.2    Epidemiology
2.1.3    Anatomy of the brain
2.1.3.1 Gross
2.1.3.2 Arterial distribution
2.1.4    Aetiology and classification of stroke
2.1.5    Risk factors for stroke
2.1.6    Pathophysiology of stroke
2.1.6.1 Molecular pathophysiology of stroke
2.1.6.2 Pathology of stroke
2.1.7    Clinical features
2.1.8    Investigation of patient with stroke
2.1.8.1 Haematological
2.1.8.2 Radiological
2.1.8.3 Microbiological/Immunological
2.1.8.4 Biochemical
2.2       Some Biomedical Markers of Stroke
2.2.1    Homocysteine
2.2.2    Vitamin B12
2.2.3    Zinc
2.3.4    Homocysteine in acute ischaemic stroke
2.3.5    Vitamin B12 in acute ischaemic stroke
2.3.6    Zinc in acute ischaemic stroke

CHAPTER THREE
3.0       MATERIALS AND METHODS
3.1       Background of study area
3.2       Study population
3.2.1    Subjects
3.2.2    Inclusion criteria for patients
3.2.3    Exclusion criteria for patients
3.2.4    Inclusion criteria for controls
3.2.5    Exclusion criteria for controls
3.2.6    Informed consent
3.2.7    Sample size determination
3.2.8    Ethical approval
3.3       Study protocol
3.3.1    Siri raj stroke score
3.4       Specimen collections and processing
3.5       Chemicals
3.6       Equipment
3.7       Analytical methods
3.7.1    Measurement of serum Homocysteine
3.7.1.1 Principle
3.7.1.2 Procedure
3.7.1.3 Calculation
3.7.2 Measurement of serum vitamin B12
3.7.2.1Principle
3.7.2.2 Procedure
3.7.2.3 Calculation
3.7.3    Measurement of serum Zinc
3.7.3.1Principle
3.7.3.2 Procedure
3.7.3.3 Calculation
3.8       Quality Control
3.9       Statistical analysis of the result

CHAPTER FOUR
4.0       RESULTS
4.1       Clinical and demographic characteristics of study population
4.2       Admission homocysteine, vitamin B12 and Zinc (mean±SD) in stroke cases and controls
4.3       Reference intervals of serum homocysteine, Vitamin B12 and Zinc using healthy controls
4.4       Serum levels of homocysteine vitamin B12 and Zinc of ischaemic stroke patients based on different modifying risk factors
4.5:      Frequency of elevated homocysteine, low vitamin B12 and low zinc among controls and patients with ischaemic stroke
4.6:      Serum level of homocysteine vitamin B12 and Zinc of stroke patients based on severity
4.7       Relationship between stroke severity and analytes abnormalities
4.8       Correlation between serum homocysteine and vitamin B12 among stroke patients

CHAPTER FIVE
5.0       DISCUSSION

CHAPTER SIX
6.0       CONCLUSION AND RECOMMENDATIONS
6.1       Summary
6.2       Conclusion
6.3       Recommendations
References
Appendices



ABSTRACT


Stroke has been a global burden, with increasing morbidity and mortality. Several risk factors have been identified, which include: hyperhomocysteinaemia, hypovitaminosis B12, and low zinc levels, which are the now target of preventive strategies. Limited studies have been done on the risk factors (analytes) in our environment hence the current study was undertaken to evaluate the serum levels of homocysteine, vitamin B12 and zinc in patients with acute ischaemic stroke in Zaria and healthy controls. One hundred ischaemic stroke patients on admission confirmed by brain CT-scan or Siri-raj stroke score of less than minus one.(-1) and equal number of apparently healthy age and sex-matched were recruited. Their serum homocysteine, and vitamin B12 were measured using enzyme linked Immunosorbent assay,and zinc was measured using direct colorimetric method. Stroke severity was determined using National Institute of Health Stroke Score (NIHSS). Mean serum homocysteine for patients was significantly higher than that of controls (p<0 .05="" and="" b="" mean="" serum="" span="" vitamin="">12and zinc were significantly lower compared to that of controls (p<0 -1.70="" .05="" 0.04="" 0.19="" 0.54="" 0.90="" 199.72-685.48pg="" 52.26-111.86="" an="" and="" b="" be="" controls="" dl="" for="" found="" from="" g="" healthy="" homocysteine="" intervals="" l="" ml="" mol="" obtained="" odds="" of="" ratio="" reference="" respectively.="" span="" the="" to="" vitamin="" were="" with="">12 and zinc respectively. Hyperhomocysteinaemia was seen in 34%, hypovitaminosis B12 was seen in 81% and low zinc was seen in 46%. Patients with hyperhomocysteinaemia, hypovitaminosis B12 and low zinc presented with more severe neurologic deficits even though the difference was not statistically significant with p-values of 0.946, 0.735, and 0.566 respectively. Elevated serum homocysteine, low vitamin B12 and zinc were found to be associated with ischaemic stroke. There was negative correlation between homocysteine and vitamin B12 and stroke severity and therefore early management of those conditions may be an effective way of decreasing the incidence of stroke in our environment. Vitamin B12 and zinc supplements may be beneficial to patients at risk.




CHAPTER ONE

1.0  INTRODUCTION


1.1  BACKGROUND


Stroke is defined as a clinical syndrome of sudden onset of rapidly developing symptoms or signs of focal and at times global loss of cerebral function, with symptoms lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin (Kameshwaret al, 2012).

The World Health Organization estimates that cardiovascular disease and stroke will be the leading cause of death and disability world wide by 2020 (Lynn,2000). Stroke is one of the leading causes of death in any population, and its prevention is a key strategy in reducing the rate of mortality and morbidity (Hoseinaliet al, 2011). It is the third commonest cause of death in Western industrialised countries (James et al,2000). Stroke is presently the leading cause of disability and the third leading cause of death in United States (US centers, 2007). In the United States, blacks have an age-adjusted risk of death from stroke that is 1.49 times that of whites (Schneider et al, 2004). More than 700,000 persons per year suffer a first time stroke in the United States with 20% of these individuals dying within the first year after stroke (American Heart Association, 2002).If current trend continues, this number is projected to reach one million per year by the year 2020(Ralph et al, 1997). In low income and middle income countries, the burden of stroke and other vascular diseases is likely to increase substantially over time in the next few decades because of their expected health and demographic transition (Ralphet al, 1997).

Globally in 2005, it was estimated that stroke caused 5.7 million deaths, and 87% of these occurred in low income and middle-income countries of the world (Strong et al, 2007).....


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