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Imam YZ, Kamran S, Saqqur M, Ibrahim F, Chandra P, Perkins JD, Malik RA, Akhtar N, Al-Jerdi S, Deleu D, Elalamy O, Osman Y, Malikyan G, Elkhider H, Elmakki S, ElSheikh L, Mhjob N, Abdelmoneim MS, Alkhawad N, Own A, Shuaib A. Stroke in the adult Qatari population (Q-stroke) a hospital-based retrospective cohort study. PLoS One 2020; 15:e0238865. [PMID: 32956364 PMCID: PMC7505434 DOI: 10.1371/journal.pone.0238865] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Studies assessing the burden of stroke in Qataris are limited. We aim to study stroke in the Qatari population. METHODS A retrospective review was undertaken of all Qatari adults presenting with stroke to Hamad Medical Corporation over a 5-year period. Descriptive statistics were used to summarize demographic and all other clinical characteristics of the patients. The primary outcome was the incidence of stroke in the Qatari patients. Comparison was made between the sexes. RESULTS 862 patients were included, with 58.9% being male. The average incidence of stroke over the 5-year period was 92.04 per 100,000 adult Qatari population. The mean age of the cohort was 64.3±14.4 years, (range 19-105 years). The mean age of first ever cerebrovascular event was 63.2±14.5 years. The diagnosis was ischemic stroke in (73.7%), transient ischemic attack in (13.8%), intracerebral hemorrhage (ICH) in (11.6%), subarachnoid hemorrhage in (0.7%) and (0.2%) cerebral venous sinus thrombosis. Small vessel disease was the most common cause of ischemic stroke accounting for (46.5%), followed by large artery atherosclerosis (24.5%). Hypertension (82.7%) and diabetes (71.6%) were particularly prevalent in this cohort. Females were older (65.8±14.1 vs 63.4±14.5 years), had more hypertension and diabetes and more disability or death at 90 days (p<0.05) compared to Qatari males. CONCLUSION Stroke occurs at a significantly lower age in Qataris compared to the western population. This study has uncovered sex differences that need to be studied further.
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Affiliation(s)
- Yahia Z. Imam
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Faisal Ibrahim
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Jon D. Perkins
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Osama Elalamy
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yasir Osman
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Gayane Malikyan
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Elkhider
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Suha Elmakki
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Lubna ElSheikh
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Noha Mhjob
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Nima Alkhawad
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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Jallow E, Al Hail H, Han TS, Sharma S, Deleu D, Ali M, Al Hussein H, Abuzaid HO, Sharif K, Khan FY, Sharma P. Current status of stroke in Qatar: Including data from the BRAINS study. JRSM Cardiovasc Dis 2019; 8:2048004019869160. [PMID: 31452875 PMCID: PMC6700866 DOI: 10.1177/2048004019869160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/06/2019] [Accepted: 07/18/2019] [Indexed: 12/16/2022] Open
Abstract
Background Qatar is located on the north-eastern coast of the Arabian Peninsula. Qatari natives account for less than 15% of the population while the largest migrant group comprising 60% derives from South Asia. Despite projections that stroke burden in Qatar will increase with population ageing, epidemiological studies focusing on stroke in Qatar are relatively scarce. Method We reviewed the available epidemiological publications relating to Qatar. In addition, we have added to this knowledge by incorporating Qatari data from the on-going Bio-Repository of DNA in Stroke, an independent multinational database of stroke patients. Results Qatar has low reported incidence and mortality rates of 58 and 9.17 per 100,000 per year, respectively, which may be explained by its middle-aged migrant worker majority population. Correspondingly, South Asian migrants in Qatar suffered younger strokes than Qatari natives (48.7 vs 63.4 years, P < 0.001). Among the most common risk factors identified in stroke patients were hypertension (77.9%), diabetes (43.8%) and hypercholesterolemia (28.5%). Ischaemic stroke was the most frequent subtype amongst migrant South Asians (71.1%). The majority of stroke cases had computed tomography and/or magnetic resonance imaging scans, but only 11.1% of ischaemic strokes were thrombolysed. Qataris on one-year follow up were more often found to have died (6.5% vs 0.3%) and had further stroke/transient ischaemic attack events (17.4% vs 6.4%, P = 0.009) compared to South Asians. Conclusion The burden of stroke is increasing in Qatar, and considerable disparities are observed between the native and migrant populations which likely will require different approaches to management by its healthcare system.
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Affiliation(s)
- Ebrima Jallow
- Institute of Cardiovascular Research, Royal Holloway University of London , London, UK
| | | | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London , London, UK
| | - Sapna Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London , London, UK
| | | | - Musab Ali
- Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London , London, UK.,Ashford & St Peters Hospital NHS Foundation Trust, Surrey, UK.,Imperial College Healthcare NHS Trust, London, UK
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Abstract
The present study was conducted to assess stroke care and outcomes in two Lebanese hospitals. Patients admitted in 2012 and 2013 were retrospectively selected. Data were extracted from medical records for time to hospital arrival, stroke severity, management, and discharge outcomes. A Cox regression analysis was then conducted to predict time to in-hospital death. A total of 201 patients were included (mean age = 69.2 years), among whom 50% arrived within a delay of 3.75 hours. Half underwent brain imaging in the first hour, and nine patients received an acute intervention. Forty-four patients died at the hospital; 142 were discharged home, among whom 98 patients were dependent in their daily activities. Stroke severity on admission and time from onset to arrival were found to be significantly associated to the time to in-hospital death (adjusted hazard ratio [HRa] = 1.13 and HRa = 0.98 respectively; p < 0.05). The study sheds light on high case fatality and dependency rates at discharge among stroke patients in Lebanese hospitals.
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Lahoud N, Abbas MH, Salameh P, Saleh N, Abes S, Hosseini H, Gebeily S. A retrospective analysis of 254 acute stroke cases admitted to two university hospitals in Beirut: classification and associated factors. FUNCTIONAL NEUROLOGY 2017; 32:41-48. [PMID: 28380323 PMCID: PMC5505529 DOI: 10.11138/fneur/2017.32.1.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lebanon is a developing country where the prevalence of stroke subtypes and their correlation with risk factors have not been studied, even though stroke management is an ongoing major national healthcare challenge. In a retrospective study conducted in two university hospitals, data were collected on all stroke cases admitted in 2012 and 2013. Ischemic strokes were then classified according to a modified TOAST classification. A total of 254 inpatients (mean age 68.41 years ±13.34, 55.1% males) was included in the study; of these, 15% had had a hemorrhagic stroke and was therefore excluded. Conversely to findings from studies in other Arab and Asian countries, where small vessel disease is the most frequent subtype, our study showed a predominance of large artery atherosclerosis (53.5%) which, in comparison with other subtypes, was found to be associated with dyslipidemia (OR= 3.82, 95% CI= [1.76-8.28]; p=0.001). Cardioembolic stroke and small vessel disease were found to be positively associated with aging and living in Beirut, respectively. Larger studies are needed to explain these findings.
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Affiliation(s)
- Nathalie Lahoud
- Lebanese University, Doctoral School of Sciences and Technology, Hadath, Lebanon
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris Est, Créteil, France
- Lebanese University, Faculty of Pharmacy, Hadath, Lebanon
| | - Marie-Helene Abbas
- Neurology Division, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Pascale Salameh
- Lebanese University, Faculty of Medical Sciences, Hadath, Lebanon
| | - Nadine Saleh
- Lebanese University, Faculty of Public Health, Fanar, Lebanon
| | - Samer Abes
- Neurology Division, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Hassan Hosseini
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris Est, Créteil, France
- Henri Mondor Hospital, AP-HP, Paris, France
| | - Souheil Gebeily
- Neurology Division, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
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Al-Shenqiti AM, Ibrahim SR, Khaled OA, Ali ARH, Ahmed MS. Incidence of First Time Stroke: A Saudi Experience. Eur Neurol 2017; 77:147-151. [PMID: 28103596 DOI: 10.1159/000455094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/14/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stroke is one of the major causes of morbidity and mortality throughout the world. A number of studies were conducted in Saudi Arabia. However, there were no studies conducted in Al-Madinah Al-Munawarah city. OBJECTIVE The aim of this study was to ascertain the incidence rate of first time stroke and the age-specific incidence in both genders in Al-Madinah Al-Munawarah city. METHODS A prospective hospital based study was conducted over a 1-year period (2014). The cases were included in the study when they were admitted with a diagnosis of cerebrovascular accident. RESULTS A total 164 patients (91 men and 73 women) who had first time stroke were found in this study with no significant difference between them (p = 0.565). The crude incidence rate of stroke was 13.89 per 100,000 persons. The age-specific incidence rate increased with age in the current study, where the peak was in the age group of more than 75 years old for men and women. CONCLUSIONS Total crude and the age-specific rates for first time stroke patients revealed in this study were markedly lower than the range reported from the developed countries. However, they were within the range that showed previously in Saudi Arabia and Arabian Peninsula countries.
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Affiliation(s)
- Abdullah M Al-Shenqiti
- Faculty of Medical Rehabilitation Sciences, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia
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El-Hajj M, Salameh P, Rachidi S, Hosseini H. The epidemiology of stroke in the Middle East. Eur Stroke J 2016; 1:180-198. [PMID: 31008279 DOI: 10.1177/2396987316654338] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/09/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose The purpose of this paper is to review and synthesize data from different countries in the Middle East on stroke and its potential risk factors. Method A systematic review of all published stroke articles in the Middle East between 1980 and May 2015 was conducted. Findings Sixty-four papers were included in the review. The incidence rate for all strokes ranged between 22.7 and 250 per 100,000 population per year. The prevalence rate for stroke ranged between 508 and 777 per 100,000 population. Among studies reporting gender differences, 75% reported a high male-to-female ratio among stroke patients. The mean age of stroke was within the sixth and the seventh decade. Ischemic stroke was the most reported type followed by intracerebral hemorrhage and subarachnoid hemorrhage. Hypertension was the most reported risk factor followed by diabetes. The overall case-fatality rate within one month was 12-32%. Discussion During the last decades, there was an increase in stroke incidence and mortality rates in the Middle East. The Middle East faces low rates of self-awareness and control of noncommunicable diseases and also lacks knowledge for stroke risk factors, awareness, causes, and symptoms. Conclusion There is an urgent need to develop more efficient and accurate methods to measure stroke in the Middle East. There is also a significant call to increase public awareness and implement interventions on stroke and its risk factors and symptoms to help people understand the negative impact of stroke on quality of life and potentially prevent this disease.
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Affiliation(s)
- Maya El-Hajj
- Lebanese University, Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Hadath, Lebanon.,Université Paris-Est, UMR 955, IMRM, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Pascale Salameh
- Lebanese University, Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Hadath, Lebanon.,Lebanese American University, School of Pharmacy, Byblos, Lebanon
| | - Samar Rachidi
- Lebanese University, Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Hadath, Lebanon
| | - Hassan Hosseini
- Université Paris-Est, UMR 955, IMRM, Institut Mondor de Recherche Biomédicale, Créteil, France.,Service de Neurologie, Hôpital Henri-Mondor, UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
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8
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Al-Hashel JY, Al-Sabah AA, Ahmed SF, Al-Enezi M, Al-Tawheid N, Al Mesailekh Z, Eliwa J, Alroughani R. Risk Factors, Subtypes, and Outcome of Ischemic Stroke in Kuwait: A National Study. J Stroke Cerebrovasc Dis 2016; 25:2145-52. [PMID: 27321967 DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/16/2016] [Accepted: 05/25/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Epidemiological studies of stroke burden in Kuwait are scarce. We aimed to identify the risk factors, subtypes, and outcome of ischemic stroke in the 6 major hospitals in Kuwait between 2008 and 2013. METHODS A cross-sectional survey was carried out using randomly selected ischemic stroke patients. It included data of sociodemographic status, stroke risk factors, stroke subtypes, treatment, and outcomes. RESULTS A total of 1257 ischemic stroke patients (811 men and 446 women; mean age 60.2 ± 13.1) were included. Small-artery ischemic stroke was the most common stroke subgroup (69.8%) whereas hypertension was the most prevalent risk factor (80.9%). History of heart disease was significantly associated (P < .001) with cardioembolic strokes (58.3%) compared to large-artery stroke (37.5%) and small-artery stroke (32.5%). Atrial fibrillation was significantly prevalent (P < .001) in cardioembolic stroke (54.2%) compared to large-artery stroke (13%) and small-artery stroke (7.6%). Presentation at ages less than 45 years was significantly (P < .001) associated with improved neurological status at discharge (82.6%) when compared to patients aged 45-70 years (78.5%) and more than 70 years (63.8%). Similar findings were observed at 6 months follow-up (78.4% versus 72.8% and 46%; P < .001). Cardioembolic stroke was significantly associated with higher mortality rates (25% versus 12.4% and 6.8%; P < .061) in large-vessel and small-vessel strokes, respectively. CONCLUSIONS Small-artery ischemic stroke was the most common stroke subgroup, and hypertension was the most common risk factor. The outcome was better in younger patients. Cardioembolic stroke was associated with worse outcome.
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Affiliation(s)
- Jasem Y Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Safat, Kuwait; Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait.
| | | | - Samar F Ahmed
- Department of Neurology, Ibn Sina Hospital, Safat, Kuwait; Department of Neurology and Psychiatry, Minia University, Minia, Egypt
| | - Maha Al-Enezi
- Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | | | | | - Jasmine Eliwa
- Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait; Neurology Clinic, Dasman Diabetes Institute, Dasman, Kuwait
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9
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Disparities in Ischemic Stroke Subtypes and Risk Factors between Taiwanese Aborigines and Han Chinese in Taitung, Taiwan. INT J GERONTOL 2016. [DOI: 10.1016/j.ijge.2014.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Ibrahim F, Deleu D, Akhtar N, Al-Yazeedi W, Mesraoua B, Kamran S, Shuaib A. Burden of Stroke in Qatar. J Stroke Cerebrovasc Dis 2015; 24:2875-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/07/2015] [Accepted: 08/19/2015] [Indexed: 11/28/2022] Open
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Akhtar N, Kamran S, Singh R, Cameron P, D'Souza A, Imam Y, Bourke P, Joseph S, Khan R, Santos M, Deleu D, El-Zouki A, Abou-Samra A, Butt AA, Shuaib A. Beneficial Effects of Implementing Stroke Protocols Require Establishment of a Geographically Distinct Unit. Stroke 2015; 46:3494-501. [PMID: 26493677 DOI: 10.1161/strokeaha.115.010552] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/15/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Usefulness of multidisciplinary stroke units in acute stroke patients is well established. There is extensive western literature on usefulness of stroke units in outcome, but limited evidence from the rest of the world. We aim to evaluate the impact of establishing a stroke unit on outcome in patients presenting to a tertiary care facility. METHODS This is a retrospective study of 1003 patients with acute stroke admitted to Hamad General Hospital, Qatar, between January 2014 and February 2015. Patients directly admitted to intensive care unit (132) were excluded. We compared outcomes of pre- and poststroke ward (SW) establishment and in SW patients versus those of general medical wards. RESULTS Before the establishment of the SW, 175 patients were admitted to the hospital. From April 2014 to February 2015, 696 patients were admitted (SW, 545; medical ward, 151). There was a significant reduction in length of stay from 14.7±27.7 to 6.2±20.2 days (P=0.0001) and incidence of complications (23.6% versus 6.4%, P=0.0001) after implementation of stroke-specific protocols. Prognosis at discharge (modified Rankin Scale 0-2 in 56.0% versus 70.4%, P=0.001) and at 90 days (modified Rankin Scale 0-2 in 70.6% versus 95.0%, P=0.001) also significantly improved. Compared with medical ward patients, outcome was significantly better in SW patients with fewer complications (10.9% versus 5.0%, P=0.013) and shorter length of stay (8.9±30.7 versus 5.4±16.1 days, P=0.05). CONCLUSIONS Establishing a distinct SW is essential for achieving full benefits of stroke protocols implementation. SW patients have significantly fewer complications and better prognosis when compared with patients in medical wards.
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Affiliation(s)
- Naveed Akhtar
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Peter Cameron
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Atlantic D'Souza
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Yahya Imam
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Paula Bourke
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Rabia Khan
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Mark Santos
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Dirk Deleu
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Abdel El-Zouki
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Abdul Abou-Samra
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Adeel A Butt
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- From the Neuroscience Institute (Stroke Center of Excellence) (N.A., S.K., A.D., Y.I., P.B., S.J., R.K., M.S., D.D., A.S.), Departments of Emergency Medicine (P.C.), Internal Medicine (A.E.-Z., A.A.-S.), Cardiology Research Center (R.S.), and Hamad Healthcare Quality Institute (A.A.B.), Hamad Medical Corporation, Doha, Qatar.
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12
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Behrouz R, Powers CJ. Epidemiology of classical risk factors in stroke patients in the Middle East. Eur J Neurol 2015; 23:262-9. [PMID: 26041584 DOI: 10.1111/ene.12742] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/06/2015] [Indexed: 01/23/2023]
Abstract
The Middle East (ME) is an ethnically and economically diverse region. A systematic review of all stroke studies conducted in the ME was carried out, with the aim of determining the prevalence of classic vascular risk factors (CRFs) across this region. Additionally, the prevalence of CRFs in the ME was compared to that of a US cohort. Prospective and retrospective ME stroke studies published from 1994 to 2014 were searched for that specifically reported on the prevalence of CRFs. The Z test for proportions was used to determine the significance of differences in CRF rates between the ME and non-ME studies. A total of 21,724 stroke patients from 13 nations in the ME were included. The prevalence rates for CRFs in the ME stroke population were hypertension, 62.1%; diabetes, 33.1%; dyslipidaemia, 36.8%; ischaemic heart disease, 24.6%; smoking, 19.3%; and atrial fibrillation, 13.6%. Compared to the US cohort, ME patients had a lower prevalence of all CRFs except diabetes (P < 0.0001) and smoking (P = 0.05). Compared with stroke patients in the USA, those in the ME have a significantly higher prevalence of diabetes and smoking. Education and lifestyle modification is perhaps the most effective strategy in reducing the risk of stroke in this population.
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Affiliation(s)
- R Behrouz
- Division of Cerebrovascular Diseases, Department of Neurology, College of Medicine, Ohio State University, Columbus, OH, USA
| | - C J Powers
- Division of Vascular and Endovascular Neurosurgery, Department of Neurological Surgery, Ohio State University College of Medicine, Columbus, OH, USA
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Abstract
Atrial fibrillation (AF) is a major public health burden worldwide, and its prevalence is set to increase owing to widespread population ageing, especially in rapidly developing countries such as Brazil, China, India, and Indonesia. Despite the availability of epidemiological data on the prevalence of AF in North America and Western Europe, corresponding data are limited in Africa, Asia, and South America. Moreover, other observations suggest that the prevalence of AF might be underestimated-not only in low-income and middle-income countries, but also in their high-income counterparts. Future studies are required to provide precise estimations of the global AF burden, identify important risk factors in various regions worldwide, and take into consideration regional and ethnic variations in AF. Furthermore, in response to the increasing prevalence of AF, additional resources will need to be allocated globally for prevention and treatment of AF and its associated complications. In this Review, we discuss the available data on the global prevalence, risk factors, management, financial costs, and clinical burden of AF, and highlight the current worldwide inadequacy of its treatment.
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Dehghani Firoozabadi M, Kazemi T, Sharifzadeh G, Dadbeh S, Dehghan P. Stroke in birjand, iran: a hospital-based study of acute stroke. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:264-8. [PMID: 23984011 PMCID: PMC3745760 DOI: 10.5812/ircmj.4282] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 06/24/2012] [Accepted: 09/13/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stroke, or cerebrovascular accident (CVA), is the second leading cause of death in the world and based on the World Health Organization (WHO) report in 2006, it is responsible for 9.9% of all deaths in the world which over 85% of these deaths occurred in developing countries. OBJECTIVES The aim of this study was to investigate the data related to the frequency, risk factors, types and mortality of stroke in Birjand city. PATIENTS AND METHODS A retrospective cohort of consecutive patients with diagnosed stroke who were admitted to hospital (the only neurological center of Birjand) between 2002 and 2008 was designed. A stroke was defined according to clinical features and CT-scan which was confirmed by agreement of a staff neurologist. Collected data included date of admission, age, sex, and hospital outcome as well as related risk factors. RESULTS Totally, 1219 stroke (85.4% ischemic type) with the mean age of 69.6 ± 12.9 years and female: male ratio of 1.09 was included in over 6 years. The stroke hospital admission rates were 48.6 and 103.4 /100,000 population /year in the first and the last year of the study, respectively. There was an increasing trend in stroke incidence rate during the study (P < 0.01). The most common epidemiological risk factors for stroke in our region were hypertension, cardiac diseases, a history of stroke, diabetes mellitus, dyslipidemia, and smoking (54.7, 24.4, 20.1, 14.9, 12.2, and 9%, respectively). Overall in-hospital mortality rate was 17.1%. CONCLUSIONS The stroke hospital admission rate might be increasing in Birjand. Therefore, health care administrators and public health authorities must work harder to promote the knowledge and practice of society about the stroke related risk factors and prevention methods.
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Affiliation(s)
| | - Toba Kazemi
- Birjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Science, Birjand, IR Iran
- Corresponding author: Toba Kazemi, Birjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Science, Birjand, IR Iran. Tel: +98-5614443001-9, Fax: +98-5614433004, E-mail:
| | | | - Somayeh Dadbeh
- Student Research Committee, Birjand University of Medical Science, Birjand, IR Iran
| | - Parvaneh Dehghan
- Student Research Committee, Birjand University of Medical Science, Birjand, IR Iran
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Li Z, Wang J, Luo S, Wei J, Hu X. Classification analysis of young stroke in zhuhai city, China. ACTA ACUST UNITED AC 2013. [DOI: 10.7243/2052-6946-1-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Fang J, Yan W, Jiang GX, Li W, Cheng Q. Time interval between stroke onset and hospital arrival in acute ischemic stroke patients in Shanghai, China. Clin Neurol Neurosurg 2011; 113:85-8. [DOI: 10.1016/j.clineuro.2010.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 09/06/2010] [Accepted: 09/07/2010] [Indexed: 11/25/2022]
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Comparisons of DSA and MR angiography with digital subtraction angiography in 151 patients with subacute spontaneous intracerebral hemorrhage. J Clin Neurosci 2010; 17:601-5. [PMID: 20227278 DOI: 10.1016/j.jocn.2009.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 09/04/2009] [Accepted: 09/13/2009] [Indexed: 01/01/2023]
Abstract
To exclude underlying vascular abnormalities in patients with spontaneous intracerebral hemorrhage, the traditional paradigm requires investigation using digital subtraction angiography (DSA) in both the acute and subacute phases. We investigated whether MRI and magnetic resonance angiography (MRA), in the subacute stage of intracerebral hematoma, had high positive predictive values (PPV) and negative predictive values (NPV) in screening for vascular abnormality in the routine clinical setting. In a regional neurosurgical center in Hong Kong, we retrospectively reviewed 151 patients investigated with both MRI and DSA for underlying structural vascular abnormalities during the subacute phase. Sensitivity, specificity, and intermodality agreement were assessed. A total of 70/151 (46%) vascular lesions accountable for the hemorrhage were found. Patients with vascular abnormalities tended to be younger (mean age+/-standard deviation [SD], 33+/-15years), less likely to be hypertensive (6.3%), and the lesion was more likely to be accompanied by intraventricular hemorrhage (22%). In terms of cerebral arteriovenous malformation and dural arteriovenous fistulas, MRI/MRA had a PPV of 0.98 and a NPV of 1.00. We concluded that MRI/MRA was able to detect most structural vascular abnormalities in the subacute phase in most patients and, thus, its use is recommended as the screening test.
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Benamer HTS, Grosset D. Stroke in Arab countries: A systematic literature review. J Neurol Sci 2009; 284:18-23. [DOI: 10.1016/j.jns.2009.04.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 03/30/2009] [Accepted: 04/08/2009] [Indexed: 12/16/2022]
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Akhtar N, Kamran SI, Deleu D, D'Souza A, Miyares F, Elsotouhy A, Al-Hail H, Mesraoua B, Own A, Salem K, Kamha A, Osman Y. Ischaemic posterior circulation stroke in State of Qatar. Eur J Neurol 2009; 16:1004-9. [PMID: 19538206 DOI: 10.1111/j.1468-1331.2009.02709.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ischaemic stroke features may show regional differences. Posterior circulation stroke (PCS) is of special interest, as symptomatology, course and outcome are usually different and complex. No significant studies or registries have reported on the characteristics and outcomes of PCS in our region. METHODS We prospectively collected data of 116 patients with PCS admitted from 2005 through 2008 in the only stroke admitting hospital in Qatar. Demographics, risk factors, clinical signs/symptoms, pattern of presentation, aetiology, imaging features, complications and outcome at discharge and follow-up were recorded. RESULTS Mean age was 53 years with 25% aged < or = 45, 85% were males. Demographically 47% were Arabs and 51% of South-Asian origin. Mean duration from onset to presentation was 29 h. Major risk factors were obesity (66%) and hypertension (61%). Minimal or fluctuating symptoms were present in 64%, while 9% had maximal deficit at onset. Thirty nine per cent had lesions in proximal territory and 23% in multiple territories. Around 41% had no occlusion, 16% had vertebro-basilar, 16% vertebral, 8% basilar occlusion. Etiologically 53% patients had large artery disease, 16% small vessel disease, and 17% cardioembolism. Seventy per cent of patients were discharged home, while 10% expired. Modified Rankin score (mRS) at discharge was < or = 2 in 53% and > or = 4 in 13% patients. At 30-day follow-up, 68% had mRS of < or = 2. Ninety-day survival status showed 89% alive with mRS < or = 2 in 73%. CONCLUSION The aetiology and lesion topography of PCS in this heterogeneous population differs from the pattern observed in other populations.
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Affiliation(s)
- N Akhtar
- Division of Neurology (Medicine), Hamad Medical Corporation, Doha, State of Qatar
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