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Al Hashmi AM, Imam Y, Mansour OY, Shuaib A. Accreditation of stroke programs at the MENA + region; between aspiration and reality. J Stroke Cerebrovasc Dis 2024; 33:107639. [PMID: 38369165 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Despite global progress in stroke care, challenges persist, especially in Low- and Middle-Income countries (LMIC). The Middle East and North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO) Stroke Program Accreditation Initiative aims to improve stroke care regionally. MATERIAL & METHOD A 2022 survey assessed stroke unit readiness in the Middle East and North Africa (MENA) + region, revealing significant regional disparities in stroke care between high-income and low-income countries. Additionally, it demonstrated interest in the accreditation procedure and suggested that regional stroke program accreditation will improve stroke care for the involved centers. CONCLUSION An accreditation program that is specifically tailored to the regional needs in the MENA + countries might be the solution. In this brief review, we will discuss potential challenges faced by such a program and we will put forward a well-defined 5-step accreditation process, beginning with a letter of intent, through processing the request and appointment of reviewers, the actual audit, the certification decisions, and culminating in granting a MIENA-SINO tier-specific certificate with recertification every 5 years.
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Affiliation(s)
- Amal M Al Hashmi
- Leader Stroke Program at Oman International Hospital, Muscat, Oman.
| | - Yahia Imam
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ossama Yassin Mansour
- Alexandria Faculty of Medicine, Department of Neurology, Alexandria University, Alexandria, Egypt
| | - Ashfaq Shuaib
- Director Stroke Program, University of Alberta, Edmonton, AB, Canada
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Al-Nusair M, Alrabadi N, Haddad R, Njem S, Aljarrah MI, Hammoudeh A. Residual risk of thromboembolic events despite anticoagulation in Middle Eastern patients with atrial fibrillation. The JoFib study. J Stroke Cerebrovasc Dis 2024:107785. [PMID: 38782168 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES To investigate residual risk of thromboembolic events despite anticoagulation in patients with atrial fibrillation form the Middle East. MATERIALS AND METHODS Using data from the JoFib registry, we described the characteristics of patients treated with anticoagulants (n=1654) and calculated the incidence rate for thromboembolic events. We constructed multivariable Cox proportional hazard models and calculated the population-attributable fraction to determine clinical factors predictive of residual thromboembolic events. RESULTS During the one-year follow-up, 57 thromboembolic events occurred (incidence rate 4.1 per 100 person-years). In multivariable time-to-event analysis, prior thromboembolic events (aHR 3.8, 95%CI 2.2-6.4, p<0.001) and diabetes (aHR 2.3, 95%CI 1.3-4.1, p=0.004) were independently predictive of residual thromboembolism. Percentage of thromboembolic risk attributable to prior thromboembolic events was 30.9% (95%CI 13.9-44.6, p=0.001) and was 37.1% (95%CI 8.8-56.6, p=0.015) for diabetes. Furthermore, the effect of diabetes on thromboembolic events depends on the type of anticoagulant, with diabetes being significantly predictive of thromboembolic events in patients anticoagulated with warfarin (aHR 4.11, 95%CI 1.81-9.37, p=0.001), but not non-vitamin K antagonist oral anticoagulants (aHR 1.23, 95%CI 0.51-2.97, p=0.643) with a p=0.045 for interaction. Prior thromboembolism was independently predictive of thromboembolic events in both anticoagulants (aHR 2.67, 95%CI 1.28-5.58, p=0.009; aHR 7.33, 95%CI 3.05-17.65, p<0.001; respectively; p=0.084 for interaction). CONCLUSIONS Middle Eastern patients with atrial fibrillation remain at significant risk of thromboembolism and its recurrence despite anticoagulation, and especially in diabetic patients. Therefore, management should focus on controlling diabetes as well as other modifiable risk factors in addition to antithrombotic therapy.
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Affiliation(s)
- Mohammed Al-Nusair
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Razan Haddad
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Jadara University, Irbid, Jordan.
| | - Sumaya Njem
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Mohammad I Aljarrah
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Ayman Hammoudeh
- Department of Cardiology, Istishari Hospital, Amman, Jordan.
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Bhutta ZA, Akhtar N, Pathan SA, Castren M, Harris T, Ganesan GS, Kamran S, Thomas SH, Cameron PA, Azad AM, Puolakka T. Epidemiological profile of stroke in Qatar: Insights from a seven-year observational study. J Clin Neurosci 2024; 123:30-35. [PMID: 38520927 DOI: 10.1016/j.jocn.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES Stroke prevalence is progressively increasing in developing countries due to increased vascular risk factors. This study aims to describe the epidemiology, prevalent risk factors, and outcomes of stroke in a multi-ethnic society of Qatar. MATERIALS AND METHODS We conducted a retrospective analysis of all patients with suspected stroke admitted to stroke services between January 2014 and September 2020. RESULTS A total of 11,892 patients were admitted during this period with suspected stroke. Of these, the diagnosis was ischemic stroke (48.8 %), transient ischemic attack (10.3 %), intracerebral hemorrhage (10.9 %), cerebral venous sinus thrombosis (1.3 %), and stroke mimics (28.6 %). The median age was 52 (43-62), with a male-female ratio of 3:1. The study population was predominantly Asian (56.8 %) and Arab (36 %). The majority of the patients were hypertensive (66.8 %), diabetic (47.9 %), and dyslipidemic (45.9 %). A history of prior stroke was observed in 11.7 %, while 0.9 % had prior transient ischemic attack. Among ischemic strokes, 31.7 % arrived within 4.5 h, 12.5 % received thrombolysis, and 4.6 % underwent thrombectomy. Median Door-to-Needle time was 51 (33-72) minutes. The average length of stay was 5.2 ± 9.0 days, with 71.5 % discharged home, 13.8 % transferred to rehabilitation, 9.3 % to other specialties, 3 % to long-term care, and 2.4 % suffered in-hospital mortality. CONCLUSION Stroke in Qatar is characterized by a younger, expatriate-dominant cohort, with notable prevalence of ischemic and hemorrhagic stroke and a distinct risk factor profile. Further analysis of epidemiological differences among different population groups can inform targeted policies for prevention and management to reduce the burden of disease.
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Affiliation(s)
- Zain A Bhutta
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Naveed Akhtar
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Sameer A Pathan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Maaret Castren
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Tim Harris
- Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK.
| | - Gowrii S Ganesan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Saadat Kamran
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Stephen H Thomas
- Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK; Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA.
| | - Peter A Cameron
- The Alfred Hospital, Emergency and Trauma Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Aftab M Azad
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Tuukka Puolakka
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Nishiyama Y, Miyamoto S, Sakaguchi M, Sakai N, Yoshida K, Tokuda N, Ichi S, Iguchi Y, Koga M, Yamaura I, Hirano T, Yamagami H, Kimura K. Clinical characteristics of stroke in SARS-CoV-2 infected patients in Japan: A prospective nationwide study. J Neurol Sci 2024; 457:122865. [PMID: 38199022 DOI: 10.1016/j.jns.2023.122865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION We investigated the clinical characteristics and outcomes of stroke in SARS-CoV-2 infected patients in Japan. METHODS This prospective, multicenter observational study of stroke in patients with SARS-CoV-2 infection involving 563 primary stroke centers across Japan was conducted between July 2020, and May 2022. We included 159 stroke cases (131 ischemic stroke, 2 transient ischemic attack (TIA), 21 intracranial hemorrhage, and 5 subarachnoid hemorrhage) and collected their clinical characteristics. Ischemic stroke and TIA (n = 133) were analyzed separately. RESULTS The mean age of the 159 patients was 70.6 years, with 66% being men. Poor outcomes (modified Rankin Scale score 5-6) occurred in 40% (63/159) at discharge. Among patients with ischemic stroke and TIA, 30%, 18%, 10%, and 42% had cardioembolism, large-artery atherosclerosis, small-vessel occlusion, and cryptogenic stroke or embolic stroke of undetermined source, respectively. One-third (34%) presented with large vessel occlusion (LVO) of the internal carotid, middle cerebral M1, or basilar arteries. Poor outcomes included age (adjusted odds ratio (aOR): 1.06, 95%CI: 1.01-1.12), ischemic heart disease (IHD) history (aOR: 13.00, 95%CI: 1.51-111.70), moderate to severe pneumonia (aOR: 7.78, 95%CI: 1.18-51.42), an National Institutes of Health Stroke Scale score at baseline (aOR: 1.10, 95%CI: 1.03-1.17), LVO (aOR: 14.88, 95%CI: 2.33-94.97), and log10 D-dimer (aOR: 3.38, 95%CI: 1.01-11.26). CONCLUSION Upon discharge, 40% of SARS-CoV-2 infected patients with ischemic stroke and TIA had poor outcomes. Poor outcomes were associated with older age, IHD history, moderate to severe pneumonia, higher NIHSS scores, LVO, and higher log10 D-dimer. REGISTRATION UMIN Clinical Trials Registry: https://www.umin.ac.jp/ctr/. Unique identifier: UMIN000041226.
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Affiliation(s)
- Yasuhiro Nishiyama
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Susumu Miyamoto
- Stroke Support Center, Kyoto University Hospital, Kyoto, Japan
| | - Manabu Sakaguchi
- Department of Neurology, Osaka General Medical Center, Osaka, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Kensaku Yoshida
- Department of Neurology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Naoki Tokuda
- Department of Neurology and Stroke Treatment, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Shunsuke Ichi
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ikuya Yamaura
- Department of Neurosurgery, Cerebrovascular Research Institute, Yoshida Hospital, Kobe, Japan
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
| | - Hiroshi Yamagami
- Department of Stroke Neurology, NHO Osaka National Hospital, Osaka, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Adeniji O, Adeleye O, Akinyemi J, Otubogun F, Ogunde G, Ogunrombi M, Adesina D, Wahab A, Ogunlana M, Alimi T, Akinyemi R. Organized multi-disciplinary stroke team care improves acute stroke outcomes in resource limited settings; Results of a retrospective study from a Nigerian tertiary hospital. J Stroke Cerebrovasc Dis 2023; 32:107307. [PMID: 37633206 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Evidence for the impact of organized stroke multidisciplinary teams (MDTs) on outcomes in Africa is sparse. AIM To compare stroke outcomes, before and after the establishment (September 16, 2016) of a pioneer MDT at a tertiary hospital in southern Nigeria. METHODS Using a retrospective, observational study design, the in-patient record of all stroke patients admitted between September 2014 to September 2018 was retrieved and rigorously reviewed. 155 patients seen 2 years before the MDT were compared with 169 stroke patients seen 2 years after the MDT. Stroke severity at admission and functioning at discharge were assessed using the Stroke Levity Scale (SLS) and the modified Rankin scale (mRS). RESULTS Mean ages (in years) were 60 pre-MDT vs 59.57 post MDT (p = 0.754). There were more males, 51% pre-MDT vs 54.2% post MDT (p = 0.565). SLS and mRS were not significantly different; severe SLS and mRS pre-MDT, 52.9% vs post-MDT, 49.4% (p = 0.727) and pre-MDT 19.4% vs post-MDT 19.5% (p = 0.685) respectively. More post-MDT patients were discharged alive, pre-MDT,56.8% vs 79.2% post MDT (p < 0.001); had swallow tests, pre-MDT 9.23% vs post-MDT 33.5% (p < 0.001); on secondary prevention, pre-MDT 67.7% vs post-MDT 78.9% (p = 0.023); had more clinic visits, pre-MDT,0.7% vs post-MDT 38.3% (p < 0.001). MDT was independently associated with lower in-hospital mortality on multivariable regression, adjusted odds ratio (OR) (95% Confidence interval CI) 0.17 (0.09-0.32). CONCLUSION Our results suggest that an organized MDT may improve acute outcomes and reduce mortality in resource constrained settings where there may be no stroke units. These findings need further prospective validation.
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Affiliation(s)
- Olaleye Adeniji
- Neurology Unit, Department of Medicine, Federal Medical Center, Postal Address- P.M.B 3031, Sapon Post Office, Abeokuta, Ogun State, Nigeria.
| | - Osi Adeleye
- Neurology Unit, Department of Medicine, Federal Medical Center, Postal Address- P.M.B 3031, Sapon Post Office, Abeokuta, Ogun State, Nigeria
| | - Joshua Akinyemi
- Department of Medical Statistics and Epidemiology, College of Medicine, University College hospital Ibadan, Oyo State, Nigeria
| | - Folajimi Otubogun
- Neurology unit, Federal Medical center, Ebute Meta, Lagos State, Nigeria
| | - Gabriel Ogunde
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Postal Address: PMB 017 GPO, General Post Office, Ibadan, Oyo State, Nigeria
| | - Mayowa Ogunrombi
- Neurology Unit, Department of Medicine, Federal Medical Center, Postal Address- P.M.B 3031, Sapon Post Office, Abeokuta, Ogun State, Nigeria
| | - Deborah Adesina
- Neurology Unit, Department of Medicine, Federal Medical Center, Postal Address- P.M.B 3031, Sapon Post Office, Abeokuta, Ogun State, Nigeria
| | - Ahmed Wahab
- Neurology Unit, Department of Medicine, Federal Medical Center, Postal Address- P.M.B 3031, Sapon Post Office, Abeokuta, Ogun State, Nigeria
| | - Michael Ogunlana
- Department of Physiotherapy, Federal Medical Center, Abeokuta, Ogun State, Nigeria
| | - Talayo Alimi
- Department of Physiotherapy, Federal Medical Center, Abeokuta, Ogun State, Nigeria
| | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Postal Address: PMB 017 GPO, General Post Office, Ibadan, Oyo State, Nigeria
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6
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Vincent M, Sereke SG, Nassanga R, Robert M, Ameda F. Correlation between clinical and brain computed tomography findings of stroke patients: A cross-sectional study. Health Sci Rep 2023; 6:e1248. [PMID: 37152223 PMCID: PMC10157266 DOI: 10.1002/hsr2.1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/10/2023] [Accepted: 04/22/2023] [Indexed: 05/09/2023] Open
Abstract
Background and Aims In developing countries, the burden of stroke is growing and causing significant morbidity and disability with high mortality rates. Neuroimaging plays a crucial role in differentiating ischemic stroke from an intracerebral hemorrhage, as well as entities other than stroke. This study sought to determine the correlation between the clinical and brain CT scan findings of stroke patients attending three hospitals in Kampala, Uganda. Methods This was a cross-sectional study of clinically suspected stroke patients who were sent for brain CT scan at three selected hospitals in Kampala, Uganda. All brain CT scans of patients with suspected stroke were evaluated and the Alberta stroke program early CT score (ASPECTS) was used for middle cerebral artery (MCA) strokes. Univariate analysis was used to describe the clinico-demographic and brain CT features of stroke and summarized them as percentages. Bivariate and multivariate analysis were used to determine the adjusted odds ratios as a measure of association with a 95% confidence interval (CI). Results Of the 270 study participants, 141 (52.2%) were male. 162 (60%) had CT findings of stroke, and 90 (33.3%) had normal brain CT findings. Eighteen (6.7%) had other CT findings like tumor, dural hemorrhage, epidermoid cyst, and others. Ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage accounted for 124 (45.9%), 34 (12.6%), and 4 (1.5%) respectively. Limb weakness (55.2%), headache (41.1%), and loss of consciousness (39.3%) were associated with stroke findings on CT. Among the acute ischemic strokes, 30 (73.2%) had a worse (0-7) ASPECT score. Those aged ≥65 years were associated with a worse ASPECTS [AOR: 22.01, (95% CI: 1.58-306.09) p = 0.021]. Conclusion More than a third of patients with a clinical diagnosis of stroke had either no CT features of stroke or had other findings. The most commonly affected vascular territory was left MCA. Old age was strongly associated with having the worst ASPECTS score.
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Affiliation(s)
- Mboizi Vincent
- Department of Radiology and Radiotherapy, College of Health SciencesMakerere UniversityKampalaUganda
| | - Senai Goitom Sereke
- Department of Radiology and Radiotherapy, College of Health SciencesMakerere UniversityKampalaUganda
| | - Rita Nassanga
- Department of Radiology and Radiotherapy, College of Health SciencesMakerere UniversityKampalaUganda
| | - Mukisa Robert
- Department of MedicineMulago National Referral HospitalKampalaUganda
| | - Faith Ameda
- Department of Radiology and Radiotherapy, College of Health SciencesMakerere UniversityKampalaUganda
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Gifford A, Biffi A, Gelaye B, Chemali Z. Shedding Light on the Causes and Characteristics of Stroke in Lebanon: A Systematic Review of Literature. J Geriatr Psychiatry Neurol 2022; 35:655-662. [PMID: 34555937 DOI: 10.1177/08919887211044753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prevalence and severity of stroke in Lebanon has increased over the past decade and stroke is currently the second leading cause of death in the country. METHODS We systematically reviewed existing research on stroke prevalence, risk factors, mortality and morbidity of stroke, stroke treatment, and stroke education to assess the epidemiology of stroke in Lebanon. A literature search was conducted on the PubMed database for articles presenting data in any of these 5 categories in Lebanon, as well as articles discussing the Middle East and North Africa region generally. RESULTS A high prevalence of modifiable risk factors (cigarette and waterpipe smoking) and risk factors that could be mitigated by lifestyle changes (obesity and hypertension) were found in Lebanon. Stroke mortality rates and risk factors of mortality were consistent with global trends, though the cost of treatment in Lebanon was significantly higher than in other developing nations. CONCLUSION Urgent public health initiatives are needed to educate the public about the dangers of modifiable stroke risk factors and to reduce the burden of stroke in Lebanon.
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Affiliation(s)
- Abbott Gifford
- Department of Psychology, Colorado College, Colorado Springs, CO, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Alessandro Biffi
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Departments of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Bizu Gelaye
- Harvard T. H. Chan School of Public Health, MA, USA.,The Chester M. Pierce, M.D. Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Zeina Chemali
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Departments of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,The Chester M. Pierce, M.D. Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Shahbandi A, Shobeiri P, Azadnajafabad S, Saeedi Moghaddam S, Sharifnejad Tehrani Y, Ebrahimi N, Rezaei N, Rashidi MM, Ghamari SH, Abbasi-Kangevari M, Koolaji S, Haghshenas R, Rezaei N, Larijani B, Farzadfar F. Burden of stroke in North Africa and Middle East, 1990 to 2019: a systematic analysis for the global burden of disease study 2019. BMC Neurol 2022; 22:279. [PMID: 35896999 PMCID: PMC9327376 DOI: 10.1186/s12883-022-02793-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While several studies investigated the epidemiology and burden of stroke in the North Africa and Middle East region, no study has comprehensively evaluated the age-standardized attributable burden to all stroke subtypes and their risk factors yet. OBJECTIVE The aim of the present study is to explore the regional distribution of the burden of stroke, including ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage, and the attributable burden to its risk factors in 2019 among the 21 countries of North Africa and Middle East super-region. METHODS The data of the Global Burden of Disease Study (GBD) 2019 on stroke incidence, prevalence, death, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs) rates, and attributed deaths, DALYs, YLLs, and YLDs to stroke risk factors were used for the present study. RESULTS The age-standardized deaths, DALYs, and YLLs rates were diminished statistically significant by 27.8, 32.0, and 35.1% from 1990 to 2019, respectively. Attributed deaths, DALYs, and YLLs to stroke risk factors, including high systolic blood pressure, high body-mass index, and high fasting plasma glucose shrank statistically significant by 24.9, 25.8, and 28.8%, respectively. CONCLUSION While the age-standardized stroke burden has reduced during these 30 years, it is still a concerning issue due to its increased burden in all-age numbers. Well-developed primary prevention, timely diagnosis and management of the stroke and its risk factors might be appreciated for further decreasing the burden of stroke and its risk factors and reaching Sustainable Development Goal 3.4 target for reducing premature mortality from non-communicable diseases.
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Affiliation(s)
- Ataollah Shahbandi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran
| | - Yeganeh Sharifnejad Tehrani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran
| | - Narges Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran
| | - Seyyed-Hadi Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran
| | - Sogol Koolaji
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Jalal Al-e-Ahmad Highway, Tehran, 1411713119, Iran. .,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Al Alawi AM, Al Busaidi I, Al Shibli E, Al-Senaidi AR, Al Manwari S, Al Busaidi I, Muhanna F, Al Qassabi A. Health outcomes after acute ischemic stroke:retrospective and survival analysis from Oman. Ann Saudi Med 2022; 42:269-275. [PMID: 35933604 PMCID: PMC9357299 DOI: 10.5144/0256-4947.2022.269] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Stroke mortality and related functional disability have been declining over the last two decades, but stroke continues to represent the second leading cause of cardiovascular death worldwide and the number one cause for acquired long-term disability. OBJECTIVES Assess short- and long-term health outcomes after acute ischemic stroke and analyze factors associated with poor survival and functional outcomes. DESIGN Retrospective and survival analysis SETTING: Inpatient unit at a tertiary care referral hospital. PATIENTS AND METHODS All patients admitted with acute ischemic stroke from 1 January 2017 to 31 August 2018 were included in the study. Functional status was assessed using the modified Rankin Scale (mRS). Other demographic and clinical variables were obtained from medical records. Data were analyzed by multivariable logistic regression, Cox proportional hazards, and the Kaplan-Meier method. Long-term follow-up data, including mortality and mRS was collected by follow-up phone call. MAIN OUTCOME MEASURES Functional dependency and factors associated with mortality. SAMPLE SIZE AND CHARACTERISTICS 110 with mean age of 67.0 (14.7) years; 59 patients (53.6%) were males. RESULTS Hypertension (75.5%), diabetes mellitus (54.6%), and dyslipidemia (29.1%) were common. Sixty-five patients (59.1%) had mRS >2 upon discharge including 18 patients (16.4%) who died during the hospital stay. The cumulative mortality rate was 25.4% (28/110) at 12 months and 30.0% (33/110) at 24 months. Twenty-nine stroke survivors (29/70, 41.4%) remained physically dependent (mRS >2) at the end of follow-up. Old age, atrial fibrillation, history of prior stroke, chronic kidney disease, and peripheral arterial disease were associated with increased mortality and functional dependence. CONCLUSIONS Patients in Oman with acute ischemic stroke tend to have a high comorbidity burden, and their functional dependency and mortality are higher compared to patients from developed countries. Therefore, evidence-based measures such as establishing stroke units are essential to improve the health outcomes of patients with acute ischemic stroke. LIMITATIONS Retrospective at single center. CONFLICT OF INTEREST None.
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Affiliation(s)
- Abdullah M Al Alawi
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman.,From the Internal Medicine Program, Oman Medical Speciality Board, Al-Athaiba, Muscat, Oman
| | - Ikhlas Al Busaidi
- From the Internal Medicine Program, Oman Medical Speciality Board, Al-Athaiba, Muscat, Oman
| | - Emaad Al Shibli
- From the Internal Medicine Program, Oman Medical Speciality Board, Al-Athaiba, Muscat, Oman
| | - Al-Reem Al-Senaidi
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shahd Al Manwari
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ibtisam Al Busaidi
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
| | - Fatema Muhanna
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ahmed Al Qassabi
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
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10
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Kharbach A, Obtel M, Achbani A, Aasfara J, Hassouni K, Lahlou L, Razine R. Ischemic stroke in Morocco: Prehospital delay and associated factors. Rev Epidemiol Sante Publique 2021; 69:345-359. [PMID: 34148762 DOI: 10.1016/j.respe.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco. PATIENTS AND METHODS An observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department. RESULTS A total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6hours (IQR, 4-16). Multiple regression analysis showed that illiteracy (OR 38.58; CI95%: 3.40-437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI95%: 1.57-80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI95%: 0.01-0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI95%: 0.00-0.36), and direct admission without reference (OR 0.005; CI95%: 0.00-0.07), were independently associated with late arrival (>4.5hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI95%: 4.37-138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI95%: 0.03-0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI95%: 0.00-0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI95%: 0.03-0.80), distance between 50 and 100km (OR 10.16; CI95%: 1.16-89.33), and direct admission without reference (OR 0.03; CI95%: 0.00-0.14), were independently associated with late arrival (>6hours) of patients with acute ischemic stroke. CONCLUSION Patient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.
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Affiliation(s)
- A Kharbach
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
| | - M Obtel
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
| | - A Achbani
- Laboratory of Cell Biology and Molecular Genetics (LBCGM), Department of Biology, Faculty of Sciences, University Ibn Zohr Agadir, Rabat, Morocco.
| | - J Aasfara
- Department of Neurology, International Cheikh Khalifa University Hospital, Mohammed VI University of Health Sciences (UM6SS) Casablanca, Rabat, Morocco.
| | - K Hassouni
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS) Casablanca, Rabat, Morocco.
| | - L Lahlou
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Faculty of Medicine and Pharmacy of Agadir, University Ibn Zohr, Agadir, Morocco.
| | - R Razine
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
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11
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Alnaami I, Alhazzani A, Alburaidi I, Alkhayri M, Dibssan H, Alqahtani MS, Alqahtani M, Alqahtani S, Shehata SF, Gaber A, Alqahtani SA. Demographic characteristics and types of stroke in Southwestern Saudi Arabia, and the potential demand of neuro endovascular specialists. ACTA ACUST UNITED AC 2021; 26:62-68. [PMID: 33530045 PMCID: PMC8015492 DOI: 10.17712/nsj.2021.1.20200104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/10/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To identify demographic characteristics, and types of stroke in Southwestern (Aseer) Region, Saudi Arabia. METHODS This study is a retrospective and hospital-based. The data of all stroke patients (n=562) admitted to the tertiary care hospital in the province, Aseer Central Hospital (ACH) within the period from January 2016 until December 2017 are included. RESULTS The mean ± SD of stoke patients' age was 62.6 ± 17.0 years. Male patients were more than female patients (62.6% and 37.4%, respectively). The majority (93.2%) were Saudi, while 91.5% had below university education and 6.4% were smokers. Interestingly, only 2% of patients had a family history of stroke, while 68.1% were diabetic, 80.4% were hypertensive, 91.6% had high serum cholesterol level, and 10.7% had history of transient ischemic attacks (TIA). Despite the lack of awareness, and leading to delay in reaching health care facility, 58.1% of stroke patients, were arriving to emergency department (ED) in less than 24 hours (potential endovascular therapeutic window). CONCLUSIONS In Aseer Region, Saudi Arabia, stroke affects mainly those who are older, less educated, diabetic, hypertensive, with hypercholesterolemia and previous history of TIA. Associated factors for stroke differ significantly according to their nationality.
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Affiliation(s)
- Ibrahim Alnaami
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Adel Alhazzani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Ibrahim Alburaidi
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Mona Alkhayri
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Hani Dibssan
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Mohammed S Alqahtani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Mohammed Alqahtani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Saleh Alqahtani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Shehata F Shehata
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Ashraf Gaber
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Saeed A Alqahtani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
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12
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Shahjouei S, Tsivgoulis G, Farahmand G, Koza E, Mowla A, Vafaei Sadr A, Kia A, Vaghefi Far A, Mondello S, Cernigliaro A, Ranta A, Punter M, Khodadadi F, Naderi S, Sabra M, Ramezani M, Amini Harandi A, Olulana O, Chaudhary D, Lyoubi A, Campbell BCV, Arenillas JF, Bock D, Montaner J, Aghayari Sheikh Neshin S, Aguiar de Sousa D, Tenser MS, Aires A, Alfonso MDL, Alizada O, Azevedo E, Goyal N, Babaeepour Z, Banihashemi G, Bonati LH, Cereda CW, Chang JJ, Crnjakovic M, De Marchis GM, Del Sette M, Ebrahimzadeh SA, Farhoudi M, Gandoglia I, Gonçalves B, Griessenauer CJ, Murat Hanci M, Katsanos AH, Krogias C, Leker RR, Lotman L, Mai J, Male S, Malhotra K, Malojcic B, Mesquita T, Mir Ghasemi A, Mohamed Aref H, Mohseni Afshar Z, Moon J, Niemelä M, Rezai Jahromi B, Nolan L, Pandhi A, Park JH, Marto JP, Purroy F, Ranji-Burachaloo S, Carreira NR, Requena M, Rubiera M, Sajedi SA, Sargento-Freitas J, Sharma VK, Steiner T, Tempro K, Turc G, Ahmadzadeh Y, Almasi-Dooghaee M, Assarzadegan F, Babazadeh A, Baharvahdat H, Cardoso FB, Dev A, Ghorbani M, Hamidi A, Hasheminejad ZS, Hojjat-Anasri Komachali S, Khorvash F, Kobeissy F, Mirkarimi H, Mohammadi-Vosough E, Misra D, Noorian AR, Nowrouzi-Sohrabi P, Paybast S, Poorsaadat L, Roozbeh M, Sabayan B, Salehizadeh S, Saberi A, Sepehrnia M, Vahabizad F, Yasuda TA, Ghabaee M, Rahimian N, Harirchian MH, Borhani-Haghighi A, Azarpazhooh MR, Arora R, Ansari S, Avula V, Li J, Abedi V, Zand R. SARS-CoV-2 and Stroke Characteristics: A Report From the Multinational COVID-19 Stroke Study Group. Stroke 2021; 52:e117-e130. [PMID: 33878892 PMCID: PMC8078130 DOI: 10.1161/strokeaha.120.032927] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: Stroke is reported as a consequence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in several reports. However, data are sparse regarding the details of these patients in a multinational and large scale. Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke, intracranial hemorrhage, and cerebral venous or sinus thrombosis among SARS-CoV-2–infected patients. We further investigated the risk of large vessel occlusion, stroke severity as measured by the National Institutes of Health Stroke Scale, and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with acute ischemic stroke. In addition, we explored the neuroimaging findings, features of patients who were asymptomatic for SARS-CoV-2 infection at stroke onset, and the impact of geographic regions and countries’ health expenditure on outcomes. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least 1 eligible stroke patient. Of 432 patients included, 323 (74.8%) had acute ischemic stroke, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis. A total of 183 (42.4%) patients were women, 104 (24.1%) patients were <55 years of age, and 105 (24.4%) patients had no identifiable vascular risk factors. Among acute ischemic stroke patients, 44.5% (126 of 283 patients) had large vessel occlusion; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median National Institutes of Health Stroke Scale (8 [3–17] versus 11 [5–17]; P=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; P<0.001) in countries with middle-to-high health expenditure when compared with countries with lower health expenditure. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144 (37.8%) were asymptomatic at the time of admission for SARS-CoV-2 infection. Conclusions: We observed a considerably higher rate of large vessel occlusions, a much lower rate of small vessel occlusion and lacunar infarction, and a considerable number of young stroke when compared with the population studies before the pandemic. The rate of mechanical thrombectomy was significantly lower in countries with lower health expenditures.
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Affiliation(s)
- Shima Shahjouei
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Greece (G. Tsivgoulis, A.H.K.)
| | - Ghasem Farahmand
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran.,Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Eric Koza
- Geisinger Commonwealth School of Medicine, Scranton, PA (E.K., O.O.)
| | - Ashkan Mowla
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.).,Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA (A. Mowla, M.S.T.)
| | - Alireza Vafaei Sadr
- Department de Physique Theorique and Center for Astroparticle Physics, University Geneva, Switzerland (A.V.S.)
| | - Arash Kia
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York City, NY (A.K.)
| | - Alaleh Vaghefi Far
- Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy (S. Mondello)
| | | | - Annemarei Ranta
- Department of Neurology, Wellington Hospital, New Zealand and Department of Medicine, University of Otago, New Zealand (A.R., M.P.)
| | - Martin Punter
- Department of Neurology, Wellington Hospital, New Zealand and Department of Medicine, University of Otago, New Zealand (A.R., M.P.)
| | - Faezeh Khodadadi
- PES University, Bangaluru, Karnataka, India (F. Khodadadi, A.D.)
| | - Soheil Naderi
- Department of Neurosurgery (S.N.), Tehran University of Medical Sciences, Iran
| | - Mirna Sabra
- Neurosciences Research Center, Lebanese University/Medical School, Beirut, Lebanon (M. Sabra, F. Kobeissy)
| | - Mahtab Ramezani
- Neurology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Ramezani, A.A.H.)
| | - Ali Amini Harandi
- Neurology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Ramezani, A.A.H.)
| | - Oluwaseyi Olulana
- Geisinger Commonwealth School of Medicine, Scranton, PA (E.K., O.O.)
| | - Durgesh Chaudhary
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Aicha Lyoubi
- Neurology Department, Delafontaine Hospital, Saint-Denis, France (A.L.)
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C.)
| | - Juan F Arenillas
- Department of Neurology, University of Valladolid, Spain (J.F.A., M.D.L.A.)
| | - Daniel Bock
- Department of Cardiology, Klinikum Frankfurt Höchst, Germany (D.B.)
| | - Joan Montaner
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain (J. Montaner)
| | | | - Diana Aguiar de Sousa
- Department of Neurology (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal.,Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S.)
| | - Matthew S Tenser
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA (A. Mowla, M.S.T.)
| | - Ana Aires
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal (A.A., E.A.).,Department of Medicine, University of Porto, Portugal (A.A., E.A.)
| | | | - Orkhan Alizada
- Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Turkey (O.A., M.M.H.)
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal (A.A., E.A.).,Department of Medicine, University of Porto, Portugal (A.A., E.A.)
| | - Nitin Goyal
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | | | - Gelareh Banihashemi
- Imam Khomeini Hospital, and Neurology Department, Sina Hospital (G.B., F.V.), Tehran University of Medical Sciences, Iran
| | - Leo H Bonati
- Department of Neurology and Stroke Unit, University Hospital Basel, Switzerland (L.H.B.)
| | - Carlo W Cereda
- Stroke Center, Neurocenter of Southern Switzerland, Lugano (C.W.C.)
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC (J.J.C.)
| | - Miljenko Crnjakovic
- Intensive Care Unit, Department of Neurology, Clinical Hospital Dubrava, Zagreb, Croatia (M.C.)
| | - Gian Marco De Marchis
- Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, University of Basel, Switzerland (G.D.M.)
| | | | | | - Mehdi Farhoudi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Iran (M.F.)
| | | | - Bruno Gonçalves
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, France (B.G., G. Turc)
| | - Christoph J Griessenauer
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Mehmet Murat Hanci
- Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Turkey (O.A., M.M.H.)
| | - Aristeidis H Katsanos
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Greece (G. Tsivgoulis, A.H.K.).,Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada (A.H.K.)
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany (C.K.)
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.)
| | - Lev Lotman
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Jeffrey Mai
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, DC (J. Mai)
| | - Shailesh Male
- Department of Neurosurgery, Vidant Medical Center, Greenville, NC (S. Male)
| | - Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, PA (K.M.)
| | - Branko Malojcic
- Department of Neurology, TIA Clinic, University Hospital Centre Zagreb, Zagreb School of Medicine, University of Zagreb, Croatia (B.M.)
| | - Teresa Mesquita
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (T.M., J.P.M.)
| | | | - Hany Mohamed Aref
- Department of Neurology, Ain Shams University, Cairo, Egypt (H.M.A.)
| | - Zeinab Mohseni Afshar
- Infection Disease Research Center, Kermanshah University of Medical Sciences, Iran (Z.M.A.)
| | - Jusun Moon
- Department of Neurology, National Medical Center, Seoul, South Korea (J. Moon)
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Finland (M.N., B.R.J.)
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Finland (M.N., B.R.J.)
| | - Lawrence Nolan
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Abhi Pandhi
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, South Korea (J.-H.P.)
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (T.M., J.P.M.)
| | - Francisco Purroy
- Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., N.R.C.)
| | - Sakineh Ranji-Burachaloo
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran
| | - Nuno Reis Carreira
- Department of Internal Medicine (N.E.C.), Hospital de Santa Maria, University of Lisbon, Portugal.,Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., N.R.C.)
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron Barcelona, Spain (M. Requena, M. Rubiera).,Department de Medicina, Universitat Autònoma de Barcelona, Spain (M. Requena, M. Rubiera)
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron Barcelona, Spain (M. Requena, M. Rubiera).,Department de Medicina, Universitat Autònoma de Barcelona, Spain (M. Requena, M. Rubiera)
| | - Seyed Aidin Sajedi
- Department of Neurology, Neuroscience Research Center, Golestan University of Medical Sciences, Iran (S.A.S.)
| | - João Sargento-Freitas
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal (J.S.-F.)
| | - Vijay K Sharma
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore (V.K.S.)
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Germany (T.S.).,Department of Neurology, Heidelberg University Hospital, Germany (T.S.)
| | - Kristi Tempro
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, France (B.G., G. Turc)
| | | | - Mostafa Almasi-Dooghaee
- Divisions of Vascular and Endovascular Neurosurgery (M.A.-D., M. Ghorbani), Firoozgar Hospital, Iran University of Medical Sciences, Tehran.,Neurology (M.A.-D.), Firoozgar Hospital, Iran University of Medical Sciences, Tehran.,Divisions of Vascular and Endovascular Neurosurgery (M.A.-D.), Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran.,Neurology (M.A.-D.), Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran
| | | | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Iran (A.B.)
| | - Humain Baharvahdat
- Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Iran (H.B.)
| | | | - Apoorva Dev
- PES University, Bangaluru, Karnataka, India (F. Khodadadi, A.D.)
| | - Mohammad Ghorbani
- Divisions of Vascular and Endovascular Neurosurgery (M.A.-D., M. Ghorbani), Firoozgar Hospital, Iran University of Medical Sciences, Tehran
| | - Ava Hamidi
- Neurology Ward, Gheshm Hospital, Iran (A.H.)
| | - Zeynab Sadat Hasheminejad
- Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran (Z.S.H., M. Sepehrnia)
| | | | - Fariborz Khorvash
- Neurology Department, Isfahan University of Medical Sciences, Iran (F. Khorvash)
| | - Firas Kobeissy
- Neurosciences Research Center, Lebanese University/Medical School, Beirut, Lebanon (M. Sabra, F. Kobeissy).,Program of Neurotrauma, Neuroproteomics and Biomarker Research, University of Florida (F. Kobeissy)
| | | | | | - Debdipto Misra
- Steele Institute of Health and Innovation, Geisinger Health System, PA (D.M.)
| | - Ali Reza Noorian
- Department of Neurology, Southern California Permanente Medical Group, Irvine, CA (A.R.N.)
| | | | - Sepideh Paybast
- Department of Neurology, Bou Ali Hospital, Qazvin University of Medical Sciences, Iran (S.P.)
| | - Leila Poorsaadat
- Department of Neurology, Arak University of Medical Sciences, Iran (L.P.)
| | - Mehrdad Roozbeh
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Roozbeh)
| | - Behnam Sabayan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (B.S.)
| | - Saeideh Salehizadeh
- Neurology Department, Salahadin Ayubi Hospital, Baneh, Iran (S. Salehizadeh)
| | - Alia Saberi
- Neurology Department, Poursina Hospital, Rasht, Guilan, Iran (S.A.S.N., A.S.)
| | - Mercedeh Sepehrnia
- Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran (Z.S.H., M. Sepehrnia)
| | - Fahimeh Vahabizad
- Imam Khomeini Hospital, and Neurology Department, Sina Hospital (G.B., F.V.), Tehran University of Medical Sciences, Iran
| | | | - Mojdeh Ghabaee
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran.,Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Nasrin Rahimian
- Department of Neurology, Yasrebi Hospital, Kashan, Iran (N.R.)
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran
| | | | | | - Rohan Arora
- Department of Neurology, Long Island Jewish Forest Hills, Queens, NY (R.A.)
| | - Saeed Ansari
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | - Venkatesh Avula
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.)
| | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.).,Biocomplexity Institute, Virginia Tech, Blacksburg, VA (J.L., V. Abedi)
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.).,Biocomplexity Institute, Virginia Tech, Blacksburg, VA (J.L., V. Abedi)
| | - Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
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13
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Khatri IA, AlSkaini M, AlDayel A, Qamra A, Masuadi E, AlShammari M, AlKhalaf A, AlRasheed D, AlKhathaami A, AlOtaibi N, Tarawneh M, AlHizan K. Patterns and outcomes of stroke thrombolysis in a large tertiary care hospital in Riyadh, Saudi Arabia. ACTA ACUST UNITED AC 2021; 26:199-206. [PMID: 33814374 PMCID: PMC8024134 DOI: 10.17712/nsj.2021.2.20200171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/23/2021] [Indexed: 11/20/2022]
Abstract
Objectives: To present the experience on stroke thrombolysis of a tertiary care center in Riyadh, KSA. Methods: Cross-sectional, observational study of patients thrombolyzed between January 2012 and December 2018. Results: Thrombolysis was performed in 148 patients (mean age: 58.2±14.5 years), 94 (63.5%) of them were men. The median onset-to-door time was 81 minutes, and 25% of the patients arrived within 1 hour. The median National Institute of Health Stroke Scale score upon admission was 13. Hypertension (68.9%), diabetes (56.1%), and dyslipidemia (40.5%) were the most common risk factors for stroke. The most common mechanism of stroke was cardioembolism (43.2%), which was associated with a more severe presentation (p=0.031). Intravenous thrombolysis alone was given to 98 patients (66.2%); the rest received intravenous tissue plasminogen activator plus endovascular therapy or endovascular therapy alone. The median door-to-needle (DTN) time was 70.5 min, with a significant improvement from 2012 (111.6 minutes) to 2018 (69.9 minutes) (p<0.001). Among the patients, 53 (35.8%) showed a good outcome (with a modified Rankin score of 0–2) whereas 14 (9.5%) died. Symptomatic intracranial hemorrhage (sICH) was seen in 8.1%. All vascular risk factors were more common in patients aged >60 years, except smoking, which was more common in the younger age group (p=0.007). Conclusion: In our cohort, the utilization of thrombolysis and the DTN time improved over time. One-thirds of the patients received endovascular treatment. Moreover, the frequency of the vascular risk factors was high. Compared with the published findings, our results showed that cardioembolic strokes were the most frequent and had severe presentation and were likely the cause of the slight increase in mortality and sICH.
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Affiliation(s)
- Ismail A Khatri
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed AlSkaini
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - AbdulRahman AlDayel
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - AlBoqami Qamra
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Emad Masuadi
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mufadhi AlShammari
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Athal AlKhalaf
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Deema AlRasheed
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ali AlKhathaami
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Nasir AlOtaibi
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Maisoun Tarawneh
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Khloud AlHizan
- From the Division of Neurology (Khatri, AlSkaini, AlDayel, AlShammari, AlKhalaf, AlRasheed, AlKhathaami, AlOtaibi), Department of Medicine, Department of Nursing (Tarawneh, AlHizan), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the College of Medicine (Khatri, Masuadi, AlKhathaami, AlOtaibi), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Khatri, Masuadi, AlKhathaami, AlOtaibi), from the College of Public Health (AlBoqami), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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14
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Chakroun-Walha O, Samet A, Ben Abdallah M, Benmansour S, Issaoui F, Rebai M, Ben Messaoud K, Benali C, Mokni W, Nasri A, Rejeb I, Rekik N. Stroke knowledge among emergency centre visitors: A cross-sectional multicenter survey. Afr J Emerg Med 2021; 11:10-14. [PMID: 33318912 PMCID: PMC7724164 DOI: 10.1016/j.afjem.2020.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Stroke is a public health problem worldwide. Community stroke knowledge is crucial to guide the prevention approach. We aimed to evaluate the level of stroke knowledge among the visitors to Emergency Centres (ECs) in the southern region of Tunisia concerning factors of risk, symptoms, and treatment of stroke. METHODS A multicenter cross-sectional survey about stroke knowledge; conducted in five ECs for 10 days. All the visitors to these ECs were invited to participate in this survey. In each center, one investigator had to conduct the questionnaire. We used the stroke knowledge test (SKT). RESULTS We enrolled 839 participants aged at 44 ± 7 years and with an M/F sex-ratio at 0.9. Relatives and mass media were the most reported sources of information about stroke. In 32.3% of cases, the participants had a university schooling level. The upper quartile had an SKT score of 55% or over (n = 247; 29.4%). The SKT score was significantly higher in young, female participants, in rural centers, with a university level of schooling and with no reported chronic diseases. Receiving information about stroke through the medium of television or via relatives was an independent predictor of a high SKT score compared with other knowledge sources. CONCLUSION This study emphasises the urgent need for improving the population's knowledge about stroke in Tunisia. These findings may reflect the lack of government policies for education and training on stroke. A national educating program is necessary to implement to increase stroke knowledge.
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Level of Knowledge on Stroke and Associated Factors: A Cross-Sectional Study at Primary Health Care Centers in Morocco. Ann Glob Health 2020; 86:83. [PMID: 32742941 PMCID: PMC7380055 DOI: 10.5334/aogh.2885] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Stroke is increasingly becoming a major cause of disability and mortality. However, it can be prevented by raising awareness about risk factors and early health care management of patients. Objective: The aim of this study is to assess the level of knowledge on stroke, its risk factors, and warning signs in the population attending urban primary health care centers in the city of Agadir, Morocco. Methods: This is a multicentric cross-sectional study with a descriptive and analytical purpose. The study was conducted at five urban primary health care centers in Agadir in centralwest Morocco. All persons over the age of 18 years who consulted the health centers and who agreed to fill in the questionnaire were recruited, except for the foreign population and health workers. An interview questionnaire was used to assess the level of knowledge on stroke. Findings: A total of 469 participants were involved in the study. The median knowledge score was 8 (Interquartile range 4–13). High blood pressure (55.7%), depression and stress (48.8%) were the most well-known risk factors. Sudden weakness of the face, arms or legs (37.3%) was the main warning sign cited by the participants. Multivariate analysis revealed that illiteracy (OR 1.92; CI95%: 1.08–3.44) primary education (OR 3.43; CI95%: 1.63–7.21), rural residential (OR 1.67; CI95%: 1.07–2.59), no history of stroke among respondents (OR 16.41; CI95%: 4.37–61.59) and no history of stroke among relatives, acquaintances, or neighbors (OR 4.42; CI95%: 2.81–6.96), were independently associated with a lower level of knowledge of stroke (Table 4). Conclusions: The low level of knowledge on stroke among this Moroccan population indicates the importance of implementing stroke education initiatives in the community. More specifically, proximity education and awareness programs ought to be considered to anchor lifestyle preventive behaviors along with appropriate and urgent actions regarding the warning signs of stroke.
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16
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Qawasmeh MA, Aldabbour B, Momani A, Obiedat D, Alhayek K, Kofahi R, Yassin A, El-Salem K. Epidemiology, Risk Factors, and Predictors of Disability in a Cohort of Jordanian Patients with the First Ischemic Stroke. Stroke Res Treat 2020; 2020:1920583. [PMID: 32566121 PMCID: PMC7292978 DOI: 10.1155/2020/1920583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/17/2020] [Accepted: 05/23/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To identify the risk factors, etiologies, length of stay, severity, and predictors of disability among patients with the first ischemic stroke in Jordan. METHODS A retrospective cohort study of 142 patients who were admitted to the Neurology Department at King Abdullah University Hospital between July/2017 and March/2018 with a first ischemic stroke. Etiology was classified according to the TOAST criteria. Severity was represented by NIHSS score, disability by mRS score, and prolonged length of stay as hospitalizations more than 75th percentile of the cohort's median length of stay. Analysis of the sample demographics and descriptive statistics were done, including frequencies of prevalence of independent variables (risk factors) and frequencies of stroke and etiology work-up. Chi-square and univariate analysis of variance "ANOVA" were used to investigate the relationship between risk factors and type of stroke. Finally, logistic regression analysis was used to measure the contribution of each of the independent variables. IRB approval was obtained as necessary. RESULTS The mean age for the cohort was 66.5 years. The most common risk factors were hypertension (78.8%), diabetes mellitus (60.5%), and ischemic heart disease (29.4%). The most common stroke etiology was small-vessel occlusion (54.2%). Median length of stay was 4 days. Prolonged length of stay was observed in 23.23% of patients, which was associated with several factors, the most common of which were persistent dysphagia (57.5%), nosocomial infection (39.3%), and combined dysphagia and nosocomial infection (21.2%). The mean admission NIHSS score was 7.94, and on discharge was 5.76. In-hospital mortality was 2.81%, while 50% of patients had a favorable outcome on discharge (mRS score between 0-2). The mean discharge mRS score for the cohort was 2.47 (SD ± 1.79). Large artery atherosclerosis was associated with the highest residual disability with a mean score of 3.67 (SD ± 1.88), while the stroke of undetermined etiology was associated with the lowest residual disability with a mean score of 1.60 (SD ± 1.78). Significant predictors of mRS score were smoking (t 3.24, P < 0.001), age (t 1.98, P < 0.049), and NIHSS score (t 9.979, P 0.000). CONCLUSION Ischemic strokes have different etiologies that are associated with different levels of impact on the patient's clinical status and prognosis. Large artery atherosclerosis was associated with the highest residual disability. Regarding predictors of prognosis, current smoking status, age above 50, gender, and NIHSS on admission appear to be the strongest predictors of prognosis. Finally, higher NIHSS score on admission resulted in a longer hospital stay.
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Affiliation(s)
- Majdi Al Qawasmeh
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Belal Aldabbour
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Aiman Momani
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Deema Obiedat
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Kefah Alhayek
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Raid Kofahi
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Ahmed Yassin
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Khalid El-Salem
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
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17
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Malek EG, Elbejjani M, Abbas R, Abed Al Ahad M, Isma'eel H, Makki A. TOAST classification and risk factors of ischemic stroke in Lebanon. Acta Neurol Scand 2020; 141:294-300. [PMID: 31782134 DOI: 10.1111/ane.13201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Ischemic stroke is a common cause of morbidity and mortality especially in the increasingly older population. The variability in ischemic stroke subtypes and its risk factors across different populations suggest that more effort is needed to describe the stroke characteristics in order to develop a more tailored management for each population. We aim to describe the demographic characteristics, risk factors, and subtype distribution of subjects with ischemic stroke in the Lebanese population. MATERIALS AND METHODS We conducted a cross-sectional study based on chart review on patients with ischemic stroke/transient ischemic attack at the American University of Beirut Medical center between 2015 and 2017. RESULTS A total of 284 cases were included with a mean age of 72 years, and 58% male gender. The most commonly identified risk factors were hypertension (77%), dyslipidemia (62%), and diabetes mellitus (42%), while atrial fibrillation was only found in 27% of cases. The cohort distribution according to TOAST classification was as follows: 15% large artery stroke, 31% cardioembolic stroke, 17% small artery stroke, 10% stroke of other determined causes, and 27% stroke of unknown cause. CONCLUSION This is the first study to address ischemic stroke characteristics in Lebanon.
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Affiliation(s)
- Elia G. Malek
- Department of Neurology American University of Beirut Medical Center Beirut Lebanon
| | - Martine Elbejjani
- Clinical Research Institute American University of Beirut Medical Center Beirut Lebanon
- Vascular Medicine Program American University of Beirut Medical Center Beirut Lebanon
| | - Rawad Abbas
- Faculty of Medicine American University of Beirut Beirut Lebanon
| | - Mary Abed Al Ahad
- Clinical Research Institute American University of Beirut Medical Center Beirut Lebanon
| | - Hussein Isma'eel
- Vascular Medicine Program American University of Beirut Medical Center Beirut Lebanon
- Division of Cardiology American University of Beirut Medical Center Beirut Lebanon
| | - Achraf Makki
- Department of Neurology American University of Beirut Medical Center Beirut Lebanon
- Vascular Medicine Program American University of Beirut Medical Center Beirut Lebanon
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Khan M, Al-Rukn S, Alhazzani AA, Aref H, Moreira T, Wahlgren N. Changing the face of stroke care in the Middle East North Africa region. J Neurol Sci 2020; 412:116727. [PMID: 32062201 DOI: 10.1016/j.jns.2020.116727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Maria Khan
- Rashid Hospital, Dubai, United Arab Emirates.
| | | | | | | | - Tiago Moreira
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Nils Wahlgren
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Abstract
Background The aim of this systematic review is to determine the epidemiological and etiological profiles, the influential factors of the prehospital delay, thrombolysis management, the acute and 3-month mortality rate and the genetic aspect of ischemic stroke in Morocco. Methods The present work is a systematic review that was conducted according to the recommendations of the “Preferred reporting items for systematic reviews and meta-analysis”. We used Pubmed, Sciencedirect, Scopus, Clinicalkey, and Google scholar databases for the raking of the gray literature during the time frame 2009 and 2018. The protocol of the review was registered in the PROSPERO register (CRD42018115206). These studies were analyzed based on: Age, sex ratio, risk factors, etiological profile according to Trial of ORG classification 10,172 in Acute Stroke Treatment, prehospital delay average and its influential factors, thrombolyzed patients’ proportion, acute and 3-month mortality and the genetic factors of ischemic stroke in Morocco. Results Twenty-nine (n = 29) studies were selected. The average age ranged from 49 ± 15.2 to 67.3 ± 9.9 years old. Moreover, we reported male predominance within all ages in 13 studies. High blood pressure, diabetes, smoking and heart disease were the four identified main risk factors by the prementioned studies. Atherosclerosis and cardioembolic were the main described etiologies of cerebral ischemia, and the average prehospital time ranged from 26 to 61.9 h. The proportion of thrombolysed patients ranged from 1.8% to 2.9%, the mortality rate varied in the acute phase from 3 to 13%, and the 3-month mortality ranged from 4.3 to 32.5%. It is also important to highlight that most of these studies, which were conducted in hospital environment, have a reduced sample size and no confidence interval. Conclusions Ischemic stroke is affecting more likely the young population with male predominance. Moreover, the long prehospital delay and the low proportion of thrombolysed patients are alarming. This indicates the need to investigate in depth the key factors influencing the access to care for Moroccan patients in order to improve the management of this neurologic deficit in Morocco.
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Okshina EY, Loukianov MM, Martsevich SY, Yakushin SS, Kutishenko NP, Vorobyev AN, Pereverzeva KG, Zagrebelnyy AV, Voronina VP, Dmitrieva NA, Lerman OV, Kudryashov EV, Boytsov SA, Drapkina OM. Patients with History of Myocardial Infarction and Acute Cerebrovascular Accidentin Clinical Practice: Demographic, Clinical Characteristics, Drug Treatment and Outcomes (Data of Outpatient and Hospital Registry REGION). RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-5-656-662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To assess the demographic and clinical characteristics, drug treatment and outcomes in patients with a history of acute cerebrovascular accident (ACVA) and with concomitant history of myocardial infarction (MI) in clinical practice based on outpatient and hospital parts of REGION registry.Material and methods. The total 1886 patients with a history of ACVA (aged of 70.6±12.5 years, 41.9% men) were enrolled into the outpatient registry REGION (Ryazan) and the hospital registry REGION (Moscow). 356 patients had ACVA and a history of MI (group “ACVA+MI” and 1530 patients had ACVA without history of MI (group “ACVA without MI”). The incidence of cardiovascular diseases (CVD), non-CVD comorbidities, drug therapy and outcomes were analyzed.Results. In the group ACVA+MI compared with group ACVA without MI the significantly higher proportions of patients with the following conditions (diagnosis) were revealed: arterial hypertension (AH) – 99.1% and 94.2%; coronary heart disease (CHD) – 100% and 57%; chronic heart failure (CHF) – 61.5% and 41.8%; atrial fibrillation (AF) – 42.7% and 23.8%; repeated ACVA – 32.9% and 18.9%, respectively, p<0.0001 for all. In ACVA+MI and ACVA without MI groups the respective proportions of patients were smokers – 16.2% and 23.7% (p=0.10), had a family history of premature CVD – 3.2% and 1.2% (p=0.01), and had a hypercholesterolemia – 47% and 59.7% (p<0.001). The incidence of drug administration with proved positive prognostic effect was insufficient in both groups, but higher in the ACVA+MI group compared with ACVA without MI group (on average 47.1% and 40%, respectively), including: anticoagulants in AF – 19.1% and 21.4% (p=0.55); antiplatelets in CHD without AF – 69.4% and 42% (p<0.001); statins in CHD – 26.4% and 17.2% (p<0.001); beta-blockers in CHF – 39% and 23.8% (p=0.002), respectively. During 4- year follow-up in the group ACVA+MI compared with group ACVA without MI there were significantly higher all-cause mortality – 44.9% and 26.8% (p<0.001), nonfatal recurrent ACVA – 13.7% and 5.6% (p=0.0001), and nonfatal MI – 6.9% and 1.0% (p<0.0001), respectively.Conclusion. The proportion of patients with a history of MI was 18.9% among the patients with a history of ACVA. In patients of ACVA+MI group, compared with patients of ACVA without MI group a higher incidence of the following characteristics was revealed: a presence of AH, CHD, CHF, AF, repeated ACVA and a family history of premature CVD. The incidence of taking drug with proved positive effect on prognosis in patients of the compared groups was insufficient, especially of statins and anticoagulants in AF. During the follow-up period ACVA+MI group was characterized by a higher all-cause mortality and higher incidence of nonfatal ACVA and MI. In these patients the improvement of the quality of pharmacotherapy and of the secondary prevention effectiveness are the measures of especial importance.
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Affiliation(s)
- E. Yu. Okshina
- National Medical Research Center for Preventive Medicine
| | | | | | - S. S. Yakushin
- Ryazan State Medical University named after Academician I.P. Pavlov
| | | | - A. N. Vorobyev
- Ryazan State Medical University named after Academician I.P. Pavlov
| | | | | | - V. P. Voronina
- National Medical Research Center for Preventive Medicine
| | | | - O. V. Lerman
- National Medical Research Center for Preventive Medicine
| | | | | | - O. M. Drapkina
- National Medical Research Center for Preventive Medicine
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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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