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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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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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KAZADI KABANDA I, KIANGEBENI NGONZO C, EMEKA BOWAMOU CK, DIVENGI NZAMBI JP, KIATOKO PONTE N, TUYINAMA MADODA O, NKODILA NATUHOYILA A, M’BUYAMBA-KABANGU JR, LONGO-MBENZA B, BANZULU BOMBA D, KIANU PHANZU B. Stroke signs knowledge and factors associated with a delayed hospital arrival of patients with acute stroke in Kinshasa. Heliyon 2024; 10:e28311. [PMID: 38571603 PMCID: PMC10988012 DOI: 10.1016/j.heliyon.2024.e28311] [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: 10/21/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
Background Rapid recognition and early medical intervention are essential to reduce stroke-related mortality and long-term disability. This study aimed to evaluate awareness of stroke symptoms/signs and determine factors delaying the hospital arrival of patients with acute stroke in Kinshasa. Methods Patients with stroke and/or accompanying family members were interviewed using a standard questionnaire, and their medical records were reviewed. Factors independently associated with a late arrival (≥4.5 h) to the hospital were identified using the logistic regression test in forward multivariate analysis. Results Overall, 202 patients with an average age of 57.9 ± 13.1 years were included. Only 27 (13.4%) patients immediately associated the initial symptoms with a stroke episode. Delayed hospital arrival was observed in 180 (89.1%) patients. Unmarried status (adjusted odds ratio [aOR], 2.29; 95% confidence interval [CI], 1.17-4.88; p = 0.007), low education level (aOR, 2.29; 95% CI, (1.12-5.10; p = 0,014), absence of impaired consciousness (aOR, 3.12; 95% CI, 1.52-4.43; p = 0.005), absence of a history of hypertention (aOR, 1.85; 95% CI, 1.18-3.78; p = 0.041), absence of a history of diabetes (aOR, 1.93; 95% CI, 1.15-4.58; p = 0.013), heavy alcohol consumption (aOR, 1.83; 95% CI, 1.12-2.83; p = 0.045), absence of a severe to very severe stroke (aOR, 4.93; 95% CI, 0.82-1.01; p = 0.002), and presence of ischemic stroke (aOR, 2.93; 95% CI, 1.54-4.59; p = 0.001) were identified as independent determinants of delayed hospital arrival. Conclusions This study depicted a low stroke awareness rate and a much longer prehospital delay than evidence-based guidelines recommend and identified eight factors that public health actions could target to promote the earliest management of stroke.
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Affiliation(s)
- Igor KAZADI KABANDA
- Faculty of Medicine, University of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | | | | | - Jean-Paul DIVENGI NZAMBI
- Department of Internal Medicine, Reference General Hospital, Kinshasa, the Democratic Republic of the Congo
| | - Nono KIATOKO PONTE
- Unit of Neurology, Centre Hospitalier Initiative Plus de Kinkole, Kinshasa, the Democratic Republic of the Congo
| | - Olivier TUYINAMA MADODA
- Emergency Unit, University Hospital of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Aliocha NKODILA NATUHOYILA
- Department of Biostatistics, Public Health School of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | | | - Benjamin LONGO-MBENZA
- Cardiology Unit, University of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Degani BANZULU BOMBA
- Department of Neuropsychiatry, University of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Bernard KIANU PHANZU
- Cardiology Unit, University of Kinshasa, Kinshasa, the Democratic Republic of the Congo
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Alhazmi H, Ameen OK, Almalki Z, Alanazi A, Albalawi A, Alshanqiti M, Almalki K, Alsaleh A, Khayat A, Ibrahim H, Almulhim IA, Jubran A, Almodarra N, Almansour N, Alnaaim SA, Al-Senani F, Shuaib A, Muthana J, Alotaibi M. Endovascular thrombectomy for acute ischemic stroke in Saudi Arabia: A single-center experience. J Stroke Cerebrovasc Dis 2024; 33:107552. [PMID: 38277959 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107552] [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: 07/23/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024] Open
Abstract
PURPOSE This study aimed to investigate the outcomes of endovascular thrombectomy-treated patients in King Fahad Medical City, Riyadh, Saudi Arabia. METHODS A retrospective cohort study of acute ischemic stroke patients treated with endovascular thrombectomy. Patients were included in the study between January 2015 and December 2022. Good outcomes were defined as a modified Rankin Scale (mRS) of 0-2 at 90 days. Multivariate logistic regression analysis was performed to identify the independent factors associated with good outcomes. RESULTS During the study period, 369 patients with acute ischemic stroke (mean ± SD age, 61/- 15.1 yrs; 55.4 % male) underwent mechanical thrombectomy. Median National Institute of Health Stroke Scale (NIHSS) 15. Intravenous thrombolysis was administered to 34.5 % of the patients. Successful recanalization in the anterior circulation was achieved in 84.8 % of patients. Data from mRS performed after 90 days in the anterior circulation were available for 71.2 % of the patients. Of these, 41 % showed a good outcome, and the mortality rate was 22.4 %. The significant factors associated with good outcomes were age, NIHSS score, Alberta Stroke Program Early Computed Tomography Score (ASPECTS), and short arterial puncture to recanalization. CONCLUSION The number of patients who underwent endovascular thrombectomy has increased over time. The treatment outcomes and mortality were comparable with those of previous endovascular thrombectomy registries despite the high prevalence of DM, lower ASPECT score, and prolonged onset-to-recanalization time.
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Affiliation(s)
- Hanan Alhazmi
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Omar K Ameen
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ziyad Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Abdulmajeed Alanazi
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Albalawi
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mahmoud Alshanqiti
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Almalki
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Alsaleh
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alaa Khayat
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hatim Ibrahim
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibrahim A Almulhim
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, King Fahad Medical City, Riyadh, Saudi Arabia; Department of Interventional Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Jubran
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nehal Almodarra
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nouf Almansour
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saud A Alnaaim
- Assistant professor, College of Medicine, Clinical Neuroscience department, King Faisal University, Hofuf, Saudi Arabia
| | - Fahmi Al-Senani
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ashfaq Shuaib
- Stroke Program, Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jamal Muthana
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; Neurology Section, Department of Medicine, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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Feigin VL, Owolabi MO. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization-Lancet Neurology Commission. Lancet Neurol 2023; 22:1160-1206. [PMID: 37827183 PMCID: PMC10715732 DOI: 10.1016/s1474-4422(23)00277-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 10/14/2023]
Abstract
Stroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends continue, Sustainable Development Goal 3.4 (reducing the burden of stroke as part of the general target to reduce the burden of non-communicable diseases by a third by 2030) will not be met. In this Commission, we forecast the burden of stroke from 2020 to 2050. We project that stroke mortality will increase by 50%—from 6·6 million (95% uncertainty interval [UI] 6·0 million–7·1 million) in 2020, to 9·7 million (8·0 million–11·6 million) in 2050—with disability-adjusted life-years (DALYs) growing over the same period from 144·8 million (133·9 million–156·9 million) in 2020, to 189·3 million (161·8 million–224·9 million) in 2050. These projections prompted us to do a situational analysis across the four pillars of the stroke quadrangle: surveillance, prevention, acute care, and rehabilitation. We have also identified the barriers to, and facilitators for, the achievement of these four pillars. Disability-adjusted life-years (DALYs) The sum of the years of life lost as a result of premature mortality from a disease and the years lived with a disability associated with prevalent cases of the disease in a population. One DALY represents the loss of the equivalent of one year of full health On the basis of our assessment, we have identified and prioritised several recommendations. For each of the four pillars (surveillance, prevention, acute care, and rehabilitation), we propose pragmatic solutions for the implementation of evidence-based interventions to reduce the global burden of stroke. The estimated direct (ie, treatment and rehabilitation) and indirect (considering productivity loss) costs of stroke globally are in excess of US$891 billion annually. The pragmatic solutions we put forwards for urgent implementation should help to mitigate these losses, reduce the global burden of stroke, and contribute to achievement of Sustainable Development Goal 3.4, the WHO Intersectoral Global Action Plan on epilepsy and other neurological disorders (2022–2031), and the WHO Global Action Plan for prevention and control of non-communicable diseases. Reduction of the global burden of stroke, particularly in low-income and middle-income countries, by implementing primary and secondary stroke prevention strategies and evidence-based acute care and rehabilitation services is urgently required. Measures to facilitate this goal include: the establishment of a framework to monitor and assess the burden of stroke (and its risk factors) and stroke services at a national level; the implementation of integrated population-level and individual-level prevention strategies for people at any increased risk of cerebrovascular disease, with emphasis on early detection and control of hypertension; planning and delivery of acute stroke care services, including the establishment of stroke units with access to reperfusion therapies for ischaemic stroke and workforce training and capacity building (and monitoring of quality indicators for these services nationally, regionally, and globally); the promotion of interdisciplinary stroke care services, training for caregivers, and capacity building for community health workers and other health-care providers working in stroke rehabilitation; and the creation of a stroke advocacy and implementation ecosystem that includes all relevant communities, organisations, and stakeholders. The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Mayowa O Owolabi
- Centre for Genomics and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria; Blossom Specialist Medical Centre, Ibadan, Nigeria.
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Xavier D, Murphy R, Pais P, Pandian J, Gosala S, Mathur N, Khurana D, Sundararajan R, Gupta R, Joshi R, Vanchilingam S, Venkatarathanamma PN, Desai S, Reddin C, O'Donnell M, Yusuf S. Characteristics, clinical practice patterns, and outcomes of strokes in India: INSPIRE-A multicentre prospective study. Int J Stroke 2023; 18:965-975. [PMID: 37114983 DOI: 10.1177/17474930231175584] [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] [Indexed: 04/29/2023]
Abstract
BACKGROUND India has a high burden of stroke, but there are limited data available on the characteristics of patients presenting with stroke in India. AIMS We aimed to document the clinical characteristics, practice patterns, and outcomes of patients presenting with acute stroke to Indian hospitals. METHODS A prospective registry study of patients admitted with acute clinical stroke was conducted in 62 centers across different regions in India between 2009 and 2013. RESULTS Of the 10,329 patients included in the prescribed registry, 71.4% had ischemic stroke, 25.2% had intracerebral hemorrhage (ICH), and 3.4% had an undetermined stroke subtype. Mean age was 60 years (SD = 14) with 19.9% younger than 50 years; 65% were male. A severe stroke at admission (modified-Rankin score 4-5) was seen in 62%, with 38.4% of patients having severe disability at discharge or dying during hospitalization. Cumulative mortality was 25% at 6 months. Neuroimaging was completed in 98%, 76% received physiotherapy, 17% speech and language therapy (SLT), 7.6% occupational therapy (OT), with variability among sites; 3.7% of ischemic stroke patients received thrombolysis. Receipt of physiotherapy (odds ratio (OR) = 0.41, 95% confidence interval (CI): 0.33-0.52) and SLT (OR = 0.45, 95% CI: 0.32-0.65) was associated with lower mortality, while a history of atrial fibrillation (OR = 2.22, 95% CI: 1.37-3.58) and ICH (OR = 2.00, 95% CI: 1.66-2.40) were associated with higher mortality. CONCLUSION In the INSPIRE (In Hospital Prospective Stroke Registry) study, one-in-five patients with acute stroke was under 50 years of age, and one-quarter of stroke was ICH. There was a low provision of thrombolysis and poor access to multidisciplinary rehabilitation highlighting how improvements are needed to reduce morbidity and mortality from stroke in India.
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Affiliation(s)
| | - Robert Murphy
- HRB Clinical Research Facility, University of Galway, Galway, Ireland
| | - Prem Pais
- St. John's Research Institute, Bangalore, India
| | | | | | | | - Dheeraj Khurana
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | | | | | | | | | - Catriona Reddin
- HRB Clinical Research Facility, University of Galway, Galway, Ireland
| | - Martin O'Donnell
- HRB Clinical Research Facility, University of Galway, Galway, Ireland
- PHRI, McMasters University, Hamilton, ON, Canada
| | - Salim Yusuf
- PHRI, McMasters University, Hamilton, ON, Canada
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Ospel J, Singh N, Ganesh A, Goyal M. Sex and Gender Differences in Stroke and Their Practical Implications in Acute Care. J Stroke 2023; 25:16-25. [PMID: 36746379 PMCID: PMC9911850 DOI: 10.5853/jos.2022.04077] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 02/04/2023] Open
Abstract
There are several controversies regarding the role of sex and gender in the pathophysiology and management of acute stroke. Assessing the role of sex, i.e., biological/pathophysiological factors, and gender, i.e., sociocultural factors, in isolation is often not possible since they are closely intertwined with each other. To complicate matters even more, the functional baseline status of women and men at the time of their first stroke is substantially different, whereby women have, on average, a poorer reported/ascertained baseline function compared to men. These differences in baseline variables account for a large part of the differences in post-stroke outcomes between women and men. Adjusting for these baseline differences is difficult, and in many cases, residual confounding cannot be excluded. Despite these obstacles, a better understanding of how patient sex and gender differences influence acute stroke and stroke care pathways is crucial to avoid biases and allow us to provide the best possible care for all acute stroke patients. Disregarding patient sex and gender on one hand and ignoring potential confounding factors in sex- and gender-stratified analyses on the other hand, may cause researchers to come to erroneous conclusions and physicians to provide suboptimal care. This review outlines sex- and gender-related factors in key aspects of acute stroke, including acute stroke epidemiology, diagnosis, access to care, treatment outcomes, and post-acute care. We also attempt to outline knowledge gaps, which deserve to be studied in further detail, and practical implications for physicians treating acute stroke patients in their daily practice.
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Affiliation(s)
- Johanna Ospel
- Department of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada,Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | - Nishita Singh
- Department of Neurology, University of Manitoba, Winnipeg, MB, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | - Mayank Goyal
- Department of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada,Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada,Correspondence: Mayank Goyal Departments of Radiology and Clinical Neurosciences, Foothills Medical Center, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada Tel: +1-403-9443379 E-mail:
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8
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Al Hashmi AM, Shuaib A, Imam Y, Amr D, Humaidan H, Al Nidawi F, Sarhan A, Mustafa W, Khalefa W, Ramadan I, Usman FS, Hokmabadi ES, Ghorbani M, Nassir T, Aladham F, Salmeen A, Kikano R, Muda S, Jose S, Bulushi MA, Sajwani B, Wasay M, Bashir Q, Al Hazzani A, Khoja W, Alkadere R, Osman H, Hussein A, Churojana A, Hammami N, Ozdemir AO, Giray S, Gurkas E, Hussain SI, Sallam AR, Mansour OY. Stroke services in the Middle East and adjacent region: A survey of 34 hospital-based stroke services. Front Neurol 2022; 13:1016376. [PMID: 36408502 PMCID: PMC9667787 DOI: 10.3389/fneur.2022.1016376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Acute stroke care is complex and requires multidisciplinary networking. There are insufficient data on stroke care in the Middle East and adjacent regions in Asia and Africa. Objective Evaluate the state of readiness of stroke programs in the Middle East North Africa and surrounding regions (MENA+) to treat acute stroke. Method Online questionnaire survey on the evaluation of stroke care across hospitals of MENA+ region between April 2021 and January 2022. Results The survey was completed by 34/50 (68%) hospitals. The median population serviced by participating hospitals was 2 million. The median admission of patients with stroke/year was 600 (250–1,100). The median length of stay at the stroke units was 5 days. 34/34 (100%) of these hospitals have 24/7 CT head available. 17/34 (50%) have emergency guidelines for prehospital acute stroke care. Mechanical thrombectomy with/without IVT was available in 24/34 (70.6%). 51% was the median (IQR; 15–75%) of patients treated with IVT within 60 min from arrival. Thirty-five minutes were the median time to reverse warfarin-associated ICH. Conclusion This is the first large study on the availability of resources for the management of acute stroke in the MENA+ region. We noted the disparity in stroke care between high-income and low-income countries. Concerted efforts are required to improve stroke care in low-income countries. Accreditation of stroke programs in the region will be helpful.
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Affiliation(s)
- Amal. M. Al Hashmi
- Central Stroke Unit, Neuroscience Directorate, Khoula Hospital, MOH, Muscat, Oman
- *Correspondence: Amal. M. Al Hashmi
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Yahia Imam
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Dareen Amr
- Stroke and Neurointervention Unit, Alexandria University School of Medicine, Alexandria, Egypt
| | - Hani Humaidan
- Stroke Unit, Salmaniya Medical Complex, Al Manamah, Bahrain
| | | | | | - Wessam Mustafa
- Department of Neurology, Mansoura University Hospital, Mansoura, Egypt
| | - Wael Khalefa
- Department of Neurology, Maady Military Hospital, Cairo, Egypt
| | - Ismail Ramadan
- Department of Neurology, Semoha Emergency Hospital, Alexandria University, Alexandria, Egypt
| | | | | | - Mohammed Ghorbani
- Division of Vascular and Endovascular Neurosurgery Firoozgar Hospital, Tehran, Iran
| | - Temeem Nassir
- Department of Internal Medicine, Maysan Cardiac Center, MOH, Musan, Iraq
| | | | - Athari Salmeen
- Department of Neurology, Jaber Al Ahmad Hospital, Kuwait City, Kuwait
| | - Raghid Kikano
- Lebanese American University, Head of Interventional Radiology, Beirut, Lebanon
| | - Sobri Muda
- Department of Radiology, Pengajar Hospital UPM, FPSK, Universiti Putra Malaysia, Serdang, Malaysia
| | - Sachin Jose
- Statistical Specialist, Oman Medical Specialty Board (OMSB), Muscat, Oman
| | | | | | - Mohammad Wasay
- Department of Neurology, Aga Khan University, Karachi, Pakistan
| | - Qasim Bashir
- Department of Neurology, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Adel Al Hazzani
- Neuroscience Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Waleed Khoja
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Haytham Osman
- Department of Neurology, National Ribat University, Khartoum, Sudan
| | - Abbashar Hussein
- Department of Neurology, El Shaab Teaching Hospital, Khartoum, Sudan
| | - Anchalee Churojana
- Department of Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nadia Hammami
- National Institute Mongi Ben Hamida of Neurology, Tunis, Tunisia
| | - Atilla Ozcan Ozdemir
- Interventional Neurology and Neurocritical Care Program, Eskisehir Osmangazi University,, Eskişehir, Turkey
| | - Semih Giray
- Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Erdem Gurkas
- Stroke Center, Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Seyd Irteza Hussain
- Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Ossama Yassin Mansour
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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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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Ospel JM, Schaafsma JD, Leslie-Mazwi TM, Amin-Hanjani S, Asdaghi N, Gordon-Perue GL, Couillard P, Hadidi NN, Bushnell C, McCullough LD, Goyal M. Toward a Better Understanding of Sex- and Gender-Related Differences in Endovascular Stroke Treatment: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2022; 53:e396-e406. [PMID: 35695016 DOI: 10.1161/str.0000000000000411] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are many unknowns when it comes to the role of sex in the pathophysiology and management of acute ischemic stroke. This is particularly true for endovascular treatment (EVT). It has only recently been established as standard of care; therefore, data are even more scarce and conflicting compared with other areas of acute stroke. Assessing the role of sex and gender as isolated variables is challenging because they are closely intertwined with each other, as well as with patients' cultural, ethnic, and social backgrounds. Nevertheless, a better understanding of sex- and gender-related differences in EVT is important to develop strategies that can ultimately improve individualized outcome for both men and women. Disregarding patient sex and gender and pursuing a one-size-fits-all strategy may lead to suboptimal or even harmful treatment practices. This scientific statement is meant to outline knowledge gaps and unmet needs for future research on the role of sex and gender in EVT for acute ischemic stroke. It also provides a pragmatic road map for researchers who aim to investigate sex- and gender-related differences in EVT and for clinicians who wish to improve clinical care of their patients undergoing EVT by accounting for sex- and gender-specific factors. Although most EVT studies, including those that form the basis of this scientific statement, report patient sex rather than gender, open questions on gender-specific EVT differences are also discussed.
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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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Abstract
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
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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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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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