Stroke services in the Middle East and adjacent region: A survey of 34 hospital-based stroke services

Need for neurorehabilitation in the Middle East and North Africa from 1990 to 2021: an analysis based on the global burden of disease study

Background

This study will present the burden of diseases needing neurorehabilitation in Middle East and North Africa (MENA) countries and describe their epidemiology across age and sex groups.

Materials and methods

This study was conducted based on the Global Burden of Disease (GBD) 2021 findings. The authors used years of healthy life lost due to disability (YLD) as a proxy for the need for neurorehabilitation, and extracted the YLD rates and counts for neonatal encephalopathy due to birth asphyxia and trauma, stroke, neural tube defects, Parkinson's disease (PD), motor neuron disease, multiple sclerosis (MS), tension-type headache, other neurological disorders (except migraine, dementia, and epilepsy), head injuries, spinal injuries, nerve injury, and asphyxiation across age groups, sexes, and MENA countries.

Results

YLD rates of disorders needing neurorehabilitation in 1990 and 2021 were 408.08 and 496.19 per 100 000 people, respectively, indicating a 21.59% rise in YLD. Stroke had the highest YLD rates in both 1990 (150.19 per 100 000) and 2021 (192.75 per 100 000). Syria, Saudi Arabia, and the United Arab Emirates had the highest YLD rates for conditions needing neurorehabilitation.

Conclusions

Considering the growing demand for neurorehabilitation with the aging of populations and the historical shortage of rehabilitation services in the region, the gap between the demand and supply may further increase in the coming years, leading to consequences for people living with neurological conditions in the region.

The one-year incidence of stroke in patients with atrial fibrillation in Jordan and its associated factors

Background

An elevated risk of stroke is linked to atrial fibrillation (AF). Effective care and prevention measures for individuals with AF require an understanding of the factors impacting the incidence of stroke in this population. Evidence regarding the incidence of stroke among patients with AF is insufficient in Jordan. This study aimed to determine the incidence of stroke and its associated factors among patients with AF in Jordan.

Methods

The Jordan Atrial Fibrillation Registry JoFib was used to identify a total of 2020 AF patients meeting the study inclusion and exclusion criteria. Demographics, clinical characteristics, and the CHA2DS2-VASc score-based evaluation of stroke risk were extracted from the registry.

Results

This study encompassed 2020 participants diagnosed with AF, with 925 (45.8%) being men and 1,095 (54.2%) women. The one-year stroke incidence among the 2020 AF patients was 3.4%. Notably, stroke incidence significantly increased with age (p = 0.04) and was associated with the history of stroke (7.4% vs. 2.7%), hypertension (3.9% vs. 1.9%), and diabetes (5.1% vs. 2.1%). In the multivariate analysis, diabetes (OR = 2.6, 95% CI: 1.5-4.4, p = 0.001) and history of stroke (OR = 2.6, 95% CI: 1.5-4.6, p = 0.001) were significantly associated with stroke incidence.

Conclusion

This study emphasizes Jordan's high stroke rate among AF patients. Diabetes and prior stroke history are associated with increased odds of stroke, like all stroke patients. These results highlight the necessity for specialized management strategies among AF patients and highlight the significance of thorough risk assessment and focused interventions to reduce stroke risk in AF patients.

Incidence, clinical features, and outcomes of posterior circulation ischemic stroke: insights from a large multiethnic stroke database

Background

Posterior cerebral circulation ischemic stroke (PCS) comprises up to 25% of all strokes. It is characterized by variable presentation, leading to misdiagnosis and morbidity and mortality. We aim to describe PCS in large multiethnic cohorts.

Methods

A retrospective review of a large national stroke database from its inception on the 1st of January 2014 till 31 December 2020. Incidence per 100,000 adult population/year, demographics, clinical features, stroke location, and outcomes were retrieved. We divided the cohort into patients from MENA (Middle East and North Africa) and others.

Results

In total, 1,571 patients were identified. The incidence of PCS was observed to be rising and ranged from 6.3 to 13.2/100,000 adult population over the study period. Men were 82.4% of the total. The mean age was 54.9 ± 12.7 years (median 54 years, IQR 46, 63). MENA patients comprised 616 (39.2%) while others were 954 (60.7%); of these, the majority (80.5%) were from South Asia. Vascular risk factors were prevalent with 1,230 (78.3%) having hypertension, 970 (61.7%) with diabetes, and 872 (55.5%) having dyslipidemia. Weakness (944, 58.8%), dizziness (801, 50.5%), and slurred speech (584, 36.2%) were the most commonly presenting symptoms. The mean National Institute of Health Stroke Score (NIHSS) score was 3.8 ± 4.6 (median 3, IQR 1, 5). The overall most frequent stroke location was the distal location (568, 36.2%). The non-MENA cohort was younger, less vascularly burdened, and had more frequent proximal stroke location (p < 0.05). Dependency or death at discharge was seen in 39.5% and was associated with increasing age, and proximal and multilocation involvement; while at 90 days it was 27.4% and was associated with age, male sex, and having a MENA nationality (p < 0.05).

Conclusion

In a multiethnic cohort of posterior circulation stroke patients from the MENA region and South Asia, we noted a rising incidence over time, high prevalence of vascular risk factors, and poor outcomes in older men from the MENA region. We also uncovered considerable disparities between the MENA and non-MENA groups in stroke location and outcome. These disparities are crucial factors to consider when tailoring individualized patient care plans. Further research is needed to thoroughly investigate the underlying reasons for these variations.