1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Imam YZ, Kamran S, Saqqur M, Ibrahim F, Chandra P, Perkins JD, Malik RA, Akhtar N, Al-Jerdi S, Deleu D, Elalamy O, Osman Y, Malikyan G, Elkhider H, Elmakki S, ElSheikh L, Mhjob N, Abdelmoneim MS, Alkhawad N, Own A, Shuaib A. Stroke in the adult Qatari population (Q-stroke) a hospital-based retrospective cohort study. PLoS One 2020; 15:e0238865. [PMID: 32956364 PMCID: PMC7505434 DOI: 10.1371/journal.pone.0238865] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Studies assessing the burden of stroke in Qataris are limited. We aim to study stroke in the Qatari population. METHODS A retrospective review was undertaken of all Qatari adults presenting with stroke to Hamad Medical Corporation over a 5-year period. Descriptive statistics were used to summarize demographic and all other clinical characteristics of the patients. The primary outcome was the incidence of stroke in the Qatari patients. Comparison was made between the sexes. RESULTS 862 patients were included, with 58.9% being male. The average incidence of stroke over the 5-year period was 92.04 per 100,000 adult Qatari population. The mean age of the cohort was 64.3±14.4 years, (range 19-105 years). The mean age of first ever cerebrovascular event was 63.2±14.5 years. The diagnosis was ischemic stroke in (73.7%), transient ischemic attack in (13.8%), intracerebral hemorrhage (ICH) in (11.6%), subarachnoid hemorrhage in (0.7%) and (0.2%) cerebral venous sinus thrombosis. Small vessel disease was the most common cause of ischemic stroke accounting for (46.5%), followed by large artery atherosclerosis (24.5%). Hypertension (82.7%) and diabetes (71.6%) were particularly prevalent in this cohort. Females were older (65.8±14.1 vs 63.4±14.5 years), had more hypertension and diabetes and more disability or death at 90 days (p<0.05) compared to Qatari males. CONCLUSION Stroke occurs at a significantly lower age in Qataris compared to the western population. This study has uncovered sex differences that need to be studied further.
Collapse
Affiliation(s)
- Yahia Z. Imam
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Faisal Ibrahim
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Jon D. Perkins
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Osama Elalamy
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yasir Osman
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Gayane Malikyan
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Elkhider
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Suha Elmakki
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Lubna ElSheikh
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Noha Mhjob
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Nima Alkhawad
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| |
Collapse
|
3
|
Imam YZ, Mohamed MF, Abdelmoneim MS, Santos M, Alkhawad N, Salam A, Amir N, Saqqur M, Muhammad A, Elsoutohy A, Kamran S, Akhtar N, Kiliyanni AS, Own A, Deleu D, Shuaib A. Prospective study to optimize the health of patients with TIAS (transient ischemic attack) and stroke admitted to the Hamad General Hospital. Medicine (Baltimore) 2020; 99:e20694. [PMID: 32664066 PMCID: PMC7360328 DOI: 10.1097/md.0000000000020694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Recurrent ischemic strokes (IS) make up to one-third of all strokes. Nine out of 10 strokes are due to modifiable risk factors. Thus, it seems that standard management strategies of modifiable risk factors are yet to improve. Hence, we planned a randomized controlled trial assessing nurses or pharmacists-led aggressive control of comorbidities and their prognostic impact on IS and transient ischemic attacks (TIA). METHODS/DESIGN Prospective study to optimize the health of patients with TIAs and stroke admitted to the Hamad General Hospital (PROMOTE HEALTH) is an assessor-blinded, open-label, randomized, two-arm, controlled trial. Eligible patients have IS or TIA, and an additional modifiable risk factor (Hypertension or dyslipidemia) attending the stroke ward or clinic at the Weill Cornell-affiliated Hamad General Hospital. Stroke specialists will offer the control group the currently practiced best risk factor management strategies. Whereas, in the intervention arm, with the assistance of a nurse and a pharmacist, we will make aggressive attempts to meet targets of defined risk factors. The primary outcomes are the mean difference in blood pressure (BP) and low-density lipoprotein. Whereas myocardial infarction, recurrent stroke events, and mortality serve as the study's secondary outcomes. We require 200 patients per study arm to achieve a power of 80% and an alpha level of <0.05. The Medical Research Center and the Institutional Review Board have approved the study, and it was prospectively registered in a trial registry. DISCUSSION A significant proportion of strokes are due to modifiable preventable risk factors. Despite having the right preventive strategies aimed at mitigating these risk factors, a sizeable proportion of strokes are due to recurring events. This prompted the medical community to evaluate aggressive means of addressing these risk factors. The nurse or pharmacist-led management of comorbidities has been proven to be of value in the management of diabetes and hypertension. It will be of value to demonstrate the effectiveness of utilizing this additional task force in aggressively managing IS or TIA patients with an overarching goal of improving their prognosis. If our intervention proves to be efficacious, this would have a substantial impact on the current stroke practices and guidelines. Additionally, it will invite further research in the area. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT02868723, last updated on September 2018.
Collapse
Affiliation(s)
- Yahia Z. Imam
- Neuroscience Institute, Hamad Medical Corporation
- Weill Cornell Medicine-Qatar
| | | | | | - Mark Santos
- Neuroscience Institute, Hamad Medical Corporation
| | | | - Abdul Salam
- Neuroscience Institute, Hamad Medical Corporation
| | - Numan Amir
- Neuroscience Institute, Hamad Medical Corporation
| | - Maher Saqqur
- Neuroscience Institute, Hamad Medical Corporation
- Weill Cornell Medicine-Qatar
| | - Ahmad Muhammad
- Neuroscience Institute, Hamad Medical Corporation
- Weill Cornell Medicine-Qatar
| | - Ahmed Elsoutohy
- Neuroscience Institute, Hamad Medical Corporation
- Weill Cornell Medicine-Qatar
| | | | | | - Abdul Salim Kiliyanni
- Radiology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroscience Institute, Hamad Medical Corporation
| | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation
- Weill Cornell Medicine-Qatar
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| |
Collapse
|
4
|
Sharif Nia H, Sivarajan-Froelicher E, Haghdoost AA, Moosazadeh M, Huak-Chan Y, Farsavian AA, Nazari R, Yaghoobzadeh A, Goudarzian AH. The estimate of average age at the onset of acute myocardial infarction in Iran: A systematic review and meta-analysis study. ARYA ATHEROSCLEROSIS 2019; 14:225-232. [PMID: 30783413 PMCID: PMC6368197 DOI: 10.22122/arya.v14i5.1739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Research indicates that the age of onset of first acute myocardial infarction (AMI) is an essential element in the life expectancy that has been decreasing in developing countries. There are various studies performed in Iran reporting a range of ages at time of AMI. Thus, this meta-analysis study is designed to determine the mean age at first AMI in the Iranian population. METHODS All studies that met the inclusion and exclusion criteria were reviewed using standard keywords in the databases from 2000 to 2016. Two raters verified a total of 658 articles. Sixteen studies met the inclusion criteria of this study for meta-analysis. Cochran test and I-squared (I2) were used for samples’ homogeneity. Pooled estimates of mean were calculated using the random effects inverse-variance model. RESULTS The mean age of AMI varied between 55.9 to 62.9 years among the primary studies. The pooled mean age of first AMI with a 95% confidence interval (CI) for the total sample, men, and women were 59 (58.9, 60.4), 58.7 (58.3, 59.2), and 64.2 (63.5, 64.8), respectively. CONCLUSION Our meta-analysis shows that the mean age of first onset of AMI in Iranian people is slightly lower than that reported elsewhere; and it is lower for men than for women.
Collapse
Affiliation(s)
- Hamid Sharif Nia
- Assistant Professor, Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Erika Sivarajan-Froelicher
- Professor, Department of Physiological Nursing, School of Nursing AND Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Ali Akbar Haghdoost
- Professor, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahmood Moosazadeh
- Assistant Professor, Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Yiong Huak-Chan
- Head of Biostatistics Unit, Department of Biostatistics, School of Medicine, National University Health System, Singapore, Singapore
| | - Ali Asghar Farsavian
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roghieh Nazari
- Assistant Professor, Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ameneh Yaghoobzadeh
- PhD Candidate, Department of Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Goudarzian
- MSc Student, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
5
|
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: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [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.
Collapse
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
| |
Collapse
|
6
|
Alhazzani AA, Mahfouz AA, Abolyazid AY, Awadalla NJ, Aftab R, Faraheen A, Khalil SN. Study of Stroke Incidence in the Aseer Region, Southwestern Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E215. [PMID: 29373563 PMCID: PMC5858284 DOI: 10.3390/ijerph15020215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 01/12/2018] [Accepted: 01/22/2018] [Indexed: 11/16/2022]
Abstract
Recent data regarding first-stroke incidence in Saudi Arabia in general and in the Aseer region in particular are scarce and even lacking. The aim of this work was to study the first-time stroke incidence in the Aseer region, southwestern Saudi Arabia. All first-stroke patients admitted to all hospitals in the Aseer region over a one-year period (January through December 2016) were included. Stroke patients outside the Aseer region were excluded from the study. The incidence per 100,000 patients and the concomitant 95% CI (Confidence Intervals) were computed. The present study included 1249 first-time stroke patients and calculated an overall minimal incidence rate of hospitalized first-time stroke of 57.64 per 100,000 persons per year (95% CI: 57.57-57.70). A steady increase was noticed depending on the patients' age, reaching a figure of 851.81 (95% CI: 849.2-854.5) for those patients aged 70 years and more. Overall, the incidence rate for females (48.14; 95% CI: 48.04-48.24) was lower compared to males (65.52; 95% CI: 65.1-66.0). Taking into consideration the expected rise of the elderly because of the prominent medical services provided by the Saudi government, leading to a subsequent change in the horizontal and vertical age distribution structure of the population, an increase in the number of stroke patients is expected. It is suggested to establish a nationwide stroke surveillance system in the Kingdom, with the objective to report, analyze, and maintain an updated overview of the stroke status in Saudi Arabia.
Collapse
Affiliation(s)
- Adel A Alhazzani
- Department of Internal Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| | - Ahmed A Mahfouz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria 21511, Egypt.
| | - Ahmed Y Abolyazid
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Community Medicine, College of Medicine, Mansoura University, Mansoura 35516, Egypt.
| | - Nabil J Awadalla
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Community Medicine, College of Medicine, Mansoura University, Mansoura 35516, Egypt.
| | - Razia Aftab
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| | - Aesha Faraheen
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| | - Shamsun Nahar Khalil
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| |
Collapse
|
7
|
Turk-Adawi K, Sarrafzadegan N, Fadhil I, Taubert K, Sadeghi M, Wenger NK, Tan NS, Grace SL. Cardiovascular disease in the Eastern Mediterranean region: epidemiology and risk factor burden. Nat Rev Cardiol 2017; 15:106-119. [PMID: 28933782 DOI: 10.1038/nrcardio.2017.138] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Eastern Mediterranean region (EMR) comprises 22 countries or territories spanning from Morocco in the west to Pakistan in the east, and contains a population of almost 600 million people. Like many other developing regions, the burden of disease in the EMR has shifted in the past 30 years from primarily communicable diseases to noncommunicable diseases such as cardiovascular disease (CVD). Cardiovascular mortality in the EMR, mostly attributable to ischaemic heart disease, is expected to increase more dramatically in the next decade than in any other region except Africa. The most prominent CVD risk factors in this region include tobacco consumption, physical inactivity, depression, obesity, hypertension, and diabetes mellitus. Many individuals living in the EMR are unaware of their risk factor status, and even if treated, these risk factors are often poorly controlled. Furthermore, infrequent use of emergency medical services, delays in access to care, and lack of access to cardiac catheterization affects the timely diagnosis of CVD. Treatment of CVD is also suboptimal in this region, consisting primarily of thrombolysis, with insufficient provision of timely revascularization. In this Review, we summarize what is known about CVD burden, risk factors, and treatment strategies for individuals living in the EMR. This information will hopefully aid decision-makers when devising strategies on how to improve CVD prevention and management in this region.
Collapse
Affiliation(s)
- Karam Turk-Adawi
- Public Health Department, College of Health Sciences, Qatar University, Al Jamea Street, Doha, Qatar
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Khorram Ave, Isfahan, Iran.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Ibtihal Fadhil
- Noncommunicable Diseases, World Health Organization, East Mediterranean Regional Office, Monazamet El Seha El Alamia Street, extension of Abdel Razak El Sanhouri Street, Nasr City, Cairo, Egypt
| | - Kathryn Taubert
- International Science and Health Strategies, American Heart Association, Aeschengraben 14, Basel 4051, Switzerland
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center. Cardiovascular Research Institute. Isfahan University of Medical Sciences, Khorram Ave, Isfahan, Iran
| | - Nanette K Wenger
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Atlanta, Georgia 30303, USA
| | - Nigel S Tan
- University Health Network, 585 University Ave, Toronto, Ontario M5G 2N2, Canada
| | - Sherry L Grace
- University Health Network, 585 University Ave, Toronto, Ontario M5G 2N2, Canada.,School of Kinesiology and Health Science, York University, Bethune 368, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| |
Collapse
|
8
|
Lahoud N, Abbas MH, Salameh P, Saleh N, Abes S, Hosseini H, Gebeily S. A retrospective analysis of 254 acute stroke cases admitted to two university hospitals in Beirut: classification and associated factors. FUNCTIONAL NEUROLOGY 2017; 32:41-48. [PMID: 28380323 PMCID: PMC5505529 DOI: 10.11138/fneur/2017.32.1.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lebanon is a developing country where the prevalence of stroke subtypes and their correlation with risk factors have not been studied, even though stroke management is an ongoing major national healthcare challenge. In a retrospective study conducted in two university hospitals, data were collected on all stroke cases admitted in 2012 and 2013. Ischemic strokes were then classified according to a modified TOAST classification. A total of 254 inpatients (mean age 68.41 years ±13.34, 55.1% males) was included in the study; of these, 15% had had a hemorrhagic stroke and was therefore excluded. Conversely to findings from studies in other Arab and Asian countries, where small vessel disease is the most frequent subtype, our study showed a predominance of large artery atherosclerosis (53.5%) which, in comparison with other subtypes, was found to be associated with dyslipidemia (OR= 3.82, 95% CI= [1.76-8.28]; p=0.001). Cardioembolic stroke and small vessel disease were found to be positively associated with aging and living in Beirut, respectively. Larger studies are needed to explain these findings.
Collapse
Affiliation(s)
- Nathalie Lahoud
- Lebanese University, Doctoral School of Sciences and Technology, Hadath, Lebanon
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris Est, Créteil, France
- Lebanese University, Faculty of Pharmacy, Hadath, Lebanon
| | - Marie-Helene Abbas
- Neurology Division, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Pascale Salameh
- Lebanese University, Faculty of Medical Sciences, Hadath, Lebanon
| | - Nadine Saleh
- Lebanese University, Faculty of Public Health, Fanar, Lebanon
| | - Samer Abes
- Neurology Division, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Hassan Hosseini
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris Est, Créteil, France
- Henri Mondor Hospital, AP-HP, Paris, France
| | - Souheil Gebeily
- Neurology Division, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| |
Collapse
|
9
|
Al-Shenqiti AM, Ibrahim SR, Khaled OA, Ali ARH, Ahmed MS. Incidence of First Time Stroke: A Saudi Experience. Eur Neurol 2017; 77:147-151. [PMID: 28103596 DOI: 10.1159/000455094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/14/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stroke is one of the major causes of morbidity and mortality throughout the world. A number of studies were conducted in Saudi Arabia. However, there were no studies conducted in Al-Madinah Al-Munawarah city. OBJECTIVE The aim of this study was to ascertain the incidence rate of first time stroke and the age-specific incidence in both genders in Al-Madinah Al-Munawarah city. METHODS A prospective hospital based study was conducted over a 1-year period (2014). The cases were included in the study when they were admitted with a diagnosis of cerebrovascular accident. RESULTS A total 164 patients (91 men and 73 women) who had first time stroke were found in this study with no significant difference between them (p = 0.565). The crude incidence rate of stroke was 13.89 per 100,000 persons. The age-specific incidence rate increased with age in the current study, where the peak was in the age group of more than 75 years old for men and women. CONCLUSIONS Total crude and the age-specific rates for first time stroke patients revealed in this study were markedly lower than the range reported from the developed countries. However, they were within the range that showed previously in Saudi Arabia and Arabian Peninsula countries.
Collapse
Affiliation(s)
- Abdullah M Al-Shenqiti
- Faculty of Medical Rehabilitation Sciences, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia
| | | | | | | | | |
Collapse
|
10
|
Global burden of stroke in 2010: a pooling analysis of worldwide population-based data on stroke incidence. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0748-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
11
|
|
12
|
El-Hajj M, Salameh P, Rachidi S, Hosseini H. The epidemiology of stroke in the Middle East. Eur Stroke J 2016; 1:180-198. [PMID: 31008279 DOI: 10.1177/2396987316654338] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/09/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose The purpose of this paper is to review and synthesize data from different countries in the Middle East on stroke and its potential risk factors. Method A systematic review of all published stroke articles in the Middle East between 1980 and May 2015 was conducted. Findings Sixty-four papers were included in the review. The incidence rate for all strokes ranged between 22.7 and 250 per 100,000 population per year. The prevalence rate for stroke ranged between 508 and 777 per 100,000 population. Among studies reporting gender differences, 75% reported a high male-to-female ratio among stroke patients. The mean age of stroke was within the sixth and the seventh decade. Ischemic stroke was the most reported type followed by intracerebral hemorrhage and subarachnoid hemorrhage. Hypertension was the most reported risk factor followed by diabetes. The overall case-fatality rate within one month was 12-32%. Discussion During the last decades, there was an increase in stroke incidence and mortality rates in the Middle East. The Middle East faces low rates of self-awareness and control of noncommunicable diseases and also lacks knowledge for stroke risk factors, awareness, causes, and symptoms. Conclusion There is an urgent need to develop more efficient and accurate methods to measure stroke in the Middle East. There is also a significant call to increase public awareness and implement interventions on stroke and its risk factors and symptoms to help people understand the negative impact of stroke on quality of life and potentially prevent this disease.
Collapse
Affiliation(s)
- Maya El-Hajj
- Lebanese University, Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Hadath, Lebanon.,Université Paris-Est, UMR 955, IMRM, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Pascale Salameh
- Lebanese University, Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Hadath, Lebanon.,Lebanese American University, School of Pharmacy, Byblos, Lebanon
| | - Samar Rachidi
- Lebanese University, Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Hadath, Lebanon
| | - Hassan Hosseini
- Université Paris-Est, UMR 955, IMRM, Institut Mondor de Recherche Biomédicale, Créteil, France.,Service de Neurologie, Hôpital Henri-Mondor, UPEC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| |
Collapse
|
13
|
Pham TL, Blizzard L, Srikanth V, Thrift AG, Lien NTK, Thang NH, Gall SL. Case-fatality and functional status three months after first-ever stroke in Vietnam. J Neurol Sci 2016; 365:65-71. [PMID: 27206877 DOI: 10.1016/j.jns.2016.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 02/18/2016] [Accepted: 03/07/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND To provide novel information on outcomes after first-ever stroke in Vietnam, case-fatality and functional status were assessed 3months after stroke onset. METHODS First-ever stroke patients admitted to the stroke unit of a tertiary teaching hospital in Ho Chi Minh City, Vietnam were recruited, examined and interviewed. Functional status was assessed on the modified Rankin Scale (mRS) at admission and again at 3months. RESULT We recruited 450 consecutive first-ever stroke patients (99.6% participation, 47.9% female, mean age 62.5 [SD 14.0] years, 76.2% ischaemic stroke). Three-month observed case-fatality was 10.4%. Under plausible assumptions about deaths among non-recruited participants, the estimated case-fatality would be higher (16.4%) Those who had died were mostly older patients compromised by comorbidities and pre-existing disability, and who had severe impairment or severe disability due to stroke at the time of admission. At 3-month follow-up of 376 patients, 34% had least severe disability (mRS=0/1), 39% had intermediate disability and 28% had most severe disability (mRS=4/5). Those with least severe disability were mostly men younger than 65years of age and principally with ischemic stroke. Those with most severe disability were predominantly women aged ≥65years and those with severe disability, mainly attributable to intracerebral haemorrhage. At 3months, 50% had better functional status than at stroke onset, and 27% had poorer function. CONCLUSION Case-fatality was relatively low in this study, possibly because of cultural preferences for end-of-life care at home. The dependency burden was relatively high, placing pressure on the healthcare system and society.
Collapse
Affiliation(s)
- Tran L Pham
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
| | - Velandai Srikanth
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Stroke and Ageing Research Centre, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research Centre, School of Clinical Sciences, Monash University, Melbourne, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Nguyen T K Lien
- Stroke Unit, Cerebrovascular Disease Department, 115 People's Hospital, Ho Chi Minh City, Viet Nam
| | - Nguyen H Thang
- Stroke Unit, Cerebrovascular Disease Department, 115 People's Hospital, Ho Chi Minh City, Viet Nam
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| |
Collapse
|
14
|
Tseng CH, Muo CH, Lin MC, Kao CH. Association Between Reduced Risk of Intracerebral Hemorrhage and Pelvic Inflammatory Disease. Medicine (Baltimore) 2016; 95:e2726. [PMID: 26844517 PMCID: PMC4748934 DOI: 10.1097/md.0000000000002726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study examines whether pelvic inflammatory disease (PID) facilitates the development of intracerebral hemorrhage (ICH).By using outpatient claims data from the National Health Insurance Research Database (NHIRD) of Taiwan, we included the data of 25,508 patients who were newly diagnosed with PID between 1999 and 2004, and also from the Taiwan NHIRD, we randomly selected 102,032 women without PID, who were frequency-matched by age and entry-year and with 4 times the number of the PID patients, as the control cohort. We measured ICH risks associated with PID and comorbidities, including hyperlipidemia, diabetes, hypertension, ischemic heart disease, and atrial fibrillation, by the end of 2011.In comparison with the controls, the ICH hazard was less in the PID group with an adjusted hazard ratio (aHR) of 0.67 (95% confidence interval [CI]:0.50-0.90), which was noted by calculation with the Cox proportional regression model. The ICH risk in the PID patients reduced progressively with the advance of age, with aHRs of 0.75 (95% CI:0.41-1.39) and 0.50 (95% CI:0.29-0.88), respectively, in the age <35-year and age ≥50-year groups. ICH risk lowered gradually with the progress of PID severity, from mild PID with an aHR of 0.72 (95% CI:0.53-0.98) to severe PID with that of 0.30 (95% CI:0.10-0.92). PID patients without any comorbidites had lower ICH risk (aHR = 0.63, 95% CI:0.42-0.94) than the controls without any comorbidites did.Our findings revealed that PID is associated with reduced ICH development, especially for older patients.
Collapse
Affiliation(s)
- Chun-Hung Tseng
- From the Department of Neurology, China Medical University Hospital (C-HT); School of Medicine, China Medical University (C-HT, C-HM); Management Office for Health Data, China Medical University Hospital, Taichung (C-HM); Department of Nuclear Medicine, E-Da Hospital and I-Shou University, Kaohsiung (M-GL); Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine (C-HK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital (C-HK), Taichung, Taiwan
| | | | | | | |
Collapse
|
15
|
Ibrahim F, Deleu D, Akhtar N, Al-Yazeedi W, Mesraoua B, Kamran S, Shuaib A. Burden of Stroke in Qatar. J Stroke Cerebrovasc Dis 2015; 24:2875-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/07/2015] [Accepted: 08/19/2015] [Indexed: 11/28/2022] Open
|
16
|
Behrouz R, Powers CJ. Epidemiology of classical risk factors in stroke patients in the Middle East. Eur J Neurol 2015; 23:262-9. [PMID: 26041584 DOI: 10.1111/ene.12742] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/06/2015] [Indexed: 01/23/2023]
Abstract
The Middle East (ME) is an ethnically and economically diverse region. A systematic review of all stroke studies conducted in the ME was carried out, with the aim of determining the prevalence of classic vascular risk factors (CRFs) across this region. Additionally, the prevalence of CRFs in the ME was compared to that of a US cohort. Prospective and retrospective ME stroke studies published from 1994 to 2014 were searched for that specifically reported on the prevalence of CRFs. The Z test for proportions was used to determine the significance of differences in CRF rates between the ME and non-ME studies. A total of 21,724 stroke patients from 13 nations in the ME were included. The prevalence rates for CRFs in the ME stroke population were hypertension, 62.1%; diabetes, 33.1%; dyslipidaemia, 36.8%; ischaemic heart disease, 24.6%; smoking, 19.3%; and atrial fibrillation, 13.6%. Compared to the US cohort, ME patients had a lower prevalence of all CRFs except diabetes (P < 0.0001) and smoking (P = 0.05). Compared with stroke patients in the USA, those in the ME have a significantly higher prevalence of diabetes and smoking. Education and lifestyle modification is perhaps the most effective strategy in reducing the risk of stroke in this population.
Collapse
Affiliation(s)
- R Behrouz
- Division of Cerebrovascular Diseases, Department of Neurology, College of Medicine, Ohio State University, Columbus, OH, USA
| | - C J Powers
- Division of Vascular and Endovascular Neurosurgery, Department of Neurological Surgery, Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
17
|
Prevalence of Cardiovascular Disease and Associated Risk Factors among Adult Population in the Gulf Region: A Systematic Review. ADVANCES IN PUBLIC HEALTH 2015. [DOI: 10.1155/2015/235101] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background. CVD is a principal cause of mortality and disability globally.Objective. To analyse the epidemiological data on CHD, strokes, and the associated risk factors among adult population in the Gulf countries.Methods. A systematic review of published articles between 1990 and 2014 was conducted.Results. The analysis included 62 relevant studies. The prevalence of CHD was reported to be 5.5% in Saudi Arabia. The annual incidence of strokes ranged from 27.6 to 57 per 100 000 in the Gulf countries with ischaemic stroke being the most common subtype and hypertension and diabetes being the most common risk factors among stroke and ACS patients. The prevalence of overweight and obesity ranged from 31.2% to 43.3% and 22% to 34.1% in males and from 28% to 34.3% and 26.1% to 44% in females, respectively. In males, the prevalence of hypertension and diabetes ranged from 26.0% to 50.7% and 9.3% to 46.8%, respectively; in females these ranged from 20.9% to 57.2% and 6% to 53.2%, respectively. The prevalence of inactivity was from 24.3% to 93.9% and 56.7% to 98.1% in males and females, respectively. Relatively more males (13.4% to 37.4%) than females (0.5% to 20.7%) were current smokers. Available data indicate poor dietary habits with high consumption of snacks, fatty foods, sugar, and fast food.Conclusion. Effective preventative strategies and education programs are crucial in the Gulf region to reduce the risk of CVD mortality and morbidity in the coming years.
Collapse
|
18
|
Abstract
Background: The aim of this hospital-based study is to determine the types, the frequency of risk factors and the 30-day case fatality of first-ever stroke in Basrah, Iraq. Materials and Methods: This was a hospital-based prospective study between January 2008 and July 2008 in Basrah, Iraq. Two hundred twenty-five (225) patients, who were admitted for first-ever stroke to the four major hospitals in Basrah, were interviewed and followed up for 30 days. Risk factors studied were smoking, history of diabetes mellitus, hypertension, atrial fibrillation, ischaemic heart diseases and transient ischaemic attack. Results: The mean age of the studied subjects was 63.8 ± 12.3 years. Males constituted 56% of cases. Clinical types of stroke were ischaemic stroke (83.6%), intracerebral haemorrhage (16%) and subarachnoid haemorrhage (0.4%). The prevalence of risk factors was; hypertension (66.2%), family history of stroke (31.6%), ischaemic heart diseases (28.9%), smoking (28.4%), diabetes mellitus (28%), transient ischaemic attack (10.2%), atrial fibrillation (9.8%) and heart failure (5.8%). The 30-day case fatality rate was 22.7%. Conclusions: Ischaemic stroke was the highly prevalent type. Hypertension, family history of stroke, ischaemic heart diseases, smoking and diabetes mellitus were the major risk factors of first ever stroke in Basrah. The 30-day case fatality rate of stroke in Basrah was nearly similar to that in western countries, but higher than that reported in the neighbouring Arab countries. Early detection of modifiable risk factors that can prevent stroke or at least minimise its complications is highly recommended.
Collapse
Affiliation(s)
- Jasim N Al-Asadi
- Department of Community Medicine, College of Medicine, University of Basrah, Basrah, Iraq
| | - Husam A Habib
- Department of Community Medicine, Basrah Health Directorate, Basrah, Iraq
| |
Collapse
|
19
|
Shahtaheri RA, Borhani Haghighi A, Safari A, Cruz-Flores S. Recombinant tissue plasminogen activator (rtPA) and stroke unit for acute ischaemic stroke in developing countries, are they cost-effective? Int J Stroke 2013; 7:E9. [PMID: 22989402 DOI: 10.1111/j.1747-4949.2012.00892.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
Khedr EM, Elfetoh NA, Al Attar G, Ahmed MA, Ali AM, Hamdy A, Kandil MR, Farweez H. Epidemiological study and risk factors of stroke in Assiut Governorate, Egypt: community-based study. Neuroepidemiology 2013; 40:288-94. [PMID: 23486276 DOI: 10.1159/000346270] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/19/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Because there have been no epidemiological studies of stroke in Egypt, a community-based survey was conducted in the Assiut Governorate to estimate the prevalence and risk factors of stroke in our community. METHODS A three-phase door-to-door study was performed in which 6,498 participants were chosen by random sampling from 7 districts in Assiut (first phase). Out of this sample, 578 dropped out leaving 3,066 males (51.8%) and 2,854 females (48.2%). There were 3,660 (61.8%) urban residents and 2,260 (38.2%) from the rural community. In the second phase participants were screened using the questionnaire for stroke, while the third phase involved medical evaluation of all suspected cases, with diagnosis of stroke confirmed by evaluation of CT scans. The Mini Mental State Examination and Hamilton Depression Scale were evaluated for each patient. RESULTS 65 participants were identified as positive on the survey questionnaire, but only 57 patients were found to have stroke, giving a crude prevalence rate of 963/100,000 inhabitants with an age-adjusted local prevalence rate of 699.2/100,000 and an age-adjusted prevalence relative to the standard world population of 980.9/100,000. The prevalence among males was higher than females (1174/100,000 vs. 736/100,000) with a ratio 1.7:1. There was a significantly higher prevalence of ischemic (895/100,000) than hemorrhagic (68/100,000) stroke. Stroke prevalence was the same in rural and urban areas and in males and females. There was, however, a significantly higher prevalence in illiterate (2413/100,000) than literate participants (357/100,000). Forty-two patients (73.7%) had one or more risk factors for stroke, hypertension being the commonest (66%) and diabetes mellitus second (38.6%). Nine cases had poststroke dementia (15.8%) and 14 cases (24.6%) had mild depression. CONCLUSIONS The overall prevalence rate of stroke is high, especially in older adults, men and illiterate individuals. A higher prevalence of ischemic than hemorrhagic stroke was recorded, with hypertension and diabetes mellitus being the commonest risk factors in our community.
Collapse
Affiliation(s)
- Eman M Khedr
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Cotlarciuc I, Khan MS, Maheshwari A, Yadav S, Khan FY, Al-Hail H, de Silva R, Gorthi SP, Gupta S, Sharma SR, Sylaja PN, Prasad K, Sharma P. Bio-repository of DNA in stroke: a study protocol of three ancestral populations. JRSM Cardiovasc Dis 2012; 1:10.1258_cvd.2012.012019. [PMID: 24175068 PMCID: PMC3738328 DOI: 10.1258/cvd.2012.012019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Stroke is a leading cause of death and disability in the world. Identifying the genes underlying stroke risk may help us to improve our understanding of the mechanisms that cause stroke and also identify novel therapeutic targets. To have sufficient power to disentangle the genetic component of stroke, large-scale highly phenotyped DNA repositories are necessary. The BRAINS (Bio-repository of DNA in stroke) study aims to recruit subjects with all subtypes of stroke as well as controls from UK, India, Sri Lanka and Qatar. BRAINS-UK will include 1500 stroke patients of European ancestry as well as British South Asians. BRAINS-South Asia aims to recruit 3000 stroke subjects and 3000 controls from across India and Sri Lanka. BRAINS-Middle East aims to enrol 1500 stroke patients from Qatar. The controls for BRAINS-Middle East will be recruited from a population-based Qatari Biobank. With the addition of new recruitment centres in India and Qatar, we present an updated version of the BRAINS study protocol. This is the first international DNA biobank for stroke patients and controls from the Middle East. By investigating the influence of genetic factors on stroke risk in European, South Asian and Middle Eastern populations, BRAINS has the potential to improve our understanding of genetic differences between these groups and may lead to new population-specific therapeutic targets.
Collapse
Affiliation(s)
- Ioana Cotlarciuc
- Imperial College Cerebrovascular Research Unit (ICCRU) , Imperial College London , London , UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Diet, genetics, and disease: a focus on the middle East and north Africa region. J Nutr Metab 2012; 2012:109037. [PMID: 22536488 PMCID: PMC3321453 DOI: 10.1155/2012/109037] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 11/27/2011] [Indexed: 12/13/2022] Open
Abstract
The Middle East and North Africa (MENA) region suffers a drastic change from a traditional diet to an industrialized diet. This has led to an unparalleled increase in the prevalence of chronic diseases. This review discusses the role of nutritional genomics, or the dietary signature, in these dietary and disease changes in the MENA. The diet-genetics-disease relation is discussed in detail. Selected disease categories in the MENA are discussed starting with a review of their epidemiology in the different MENA countries, followed by an examination of the known genetic factors that have been reported in the disease discussed, whether inside or outside the MENA. Several diet-genetics-disease relationships in the MENA may be contributing to the increased prevalence of civilization disorders of metabolism and micronutrient deficiencies. Future research in the field of nutritional genomics in the MENA is needed to better define these relationships.
Collapse
|
23
|
Abstract
This study aimed to identify the main risk factors of cerebrovascular accident (CVA) in Jordan. Identification of risk factors may help to reduce the incidence of CVA. A form was prepared for data collection which consisted of two parts to gather biodata and the incidence of risk factors. A sample of 200 patients with CVA (60% men) were randomly selected from various areas of Jordan. An age, region distribution, and gender-matched sample were selected to serve as control. Hypertension in the experimental group (66%) was significantly higher than the control group (32%) p < 0.001. Half of the subjects with stroke had diabetes compared to 22% of the control group (p < 0.001). Cardiovascular diseases were found in 29% of subjects with CVA compared to 14% in the control group (p < 0.001). About 27% of the CVA group had hyperlipidemia in comparison to 13% in the controls (p < 0.002). Smokers represented 54% of the experimental group compared to 30% of the control group (p < 0.05). An important finding in the present study was that about half of the selected subjects with strokes were under the age of 60 years. In conclusion, hypertension, diabetes, cardiovascular diseases, hyperlipidemia, and smoking are risk factors for CVA in Jordan.
Collapse
Affiliation(s)
- Mohammad A Auais
- School of Physical & Occupational therapy, Faculty of Medicine, McGill University, Quebec, Canada
| | | | | | | |
Collapse
|
24
|
Gujjar AR, William R, Jacob PC, Jain R, Al-Asmi AR. Transcranial Doppler ultrasonography in acute ischemic stroke predicts stroke subtype and clinical outcome: a study in Omani population. J Clin Monit Comput 2011; 25:121-8. [PMID: 21713538 DOI: 10.1007/s10877-011-9288-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 06/11/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Transcranial Doppler ultrasonography (TCD) is being increasingly used for its ability to provide cerebral hemodynamic information in stroke. Few studies have explored its association with cerebral arteriographic changes and stroke subtype. This study explored the relation of TCD changes in acute stroke with stroke subtypes, MR cerebral arteriography and clinical outcome in Omani population. METHODS Adult patients presenting with acute ischemic stroke within 4 days of stroke onset were subjected to TCD through the temporal and suboccipital windows using a 2 MHz probe; flow velocities, pulsatility and direction of flow were recorded from arteries at the skull base. MR arteriographic (MRA) changes on corresponding arteries were graded on a scale of 1-4. ANOVA, student's t test and ROC analysis were used to evaluate TCD in relation to stroke type, outcome and stenosis on MRA. RESULTS Of 60 patients recruited, 52 (M:F::36:16; mean age: 60 + 13 years) had adequate bone window for TCD study. Large artery stroke occurred in 30 (58%) patients; lacunar stroke-11 (21%); cardioembolic and mixed groups 9 (17%), other specificed causes-2 (4%). 86.5% had evidence of intracranial disease. 10/52 patients (19%) died while 33 (63%) had good outcome (modified Rankin Score 0-3). Of the 186 arteries studied by the two methods, 52 had TCD evidence of stenosis while 42 were abnormal on MRA, giving a sensitivity of 60%, specificity: 81.25%; positive likelihood ratio: 3.18 and negative likelihood ratio: 0.5. 29/52 (56%) of patients had TCD changes in the arteries corresponding to stroke location. Abnormal TCD was associated with large artery strokes (p = 0.007), poor outcome (p = 0.038) and mortality (p = 0.01). CONCLUSION This study of TCD in acute stroke in Omani population demonstrates a relatively higher burden of intracranial arterial disease. TCD changes are associated with type of stroke and outcome in this population. TCD is a simple and fairly useful method of evaluation in patients with acute stroke. Adopting TCD in evaluation of stroke patients may provide useful information regarding the pathophysiology which could enhance patient management.
Collapse
Affiliation(s)
- Arunodaya R Gujjar
- Department of Medicine (Neurology), College of Medicine and Health Sciences, Sultan Qaboos University, PO Box 35, PC 123 Muscat, Oman.
| | | | | | | | | |
Collapse
|
25
|
Risk factors, management and outcome of subtypes of ischemic stroke. J Neurol Sci 2011; 300:142-7. [DOI: 10.1016/j.jns.2010.08.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 08/18/2010] [Accepted: 08/20/2010] [Indexed: 11/20/2022]
|
26
|
Hosseini AA, Sobhani-Rad D, Ghandehari K, Benamer HTS. Frequency and clinical patterns of stroke in Iran - Systematic and critical review. BMC Neurol 2010; 10:72. [PMID: 20731823 PMCID: PMC2936882 DOI: 10.1186/1471-2377-10-72] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Accepted: 08/23/2010] [Indexed: 11/17/2022] Open
Abstract
Background Cerebrovascular disease is the second commonest cause of death, and over a third of stroke deaths occur in developing countries. To fulfil the current gap on data, this systematic review is focused on the frequency of stroke, risk factors, stroke types and mortality in Iran. Methods Thirteen relevant articles were identified by keyword searching of PubMed, Iranmedex, Iranian University index Libraries and the official national data on burden of diseases. Results The publication dates ranged from 1990 to 2008. The annual stroke incidence of various ages ranged from 23 to 103 per 100,000 population. This is comparable to the figures from Arab Countries, higher than sub-Saharan Africa, but lower than developed countries, India, the Caribbean, Latin America, and China. Similarly to other countries, ischaemic stroke was the commonest subtype. Likewise, the most common related risk factor is hypertension in adults, but cardiac causes in young stroke. The 28-day case fatality rate is reported at 19-31%. Conclusions Data on the epidemiology of stroke, its pattern and risk factors from Iran is scarce, but the available data highlights relatively low incidence of stroke. This may reflect a similarity towards the neighbouring nations, and a contrast with the West.
Collapse
Affiliation(s)
- Akram A Hosseini
- Neurology Department, University Hospital Coventry and Warwickshire, Coventry, UK.
| | | | | | | |
Collapse
|
27
|
Tran J, Mirzaei M, Anderson L, Leeder SR. The epidemiology of stroke in the Middle East and North Africa. J Neurol Sci 2010; 295:38-40. [PMID: 20541222 DOI: 10.1016/j.jns.2010.05.016] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Accepted: 05/17/2010] [Indexed: 10/19/2022]
Abstract
Stroke is the second leading cause of death in the world. In the Middle East and North Africa stroke is increasingly becoming a major health problem, with projections that deaths from it will nearly double by 2030. This systematic review aims to bring together age-adjusted epidemiological data of stroke in this region. A literature review of five databases was conducted. Twenty-three papers met the criteria. The incidence of stroke varied extensively among studies. Studies reported rates from 29.8 per 100000 people in Saudi Arabia to 57 per 100000 people in Bahrain. Furthermore, the 28-day case mortality rate also differed among studies, ranging from 10% in Kuwait to 31.5% in Iran. The rates are comparable with those in the Western world; however, the population of the region is younger. The Middle East and North Africa are lacking in data on the epidemiology of stroke. There is an urgent need to develop strategies to prevent and better care for stroke patients in the Middle East and North Africa.
Collapse
Affiliation(s)
- Jackie Tran
- Menzies Centre of Health Policy, Victor Coppleson Building (D02), University of Sydney, Australia
| | | | | | | |
Collapse
|
28
|
Benamer HTS, Grosset D. Stroke in Arab countries: A systematic literature review. J Neurol Sci 2009; 284:18-23. [DOI: 10.1016/j.jns.2009.04.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 03/30/2009] [Accepted: 04/08/2009] [Indexed: 12/16/2022]
|
29
|
Akhtar N, Kamran SI, Deleu D, D'Souza A, Miyares F, Elsotouhy A, Al-Hail H, Mesraoua B, Own A, Salem K, Kamha A, Osman Y. Ischaemic posterior circulation stroke in State of Qatar. Eur J Neurol 2009; 16:1004-9. [PMID: 19538206 DOI: 10.1111/j.1468-1331.2009.02709.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ischaemic stroke features may show regional differences. Posterior circulation stroke (PCS) is of special interest, as symptomatology, course and outcome are usually different and complex. No significant studies or registries have reported on the characteristics and outcomes of PCS in our region. METHODS We prospectively collected data of 116 patients with PCS admitted from 2005 through 2008 in the only stroke admitting hospital in Qatar. Demographics, risk factors, clinical signs/symptoms, pattern of presentation, aetiology, imaging features, complications and outcome at discharge and follow-up were recorded. RESULTS Mean age was 53 years with 25% aged < or = 45, 85% were males. Demographically 47% were Arabs and 51% of South-Asian origin. Mean duration from onset to presentation was 29 h. Major risk factors were obesity (66%) and hypertension (61%). Minimal or fluctuating symptoms were present in 64%, while 9% had maximal deficit at onset. Thirty nine per cent had lesions in proximal territory and 23% in multiple territories. Around 41% had no occlusion, 16% had vertebro-basilar, 16% vertebral, 8% basilar occlusion. Etiologically 53% patients had large artery disease, 16% small vessel disease, and 17% cardioembolism. Seventy per cent of patients were discharged home, while 10% expired. Modified Rankin score (mRS) at discharge was < or = 2 in 53% and > or = 4 in 13% patients. At 30-day follow-up, 68% had mRS of < or = 2. Ninety-day survival status showed 89% alive with mRS < or = 2 in 73%. CONCLUSION The aetiology and lesion topography of PCS in this heterogeneous population differs from the pattern observed in other populations.
Collapse
Affiliation(s)
- N Akhtar
- Division of Neurology (Medicine), Hamad Medical Corporation, Doha, State of Qatar
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Predictors of in-Hospital Mortality after Acute Stroke: Impact of Gender. Int J Clin Exp Med 2009. [PMID: 19436831 PMCID: PMC2680055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to identify predictors of in-hospital mortality after acute stroke and investigate the impact of gender on stroke mortality. All patients admitted to Al-watani governmental hospital in Palestine from September 2006 to August 2007 and diagnosed with acute stroke were included in the study. Diagnosis of stroke was confirmed by computerized tomography scan. Demographics and clinical data pertaining to the patients were obtained from their medical files. The main outcome measure in this study was vital status at hospital discharge. Multiple logistic regression analysis was used to identify the independent predictors of in-hospital mortality. Statistical analysis was carried out using SPSS 15. A total of 186 acute stroke cases (95 females and 91 males) were included in the study. Hypertension (69.9%) and diabetes mellitus (45.2%) were the most common risk factors among the patients. Thirty nine (21%) of the stroke patients died in hospital. Multiple logistic regression analysis indicated that chronic kidney disease (P = 0.004), number of post-stroke complications (P = 0.037), and stroke subtype (P = 0.015) were independent predictors of in-hospital mortality among the total stroke patients. Knowledge of in-hospital mortality predictors is required to improve survival rate after acute stroke. The study showed that gender was not an independent predictor of mortality after acute stroke. More research is required to understand gender differences in stroke mortality.
Collapse
|
31
|
Sweileh WM, Sawalha AF, Al-Aqad SM, Zyoud SH, Al-Jabi SW. The epidemiology of stroke in northern palestine: a 1-year, hospital-based study. J Stroke Cerebrovasc Dis 2008; 17:406-11. [PMID: 18984436 DOI: 10.1016/j.jstrokecerebrovasdis.2008.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 06/01/2008] [Accepted: 06/09/2008] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although stroke is one of the leading causes of morbidity and mortality worldwide, no studies on stroke were reported from Palestine. The objective of this study was to identify the risk factors and incidence rates of stroke in a well-defined area in north Palestine (i.e., the district of Nablus) with 362,159 native Palestinian inhabitants. METHODS All patients admitted to Al-Watani governmental hospital from September 2006 to August 2007 and given the diagnosis of acute stroke were included in the study. Diagnosis of stroke was confirmed by computerized tomography scan. Demographic characteristics and clinical data pertaining to the patients were obtained from their medical files. RESULTS A total of 186 patients with stroke (95 female and 91 male) were identified during the study. The average age of the patients was 69.09 +/- 10.9 years. Among the total patients, 112 had a first-ever stroke (FES) and 74 had recurrent stroke (RS). Hypertension, diabetes mellitus, and renal dysfunction were the most common risk factors with comparable prevalence in both FES and RS. The majority of patients (153; 82.3%) had ischemic stroke subtype whereas 33 (17.7%) had hemorrhagic stroke subtype. The overall (FES + RS) annual crude incidence rate of stroke was 51.4 per 100,000 persons whereas the annual crude incidence rate of FES was 31 per 100,000 persons. The age-adjusted incidence rates were 54.5 (FES) and 89.8 (FES and RS). The overall inhospital mortality was 21% and was higher in patients with RS than in those with FES. CONCLUSION Modifiable risk factors were common among patients with stroke. Better control of these risk factors might decrease incidence of stroke and all consequences thereafter. Incidence rate and inhospital mortality of stroke reported in this study were within the range reported from other Arab countries.
Collapse
Affiliation(s)
- Waleed M Sweileh
- College of Pharmacy, An-Najah National University, Nablus, Palestine.
| | | | | | | | | |
Collapse
|
32
|
Khan FY, Yasin M, Abu-Khattab M, El Hiday AH, Errayes M, Lotf AK, Ibrahim AS, Abbas MT, Matar I, Alsamawi M, Alhail H. Stroke in Qatar: a first prospective hospital-based study of acute stroke. J Stroke Cerebrovasc Dis 2008; 17:69-78. [PMID: 18346648 DOI: 10.1016/j.jstrokecerebrovasdis.2007.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 11/18/2007] [Accepted: 11/30/2007] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Stroke is a major cause of morbidity and mortality in Qatar. OBJECTIVES The aim of our study was to determine types of strokes, the associated risk factors, clinical presentation, outcome, and time to hospital admission among Qatari and non-Qatari patients as well as young and nonyoung patients. METHODS We conducted a hospital-based prospective observational study including all patients admitted to Hamad Medical Corporation with first-ever stroke from September 15, 2004, to September 14, 2005. A stroke was defined according to World Health Organization criteria. RESULTS Stroke was confirmed in 270 patients of whom 217 (80.4%) had ischemic stroke and 53 (19.6%) had hemorrhagic stroke. Male patients predominated in all types of stroke. The main risk factors for stroke were hypertension and diabetes, whereas lacunar infarct was the most common subtype of ischemic stroke. Risk factor profiles were similar between Qatari and non-Qatari patients except for hypercholesterolemia, which was observed with a higher frequency in Qatari compared with non-Qatari patients with ischemic stroke. There were significant differences between the young and nonyoung patients with ischemic stroke with respect to risk factors, ejection fraction, ventricular wall-motion abnormalities, time to hospital admission, and outcome. Most patients arrived at the hospital more than 3 hours from stroke onset because of unawareness of stroke symptoms. The overall in-hospital mortality was 9.3%. CONCLUSIONS Hypertension and diabetes mellitus were the main risk factors for stroke in Qatar, whereas lacunar infarct was the most common subtype. Significant differences between the young and nonyoung patients were observed with respect to risk factors, ejection fraction, ventricular wall-motion abnormalities, time to hospital admission, and outcome.
Collapse
|
33
|
Kamran S, Bener A, Deleu D, Khoja W, Jumma M, Al Shubali A, Inshashi J, Sharouqi I, Al Khabouri J. The Level of Awareness of Stroke Risk Factors and Symptoms in the Gulf Cooperation Council Countries: Gulf Cooperation Council Stroke Awareness Study. Neuroepidemiology 2008; 29:235-42. [DOI: 10.1159/000112856] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
34
|
Deleu D, Hamad AA, Kamram S, El Siddig A, Al Hail H, Hamdy SMK. Ethnic Variations in Risk Factor Profile, Pattern and Recurrence of Non-Cardioembolic Ischemic Stroke. Arch Med Res 2006; 37:655-62. [PMID: 16740438 DOI: 10.1016/j.arcmed.2006.01.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Accepted: 01/06/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ischemic stroke is influenced by ethnic and geographical variations. The aim of this study was to identify the risk factor profiles, subtypes and recurrence of non-cardioembolic ischemic stroke for the two largest subpopulations, the Arab and South Asians, at the only stroke-admitting hospital in Qatar. METHODS Data on stroke patients admitted to Hamad Medical Corporation from January through December 2001 were reviewed in January 2005. Only patients with non-cardioembolic ischemic stroke and complete work-up were included. RESULTS A total of 303 patients with ischemic non-cardioembolic stroke fit the entry criteria. Sixty seven percent of the overall patient population (sex ratio 2:6, M/F) was of Arab origin, and 32% were South Asians. Hypertension was the most commonly encountered risk factor followed by dyslipidemia, diabetes mellitus, and obesity. Significant differences between the Arab and South Asian subgroup of patients were observed with respect to number of risk factors and occurrence of obesity and diabetes. Carotid artery stenotic lesions, ventricular wall motion abnormalities and stroke recurrence were observed with a higher frequency in the Arab subgroup of patients compared with the South Asians. The majority of strokes were lacunar hemispheric strokes (68%), followed by lacunar brainstem strokes (15%) and large-vessel hemispheric infarctions (10%). Patients with a previous history of stroke had a higher frequency of carotid artery stenosis (p = 0.05) and risk of stroke recurrence (p = 0.04). CONCLUSIONS Unlike in other studies originating from the Arabian Gulf, lacunar stroke is the most common subtype of non-cardioembolic ischemic stroke in both the Arabs and South Asians in Qatar. Significant ethnic differences in age of occurrence, risk factor profile, and cardiovascular variables were observed.
Collapse
Affiliation(s)
- Dirk Deleu
- Department of Neurology, Hamad Medical Corporation, Doha, State of Qatar.
| | | | | | | | | | | |
Collapse
|
35
|
Bahou Y, Hamid H, Raqab MZ. Ischemic stroke in Jordan 2000 to 2002: A two-year, hospital-based study. J Stroke Cerebrovasc Dis 2004; 13:81-4. [PMID: 17903954 DOI: 10.1016/j.jstrokecerebrovasdis.2004.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2004] [Revised: 02/11/2004] [Accepted: 02/11/2004] [Indexed: 11/27/2022] Open
Abstract
A total of 200 consecutive patients with first ischemic stroke seen at Jordan University Hospital in Amman, Jordan, during a 2-year period were studied retrospectively. Mean age was 61.2 years (range: 29-95 years). The most common stroke subtype was lacunar infarct (51%), but the frequency of cardioembolic strokes was low (8%). Hypertension, diabetes mellitus, coronary artery disease, and smoking were the most common risk factors for atherosclerotic noncardioembolic strokes. Chronic atrial fibrillation was the most common risk factor for cardioembolic strokes. No patient had significant (>50%) extracranial carotid or vertebral artery stenosis. The outcome was relatively good; 85% of patients were discharged home, the majority with only mild neurologic deficit. The favorable outcome is most likely because of the relatively young mean age and the predominance of lacunar infarcts.
Collapse
Affiliation(s)
- Yacoub Bahou
- Department of Internal Medicine, Division of Neurology, Jordan University, Amman, Jordan
| | | | | |
Collapse
|