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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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Akhtar N, Kate M, Kamran S, Joseph S, Morgan D, Uy R, Babu B, Shanti S, Shuaib A. Short-term functional outcomes of patients with acute intracerebral hemorrhage in the native and expatriate population. Front Neurol 2024; 15:1384985. [PMID: 38756212 PMCID: PMC11097684 DOI: 10.3389/fneur.2024.1384985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives Functional outcomes in patients with intracerebral hemorrhage (ICH) have not been well characterized in the Middle East and North Africa Region. We report the 30 and 90-day clinical outcomes in the native and expatriate of Qatar with ICH. Methods We evaluated the Glasgow Coma Scale (GCS), NIHSS, and imaging in the Qatar Stroke Registry (2013-22). The outcome measures were a modified Rankin Scale (mRS) at 90 days and mortality at 30 and 90 days. Unfavorable outcome was defined as mRS of 4-6. We performed non-parametric ROC analyses to measure the concordance index (C-index) to assess the goodness-of-fit of ICH score for predicting 30 day and 90-day mortality and functional outcome. Results 1,660 patients (median age of 49 (41.5-58) years; male 83.1%, expatriates 77.5%) with ICH, including supratentorial deep in 65.2%, cortical in 16.2%, infratentorial 16% and primary intraventricular in 2.5% were studied. The median baseline ICH volume was 7.5 (3.2-15.8) ml. An unfavorable outcome was seen in 673 (40.5%) patients at 90 days. The unfavorable 90-day outcome (mRS 4-6) was 49.2% in the native population vs. 44.4% in Africans, 39.0% in South Asian, 35.3% in Far Eastern, and 7.7% in Caucasians, p < 0.001. Mortality at 30 days and 90 days was 10.4 and 15.1%. Increasing age [OR (95% CI), 1.02 (1.00-1.03)], lower GCS [0.77 (0.73-0.80)], prior use of antiplatelet medications [1.82 (1.19-2.08)], higher ICH volume [1.03 (1.02-1.04)], and presence of any intraventricular hemorrhage [1.57(1.19-2.08)], were associated with unfavorable outcome. Conclusion In this relatively younger ICH cohort more than 75% were expatriates. The ICH volume, 90-day unfavorable outcome and mortality was lower in the expatriates compared to the local Arab population, likely related to the younger age and smaller size of the hemorrhages. Prognostic scoring systems may have to be modified in this population to avoid early withdrawal of care.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mahesh Kate
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ryan Uy
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Shobhna Shanti
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Abujaber AA, Albalkhi I, Imam Y, Nashwan A, Akhtar N, Alkhawaldeh IM. Machine learning-based prognostication of mortality in stroke patients. Heliyon 2024; 10:e28869. [PMID: 38601648 PMCID: PMC11004568 DOI: 10.1016/j.heliyon.2024.e28869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/22/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
Objectives Predicting stroke mortality is crucial for personalized care. This study aims to design and evaluate a machine learning model to predict one-year mortality after a stroke. Materials and methods Data from the National Multiethnic Stroke Registry was utilized. Eight machine learning (ML) models were trained and evaluated using various metrics. SHapley Additive exPlanations (SHAP) analysis was used to identify the influential predictors. Results The final analysis included 9840 patients diagnosed with stroke were included in the study. The XGBoost algorithm exhibited optimal performance with high accuracy (94.5%) and AUC (87.3%). Core predictors encompassed National Institutes of Health Stroke Scale (NIHSS) at admission, age, hospital length of stay, mode of arrival, heart rate, and blood pressure. Increased NIHSS, age, and longer stay correlated with higher mortality. Ambulance arrival and lower diastolic blood pressure and lower body mass index predicted poorer outcomes. Conclusions This model's predictive capacity emphasizes the significance of NIHSS, age, hospital stay, arrival mode, heart rate, blood pressure, and BMI in stroke mortality prediction. Specific findings suggest avenues for data quality enhancement, registry expansion, and real-world validation. The study underscores machine learning's potential for early mortality prediction, improving risk assessment, and personalized care. The potential transformation of care delivery through robust ML predictive tools for Stroke outcomes could revolutionize patient care, allowing for personalized plans and improved preventive strategies for stroke patients. However, it is imperative to conduct prospective validation to evaluate its practical clinical effectiveness and ensure its successful adoption across various healthcare environments.
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Affiliation(s)
| | - Ibrahem Albalkhi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London WC1N 3JH, United Kingdom
| | - Yahia Imam
- Neurology Section, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Naveed Akhtar
- Neurology Section, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
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Akhtar N, Singh R, Kamran S, Joseph S, Morgan D, Uy RT, Treit S, Shuaib A. Association between serum triglycerides and stroke type, severity, and prognosis. Analysis in 6558 patients. BMC Neurol 2024; 24:88. [PMID: 38443844 PMCID: PMC10913234 DOI: 10.1186/s12883-024-03572-9] [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: 05/29/2023] [Accepted: 02/15/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Hypertriglyceridemia (HT) may increase the risk of stroke. Limited studies have shown that stroke severity and infarction size are smaller in patients with HT. We explored the relationship between triglyceride levels and stroke risk factors, severity and outcome in a large prospective database. DESIGN Prospective Cross-sectional study. SETTING We retrospectively interrogated the Qatar Stroke Database in all patients admitted between 2014-2022 with acute ischemic stroke and evaluated the relationship between triglyceride, diabetes, stroke severity (measured on NIHSS), stroke type (TOAST classification) and the short- (mRS at 90 days) and long-term outcomes (MACE at 1 year) in patients with HT. PARTICIPANTS Six thousand five hundred fifty-eight patients ≥20 years were included in this study RESULTS: Six thousand five hundred fifty-eight patients with ischemic stroke [mean age 54.6 ± 12. 9; male 82.1%) were included. Triglyceride levels upon admission were low-normal (≤1.1 mmol/L) in 2019 patients, high-normal (1.2-1.7 mmol/L) in 2142 patients, borderline-high (1.8-2.2 mmol/L) in 1072 patients and high (≥2.3 mmol/L) in 1325 patients. Higher triglyceride levels were associated with stroke and increased likelihood of having diabetes, obesity, active smoking, and small vessel/lacunar stroke type. An inverse relationship was noted whereby higher triglyceride levels were associated with lower stroke severity and reduced likelihood of poorer outcome (mRS 3-6) at discharge and 90 days. Long-term MACE events were less frequent in patients with higher triglyceride levels. After adjusting age, gender, diabetes, prior stroke, CAD, and obesity, multivariate analysis showed that hypertension and triglyceride levels were higher in mild ischemic strokes patients. CONCLUSIONS Increasing triglycerides are associated with higher risk of small vessel disease and requires further prospective cohort studies for confirmation.
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Affiliation(s)
- Naveed Akhtar
- Hamad Medical Corporation, Neurology, North Tower, Doha, Qatar
| | - Rajvir Singh
- Hamad Medical Corporation, Neurology, North Tower, Doha, Qatar
| | - Saadat Kamran
- Hamad Medical Corporation, Neurology, North Tower, Doha, Qatar
| | - Sujatha Joseph
- Hamad Medical Corporation, Neurology, North Tower, Doha, Qatar
| | - Deborah Morgan
- Hamad Medical Corporation, Neurology, North Tower, Doha, Qatar
| | - Ryan Ty Uy
- Hamad Medical Corporation, Neurology, North Tower, Doha, Qatar
| | - Sarah Treit
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Imam YZ, Chandra P, Singh R, Hakeem I, Al Sirhan S, Kotob M, Akhtar N, Kamran S, Al Jerdi S, Muhammad A, Haroon KH, Hussain S, Perkins JD, Elalamy O, Alhatou M, Ali L, Abdelmoneim MS, Joseph S, Morgan D, Uy RT, Bhutta Z, Azad A, Ayyad A, Elsotouhy A, Own A, Deleu D. Incidence, clinical features, and outcomes of posterior circulation ischemic stroke: insights from a large multiethnic stroke database. Front Neurol 2024; 15:1302298. [PMID: 38385041 PMCID: PMC10879388 DOI: 10.3389/fneur.2024.1302298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/08/2024] [Indexed: 02/23/2024] Open
Abstract
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.
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Affiliation(s)
- Yahia Z. Imam
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Prem Chandra
- Statistics, Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Ishrat Hakeem
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Mona Kotob
- College of Medicine, Qatar University, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Ahmad Muhammad
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Suhail Hussain
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Jon D. Perkins
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Osama Elalamy
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Mohamed Alhatou
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Liaquat Ali
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Sujatha Joseph
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ryan Ty Uy
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Zain Bhutta
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Aftab Azad
- College of Medicine, Qatar University, Doha, Qatar
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ali Ayyad
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Elsotouhy
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
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Naveed H, Akhtar N, Al-Jerdi S, Uy RT, Joseph S, Morgan D, Babu B, Shanthi S, Shuaib A. Appropriate use of antiplatelet medications following transient ischemic attacks and stroke: a 9-year study from the Middle East. Front Neurol 2023; 14:1269292. [PMID: 38020628 PMCID: PMC10666165 DOI: 10.3389/fneur.2023.1269292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background and purpose Guidelines recommend that patients with high-risk TIAs and minor strokes presenting within 1-3 days from onset should be offered dual antiplatelet therapy (DAPT). There are little data on real-world adherence to these recommendations. We evaluated the appropriateness of DAPT use in TIA and stroke patients in a prospective database. Methods The Qatar Stroke Database began the enrollment of patients with TIAs and acute stroke in 2014 and currently has ~16,000 patients. For this study, we evaluated the rates of guideline-adherent use of antiplatelet treatment at the time of discharge in patients with TIAs and stroke. TIAs were considered high-risk with an ABCD2 score of 4, and a minor stroke was defined as an NIHSS of 3. Patient demographics, clinical features, risk factors, previous medications, imaging and laboratory investigations, final diagnosis, discharge medications, and discharge and 90-day modified Rankin Scale (mRS) were analyzed. Results After excluding patients with ICH, mimics, and rare secondary causes, 8,082 patients were available for final analysis (TIAs: 1,357 and stroke: 6,725). In high-risk TIAs, 282 of 666 (42.3%) patients were discharged on DAPT. In patients with minor strokes, 1,207 of 3,572 (33.8%) patients were discharged on DAPT. DAPT was inappropriately offered to 238 of 691 (34.4%) low-risk TIAs and 809 of 3,153 (25.7%) non-minor stroke patients. Conclusion This large database of prospectively collected patients with TIAs and stroke shows that, unfortunately, despite several guidelines, a large majority of patients with TIAs and stroke are receiving inappropriate antiplatelet treatment at discharge from the hospital. This requires urgent attention and further investigation.
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Affiliation(s)
- Hiba Naveed
- Department of Medical Education, Weill Cornell College of Medicine, Doha, Qatar
| | - Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Salman Al-Jerdi
- Department of Medical Education, Weill Cornell College of Medicine, Doha, Qatar
| | - Ryan Ty Uy
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Shobana Shanthi
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Naveed H, Almasri M, Kazani B, Nauman A, Akhtar N, Singh R, Kamran S, Al Jerdi S, Thermalingem S, Shuaib A. Women and stroke: disparities in clinical presentation, severity, and short- and long-term outcomes. Front Neurol 2023; 14:1147858. [PMID: 37255725 PMCID: PMC10225500 DOI: 10.3389/fneur.2023.1147858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/17/2023] [Indexed: 06/01/2023] Open
Abstract
Objectives There are limited data from the Middle East on sex-related differences in short- and long-term stroke outcomes. We present 8 years of experience based on the Qatar stroke database. Setting The Qatar stroke database prospectively collects data on all stroke patients admitted to Hamad General Hospital. For this study, we compared female and male acute ischemic stroke patients on their characteristics at admission, short-term outcomes [modified Rankin Scale (mRS) score], and long-term outcomes [incidence of major adverse cardiovascular events (MACEs)]. Participants A total of 7,300 patients [F: 1,406 (19.3%), M: 5,894 (80.7%); mean age 55.1 ± 13.3 (F: 61.6 ± 15.1, M: 53.5 ± 12.3; p < 0.001)] were admitted with acute ischemic stroke. Results Significantly fewer women presented within 4.5 h of onset (F: 29% vs. M: 32.8%; p = 0.01). Although women were more likely to experience severe stroke (NIHSS >10; F: 19.9% vs. M: 14.5%; p < 0.001), fewer were treated with thrombolysis (F: 9.8% vs. M: 12.1%; p = 0.02). Women experienced more medical complications (F: 11.7% vs. M: 7.4%; p < 0.001) and tended to have a more prolonged length of stay in the hospital (F: 6.4 ± 7.6 days vs. M: 5.5 ± 6.8 days; p < 0.001). Primary and secondary outcome measures Good outcomes at 90 days (mRS score of 0-2) were less frequent in women (F: 53.3% vs. M: 71.2%; p < 0.001). Fewer female patients were taking antiplatelets (F: 78% vs. M: 84.8%; p < 0.001) or statins (F: 81.2% vs. M: 85.7%; p < 0.001). Significantly more female patients experienced a MACE (F: 12.6% vs. M: 6.5%; p < 0.001). Conclusion Older age at presentation contributes to poor outcomes following acute stroke in women. Other contributing factors include delays in admission to the hospital, lower rates of thrombolysis, and lower rates of provision of preventative treatments.
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Affiliation(s)
- Hiba Naveed
- Weill Cornell College of Medicine, Doha, Qatar
| | | | | | | | - Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Sathvika Thermalingem
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Parray A, Akhtar N, Pir GJ, Pananchikkal SV, Ayadathil R, Mir FA, Francis R, Own A, Shuaib A. Increase in repulsive guidance molecule-a (RGMa) in lacunar and cortical stroke patients is related to the severity of the insult. Sci Rep 2022; 12:20788. [PMID: 36456640 PMCID: PMC9715939 DOI: 10.1038/s41598-022-24481-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
Repulsive guidance molecule-a (RGMa) inhibits angiogenesis and increases inflammation. Animal models of cerebral ischemia have shown that an increased expression of RGMa leads to larger infarction and its inhibition attenuates effects of ischemia. We report on the relationship of RGMa to stroke types and severity. This is a prospective study in patients admitted to the stroke service in Qatar. We collected the clinical determinants, including NIHSS at admission, imaging and outcome at discharge and 90-days. RGMa levels were determined by measuring mRNA levels extracted from peripheral blood mononuclear cells (PBMCs) within 24 h of onset and at 5 days. There were 90 patients (lacunar: 64, cortical: 26) and 35 age-matched controls. RGMa mRNA levels were significantly higher in the stroke patients: day 1: 1.007 ± 0.13 versus 2.152 ± 0.19 [p < 0.001] and day-5: 3.939 ± 0.36 [p < 0.0001]) and significantly higher in patients with severe stroke (NIHSS ≥ 8) compared to milder symptoms (NIHSS < 8) at day 1 (NIHSS ≥ 8: 2.563 ± 0.36; NIHSS < 8: 1.947 ± 0.2) and day 5 (NIHSS ≥ 8: 5.25 ± 0.62; NIHSS < 8: 3.259 ± 0.419). Cortical stroke patients had marginally higher RGMa mRNA levels compared to lacunar stroke at day 1 (cortical stroke: 2.621 ± 0.46 vs lacunar stroke: 1.961 ± 0.19) and day 5 (cortical stroke: 4.295 ± 0.76 vs lacunar stroke: 3.774 ± 0.39). In conclusion, there is an increase in the level of RGMa mRNA in patients with acute stroke and seen in patients with lacunar and cortical stroke. The increase in RGMa mRNA levels is related to the severity of the stroke and increases over the initial 5 days. Further studies are required to determine the effects of the increase in RGMa on stroke recovery.
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Affiliation(s)
- Aijaz Parray
- grid.413548.f0000 0004 0571 546XThe Neuroscience Institute, Academic Health System, Hamad Medical Corporation, 3050 Doha, Qatar
| | - Naveed Akhtar
- grid.413548.f0000 0004 0571 546XThe Neuroscience Institute, Academic Health System, Hamad Medical Corporation, 3050 Doha, Qatar
| | - Ghulam Jeelani Pir
- grid.413548.f0000 0004 0571 546XThe Neuroscience Institute, Academic Health System, Hamad Medical Corporation, 3050 Doha, Qatar
| | - Sajitha V. Pananchikkal
- grid.413548.f0000 0004 0571 546XThe Neuroscience Institute, Academic Health System, Hamad Medical Corporation, 3050 Doha, Qatar
| | - Raheem Ayadathil
- grid.413548.f0000 0004 0571 546XThe Neuroscience Institute, Academic Health System, Hamad Medical Corporation, 3050 Doha, Qatar
| | - Fayaz Ahmad Mir
- grid.413548.f0000 0004 0571 546XQatar Metabolic Institute, Academic Health System, Hamad Medical Corporation, 3050 Doha, Qatar
| | - Reny Francis
- grid.413548.f0000 0004 0571 546XThe Neuroscience Institute, Academic Health System, Hamad Medical Corporation, 3050 Doha, Qatar
| | - Ahmed Own
- grid.413548.f0000 0004 0571 546XThe Neuroscience Institute, Academic Health System, Hamad Medical Corporation, 3050 Doha, Qatar
| | - Ashfaq Shuaib
- grid.17089.370000 0001 2190 316XDivision of Neurology, Faculty of Medicine, University of Alberta, Edmonton, T6G 2G3 Canada
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Akhtar N, Abid F, Singh R, Kamran S, Imam Y, Al-Jerdi S, Salamah S, Al Attar R, Yasir M, Shabir H, Morgan D, Joseph S, AlMaslamani M, Shuaib A. Ischemic stroke in patients that recover from COVID-19: Comparisons to historical stroke prior to COVID-19 or stroke in patients with active COVID-19 infection. PLoS One 2022; 17:e0270413. [PMID: 35749524 PMCID: PMC9232148 DOI: 10.1371/journal.pone.0270413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background and purpose Understanding the relationship of COVID-19 to stroke is important. We compare characteristics of pre-pandemic historical stroke (Pre-C), cases in acute COVID infection (Active-C) and in patients who have recovered from COVID-19 infection (Post-C). Methods We interrogated the Qatar stroke database for all stroke admissions between Jan 2019 and Feb 2020 (Pre-C) to Active-C (Feb2020-Feb2021) and Post-C to determine how COVID-19 affected ischemic stroke sub-types, clinical course, and outcomes prior to, during and post-pandemic peak. We used the modified Rankin Scale (mRS) to measure outcome at 90-days (mRS 0–2 good recovery and mRS 3–6 as poor recovery). For the current analysis, we compared the clinical features and prognosis in patients with confirmed acute ischemic stroke. Results There were 1413 cases admitted (pre-pandemic: 1324, stroke in COVID-19: 46 and recovered COVID-19 stroke: 43). Patients with Active-C were significantly younger, had more severe symptoms, fever on presentation, more ICU admissions and poor stroke recovery at discharge when compared to Pre-C and Post-C. Large vessel disease and cardioembolic disease was significantly more frequent in Active-C compared to PRE-C or post-C. Conclusions Stroke in Post-C has characteristics similar to Pre-C with no evidence of lasting effects of the virus on the short-term. However, Active-C is a more serious disease and tends to be more severe and have a poor prognosis.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Fatma Abid
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yahia Imam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Sarah Salamah
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Rand Al Attar
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Muhammad Yasir
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Hammad Shabir
- Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Muna AlMaslamani
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Akhtar N, Abid F, Singh R, Kamran S, Imam Y, Al Jerdi S, Salameh S, Al Attar R, Yasir M, Shabir H, Morgan D, Joseph S, AlMaslamani M, Shuaib A. Characteristics and comparisons of acute stroke in "recovered" to "active COVID-19 and "pre-pandemic" in Qatar database. J Thromb Thrombolysis 2022; 53:824-828. [PMID: 35244832 PMCID: PMC8894126 DOI: 10.1007/s11239-021-02581-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 12/02/2022]
Abstract
Understanding the relationship of COVID-19 to stroke is important. We compare characteristics of pre-pandemic stroke (PPS), cases in acute COVID infection (CS) and in patients who have recovered from COVID-19 infection (RCS). We interrogated the Qatar stroke database for all stroke admissions between Jan 2020 and Feb 2021 (PPS) to CS and RCS to determine how COVID-19 affected ischemic stroke sub-types, clinical course, and outcomes prior to, during and post-pandemic peak. There were 3264 cases admitted (pre-pandemic: 3111, stroke in COVID-19: 60 and recovered COVID-19 stroke: 93). Patients with CS were significantly younger, had more severe symptoms, fever on presentation, more ICU admissions and poor stroke recovery at discharge when compared to PPS and RCS. Large vessel disease and cardioembolic disease was significantly higher in CS compared to PPS or RCS. There was a significant decline in stroke mimics in CS. Stroke in RCS has characteristics similar to PPS with no evidence of lasting effects of the virus on the short-term. However, CS is a more serious disease and tends to be more severe and have a poor prognosis.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Fatma Abid
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yahia Imam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Sarah Salameh
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Rand Al Attar
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Muhammad Yasir
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Hammad Shabir
- Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Muna AlMaslamani
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, AB Canada
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11
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Akhtar N, Kamran S, Al-Jerdi S, Imam Y, Joseph S, Morgan D, Abokersh M, Uy RT, Shuaib A. Trends in stroke admissions before, during and post-peak of the COVID-19 pandemic: A one-year experience from the Qatar stroke database. PLoS One 2022; 17:e0255185. [PMID: 35324905 PMCID: PMC8947388 DOI: 10.1371/journal.pone.0255185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/10/2021] [Indexed: 12/23/2022] Open
Abstract
Background Several reports document a decrease in the rates of stroke hospital admissions during the covid-19 pandemic. There is very little information whether the admission rates will change as the infection is controlled. We report on our rates of admissions before, during and following the peak of covid-19 infections in a prospective database from Qatar. Methods and results The stroke admissions in the six months prior to COVID-19 pandemic averaged 229/month. There was a decrease to 157/month in March-June during the peak of the pandemic. In the 6 months following the peak, as covid-19 numbers began to decrease, the average numbers increased back to 192/month. There was an increase in severe ischemic strokes and decreased in functional recovery. The decreased admissions were mainly driven by fewer stroke mimics. Patients presenting with ischemic stroke or cerebral hemorrhage remained unchanged. Conclusions Fewer stroke mimics presenting to the hospital can explain the fewer admissions and poor outcome at the height of the covid-19 pandemic. The continued decrease in the number of ischemic stroke and stroke mimic admissions following the pandemic peak requires more study.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Salman Al-Jerdi
- Weill Cornell Medical College- Qatar Foundation, Doha, Qatar
| | - Yahia Imam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Abokersh
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - R. T. Uy
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, Canada
- * E-mail:
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Al Jerdi S, Akhtar N, Mahfoud Z, Kamran S, Shuaib A. Major cardiovascular events in patients presenting with acute stroke: a 5-year follow-up study in patients who had ischaemic stroke and stroke mimics. BMJ Open 2022; 12:e053059. [PMID: 35236730 PMCID: PMC8896026 DOI: 10.1136/bmjopen-2021-053059] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The long-term acute stroke outcome has not been well studied in the Middle-Eastern population. The primary objective of our study is to compare the long-term outcome of acute ischaemic stroke (IS) with/without previous cerebrovascular/cardiovascular disease (CVD) to stroke mimics (SM) with CVD. SETTINGS AND PARTICIPANTS The Qatar stroke database was reviewed for IS and SM admissions in Qatari Nationals between 2013 and 2019. OUTCOMES Patients were prospectively assessed for development of recurrent stroke, myocardial infarction or death. Frequency of major cardiovascular events (MACEs) were compared between patients with or without a previous CVD. RESULTS There were 1114 stroke admissions (633 IS (prior CVD 211/18.9%), 481 SM (prior CVD 159/14.3%)). Patients with IS/CVD were significantly older versus others (IS/CVD: 68.3±12.2; IS/no CVD: 63.3±14.4; SM/CVD: 67.6±13.1; SM/no CVD: 52.4±17.9. p<0.0001). Vascular risk factors were significantly higher in patients with IS and SM with previous CVD. Functional recovery (90-day mRS 0-2) was significantly better in SM/no CVD (IS/CVD: 55.0%; IS/no CVD: 64.2%; SM/CVD 59.7%; SM/no CVD: 88.8%. p<0.001). MACE occurred in 36% (76/211) IS/CVD, 24.9% (105/422) IS/no CVD, 22.0% (35/179) SM/CVD and only 6.8% (22/322) SM/no CVD. MACE occurred mostly during the first year of follow-up. Mortality 90 days was significantly higher in IS/CVD (IS/CVD 36%; IS/no CVD 24.9%; SM/CVD: 22%; SM/no CVD: 6.8%. p<0.0001). CONCLUSIONS Prior CVD significantly increases the risk of MACE and early mortality in IS or SM patients. Age, male gender, obesity, atrial fibrillation and admission National Institute of Health Stroke Scale also increases risk of MACE during follow-up. Hence, aggressive vascular risk factor modification is needed even in patients with SM.
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Affiliation(s)
- Salman Al Jerdi
- Department of Neurology, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corp, Doha, Qatar
| | - Ziyad Mahfoud
- Department of Medical Education, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
| | - Ashfaq Shuaib
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Akhtar N, Al-Jerdi S, Kamran S, Singh R, Babu B, Abdelmoneim MS, Morgan D, Joseph S, Francis R, Shuaib A. Night-Time Non-dipping Blood Pressure and Heart Rate: An Association With the Risk of Silent Small Vessel Disease in Patients Presenting With Acute Ischemic Stroke. Front Neurol 2021; 12:719311. [PMID: 34867710 PMCID: PMC8637909 DOI: 10.3389/fneur.2021.719311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Nocturnal non-dipping blood pressure and heart rate are associated with an increased risk of cardiovascular disease. The effects of such variance on cerebrovascular disease have not been well studied. Methods: The 24-h ambulatory blood pressure (ABPM) and heart rate were monitored with B-pro in patients with acute stroke within the initial week of hospital admission. The risk factor profiles, clinical presentation, imaging, and short-term prognosis were compared in nocturnal dippers and non-dippers (more than 10% nocturnal decrease) of blood pressure and heart rate. Results: We enrolled 234 patients in whom ABPM and MRI data were available. Heart rate data were available in 180 patients. Lacunar sub-cortical stroke was the most common acute lesion (58.9%), while hypertension (74%) and diabetes (41.5%) were the most common associated risk factors. ABPM revealed non-dipping in 69% of patients. On univariate analysis, Small Vessel Disease (SVD) was significantly more frequent in non-dippers vs. dippers (BP: 56.8 vs. 40.3% p = 0.02; heart rate: 57.9 vs. 40.7% p = 0.03). Silent strokes were also more frequent in non-dippers vs. dippers (BP: 40.7 vs. 26.4% p = 0.35; heart rate: 44.6 vs. 25.4% p = 0.01). Multivariate analysis revealed SVD to be significantly related to age, hypertension, blood pressure non-dipping, and severity of symptoms at index event. Conclusions: The presence of nocturnal non-dipping of blood pressure and heart rate are associated with an increased risk of silent stroke and SVD. Increased use of ABPM may allow for improved diagnosis of non-dippers.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Reny Francis
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Akhtar N, Al Jerdi S, Mahfoud Z, Imam Y, Kamran S, Saqqur M, Morgan D, Joseph S, Khan K, Shuaib A. Impact of COVID-19 pandemic on stroke admissions in Qatar. BMJ Neurol Open 2021; 3:e000084. [PMID: 33665617 PMCID: PMC7817384 DOI: 10.1136/bmjno-2020-000084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 02/03/2023] Open
Abstract
Introduction The COVID-19 pandemic has resulted in a dramatic unexplained decline in hospital admissions due to acute coronary syndromes and stroke. Several theories have emerged aiming to explain this decline, mostly revolving around the fear of contracting the disease and thus avoiding hospital visits. Aims In this study, we aim to examine the impact of the COVID-19 pandemic on stroke admissions to a tertiary care centre in Qatar. Methods The Hamad General Hospital stroke database was interrogated for stroke admissions between September 2019 and May 2020. The number of stroke admissions, stroke subtypes and short-term outcomes was compared between the ‘pre-COVID-19’ period (September 2019 to February 2020) and the COVID-19 pandemic period (March to May 2020). Results We observed a significant decline in monthly admissions in March (157), April (128) and May (135) compared with the pre-COVID-19 6-month average (229) (p=0.024). The reduction in admissions was most evident in functional stroke mimics. The average admissions decreased from 87 to 34 per month (p=0.0001). Although there were no significant differences in admissions due to ischaemic stroke (IS), intracranial haemorrhage or transient ischaemic attacks between the two periods, we noted a relative decrease in IS due to small vessel disease and an increase in those due to large vessel atherosclerosis in March to May 2020. Conclusions The decline in overall stroke admissions during the COVID-19 pandemic is most likely related to concerns of contracting the infection, evidenced mainly by a decline in admissions of stroke mimics. However, a relative increase in large vessel occlusions raises suspicion of pathophysiological effects of the virus, and requires further investigation.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Yahia Imam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- University of Alberta, Edmonton, Alberta, Canada
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
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Akhtar N, Abid FB, Kamran S, Singh R, Imam Y, AlJerdi S, AlMaslamani M, Shuaib A. Characteristics and Comparison of 32 COVID-19 and Non-COVID-19 Ischemic Strokes and Historical Stroke Patients. J Stroke Cerebrovasc Dis 2021; 30:105435. [PMID: 33171425 PMCID: PMC7605738 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/13/2020] [Accepted: 10/29/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The presence of COVID-19 infection may increase the risk of thrombotic events including ischemic strokes. Whilst a number of recent reports suggest that COVID-19 associated stroke tends to be severe, there is limited data on the effects of COVID-19 in prospective registries. MATERIAL AND METHODS To determine how COVID-19 infection may affect cerebrovascular disease, we evaluated the ischemic stroke sub-types, clinical course and outcomes prior to and during the pandemic in Qatar. The Hamad General Hospital (HGH) stroke database was interrogated for stroke admissions during the last 4 months of 2019 and January-May 2020. RESULTS In Qatar the number of confirmed cases of COVID-19 increased from only 2 in February to 779 in March, 12,628 in April and 45,501 in May. Stroke admissions to HGH declined marginally from an average of 97/month for six pre-COVID months to 72/month in March-May. There were 32 strokes that were positive for COVID-19. When compared to non-COVID-19 stroke during the three months of the pandemic, COVID-19 patients were younger with significantly lower rates of hypertension, diabetes and dyslipidemia. COVID-19 positive patients had more cortical strokes (34.4% vs 5.6%; p = 0.001), severe disease (NIHSS >10: 34.4% vs 16.7%; p = 0.001) prolonged hospitalization and fewer with good recovery (mRS 0-2: 28.1% vs 51.9%; p = 0.001). CONCLUSIONS When compared to six pre-COVID-19 months, the number of ischemic stroke admissions during the three months of the pandemic declined marginally. COVID-19 positive patients were more likely to have a large cortical stroke with severe symptoms and poor outcome.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar.
| | - Fatma Ben Abid
- Infectious Diseases Section, Medicine Department, Communicable Diseases Centre, HMC, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar.
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar.
| | - Rajvir Singh
- Acute Care Surgery Department, Hamad Medical Corporation, Doha, Qatar.
| | - Yahia Imam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar.
| | | | - Muna AlMaslamani
- Infectious Diseases Section, Medicine Department, Communicable Diseases Centre, HMC, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar.
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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The prevalence, mortality rate and functional outcome of intracerebral hemorrhage according to age sex and ethnic group in the state of Qatar. Clin Neurol Neurosurg 2020; 199:106255. [PMID: 33161215 DOI: 10.1016/j.clineuro.2020.106255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the prevalence of intracerebral hemorrhage (ICH) using stroke database from the main tertiary hospital in Qatar (Hamad General Hospital) over the period of Dec 2013 to Oct 2017. METHODS The prevalence of ICH was calculated based on age groups and ethnicity (Qatari nationals, non-Qatari Arab, South east Indian (SI) and Far East Asians (FE)). Thirty-day case fatality rate, poor clinical outcome at discharge (modified Rankin scale (mRS):3-6) and poor long-term outcome (mRS at 90 days: 3-6) were calculated per each age group sex and ethnicity. RESULT There were 653/4039 (16 %) with ICH. The median age was 53 (IQ range: 45-64) with a male/female ratio: 557/96 (85.3/14.7 %). The 30-day mortality rate was 14.7 % (96/653), poor outcome at discharge (mRS 3-6): 66.8 % (436/653) and poor long-term outcome (mRS 90 days:3-6) 50.1 % (199/397). The prevalence of ICH in Qatar was 24.9 per 100 000. The highest mortality rate was seen in the elderly (≥ 70 years old) (16/67 (23.9 %)) and young group (48/291 (16.5 %)). The most common ethnic group among our ICH population are the following: FE (40.59 per 100 000), Qatari (25.26 per 100 000) and SI ethnic group (24.97 per 100 000). In multiple logistic regression analysis only, old age (≥ 70 years old) was associated with 30 days mortality (adj OR: 2.51, 95 % CI: 1.14-5.54, P = 0.023). Similar regression analysis was also observed that age ≥ 70 years old (adj. OR: 4.18, 95 % CI: 1.27-13.77, P = 0.019), sex (male) (adj. OR: 0.21, 95 % CI: 0.08-0.56, P = 0.002), and ethnicity (SI vs Qatari: adj. OR: 4.08, 95 % CI: 1.28-12.92, P = 0.017); (FE vs Qatari: adj. OR: 2.22, 95 % CI: 0.65-7.67, P = 0.203) are statistically associated with poor outcome. CONCLUSION The prevalence of ICH was high in the elderly and in the FE, Qatari, and SI ethnic group. Further studies are needed to better understand the differences in ICH prognosis in multiethnic groups.
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Akhtar N, Kate M, Kamran S, Singh R, Bhutta Z, Saqqur M, Elzouki AN, Babu B, Bourke P, Morgan D, Joseph S, Jose N, Francis R, Imam Y, Amir N, Own A, Shuaib A. Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar. Eur Neurol 2020; 83:154-161. [PMID: 32434193 DOI: 10.1159/000507193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sex differences may determine presentation, utility of treatment, rehabilitation, and occurrences of major adverse cardiovascular events (MACEs) in acute stroke (AS). OBJECTIVE The purpose of the study was to evaluate the short-term prognosis and long-term outcomes in MACEs in Qatari nationals admitted with AS. METHODS All AS patients admitted between January 2014 and February 2019 were included. We evaluated the preadmission modified Rankin scale (mRS) score, etiology and severity of symptoms, complications, and functional recovery at discharge and 90 days. MACEs were recorded for 5 years. RESULTS There were 891 admissions for AS (mean age 64.0 ± 14.2 years) (male, n = 519 [mean age ± SD 62.9 ± 14.1 years]; female, n = 372 [mean age ± SD 65.6 ± 14.2 years] p = 0.005). There were no differences in the preadmission mRS and severity of symptoms as measured on National Institute of Stroke Scale. At discharge, the outcome was better (mRS 0-2) in men (57.8 vs. 46.0%), p = 0.0001. This difference persisted at the 90-day follow-up (mRS 0-2, male 69.4% vs. female 53.2%, p = 0.0001). At the 90-day follow-up, more women died (total deaths 70; women 38 [10.2%] versus men 32 [6.2%], p = 0.03). MACEs occurred in 25.6% (133/519) males and 30.9% (115/372) females over the 5-year follow-up period (odds ratio 0.77, 95% confidence interval 0.57-1.0, p = 0.83). CONCLUSIONS Female patients have a poor short-term outcome following an AS when corrected for age and comorbidities. While our study cannot explain the reasons for the discrepancies, higher poststroke depression and social isolation in women may be important contributory factors, and requires further studies are required to confirm these findings.
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Affiliation(s)
- Naveed Akhtar
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mahesh Kate
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Saadat Kamran
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Accident & Emergency, Hamad Medical Corporation, Doha, Qatar
| | - Zain Bhutta
- Accident & Emergency, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Blessy Babu
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Paula Bourke
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Namitha Jose
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Reny Francis
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yahia Imam
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Numan Amir
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada,
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Khatib R, Jawaadah AM, Khammash U, Babiker A, Huffman MD, Prabhakaran S. Presentation, Management, and Outcomes of Acute Stroke in Palestine. J Am Heart Assoc 2019; 7:e010778. [PMID: 30571480 PMCID: PMC6404450 DOI: 10.1161/jaha.118.010778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Stroke is a leading cause of death and disability in the Middle East. Data on the uptake of evidence-based practices are limited in the region. We aimed to examine patterns of stroke presentation, management, and outcomes at public Palestinian hospitals. Methods and Results Comprehensive data from all patients with acute stroke admitted to 2 public hospitals in the West Bank of Palestine were prospectively collected. Acute stroke presentation patterns, in-hospital evaluation and management, mortality, and stroke complications were evaluated. Data were available for 150 patients with acute stroke between September 2017 and May 2018. The mean ( SD ) age was 65 (14) years and 49% were women. Only 25% of patients utilized ambulance services for transportation to the hospital. All patient received head computed tomography scans, although few received other investigations such as magnetic resonance imaging (8%) or carotid Doppler (4%). Most patients with ischemic stroke received antiplatelet therapy (98%), although none received thrombolysis. Only 17% received physical therapy evaluation. In-hospital mortality was 12%, 23% of patients had at least 1 poststroke complication, and the median modified Rankin Score at discharge was 4 (interquartile range, 2-5). Conclusions We identified high stroke mortality and discharge disability rates in Palestine. Key evidence-based gaps were highlighted, suggesting opportunities for quality improvement.
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Affiliation(s)
- Rasha Khatib
- 1 Department of Neurology Northwestern University Feinberg School of Medicine Chicago IL.,2 Institute for Community and Public Health Birzeit University Birzeit Palestine
| | - Assef M Jawaadah
- 3 Department of General Surgery Palestine Medical Complex Ramallah Palestine.,4 Faculty of Pharmacy, Nursing and Health Professions Birzeit University Birzeit Palestine
| | | | - Ahmed Babiker
- 1 Department of Neurology Northwestern University Feinberg School of Medicine Chicago IL
| | - Mark D Huffman
- 6 Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Shyam Prabhakaran
- 1 Department of Neurology Northwestern University Feinberg School of Medicine Chicago IL
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19
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Smith C, Almallouhi E, Feng W. Urinary tract infection after stroke: A narrative review. J Neurol Sci 2019; 403:146-152. [DOI: 10.1016/j.jns.2019.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/09/2019] [Accepted: 06/04/2019] [Indexed: 12/18/2022]
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20
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Medeiros CSPD, Pacheco TBF, Cavalcanti FADC, Cacho RDO, Bezerra AMDS. Level of motor, sensory and functional impairment from stroke at admission and hospital discharge in Brazil. Brain Inj 2019; 33:1430-1435. [DOI: 10.1080/02699052.2019.1642515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | - Roberta de Oliveira Cacho
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte (UFRN), Santa Cruz/RN, Brazil
| | - Aíla Maria da Silva Bezerra
- Multiprofessional Residency in Neurology and Neurosurgery, School of Public Health of Ceará (ESP), Fortaleza/CE, Brazil
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Imam YZ, Kamran S, Akhtar N, Deleu D, Singh R, Malik RA, Abdelmoneim MS, Bermejo P, Bourke P, Morgan D, Santos M, Joseph S, Shuaib A. Incidence, clinical features and outcomes of atrial fibrillation and stroke in Qatar. Int J Stroke 2019; 15:85-89. [PMID: 30789323 DOI: 10.1177/1747493019830577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Atrial fibrillation is an important risk factor for stroke but there are limited data on atrial fibrillation-related stroke from the Middle East. METHODS We interrogated the Qatar Stroke Database to establish the occurrence, clinical features, and outcomes of atrial fibrillation-related stroke at Hamad General Hospital, the sole provider of acute stroke care in Qatar. RESULTS A total of 4079 patients (81.4% male, mean age 55.4 ± 13.3 years) were enrolled in the stroke database between January 2014 and 21 October 2017. Atrial fibrillation was present in 260 (6.4%) patients, of whom 106 (2.6%) had newly diagnosed atrial fibrillation. The National Institute of Health Stroke Scale (NIHSS) was significantly higher (7.9 + 7.0 (median 6; IQR 11) vs. 5.9 + 6.4 (median 4; IQR 6), P < 0.001) in atrial fibrillation patients. The modified Rankin Score (mRS) (P < 0.001) and mortality at 90-day follow-up (P = 0.002) were significantly higher in atrial fibrillation compared to non-atrial fibrillation stroke patients. CONCLUSION We demonstrate a low rate of atrial fibrillation and stroke in Qatar, perhaps reflecting the relatively young age of these patients. Atrial fibrillation-related strokes had higher admission NIHSS, greater disability, and higher mortality at 90 days when compared to non-atrial fibrillation strokes.
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Affiliation(s)
- Yahia Z Imam
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiac Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Doha, Qatar.,Division of Cardiovascular Medicine, Central Manchester University Hospitals Foundation Trust, University of Manchester, Manchester, UK
| | - M S Abdelmoneim
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Pablo Bermejo
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Paula Bourke
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mark Santos
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.,Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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Akhtar N, Kamran S, Singh R, Malik RA, Deleu D, Bourke PJ, Joseph S, Santos MD, Morgan DM, Wadiwala FM, Francis R, Babu BM, George P, Ibrahim R, Garcia-Bermejo P, Shuaib A. The Impact of Diabetes on Outcomes After Acute Ischemic Stroke: A Prospective Observational Study. J Stroke Cerebrovasc Dis 2018; 28:619-626. [PMID: 30545720 DOI: 10.1016/j.jstrokecerebrovasdis.2018.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/24/2018] [Accepted: 11/03/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Stroke in diabetics may delay recovery and increases the risk of early recurrence of stroke. We compared the outcomes of patients (with and without diabetes) admitted with an acute ischemic stroke (AIS) in the state of Qatar. PATIENTS AND METHODS We prospectively compared the clinical presentation, complications, discharge outcome, and stroke recurrence at 90 days in patients with and without diabetes. RESULTS Five thousand two hundred twenty-eight stroke patients were admitted between January 2014 and December 2017. Two thousand nine hundred sixty-one had confirmed AIS, 1695 (57.2%) had diabetes, 429 (14.5%) had prediabetes and 873 (29.5%) had no diabetes. Comparing diabetic patients to prediabetic and nondiabetics, they were significantly older (58.5 ± 11.9 versus 54.0 ± 12.9 versus 49.5 ± 13.8, P = .0001), had higher rates of hypertension (80.8% versus 67.4% versus 59.2%), previous stroke (18.0% versus 5.4% versus 6.2%), and coronary artery disease (12.9% versus 5.6% versus 5.0%; P = .001 for all). The percentage of patients with modified Rankin scale 3-6 at discharge (39.7% versus 32.6% versus 30.2%; P = .0001) and 90 days (26.7% versus 18.8% versus 21.4%, P = .001); 90-day mortality (6.2% versus 2.2% versus 5.2%; P = .03) and stroke recurrence (4.2% versus .7% versus 2.2%; P = .005) was significantly higher in diabetic patients. CONCLUSIONS Patients with diabetes and AIS have more in-hospital complications, worse discharge outcomes, higher mortality and stroke recurrence at 90 days, compared to prediabetes and no diabetes.
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Affiliation(s)
- Naveed Akhtar
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Department of Cardiology, Hamad Medical Corporation, Qatar
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Dirk Deleu
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Paula J Bourke
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mark D Santos
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah M Morgan
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Faisal M Wadiwala
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Reny Francis
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy M Babu
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Pooja George
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rumissa Ibrahim
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Pablo Garcia-Bermejo
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar; Department of Medicine (Neurology), University of Alberta Stroke Program, Edmonton, Alberta, Canada.
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23
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Pre-existing Small Vessel Disease in Patients with Acute Stroke from the Middle East, Southeast Asia, and Philippines. Transl Stroke Res 2017; 9:274-282. [DOI: 10.1007/s12975-017-0578-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
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24
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Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke: South Asian Experience. J Stroke Cerebrovasc Dis 2017; 26:2306-2312. [PMID: 28579508 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/15/2017] [Accepted: 05/14/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The randomized trials showed improved outcome and reduced mortality in malignant middle cerebral artery (MMCA) undergoing Decompressive hemicraniectomy (DHC) within 48 hours of stroke onset. Despite high prevalence of stroke, especially in younger individuals, high and short-term mortality from stroke in South Asian and Middle East, there is little published data on DHC in patients with MMCA stroke. METHODS This is a retrospective, multicenter cross-sectional study to measure outcome following DHC using the modified Rankin Scale (mRS) and dichotomized as favorable (mRS ≤ 4) or unfavorable (mRS > 4), at 3 months. RESULTS In total, 137 patients underwent DHC. At 90 days, mortality was 16.8%; 61.3% of patients survived with an mRS of 4 or less and 38.7% had an mRS greater than 4. Age (55 years), diabetes (P = .004), hypertension (P = .021), pupillary abnormality (P = .048), uncal herniation (P = .007), temporal lobe involvement (P = .016), additional infarction (MCA + anterior cerebral artery, posterior cerebral artery) (P = .001), and infarction growth rates (P = .025) were significantly higher in patients with unfavorable prognosis in univariate analysis. Multivariate analysis showed age, additional infarction, septum pellucidum deviation greater than 1 cm, and uncal herniation to be associated with a significantly poor prognosis. Time to surgery had no impact on outcome (P = .109). CONCLUSIONS Similar to the results of the studies from the West, DHC Improves functional outcome in predominantly South Asian patients with MMCA Stroke.
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25
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Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth Rate. Stroke Res Treat 2017; 2017:2507834. [PMID: 28409051 PMCID: PMC5376465 DOI: 10.1155/2017/2507834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/22/2017] [Indexed: 11/25/2022] Open
Abstract
Objective and Methods. The outcome in late decompressive hemicraniectomy in malignant middle cerebral artery stroke and the optimal timings of surgery has not been addressed by the randomized trials and pooled analysis. Retrospective, multicenter, cross-sectional study to measure outcome following DHC under 48 or over 48 hours using the modified Rankin scale [mRS] and dichotomized as favorable ≤4 or unfavorable >4 at three months. Results. In total, 137 patients underwent DHC. Functional outcome analyzed as mRS 0–4 versus mRS 5-6 showed no difference in this split between early and late operated on patients [P = 0.140] and mortality [P = 0.975]. Multivariate analysis showed that age ≥ 55 years, MCA with additional infarction, septum pellucidum deviation ≥1 cm, and uncal herniation were independent predictors of poor functional outcome at three months. In the “best” multivariate model, second infarct growth rate [IGR2] >7.5 ml/hr, MCA with additional infarction, and patients with temporal lobe involvement were independently associated with surgery under 48 hours. Both first infarct growth rate [IGR1] and second infarct growth rate [IGR2] were nearly double [P < 0.001] in patients with early surgery [under 48 hours]. Conclusions. The outcome and mortality in malignant middle cerebral artery stroke patients operated on over 48 hours of stroke onset were comparable to those of patients operated on less than 48 hours after stroke onset. Our data identifies IGR, temporal lobe involvement, and middle cerebral artery with additional infarct as independent predictors for early surgery.
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26
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Akhtar N, Salam A, Kamran S, Bourke P, Joseph S, Santos M, Khan R, Irfan F, Deleu D, Malik RA, Shuaib A. Ethnic variation in acute cerebrovascular disease: Analysis from the Qatar stroke registry. Eur Stroke J 2016; 1:231-241. [PMID: 31008284 DOI: 10.1177/2396987316663776] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 07/20/2016] [Indexed: 11/17/2022] Open
Abstract
Objective We analysed the Qatar stroke registry for ethnic variations in patients admitted with cerebrovascular disease at Hamad General Hospital, Qatar. Methods Patients admitted with acute stroke from January 2014 to December 2015, enrolled in the registry were included in the study. We evaluated the clinical presentation, risk factors, and outcome at discharge and 90 days post-discharge in relation to the patient's ethnic background. Results A total of 1727 patients were enrolled in the Hamad General Hospital stroke registry (Middle Eastern 594 (34.4%), South East Asian 924 (53.5%) and Far Eastern 209 (12.1%)). There were significant differences in risk factors, clinical presentation and prognosis. Compared to Middle Eastern patients, Far Eastern patients were younger (62.8 ± 13.7 vs. 48.9 ± 9.1 years; p < 0.001). Diabetes and hypertension were significantly more common in Middle Eastern patients (358 (60.3%), 458 (77.1%)) compared to South East Asian patients (420 (45.5%), 596 (64.5%)) and Far Eastern patients (57 (27.3%), 154 (73.7%)), respectively (p < 0.001). Stroke was more severe in the Far Eastern group (median (interquartile range) - 5.0 (2-11.5)) compared to the Middle Eastern group (median (interquartile range) - 4.0 (1-8)) and South East Asian (median (interquartile range) - 4.0 (2-9)), p = 0.011. Mortality at 90 days was highest in patients from the Far East (15/209 (8.2%)) compared to the Middle East (35/594 (6.5%)) and South East Asia (33/924 (4.0)), p = 0.028. Patients from the Far East had significantly higher rates of intracranial hemorrhage compared to the Middle East and South East Asia (70/209 (33.5%), 77/594 (13.0%), and 169/924 (18.3%)), respectively (p < 0.001). Conclusion The early age at presentation and the poor control of risk factors, especially in patients from South East Asia and the Far East requires attention.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar
| | - Abdul Salam
- The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar
| | - Paula Bourke
- The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar
| | - Mark Santos
- The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar
| | - Rabia Khan
- The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar
| | - Furqan Irfan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Dirk Deleu
- The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation, Doha, Qatar
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ashfaq Shuaib
- The Neuroscience Institute (Stroke Center of Excellence), Hamad Medical Corporation & Department of Medicine, University of Alberta, Alberta, Canada
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