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Jones SP, Spencer J, Adeniji O, Abd-Allah F, Ogunde G, Ebenezer AA, Kalaria R, Lightbody CE, Langhorne P, Melifonwu R, Naidoo P, Macaire Ossou-Nguiet P, Ogunniyi A, Olowoyo P, Owolabi MO, Sarfo FS, Walker R, Yaria J, Watkins C CL, Akinyemi RO. Towards improving stroke services in Africa: Results from the Africa-UK Stroke Partnership [AUKSP] surveys. J Stroke Cerebrovasc Dis 2024; 33:107891. [PMID: 39094719 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107891] [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: 12/09/2023] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The African Stroke Organization (ASO) in partnership with the University of Central Lancashire's Stroke Research Team launched the Africa-UK Stroke Partnership (AUKSP). AUKSP undertook two (stroke expert and hospital Stroke Unit (SU)) on-line surveys mapping existing capacity and capability to deliver African stroke care. METHODS An on-line expert survey tool was sent to 139 stroke experts in 54 African countries October 2021-March 2022 and the hospital SU survey to 120 hospital SUs (identified from the expert survey) June-October 2022. Both survey tools were prepared according to the World Stroke Organisation's Roadmap for Delivering Quality Stroke Care. Completed responses were exported from Qualtrics into Microsoft excel and were analysed descriptively. RESULTS Forty-five expert responses and 62 hospital SU responses were analysed, representing 54(87%) public hospitals, 7(11%) private and 1(2%) charitable organization. In both surveys, three main priorities for improvement of stroke services were: a rapid and prompt stroke diagnosis; effective primary and secondary stroke prevention, and acute stroke management. Survey findings suggest that there is a low presence of national stroke surveillance systems and registries, and heterogeneity in availability of diagnostic services, SUs, endovascular treatments, and rehabilitation. CONCLUSION Significant gaps exist in Africa's capacity and capability to deliver essential elements of effective and quality stroke care. Tackling these challenges requires urgent and sustained multi-stakeholder action including: government, administrators, policy makers and other partners. Our survey findings highlight key priority areas for multi-stakeholder engagement and crafting of a pragmatic, prioritized and context-sensitive African Stroke Action Plan.
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Affiliation(s)
| | - Joseph Spencer
- University of Central Lancashire, Preston, Lancashire, UK
| | | | - Foad Abd-Allah
- Department of Neurology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Gabriel Ogunde
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ad Adams Ebenezer
- Stroke Association Support Network-Ghana (SASNET-GHANA), Accra, Ghana
| | | | | | - Peter Langhorne
- University of Glasgow, Glasgow, Scotland, UK; Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | | | - Pamela Naidoo
- Heart and Stroke Foundation, South Africa; University of Stellenbosch, South Africa
| | | | - Adesola Ogunniyi
- College of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria
| | | | - Mayowa O Owolabi
- College of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria
| | - Fred S Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | - Rufus O Akinyemi
- College of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria
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Yogendrakumar V, Vandelanotte S, Mistry EA, Hill MD, Coutts SB, Nogueira RG, Nguyen TN, Medcalf RL, Broderick JP, De Meyer SF, Campbell BCV. Emerging Adjuvant Thrombolytic Therapies for Acute Ischemic Stroke Reperfusion. Stroke 2024; 55:2536-2546. [PMID: 39105286 DOI: 10.1161/strokeaha.124.045755] [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] [Indexed: 08/07/2024]
Abstract
Thrombolytic therapies for acute ischemic stroke are widely available but only result in recanalization early enough, to be therapeutically useful, in 10% to 30% of cases. This large gap in treatment effectiveness could be filled by novel therapies that can increase the effectiveness of thrombus clearance without significantly increasing the risk of harm. This focused update will describe the current state of emerging adjuvant treatments for acute ischemic stroke reperfusion. We focus on new treatments that are designed to (1) target different components that make up a stroke thrombus, (2) enhance endogenous fibrinolytic systems, (3) reduce stagnant blood flow, and (4) improve recanalization of distal thrombi and postendovascular thrombectomy.
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Affiliation(s)
- Vignan Yogendrakumar
- Division of Neurology, The Ottawa Hospital and Ottawa Hospital Research Institute, University of Ottawa, Canada (V.Y.)
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Australia (V.Y., B.C.V.C.)
| | - Sarah Vandelanotte
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak, Kortrijk, Belgium (S.V., S.F.D.M.)
| | - Eva A Mistry
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (E.A.M., J.P.B.)
| | - Michael D Hill
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Canada (M.D.H., S.B.C.)
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Canada (M.D.H., S.B.C.)
| | - Raul G Nogueira
- Department of Neurology, University of Pittsburgh, PA (R.G.N.)
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N.)
| | - Robert L Medcalf
- Central Clinical School, Australian Centre for Blood Diseases, Monash University, Australia (R.L.M.)
| | - Joseph P Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (E.A.M., J.P.B.)
- Gardner Neuroscience Institute, Cincinnati, OH (J.P.B.)
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak, Kortrijk, Belgium (S.V., S.F.D.M.)
| | - Bruce C V Campbell
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Australia (V.Y., B.C.V.C.)
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3
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Sedzro MT, Murray L, Garnett A, Nouvet N, Kankam K, Fiadzomor P. Exploring the lived experiences of family caregivers of patients with stroke in Africa: a scoping review of qualitative evidence. Brain Inj 2024; 38:390-402. [PMID: 38317299 DOI: 10.1080/02699052.2024.2310798] [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: 04/19/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE The burden of stroke is immense in African countries, with post-stroke care usually becoming the responsibility of family. This review sought to determine the current breadth and depth of qualitative evidence regarding the lived experiences of family caregivers of patients with stroke in Africa. METHODS Informed by Joanna Briggs Institute (JBI) methodology for scoping reviews, six databases were searched. Included articles were appraised for quality using the JBI checklist. A priori themes developed using the study objectives were used to synthesize study findings. RESULTS The review included 22 articles, which outlined key patterns in stroke outcomes with most articles focused on rehabilitation and the experiences, outcomes, burdens, and coping mechanisms of caregiving. The intersectionality of socio-economic status, socio-political structures, and religious or traditional beliefs, attitudes, and practices characterized etiology beliefs, treatment trajectories of stroke, and caregiving role assignment. Whereas burdens were driven by limited resources, adopted coping strategies involved spiritual or religious beliefs, optimism, resilience, and social support networks. CONCLUSIONS Family caregivers' values must be acknowledged, supported, and integrated into the traditional healthcare system to provide comprehensive stroke care. Caregivers' health and well-being should be given more attention given their necessary contribution to stroke survivorship in Africa.
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Affiliation(s)
- Mawukoenya Theresa Sedzro
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Department of Speech, Language & Hearing Sciences, School of Allied Health Sciences, University of Health & Allied Sciences, Ho, Volta Region, Ghana
| | - Laura Murray
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Communication Sciences & Disorders, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Anna Garnett
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Nouvet Nouvet
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Keren Kankam
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Peace Fiadzomor
- Department of Speech, Language & Hearing Sciences, School of Allied Health Sciences, University of Health & Allied Sciences, Ho, Volta Region, Ghana
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4
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Silva GS, Rocha E. Developing Systems of Care for Stroke in Resource-limited Settings. Semin Neurol 2024; 44:119-129. [PMID: 38513704 DOI: 10.1055/s-0044-1782617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Although stroke prevention and treatment strategies have significantly advanced in recent years, implementation of these care elements in resource-limited settings can be challenging, since the burden of stroke is higher and access to stroke care is lower. Barriers to stroke care in resource-limited settings include insufficient prevention, reduced awareness of stroke symptoms, limited prehospital care and lack of triage systems, limited access to comprehensive stroke centers, inadequate personnel education, lack of staff and resources, as well as limited access to neuroimaging, thrombolytics, mechanical thrombectomy, neurosurgical care, and rehabilitation. Here, we suggest strategies to improve stroke care in these settings, including public health campaigns, protocols for prehospital notification, organized flow to specialized stroke centers, development of dedicated stroke units, and utilization of telemedicine and telerehabilitation. We also highlight the role of international organizations and governments in reducing the global burden of stroke.
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Affiliation(s)
- Gisele Sampaio Silva
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Neurology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eva Rocha
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
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Belay HD, Gebrewold MA, Ayele BA, Oda DM, Kelemu FT, Zewde YZ, Melkamu SK, Wuhib MZ, Gugssa SA, Mengesha AT, Metaferia GZ. Neurology Training and Medical Education in Resource-Limited Settings: Building and Growing the First Neurology Residency Program in East Africa. Semin Neurol 2024; 44:147-158. [PMID: 38631360 DOI: 10.1055/s-0044-1785539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The burden of neurological disease disproportionately affects low- and middle-income countries, where the lowest number of neurologists are located. Building local training opportunities in resource-limited settings is a foundational step to enhancing the neurological workforce and improving access to neurological care in these regions. In this article, we describe the development and growth of the first neurology residency program in East Africa, which was established in 2006 at Zewditu Memorial Hospital and the Tikur Anbessa Specialized Hospital, Addis Ababa University, Ethiopia. We highlight the impact of the program on clinical care, research, collaborations between neurologists across Ethiopia, and ways to build educational opportunities and mentorship while faced with limited resources. The main challenges in starting the residency program included lack of faculty with neurological expertise, lack of a precedent for subspecialty training in our setting, as well as limited resources and space. The formation of sustainable international collaborations with clinicians at established institutions in high-income countries and neurological societies has been a major source of support in developing the initial infrastructure, curriculum and educational content, knowledge assessments, and mentored research projects. Local partnerships with related medical specialties, including internal medicine, critical care, neurological surgery, and psychiatry, were also instrumental in creating training opportunities. As the program continues to evolve, many challenges remain, including limited diagnostics, lack of access to advanced treatment modalities, lack of fellowship training opportunities in various neurological subspecialties, and insufficient training and experience in scientific writing. Despite these challenges, the residency program has persevered and its creation resulted in many positive changes: since its inception in 2006, we graduated 80 neurologists and the number of practicing neurologists in Ethiopia has increased from 5 to 78, our institution has evolved into a national referral center for neurology, graduates have published 61 articles in the past 3 years and contributed to international neurology research, and alumni of the program have grown the Association of Ethiopian Neurologists. Future directions include development of fellowship opportunities, creation of international rotations, and implementation of teleneurology to further strengthen neurological care across Ethiopia.
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Affiliation(s)
- Hanna D Belay
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Meron A Gebrewold
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Biniyam A Ayele
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dereje M Oda
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fikru T Kelemu
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yared Z Zewde
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Selam K Melkamu
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mehila Z Wuhib
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seid A Gugssa
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abenet T Mengesha
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Guta Z Metaferia
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
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Markus HS. Reperfusion therapy for stroke: From improving global access, to thrombectomy beyond 24 hours. Int J Stroke 2024; 19:248-250. [PMID: 38420839 DOI: 10.1177/17474930241232131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
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7
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Ackah M, Ameyaw L, Appiah R, Owiredu D, Boakye H, Donaldy W, Yarfi C, Abonie US. 30-day in-hospital stroke case fatality and significant risk factors in sub-Saharan-Africa: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002769. [PMID: 38241232 PMCID: PMC10798456 DOI: 10.1371/journal.pgph.0002769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/01/2024] [Indexed: 01/21/2024]
Abstract
Existing studies investigating 30-day in-hospital stroke case fatality rates in sub-Saharan Africa have produced varying results, underscoring the significance of obtaining precise and reliable estimations for this indicator. Consequently, this study aimed to conduct a systematic review and update of the current scientific evidence regarding 30-day in-hospital stroke case fatality and associated risk factors in sub-Saharan Africa. Medline/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNet (encompassing PsycINFO and PsychArticle), Google Scholar, and Africa Journal Online (AJOL) were systematically searched to identify potentially relevant articles. Two independent assessors extracted the data from the eligible studies using a pre-tested and standardized excel spreadsheet. Outcomes were 30-day in-hospital stroke case fatality and associated risk factors. Data was pooled using random effects model. Ninety-three (93) studies involving 42,057 participants were included. The overall stroke case fatality rate was 27% [25%-29%]. Subgroup analysis revealed 24% [21%-28%], 25% [21%-28%], 29% [25%-32%] and 31% [20%-43%] stroke case fatality rates in East Africa, Southern Africa, West Africa, and Central Africa respectively. Stroke severity, stroke type, untyped stroke, and post-stroke complications were identified as risk factors. The most prevalent risk factors were low (<8) Glasgow Coma Scale score, high (≥10) National Institute Health Stroke Scale score, aspiration pneumonia, hemorrhagic stroke, brain edema/intra-cranial pressure, hyperglycemia, untyped stroke (stroke diagnosis not confirmed by neuroimaging), recurrent stroke and fever. The findings indicate that one in every four in-hospital people with stroke in sub-Saharan Africa dies within 30 days of admission. Importantly, the identified risk factors are mostly modifiable and preventable, highlighting the need for context-driven health policies, clinical guidelines, and treatments targeting these factors.
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Affiliation(s)
- Martin Ackah
- Faculty of Health and Life Sciences Northumbria University University, Department of Sport, Exercise & Rehabilitation, Newcastle upon Tyne, United Kingdom
| | - Louise Ameyaw
- Department of Medicine, Achimota Government Hospital, Accra, Ghana
| | - Richard Appiah
- Faculty of Health and Life Sciences Northumbria University University, Department of Psychology, Newcastle upon Tyne, United Kingdom
- Department of Occupational therapy, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
| | - David Owiredu
- Centre for Evidence synthesis, University of Ghana, Accra, Ghana
| | - Hosea Boakye
- Department of Physiotherapy, LEKMA Hospital, Accra, Ghana
| | | | - Comos Yarfi
- Department of Physiotherapy, University of Allied and Health Sciences, Ho, Ghana
| | - Ulric S. Abonie
- Faculty of Health and Life Sciences Northumbria University University, Department of Sport, Exercise & Rehabilitation, Newcastle upon Tyne, United Kingdom
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Feigin VL, Owolabi MO. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization-Lancet Neurology Commission. Lancet Neurol 2023; 22:1160-1206. [PMID: 37827183 PMCID: PMC10715732 DOI: 10.1016/s1474-4422(23)00277-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 10/14/2023]
Abstract
Stroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends continue, Sustainable Development Goal 3.4 (reducing the burden of stroke as part of the general target to reduce the burden of non-communicable diseases by a third by 2030) will not be met. In this Commission, we forecast the burden of stroke from 2020 to 2050. We project that stroke mortality will increase by 50%—from 6·6 million (95% uncertainty interval [UI] 6·0 million–7·1 million) in 2020, to 9·7 million (8·0 million–11·6 million) in 2050—with disability-adjusted life-years (DALYs) growing over the same period from 144·8 million (133·9 million–156·9 million) in 2020, to 189·3 million (161·8 million–224·9 million) in 2050. These projections prompted us to do a situational analysis across the four pillars of the stroke quadrangle: surveillance, prevention, acute care, and rehabilitation. We have also identified the barriers to, and facilitators for, the achievement of these four pillars. Disability-adjusted life-years (DALYs) The sum of the years of life lost as a result of premature mortality from a disease and the years lived with a disability associated with prevalent cases of the disease in a population. One DALY represents the loss of the equivalent of one year of full health On the basis of our assessment, we have identified and prioritised several recommendations. For each of the four pillars (surveillance, prevention, acute care, and rehabilitation), we propose pragmatic solutions for the implementation of evidence-based interventions to reduce the global burden of stroke. The estimated direct (ie, treatment and rehabilitation) and indirect (considering productivity loss) costs of stroke globally are in excess of US$891 billion annually. The pragmatic solutions we put forwards for urgent implementation should help to mitigate these losses, reduce the global burden of stroke, and contribute to achievement of Sustainable Development Goal 3.4, the WHO Intersectoral Global Action Plan on epilepsy and other neurological disorders (2022–2031), and the WHO Global Action Plan for prevention and control of non-communicable diseases. Reduction of the global burden of stroke, particularly in low-income and middle-income countries, by implementing primary and secondary stroke prevention strategies and evidence-based acute care and rehabilitation services is urgently required. Measures to facilitate this goal include: the establishment of a framework to monitor and assess the burden of stroke (and its risk factors) and stroke services at a national level; the implementation of integrated population-level and individual-level prevention strategies for people at any increased risk of cerebrovascular disease, with emphasis on early detection and control of hypertension; planning and delivery of acute stroke care services, including the establishment of stroke units with access to reperfusion therapies for ischaemic stroke and workforce training and capacity building (and monitoring of quality indicators for these services nationally, regionally, and globally); the promotion of interdisciplinary stroke care services, training for caregivers, and capacity building for community health workers and other health-care providers working in stroke rehabilitation; and the creation of a stroke advocacy and implementation ecosystem that includes all relevant communities, organisations, and stakeholders. The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Mayowa O Owolabi
- Centre for Genomics and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria; Blossom Specialist Medical Centre, Ibadan, Nigeria.
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Tunkl C, Paudel R, Bajaj S, Thapa L, Tunkl P, Chandra A, Shah B, Karmacharya B, Subedi A, Jalan P, Ghimire P, Ghimire MR, Dorje G, Begli NH, Golenia J, Gajurel BP, Shreyan S, Sharma N, Krauss A, Pandian J, Fischer T, van der Merwe J, Wick W, Hacke W, Gumbinger C. Implementing stroke care in a lower-middle-income country: results and recommendations based on an implementation study within the Nepal Stroke Project. Front Neurol 2023; 14:1272076. [PMID: 37941574 PMCID: PMC10628475 DOI: 10.3389/fneur.2023.1272076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/22/2023] [Indexed: 11/10/2023] Open
Abstract
Background Globally, the majority of strokes affect people residing in lower- and lower-middle-income countries (LMICs), but translating evidence-based knowledge into clinical practice in regions with limited healthcare resources remains challenging. As an LMIC in South Asia, stroke care has remained a healthcare problem previously unaddressed at a national scale in Nepal. The Nepal Stroke Project (NSP) aims to improve acute stroke care in the tertiary healthcare sector of Nepal. We hereby describe the methods applied and analyze the barriers and facilitators of the NSP after 18 months. Methods The NSP follows a four-tier strategy: (1) quality improvement by training healthcare professionals in tertiary care centers; (2) implementation of in-hospital stroke surveillance and quality monitoring system; (3) raising public awareness of strokes; and (4) collaborating with political stakeholders to facilitate public funding for stroke care. We performed a qualitative, iterative analysis of observational data to analyze the output indicators and identify best practices. Results Both offline and online initiatives were undertaken to address quality improvement and public awareness. More than 1,000 healthcare professionals across nine tertiary care hospitals attended 26 stroke-related workshops conducted by Nepalese and international stroke experts. Monthly webinars were organized, and chat groups were made for better networking and cross-institutional case sharing. Social media-based public awareness campaigns reached more than 3 million individuals. Moreover, live events and other mass media campaigns were instituted. For quality monitoring, the Registry of Stroke Care Quality (RES-Q) was introduced. Collaboration with stakeholders (both national and international) has been initiated. Discussion We identified six actions that may support the development of tertiary care centers into essential stroke centers in a resource-limited setting. We believe that our experiences will contribute to the body of knowledge on translating evidence into practice in LMICs, although the impact of our results must be verified with process indicators of stroke care.
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Affiliation(s)
- Christine Tunkl
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Raju Paudel
- Department of Neurology, Grande International Hospital, Kathmandu, Nepal
| | - Sunanjay Bajaj
- Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, United States
| | - Lekhjung Thapa
- Department of Neurology, National Neuro Center, Kathmandu, Nepal
| | - Patrick Tunkl
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Avinash Chandra
- Department of Neurology, Annapurna Neurological Institute, Kathmandu, Nepal
| | - Bhupendra Shah
- Department of Neurology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Balgopal Karmacharya
- Department of Neurosurgery and Emergency Medicine, Manipal Teaching Hospital, Pokhara, Nepal
| | - Ashim Subedi
- Department of Neurosurgery and Emergency Medicine, Manipal Teaching Hospital, Pokhara, Nepal
| | - Pankaj Jalan
- Department of Neurology, Norvic International Hospital, Kathmandu, Nepal
| | | | - Mahesh Raj Ghimire
- Department of Neurology, National Neuro Center, Kathmandu, Nepal
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Nima Haji Begli
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jessica Golenia
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Nooma Sharma
- Department of Neurology, National Neuro Center, Kathmandu, Nepal
| | - Alexandra Krauss
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Thomas Fischer
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | | | - Wolfgang Wick
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Werner Hacke
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Gumbinger
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
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Adeniji O, Adeleye O, Akinyemi J, Otubogun F, Ogunde G, Ogunrombi M, Adesina D, Wahab A, Ogunlana M, Alimi T, Akinyemi R. Organized multi-disciplinary stroke team care improves acute stroke outcomes in resource limited settings; Results of a retrospective study from a Nigerian tertiary hospital. J Stroke Cerebrovasc Dis 2023; 32:107307. [PMID: 37633206 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Evidence for the impact of organized stroke multidisciplinary teams (MDTs) on outcomes in Africa is sparse. AIM To compare stroke outcomes, before and after the establishment (September 16, 2016) of a pioneer MDT at a tertiary hospital in southern Nigeria. METHODS Using a retrospective, observational study design, the in-patient record of all stroke patients admitted between September 2014 to September 2018 was retrieved and rigorously reviewed. 155 patients seen 2 years before the MDT were compared with 169 stroke patients seen 2 years after the MDT. Stroke severity at admission and functioning at discharge were assessed using the Stroke Levity Scale (SLS) and the modified Rankin scale (mRS). RESULTS Mean ages (in years) were 60 pre-MDT vs 59.57 post MDT (p = 0.754). There were more males, 51% pre-MDT vs 54.2% post MDT (p = 0.565). SLS and mRS were not significantly different; severe SLS and mRS pre-MDT, 52.9% vs post-MDT, 49.4% (p = 0.727) and pre-MDT 19.4% vs post-MDT 19.5% (p = 0.685) respectively. More post-MDT patients were discharged alive, pre-MDT,56.8% vs 79.2% post MDT (p < 0.001); had swallow tests, pre-MDT 9.23% vs post-MDT 33.5% (p < 0.001); on secondary prevention, pre-MDT 67.7% vs post-MDT 78.9% (p = 0.023); had more clinic visits, pre-MDT,0.7% vs post-MDT 38.3% (p < 0.001). MDT was independently associated with lower in-hospital mortality on multivariable regression, adjusted odds ratio (OR) (95% Confidence interval CI) 0.17 (0.09-0.32). CONCLUSION Our results suggest that an organized MDT may improve acute outcomes and reduce mortality in resource constrained settings where there may be no stroke units. These findings need further prospective validation.
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Affiliation(s)
- Olaleye Adeniji
- Neurology Unit, Department of Medicine, Federal Medical Center, Postal Address- P.M.B 3031, Sapon Post Office, Abeokuta, Ogun State, Nigeria.
| | - Osi Adeleye
- Neurology Unit, Department of Medicine, Federal Medical Center, Postal Address- P.M.B 3031, Sapon Post Office, Abeokuta, Ogun State, Nigeria
| | - Joshua Akinyemi
- Department of Medical Statistics and Epidemiology, College of Medicine, University College hospital Ibadan, Oyo State, Nigeria
| | - Folajimi Otubogun
- Neurology unit, Federal Medical center, Ebute Meta, Lagos State, Nigeria
| | - Gabriel Ogunde
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Postal Address: PMB 017 GPO, General Post Office, Ibadan, Oyo State, Nigeria
| | - Mayowa Ogunrombi
- Neurology Unit, Department of Medicine, Federal Medical Center, Postal Address- P.M.B 3031, Sapon Post Office, Abeokuta, Ogun State, Nigeria
| | - Deborah Adesina
- Neurology Unit, Department of Medicine, Federal Medical Center, Postal Address- P.M.B 3031, Sapon Post Office, Abeokuta, Ogun State, Nigeria
| | - Ahmed Wahab
- Neurology Unit, Department of Medicine, Federal Medical Center, Postal Address- P.M.B 3031, Sapon Post Office, Abeokuta, Ogun State, Nigeria
| | - Michael Ogunlana
- Department of Physiotherapy, Federal Medical Center, Abeokuta, Ogun State, Nigeria
| | - Talayo Alimi
- Department of Physiotherapy, Federal Medical Center, Abeokuta, Ogun State, Nigeria
| | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Postal Address: PMB 017 GPO, General Post Office, Ibadan, Oyo State, Nigeria
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11
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Klein P, Huo X, Chen Y, Abdalkader M, Qiu Z, Nagel S, Raymond J, Liu L, Siegler JE, Strbian D, Field TS, Yaghi S, Qureshi MM, Demeestere J, Puetz V, Berberich A, Michel P, Fischer U, Kaesmacher J, Yamagami H, Alemseged F, Tsivgoulis G, Schonewille WJ, Hu W, Liu X, Li C, Ji X, Drumm B, Banerjee S, Sacco S, Sandset EC, Kristoffersen ES, Slade P, Mikulik R, Romoli M, Diana F, Krishnan K, Dhillon P, Lee JS, Kasper E, Dasenbrock H, Ton MD, Masiliūnas R, Arsovska AA, Marto JP, Dmytriw AA, Regenhardt RW, Silva GS, Siepmann T, Sun D, Sang H, Diestro JD, Yang P, Mohammaden MH, Li F, Masoud HE, Ma A, Raynald, Ganesh A, Liu J, Meyer L, Dippel DWJ, Thomalla G, Parsons M, Qureshi AI, Goyal M, Yoo AJ, Lapergue B, Zaidat OO, Chen HS, Campbell BCV, Jovin TG, Nogueira RG, Miao Z, Saposnik G, Nguyen TN. Specialist Perspectives on the Imaging Selection of Large Vessel Occlusion in the Late Window. Clin Neuroradiol 2023; 33:801-811. [PMID: 37010551 PMCID: PMC10069362 DOI: 10.1007/s00062-023-01284-0] [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: 01/04/2023] [Accepted: 02/23/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND The proper imaging modality for use in the selection of patients for endovascular thrombectomy (EVT) presenting in the late window remains controversial, despite current guidelines advocating the use of advanced imaging in this population. We sought to understand if clinicians with different specialty training differ in their approach to patient selection for EVT in the late time window. METHODS We conducted an international survey of stroke and neurointerventional clinicians between January and May 2022 with questions focusing on imaging and treatment decisions of large vessel occlusion (LVO) patients presenting in the late window. Interventional neurologists, interventional neuroradiologists, and endovascular neurosurgeons were defined as interventionists whereas all other specialties were defined as non-interventionists. The non-interventionist group was defined by all other specialties of the respondents: stroke neurologist, neuroradiologist, emergency medicine physician, trainee (fellows and residents) and others. RESULTS Of 3000 invited to participate, 1506 (1027 non-interventionists, 478 interventionists, 1 declined to specify) physicians completed the study. Interventionist respondents were more likely to proceed directly to EVT (39.5% vs. 19.5%; p < 0.0001) compared to non-interventionist respondents in patients with favorable ASPECTS (Alberta Stroke Program Early CT Score). Despite no difference in access to advanced imaging, interventionists were more likely to prefer CT/CTA alone (34.8% vs. 21.0%) and less likely to prefer CT/CTA/CTP (39.1% vs. 52.4%) for patient selection (p < 0.0001). When faced with uncertainty, non-interventionists were more likely to follow clinical guidelines (45.1% vs. 30.2%) while interventionists were more likely to follow their assessment of evidence (38.7% vs. 27.0%) (p < 0.0001). CONCLUSION Interventionists were less likely to use advanced imaging techniques in selecting LVO patients presenting in the late window and more likely to base their decisions on their assessment of evidence rather than published guidelines. These results reflect gaps between interventionists and non-interventionists reliance on clinical guidelines, the limits of available evidence, and clinician belief in the utility of advanced imaging.
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Affiliation(s)
- Piers Klein
- Neurology, Boston Medical Center, Boston, USA
- Radiology, Boston Medical Center, Boston, USA
| | - Xiaochuan Huo
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Yimin Chen
- Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | - Mohamad Abdalkader
- Radiology, Boston Medical Center, Boston, USA
- Neurology, St. Elizabeth's Medical Center, Boston, USA
| | - Zhongming Qiu
- Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Simon Nagel
- Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
- Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jean Raymond
- Interventional Neuroradiology, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
| | - Liping Liu
- Neurology, Beijing Tiantan Hospital, Beijing, China
| | | | - Daniel Strbian
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Thalia S Field
- Neurology, University of British Columbia, Vancouver, Canada
| | - Shadi Yaghi
- Neurology, Rhode Island Hospital, Providence, USA
| | | | | | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | | | - Patrik Michel
- Stroke Center/Neurology, Lausanne University Hospital, Lausanne, Switzerland
| | - Urs Fischer
- Neurology, Basel University Hospital, Basel, Switzerland
| | - Johannes Kaesmacher
- Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | | | | | | | | | - Wei Hu
- Stroke Center, The First Affiliated Hospital of USTC, Hefei, China
| | - Xinfeng Liu
- Stroke Center, The First Affiliated Hospital of USTC, Hefei, China
| | | | - Xunming Ji
- Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Brian Drumm
- Stroke Medicine, Imperial College Healthcare, London, UK
| | - Soma Banerjee
- Stroke Medicine, Imperial College Healthcare, London, UK
| | - Simona Sacco
- Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | - Peter Slade
- Morriston Hospital, Swansea Hospital, Swansea, Wales, UK
| | - Robert Mikulik
- Neurology, St Anne's University Hospital, Brno, Czech Republic
| | | | - Francesco Diana
- Neuroradiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Kailash Krishnan
- Stroke, Department of Acute Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Permesh Dhillon
- Interventional Neuroradiology, Nottingham University Hospitals, Nottingham, UK
| | - Jin Soo Lee
- Neurology, Ajou University Hospital, Suwon, Korea (Republic of)
| | - Ekkehard Kasper
- Neurosurgery, Boston Medical Center, Boston, USA
- Neurosurgery, St. Elizabeth's Medical Center, Boston, USA
| | - Hormuzdiyar Dasenbrock
- Neurosurgery, Boston Medical Center, Boston, USA
- Neurosurgery, St. Elizabeth's Medical Center, Boston, USA
| | - Mai Duy Ton
- Stroke Center, Bach Mai Hospital, Hanoi, Viet Nam
- Neurology, Vietnam National University of Medicine and Pharmacy, Hanoi, Vietnam
| | | | | | | | - Adam A Dmytriw
- Neurointerventional, London Health Sciences Centre, London, Canada
- Neuroendovascular, Massachusetts General Hospital, Boston, USA
| | | | - Gisele Sampaio Silva
- Universidade Federal de São Paulo (UNIFESP) and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Dapeng Sun
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Hongfei Sang
- Neurology, Affiliated Hangzhou First People's Hospital, Hangzhou, China
| | - Jose Danilo Diestro
- Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Pengfei Yang
- Neurosurgery, Changhai Hospital, Shanghai, China
| | | | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | | | - Alice Ma
- Royal North Shore Hospital, Sydney, Australia
| | - Raynald
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | | | - Jianmin Liu
- Neurosurgery, Changhai Hospital, Shanghai, China
| | - Lukas Meyer
- Interventionelle Neuroradiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Götz Thomalla
- Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Mark Parsons
- South Western Sydney Clinical School, Liverpool Hospital, Liverpool, Australia
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, USA
| | - Mayank Goyal
- Radiology, University of Calgary, Calgary, Canada
| | - Albert J Yoo
- Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, USA
| | | | - Osama O Zaidat
- Neuroscience, Mercy Health St Vincent Hospital, Toledo, OH, USA
| | - Hui-Sheng Chen
- Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Bruce C V Campbell
- Royal Melbourne Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | | | - Raul G Nogueira
- Neurology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Zhongrong Miao
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Gustavo Saposnik
- Stroke Outcomes and Decision Neuroscience Research Unit, University of Toronto, Toronto, Canada
| | - Thanh N Nguyen
- Neurology, Boston Medical Center, Boston, USA.
- Radiology, Boston Medical Center, Boston, USA.
- Neurology, St. Elizabeth's Medical Center, Boston, USA.
- Neurosurgery, Boston Medical Center, Boston, USA.
- Boston University Chobanian and Avedisian School of Medicine, Boston Medical Center, 85 East Concord Street, 02118, Boston, MA, USA.
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12
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Sahoo A, Abdalkader M, Yamagami H, Huo X, Sun D, Jia B, Weyland CS, Diana F, Kaliaev A, Klein P, Bui J, Kasab SA, de Havenon A, Zaidat OO, Zi W, Yang Q, Michel P, Siegler JE, Yaghi S, Hu W, Nguyen TN. Endovascular Therapy for Acute Stroke: New Evidence and Indications. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:232-242. [PMID: 38025253 PMCID: PMC10657733 DOI: 10.5797/jnet.ra.2023-0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/25/2023] [Indexed: 12/01/2023]
Abstract
Endovascular therapy (EVT) has revolutionized the treatment of acute ischemic stroke. In the past few years, endovascular treatment indications have expanded to include patients being treated in the extended window, with large ischemic core infarction, basilar artery occlusion (BAO) thrombectomy, as demonstrated by several randomized clinical trials. Intravenous thrombolysis (IVT) bridging to mechanical thrombectomy has also been studied via several randomized clinical trials, with the overall results indicating that IVT should not be skipped in patients who are candidates for both IVT and EVT. Simplification of neuroimaging protocols in the extended window to permit non-contrast CT, CTA collaterals have also expanded access to mechanical thrombectomy, particularly in regions across the world where access to advanced imaging may not be available. Ongoing study of areas to develop include rescue stenting in patients with failed thrombectomy, medium vessel occlusion thrombectomy, and carotid tandem occlusions. In this narrative review, we summarize recent trials and key data in the treatment of patients with large ischemic core infarct, simplification of neuroimaging protocols for the treatment of patients presenting in the late window, bridging thrombolysis, and BAO EVT evidence. We also summarize areas of ongoing study including medium and distal vessel occlusion.
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Affiliation(s)
- Anurag Sahoo
- Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Mohamad Abdalkader
- Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Hiroshi Yamagami
- Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Xiaochuan Huo
- Cerebrovascular Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dapeng Sun
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Baixue Jia
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | | | - Francesco Diana
- Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute, Barcelona, Spain
| | - Artem Kaliaev
- Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Piers Klein
- Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Jenny Bui
- Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Sami Al Kasab
- Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Wenjie Zi
- Neurology, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Qingwu Yang
- Neurology, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Patrik Michel
- Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Shadi Yaghi
- Neurology, Rhode Island Hospital, Brown University School of Medicine, Providence, RI, USA
| | - Wei Hu
- Neurology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Thanh N Nguyen
- Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
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13
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Malaeb D, Hallit S, Sakr F, Dabbous M, Saadeh W, Mansour S, Cherri S, Sarayeldyine SA, Salameh P, Hosseini H. The use of intravenous thrombolytics in acute ischemic stroke management: A scoping review from 2008 till 2021 in the Arab world in the Middle East and North Africa. J Stroke Cerebrovasc Dis 2023; 32:107201. [PMID: 37290154 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107201] [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: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE The aim of this review was to assess and analyze the research output on intravenous thrombolysis in acute ischemic stroke in the Arab world in the Middle East and North Africa. METHODS Published literature on intravenous thrombolysis for acute ischemic stroke from 2008 to 2021 were retrieved from several electronic databases. Extracted records were analyzed in terms of year of publication, country, journal, research area, authors, and organizational affiliations. RESULTS A total of 37 studies were published between 2008 and 2021 from different Arab countries. Eight studies assessed the safety and efficacy of thrombolytic agents in AIS. Three studies were KAP studies addressing the knowledge, attitude and practice towards IVT. The majority of the selected studies (n=16) discussed the utilization rate of IVT among patients in different hospital settings across these countries. Ten studies reported the outcomes associated with the use of IVT for AIS. CONCLUSION This is the first scoping review to study the research activity related to the use of IVT in stroke in the Arab nations. In the last 15 years, stroke research productivity was very low in the Arab world compared to other regions of the world due to several impeding factors. Given the high burden of in-adherence to acute stroke treatment in the Arab nations, there is a serious need for an increased high-quality research activity to highlight the roadblocks associated with the limited use of IVT.
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Affiliation(s)
- Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates; School of Pharmacy, Lebanese International University, Beirut, Lebanon.
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), P.O Box: 446, Jounieh lebanon; Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon; INSPECT-LB (Institut National de Sant e Publique, d'Épid emiologie Clinique et de Toxicologie-Liban); UMR U955 INSERM, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, 94010 Créteil, France; École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, 94010 Créteil, France
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Wadih Saadeh
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; Faculty of Public health, Lebanese University, Fanar, Lebanon
| | - Sara Mansour
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Sarah Cherri
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | | | - Pascale Salameh
- INSPECT-LB (Institut National de Sant e Publique, d'Épid emiologie Clinique et de Toxicologie-Liban); Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus; School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hassan Hosseini
- INSERM U955-E01, IMRB, Henri Mondor Hospital, Créteil, France; Department of Neurology, Henri Mondor Hospital, AP-HP, Créteil, France
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14
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Markus HS. The global burden of stroke. Int J Stroke 2023; 18:632-633. [PMID: 37376832 DOI: 10.1177/17474930231181677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
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15
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Okekunle AP, Jones S, Adeniji O, Watkins C, Hackett M, Di Tanna GL, Owolabi M, Akinyemi R. Stroke in Africa: A systematic review and meta-analysis of the incidence and case-fatality rates. Int J Stroke 2023; 18:634-644. [PMID: 36503371 PMCID: PMC10313746 DOI: 10.1177/17474930221147164] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The burden of stroke (a leading cause of disability and mortality) in Africa appears to be increasing, but a systematic review of the best available data to support or refute this observation is lacking. AIM To determine the incidence and 1-month case-fatality rates from high-quality studies of stroke epidemiology among Africans. SUMMARY OF REVIEW We searched and retrieved eligible articles on stroke epidemiology among indigenous Africans in bibliographic databases (MEDLINE, ScienceDirect, Google Scholar, and Cochrane library) using predefined search terms from the earliest records through January 2022. Methodological assessment of eligible studies was conducted using the Newcastle-Ottawa scale. Pooling of incidence and case-fatality rates was performed via generalized linear models (Poisson-Normal random-effects model). Of the 922 articles retrieved, 14 studies were eligible for inclusion. The total number of stroke cases was 2568, with a population denominator (total sample size included in population-based registries or those who agreed to participate in door-to-door community studies) of 3,384,102. The pooled crude incidence rate of stroke per 100,000 persons in Africa was 106.49 (95% confidence interval (CI) = 58.59-193.55), I2 = 99.6%. The point estimate of the crude incidence rate was higher among males, 111.33 (95% CI = 56.31-220.12), I2 = 99.2%, than females, 91.14 (95% CI = 47.09-176.37), I2 = 98.9%. One-month case-fatality rate was 24.45 (95% CI = 16.84-35.50), I2 = 96.8%, with lower estimates among males, 22.68 (95% CI = 18.62-27.63), I2 = 12.9%, than females, 27.57 (95% CI = 21.47-35.40), I2 = 51.6%. CONCLUSION The burden of stroke in Africa remains very high. However, little is known about the dynamics of stroke epidemiology among Africans due to the dearth of high-quality evidence. Further continent-wide rigorous epidemiological studies and surveillance programs using the World Health Organization STEPwise approach to Surveillance (WHO STEPS) framework are needed.
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Affiliation(s)
- Akinkunmi Paul Okekunle
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | | | - Olaleye Adeniji
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | | | - Maree Hackett
- University of Central Lancashire, Preston, UK
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Innovative Technologies, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rufus Akinyemi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
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16
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George J, Aref H, Nasser AA, Nasef A, Elbassiouny A, Roushdy T. Gender disparity versus equality in acute stroke: a Middle Eastern country hospital-based study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023; 59:73. [PMID: 37305216 PMCID: PMC10234681 DOI: 10.1186/s41983-023-00672-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/19/2023] [Indexed: 06/13/2023] Open
Abstract
Background Acute stroke management is well-established in developed countries with no gender difference. Yet, in developing countries there are reports on gender disparity in medical services including stroke services. Egypt, a developing low-middle-income country, heavily populated, in the Middle East is a good example to answer whether acute ischemic stroke service is provided equally to males and females or there is disparity in risk factors, onset to door (OTD), door to needle (DTN), and outcome. The current study was prospective observational analytical hospital-based study, on acute ischemic stroke cases admitted to Nasr city insurance hospital stroke unit between September 2020 and September 2022. Results 350 cases were included, 257 males and 93 females. Hypertension was the commonest risk factor 66% males and 81% females P = 0.011, atrial fibrillation was predominant in females P < 0.001, smoking was predominant in males P < 0.001. Median OTD in hours was 8.0 among both genders with minimum zero and maximum 96 h in males compared to minimum 1 and maximum 120 h in females, DTN was around 30 min with no significant difference. Median NIHSS on which rtPA was administered was 12.5 (6-13) in females compared to 10 (6-12) in males. Males who did not receive rtPA had a better mRS on discharge and on 90 days P = 0.01, 0.009, respectively, while there was no significant difference on discharge and 90 days between both genders on receiving rtPA. Conclusions No gender disparity was found in DTN, discharge outcome, and 90 days among rtPA recipients. Females tended to have higher NIHSS and relatively delayed presentation to ER with less favorable outcome at discharge and 90 days in case of not receiving rtPA. Encouraging earlier arrival and conducting awareness campaigns for risk factors management is warranted.
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Affiliation(s)
- John George
- Neurology Specialist, Nasr City Insurance Hospital, Cairo, Egypt
| | - Hany Aref
- Neurology Department, Faculty of Medicine, Ain Shams University, 38 Abbasia, Cairo, PO 11591 Egypt
| | - Azza Abdel Nasser
- Neurology Department, Faculty of Medicine, Ain Shams University, 38 Abbasia, Cairo, PO 11591 Egypt
| | - Ayman Nasef
- Neurology Department, Faculty of Medicine, Ain Shams University, 38 Abbasia, Cairo, PO 11591 Egypt
| | - Ahmed Elbassiouny
- Neurology Department, Faculty of Medicine, Ain Shams University, 38 Abbasia, Cairo, PO 11591 Egypt
| | - Tamer Roushdy
- Neurology Department, Faculty of Medicine, Ain Shams University, 38 Abbasia, Cairo, PO 11591 Egypt
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17
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Markus HS. The global impact of stroke in 2022. Int J Stroke 2022; 17:944-945. [DOI: 10.1177/17474930221132025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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18
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Nguyen TN, Qureshi MM, Klein P, Yamagami H, Abdalkader M, Mikulik R, Sathya A, Mansour OY, Czlonkowska A, Lo H, Field TS, Charidimou A, Banerjee S, Yaghi S, Siegler JE, Sedova P, Kwan J, de Sousa DA, Demeestere J, Inoa V, Omran SS, Zhang L, Michel P, Strambo D, Marto JP, Nogueira RG. Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality. J Stroke 2022; 24:256-265. [PMID: 35677980 PMCID: PMC9194544 DOI: 10.5853/jos.2022.00752] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. METHODS We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). RESULTS There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. CONCLUSIONS During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.
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Affiliation(s)
- Thanh N. Nguyen
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Muhammad M. Qureshi
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Piers Klein
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Robert Mikulik
- Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Anvitha Sathya
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | | | - Anna Czlonkowska
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Hannah Lo
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Thalia S. Field
- Division of Neurology, Dept. Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andreas Charidimou
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Soma Banerjee
- Department of Stroke Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Shadi Yaghi
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | | | - Petra Sedova
- Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Joseph Kwan
- Department of Stroke Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Diana Aguiar de Sousa
- Department of Neurology, Hospital de Santa Maria, North Lisbon University Hospital Center (CHULN), Lisbon, Portugal
| | - Jelle Demeestere
- Neurology Department, Leuven University Hospital, Leuven, Belgium
| | - Violiza Inoa
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Liqun Zhang
- Department of Neurology St George’s University Hospital, London, UK
| | - Patrik Michel
- Department of Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Davide Strambo
- Department of Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - João Pedro Marto
- Department of Neurology, Egas Moniz Hospital, West Lisbon Hospital Center (CHLO), Lisbon, Portugal
| | - Raul G. Nogueira
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - SVIN COVID-19 Global COVID Stroke Registry
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Department of Stroke Neurology, National Hospital Organization, Osaka National Hospital, Osaka, Japan
- Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurology, Alexandria University, Alexandria, Egypt
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
- Division of Neurology, Dept. Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Stroke Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
- Department of Neurology, Cooper University, Camden, NJ, USA
- Department of Neurology, Hospital de Santa Maria, North Lisbon University Hospital Center (CHULN), Lisbon, Portugal
- Neurology Department, Leuven University Hospital, Leuven, Belgium
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurology St George’s University Hospital, London, UK
- Department of Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
- Department of Neurology, Egas Moniz Hospital, West Lisbon Hospital Center (CHLO), Lisbon, Portugal
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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