Conceptual framework for establishing the African Stroke Organization

Africa is the world's most genetically diverse, second largest, and second most populous continent, with over one billion people distributed across 54 countries. With a 23% lifetime risk of stroke, Africa has some of the highest rates of stroke worldwide and many occur in the prime of life with huge economic losses and grave implications for the individual, family, and the society in terms of mental capital, productivity, and socioeconomic progress. Tackling the escalating burden of stroke in Africa requires prioritized, multipronged, and inter-sectoral strategies tailored to the unique African epidemiological, cultural, socioeconomic, and lifestyle landscape. The African Stroke Organization (ASO) is a new pan-African coalition that brings together stroke researchers, clinicians, and other health-care professionals with participation of national and regional stroke societies and stroke support organizations. With a vision to reduce the rapidly increasing burden of stroke in Africa, the ASO has a four-pronged focus on (1) research, (2) capacity building, (3) development of stroke services, and (4) collaboration with all stakeholders. This will be delivered through advocacy, awareness, and empowerment initiatives to bring about people-focused changes in policy, clinical practice, and public education. In the spirit of the African philosophy of Ubuntu "I am because we are," the ASO will harness the power of diversity, inclusiveness, togetherness, and team work to build a strong, enduring, and impactful platform for tackling stroke in Africa.

[Contribution of Holter ECG in the etiologic diagnosis of the ischemic stroke in Brazzaville, Congo]

Déterminer la prévalence des troubles rythmiques au cours des infarctus cérébraux et identifier les facteurs prédictifs de la fibrillation atriale (FA) paroxystique. Il s'est agi d'une étude transversale, descriptive et analytique, menée à Brazzaville entre janvier 2012 et décembre 2016. Elle a porté sur une série consécutive de 267 patients victimes d'un accident vasculaire cérébral ischémique transitoire (n = 17) ou constitué (n = 250), documenté par un scanner cérébral. Tous ces patients ont bénéficié d'un enregistrement Holter ECG dès 24h, réalisé dans le cadre de la recherche étiologique. Les principales anomalies rythmiques enregistrées ont été répertoriées et la régression logistique a permis l'identification des facteurs prédictifs de survenue de la FA paroxystique. Il s'agissait de 164 hommes (61,4%) et 103 femmes (38,6%), âgés en moyenne de 60,2 ± 12,1 ans (extrêmes: 22 et 94 ans). Les principaux facteurs de risque cardiovasculaire identifiés étaient une hypertension artérielle (HTA) dans 214 cas (80,1%), un diabète sucré dans 36 cas (13,5%), et un tabagisme dans 18 cas (6,7%), avec un taux de cumul de 1,5 facteur par individu. L'examen Holter ECG, normal dans 216 cas (81%), était pathologique dans 51 cas (19%). Les principales anomalies enregistrées consistaient en des extrasystoles ventriculaires bénignes (n = 32), une FA paroxystique (n = 7), des extrasystoles supraventriculaires (n = 5), une tachycardie ventriculaire (TV) non soutenue (n = 4), une TV soutenue (n = 2) et un bloc auriculo-ventriculaire type Mobitz II (n = 1). La fréquence de la FA paroxystique était de 2,6%. En analyse bivariée, il n'a pas été noté de corrélation entre la FA paroxystique et le sexe (p = 0,890), l'HTA (p = 0,818), le diabète (p = 0,839), le tabac (p = 0,969). En analyse multivariée, seul l'âge était prédictif de la survenue d'une FA paroxystique au cours des infarctus cérébraux (OR = 1,11;p = 0,0134). Il ressort de cette étude préliminaire que les troubles du rythme emboligènes sont relativement rares au cours des infarctus cérébraux à Brazzaville. La FA paroxystique, quoique peu fréquente, reste essentiellement corrélée à l'âge. Sa recherche systématique chez les sujets âgés contribue à améliorer la prise en charge.

Abus médicamenteux et céphalées chroniques à Brazzaville: profil et parcours thérapeutique des patients

Introduction

Les céphalées par abus médicamenteux (CAM) restent le type de céphalées le moins étudié en Afrique.

Méthodes

Dans le but de rapporter l'expérience Brazzavilloise, nous avons mené une étude longitudinale durant 4 ans, de septembre 2010 à août 2014, en consultation de neurologie à Brazzaville. Nous avons inclus tous les patients présentant des céphalées primaires chroniques selon la International Classification of Headache Disorders-2 (ICHD-2). Tout patient présentant des céphalées secondaires ou n'ayant pas donné son consentement a été exclu. Les patients ont été divisés en deux groupes: ceux ayant évolué vers une CAM, et ceux qui ne présentent pas des critères d'abus médicamenteux (sans-CAM). Les variables d'études ont été sociodémographiques, les caractéristiques de la céphalée primaire initiale et la prise en charge de la CAM.

Résultats

Sur 212 patients inclus, 193 ont constitué notre population d'étude. L'âge moyen de 42±14 ans, dont 66,32% de femmes. La fréquence des CAM était de 35,75%. Les facteurs associés identifiés étaient: l'âge jeune (p=0,003), l'utilisation de l'association antiinflammatoire non stéroïdien (AINS) et paracétamol (p=0,0001) et l'automédication (p<0,0001). Par contre, le niveau d'instruction supérieur (p<0,0001) et l'utilisation de l'AINS seul (0,002) étaient protecteurs contre la survenue de la CAM. Le sevrage ambulatoire a été le plus pratiqué, l'amitriptyline reste le médicament le plus utilisé.

Conclusion

Les CAM sont fréquentes en consultation de neurologie en Afrique et méritent d'être identifiées pour une meilleure prise en charge.

[Factors associated with quality of life for patients with post-stroke aphasia in the Cotonou hospitals, Benin]

INTRODUCTION

The objective of this study was to determine the factors influencing quality of life for patients with post-stroke aphasia followed in Cotonou hospitals.

METHOD

A prospective descriptive and analytical cross-sectional study was conducted in CNHU-HKM (Cotonou, Benin) from October to December 2012; focusing on patients with at least six months of post-stroke aphasia. For each patient, a SIP-65 questionnaire was administered. The Epi Info 3.5 software was used for data analysis. A multivariate analysis was performed to determine factors associated with quality of life for patients with aphasia.

RESULTS

In total, 41 patients were included in this study with a sex ratio of 1.3. The average age was 55.3 ± 2.5 years. The average duration of the aphasia was 10 months. Broca's aphasia was predominant (68.3%). 60.8% of aphasia patients were able to preserve their quality of life. Multivariate analysis showed that age, family support, the type of stroke and aphasia and speech therapy were associated with quality of life.

CONCLUSION

The treatment of post-stroke aphasia must incorporate these factors associated with quality of life for a better recovery of patients.

[Contribution of vascular ultrasonography in patients with ischemic strokes in Brazzaville (Congo)]

OBJECTIVE

To determine the prevalence of the carotid lesions during ischemic strokes.

METHODS

This was a descriptive cross-sectional study, conducted in Brazzaville from January 2011 to June 2012 in a consecutive series of 73 patients, victims of a transient ischemic attack or ischemic stroke, documented by a brain computed tomography. All patients underwent vascular ultrasonography of the supra-aortic trunks, carried out within the framework of etiological assessment. The examination searched for plaques, parietal infiltration (measurement of intima-media thickness), and carotid stenosis or occlusion.

RESULTS

There were 49 men (67%) and 24 women (33%), mean age 58.7 ± 11.8 years. Eleven patients (15%) had a transient ischemic attack and 62 (85%) an ischemic stroke. The identified independent vascular risk factors were known and treated hypertension (n=66, 90.4%), dyslipidemia (n=16, 22%), diabetes mellitus (n=9, 12.3%), and smoking (n=5, 6.8%), with on average 2.5 factors per individual. Vascular ultrasonography of the supra-aortic trunks, normal in 44 patients (60.3%) was pathological in the other 29 (39.7%). The main anomalies were atheromatous plaque (n=10, 13.7%), parietal infiltration (n=19, 26%). On average intima-media thickness was 0.86 ± 0.11 mm on the left and 0.83 ± 0.11 mm on the right. Two cases of moderate stenosis were noted on the right and left internal carotids, respectively.

CONCLUSION

This preliminary study confirms the existence of carotid atherosclerosis anomalies during ischemic strokes. These lesions, though non-significant, must nevertheless be taken into consideration when searching for the cause of stroke in high-risk vascular patients.

[Gender and stroke in Brazzaville]

BACKGROUND

The relationship between gender and cerebrovascular disease is controversial. The aim of our study was to evaluate the relationship between gender and vascular risk factors, biological variables and the severity of the neurological deficit in stroke.

METHODS

This cross-sectional study, conducted from March to August 2011 in the department of neurology of the university hospital of Brazzaville which included all patients hospitalized for confirmed stroke. The study variables were: age, sex, vascular risk factors, NIHSS scores and Glasgow, blood pressure, and the biological exams and complications. Statistical analysis was performed on SPSS12.

RESULTS

Eighty patients were included. The mean age was 62.7 ± 11.2 years, with 58.8% of men. Alcohol intake and smoking were more frequent in men than women respectively P=0.005 and P=0.032. Psychosocial stress was more often declared by women than men (P=0.042). However there was no significant difference in biological variables, the severity of stroke and the occurrence of complications

CONCLUSION

Our study suggests that in the Congolese context, gender does not influence significantly most parameters during stroke, but men consume more alcohol and women are exposed to psychosocial stress.

[Determinants of cerebral malaria in Congolese children]

Malaria still constitutes a worrying problem of public health. It remains an important cause of infant mortality. To determine the determinants of severe malaria a case control study was carried out from July to December 2011 in the pediatric intensive care department of the university hospital of Brazzaville. The group included 230 children hospitalised for severe malaria, and the control group consisted of children followed up for non-severe malaria. Cases and controls were compared using statistical tests for matched group. The young age of the mother (OR=4.13), her poor education level (OR=2.36), the low socioeconomic level of parents (OR=5.90), the malnutrition (OR=2.67), the delay of consultation (OR=13.69) and parasitemia were associated with significantly higher risk of severe malaria. The importance of identified determinants imposes the implementation of primary prevention measures, which pass through the amelioration of socioeconomic and cultural conditions of populations, the reinforcement of sanitary education, and also a secondary prevention consisting of an early and accurate management of ordinary malaria.

[Erectile dysfonction after stroke in Brazzaville]

INTRODUCTION

Erectile dysfunction is one of the disability post-stroke the least documented. However, it affects the quality of life, not only the patient but also the couple.

OBJECTIVE

The purpose of this work was to study the characteristics of erectile dysfunction after stroke.

METHOD

This is a cross-sectional descriptive and analytical data collection survey conducted from February to October 2011, having identified, 104 patients for follow-up post-stroke, seen in outpatient Neurology University Hospital of Brazzaville and in the functional rehabilitation centers. Among them 54 had erectile dysfunction. The parameters studied were: age, marital status, history, vascular risk factors, and the location of the hemiplegic, the etiology of stroke, modified Rankin score and NIHSS. The clinical features and laboratory, the international index of erectile dysfunction (IIEF-5) in its French version. SPSS 12 was used for recording and statistical analysis of data. Chi(2) test was used for comparisons. The significance level was P≤0.05.

RESULTS

The frequency of erectile dysfunction after stroke was 51.92%, the average age was 56.32 years. The mean time to onset of erectile dysfunction after stroke was 5 months. The onset was progressive in 70,4%. The hypercholesterolemia was well correlated with the risk of erectile dysfunction (P=0.007) and its severity (P=0,01). Erectile dysfonction was moderate in 61.1% and almost bearable in half the cases.

CONCLUSION

Erectile dysfunction post-stroke is common with an impact in the lives of the couple. High cholesterol is an independent risk factor of occurrence of post-stroke.