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Bhutta ZA, Akhtar N, Pathan SA, Castren M, Harris T, Ganesan GS, Kamran S, Thomas SH, Cameron PA, Azad AM, Puolakka T. Epidemiological profile of stroke in Qatar: Insights from a seven-year observational study. J Clin Neurosci 2024; 123:30-35. [PMID: 38520927 DOI: 10.1016/j.jocn.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES Stroke prevalence is progressively increasing in developing countries due to increased vascular risk factors. This study aims to describe the epidemiology, prevalent risk factors, and outcomes of stroke in a multi-ethnic society of Qatar. MATERIALS AND METHODS We conducted a retrospective analysis of all patients with suspected stroke admitted to stroke services between January 2014 and September 2020. RESULTS A total of 11,892 patients were admitted during this period with suspected stroke. Of these, the diagnosis was ischemic stroke (48.8 %), transient ischemic attack (10.3 %), intracerebral hemorrhage (10.9 %), cerebral venous sinus thrombosis (1.3 %), and stroke mimics (28.6 %). The median age was 52 (43-62), with a male-female ratio of 3:1. The study population was predominantly Asian (56.8 %) and Arab (36 %). The majority of the patients were hypertensive (66.8 %), diabetic (47.9 %), and dyslipidemic (45.9 %). A history of prior stroke was observed in 11.7 %, while 0.9 % had prior transient ischemic attack. Among ischemic strokes, 31.7 % arrived within 4.5 h, 12.5 % received thrombolysis, and 4.6 % underwent thrombectomy. Median Door-to-Needle time was 51 (33-72) minutes. The average length of stay was 5.2 ± 9.0 days, with 71.5 % discharged home, 13.8 % transferred to rehabilitation, 9.3 % to other specialties, 3 % to long-term care, and 2.4 % suffered in-hospital mortality. CONCLUSION Stroke in Qatar is characterized by a younger, expatriate-dominant cohort, with notable prevalence of ischemic and hemorrhagic stroke and a distinct risk factor profile. Further analysis of epidemiological differences among different population groups can inform targeted policies for prevention and management to reduce the burden of disease.
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Affiliation(s)
- Zain A Bhutta
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Naveed Akhtar
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Sameer A Pathan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Maaret Castren
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Tim Harris
- Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK.
| | - Gowrii S Ganesan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Saadat Kamran
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Stephen H Thomas
- Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK; Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA.
| | - Peter A Cameron
- The Alfred Hospital, Emergency and Trauma Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Aftab M Azad
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Tuukka Puolakka
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Awan UA, Khattak AA, Haq M, Saadia Z, Marwat M, Khalid S, Kamran S, Haseeb A, Ahmed B, Irfani MA, Nadeem MF, Javed F. Frequency, distribution and determinants of Helicobacter pylori infection in adults and adolescents with gastric symptoms: cross-sectional epidemiological inquiry in district Haripur, Pakistan. BRAZ J BIOL 2024; 84:e248913. [DOI: 10.1590/1519-6984.248913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 11/13/2021] [Indexed: 12/25/2022] Open
Abstract
Abstract Helicobacter pylori (HP) is a vital element in the etiology of peptic ulcers and gastric cancer. This research aimed to determine the frequency, distribution, and determinants of HP infection in adults and adolescents with gastric symptoms in district Haripur, Khyber Pakhtunkhwa, Pakistan. This cross-sectional study was performed from June 2018 to June 2020 at the Medical Laboratory Technology Department, The University of Haripur, Pakistan. Presence of HP was a research variable, while sex, age groups, education status, overcrowding, dining habits, milk intake, drinking water source and animal contact were grouping variables. Immuno-chromatographic technique (ICT) was used to for serological detection of HP antibodies. All variables were represented by frequency and percentage with 95%CI. Prevalence of HP and its distribution by eight socio-demographic variables was testified by the chi-square goodness-of-fit test while association was testified by chi-square test of association. Out of total 1160 cases, 557 (48%) were positive for HP. Population prevalence was higher in men, in the age group 20-40 years, illiterate, family size ≤ 10 persons, taking restaurant food, using tetra pack, using municipal water, and having animal contact. The observed prevalence of HP was similar to its expected prevalence in the population. The observed distribution of HP in the sample was different from its expected distribution in population by eight socio-demographic variables. Presence of HP was associated with all eight socio-demographic variables besides age groups.
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Affiliation(s)
| | | | - M. Haq
- Riphah International University, Pakistan
| | - Z. Saadia
- Qassim University College of Medicine, Kingdom of Saudi Arabia
| | | | - S. Khalid
- Riphah International University, Pakistan
| | - S. Kamran
- University of Management and Technology - UMT, Pakistan
| | - A. Haseeb
- Abbottabad University of Science and Technology, Pakistan
| | - B. Ahmed
- Abbottabad University of Science and Technology, Pakistan
| | | | | | - F. Javed
- Pak-Austria Fachhochschule: Institute of Applied Sciences & Technology, Pakistan
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Al-Ali A, Qidwai U, Kamran S. Predicting infarction growth rate II using ANFIS-based binary particle swarm optimization technique in ischemic stroke. MethodsX 2023; 11:102375. [PMID: 37753352 PMCID: PMC10518723 DOI: 10.1016/j.mex.2023.102375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
Ischemic stroke, a severe medical condition triggered by a blockage of blood flow to the brain, leads to cell death and serious health complications. One key challenge in this field is accurately predicting infarction growth - the progressive expansion of damaged brain tissue post-stroke. Recent advancements in artificial intelligence (AI) have improved this prediction, offering crucial insights into the progression dynamics of ischemic stroke. One such promising technique, the Adaptive Neuro-Fuzzy Inference System (ANFIS), has shown potential, but it faces the 'curse of dimensionality' and long training times as the number of features increased. This paper introduces an innovative, automatic method that combines Binary Particle Swarm Optimization (BPSO) with ANFIS architecture, achieves reduction in dimensionality by reducing the number of rules and training time. By analyzing the Pearson correlation coefficients and P-values, we selected clinically relevant features strongly correlated with the Infarction Growth Rate (IGR II), extracted after one CT scan. We compared our model's performance with conventional ANFIS and other machine learning techniques, including Support Vector Regressor (SVR), shallow Neural Networks, and Linear Regression. •Inputs: Real data about ischemic stroke represented by clinically relevant features.•Output: An innovative model for more accurate and efficient prediction of the second infarction growth after the first CT scan.•Results: The model achieved commendable statistical metrics, which include a Root Mean Square Error of 0.091, a Mean Squared Error of 0.0086, a Mean Absolute Error of 0.064, and a Cosine distance of 0.074.
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Affiliation(s)
- Afnan Al-Ali
- Computer Science and Engineering Department, Qatar University, Doha, Qatar
| | - Uvais Qidwai
- Computer Science and Engineering Department, Qatar University, Doha, Qatar
| | - Saadat Kamran
- Department of Neurology, Hamad Medical Corporation, Doha, Qatar
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6
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Perkins JD, Abdelmoneim MS, Wilkins SS, Kamran S, Mesraoua B, Melikyan G, Alrabi A, El-Bardissy A, Elalamy O, Al Hail HJ. Dosage, time, and polytherapy dependent effects of different levetiracetam regimens on cognitive function. Epilepsy Behav 2023; 148:109453. [PMID: 37783028 DOI: 10.1016/j.yebeh.2023.109453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/20/2023] [Accepted: 09/16/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Cognitive impairment is a potential drawback of antiseizure medications. This study aimed to evaluate the impact of different levetiracetam drug regimens on cognitive function. METHODS A retrospective analysis identified 221 patients diagnosed with seizures who underwent cognitive screening. Patients were categorized into four groups: no medications, non-levetiracetam medications, high and low dose levetiracetam. Composite scores determined low and high levetiracetam groups whereby one point was added for each increment in dosage, duration since uptake, and concurrent anti-seizure medication. Variables known to affect cognition were recorded and classified as demographic, seizure-related, diagnosis-related, and psychopathology. Logistic regression was used to identify variables associated with cognitive scores below cut-off. RESULTS Multivariable analysis found being male, non-active in the community, less than 12 years of education, left temporal lobe epilepsy, high seizure frequency, and depression were associated with poor cognitive performance. In a final regression analysis, the high levetiracetam group exhibited a 4.5-fold higher likelihood of scoring below cut-off than the medication-free group (OR 4.5, CI 1.5-13.6, p<.08). Depression (OR 2.1, CI 1.1-3.9, p<.03), being male (OR 2.2, CI 1.1-4.3, p<.02), and not being active in the community (OR 3.8, 1.6-8.7, p <.003) remained significant contributors to the model. Language (p<.05), attention (p<.05), and delayed recall (p<.001) were the most affected cognitive domains. SIGNIFICANCE When taken in small doses, for brief periods as monotherapy, levetiracetam minimally influences cognition. At higher doses, as part of long-term seizure management, in conjunction with multiple ASMs, LEV is associated with cognitive impairment.
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Affiliation(s)
- Jon Davis Perkins
- Hamad Medical Corporation, Doha, Qatar; PMARC, University of Edinburgh, Edinburgh. UK.
| | | | - Stacy Schantz Wilkins
- Greater Los Angeles VA Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Saadat Kamran
- Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Qatar, Education City, Doha, Qatar
| | - Boulenouar Mesraoua
- Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Qatar, Education City, Doha, Qatar
| | - Gayane Melikyan
- Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Qatar, Education City, Doha, Qatar
| | | | | | - Osama Elalamy
- Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Qatar, Education City, Doha, Qatar
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Petropoulos IN, John K, Al-Shibani F, Ponirakis G, Khan A, Gad H, Mahfoud ZR, Altarawneh H, Rehman MH, Al-Merekhi D, George P, Ibrahim F, Francis R, Canibano B, Deleu D, El-Sotouhy A, Vattoth S, Stettner M, Own A, Shuaib A, Akhtar N, Kamran S, Malik RA. Corneal immune cells as a biomarker of inflammation in multiple sclerosis: a longitudinal study. Ther Adv Neurol Disord 2023; 16:17562864231204974. [PMID: 37915502 PMCID: PMC10617262 DOI: 10.1177/17562864231204974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/12/2023] [Indexed: 11/03/2023] Open
Abstract
Background Corneal immune cells (ICs) are antigen-presenting cells that are known to increase ocular and systemic inflammatory conditions. Objective We aimed to assess longitudinal changes in corneal IC in patients with multiple sclerosis (MS) and relation to disability and ongoing treatment. Design Prospective observational study conducted between September 2016 and February 2020. Methods Patients with relapsing-remitting MS (RRMS) (n = 45) or secondary progressive MS (SPMS) (n = 15) underwent corneal confocal microscopy (CCM) at baseline and 2-year follow-up for estimation of corneal IC density [dendritic cells with (DCF) (cells/mm2) or without nerve fiber contact (DCP); and non-dendritic cells with (NCF) or without nerve fiber contact (NCP)]. Optical coherence tomography, neuroimaging, and disability assessments were additionally performed. Healthy controls (n = 20) were assessed at baseline. Results In both RRMS and SPMS compared to controls, DCP (p < 0.001 and p < 0.001, respectively) and DCF (p < 0.001 and p = 0.005) were higher and NCF (p = 0.007 and p = 0.02) was lower at baseline. DCP showed excellent performance in identifying patients with MS (sensitivity/specificity = 0.88/0.90) followed by DCF (0.80/0.75) and NCF (0.80/0.85). At follow-up compared to baseline, DCP (p = 0.01) was significantly reduced, and NCP (p = 0.004) and NCF (p = 0.04) were increased. Subgroup analysis showed that baseline NCP and NCF were significantly higher (p = 0.04-0.05) in patients who switched disease-modifying treatment, and baseline NCP (p = 0.05) was higher in patients on interferon. Conclusion Baseline and change in corneal IC were related to axonal degeneration and treatment status. Evaluation of corneal IC using CCM may allow an assessment of ongoing inflammation, disease progression, and the effect of treatment in MS.
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Affiliation(s)
| | - Karen John
- Division of Research, Weill Cornell Medicine, Doha, Qatar
| | | | | | - Adnan Khan
- Division of Research, Weill Cornell Medicine, Doha, Qatar
| | - Hoda Gad
- Division of Research, Weill Cornell Medicine, Doha, Qatar
| | - Ziyad R. Mahfoud
- Division of Medical Education, Weill Cornell Medicine, Doha, Qatar
- Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | - Pooja George
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Faiza Ibrahim
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Reny Francis
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Surjith Vattoth
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mark Stettner
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Ahmed Own
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, University of Alberta, Edmonton, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rayaz A. Malik
- Weill Cornell Medicine-Qatar of Cornell University, Research Division, Qatar Foundation, Education City, Al-Luqta street, Doha 24144, Qatar
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8
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Imam YZ, Akhtar N, Kamran S, Garcia-Bermejo P, Al Jerdi S, Zakaria A, Own A, Patro S. Rescue Stent Placement for Acute Ischemic Stroke with Large Vessel Occlusion Refractory to Mechanical Thrombectomy: A Multiethnic Middle Eastern/African/Asian Cohort. J Vasc Interv Radiol 2023; 34:1740-1748. [PMID: 37302471 DOI: 10.1016/j.jvir.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/20/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023] Open
Abstract
PURPOSE To investigate the safety and effectiveness of rescue stent placement in patients who experienced acute stroke in whom mechanical thrombectomy failed. METHODS This was a retrospective review of a multiethnic stroke database. After stent placement, an aggressive antiplatelet protocol was followed with glycoprotein IIb/IIIa infusion. The primary outcomes were incidence of intracerebral hemorrhage (ICH), recanalization score, and favorable prognosis (modified Rankin score ≤ 2) at 90 days. A comparison was made between patients from the Middle East and North Africa (MENA) region and those from other regions. RESULTS Fifty-five patients were included, with 87% being men. The mean age was 51.3 years (SD ±11.8); 32 patients (58%) were from South Asia, 12 (22%) from MENA, 9 (16%) from Southeast Asia, and 2 (4%) from elsewhere. Successful recanalization (modified Thrombolysis in Cerebral Infarction score = 2b/3) was achieved in 43 patients (78%), and symptomatic ICH occurred in 2 patients (4%). A favorable outcome at 90 days was seen in 26 of the 55 patients (47%). Apart from significantly older age-mean, 62.8 years (SD ±13; median, 69 years) versus 48.1 years (SD ±9.3; median, 49 years)-and coronary artery disease burden-4 (33%) versus 1 (2%) (P < .05), patients from MENA had risk factors, stroke severity, recanalization rates, ICH rates, and 90-day outcomes similar to those from South and Southeast Asia. CONCLUSION Rescue stent placement showed good outcomes and a low risk of clinically significant bleeding in a multiethnic cohort of patients from MENA and South and Southeast Asia, similar to that in published literature.
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Affiliation(s)
- Yahia Z Imam
- Neurosceince Institute, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar.
| | - Naveed Akhtar
- Neurosceince Institute, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Saadat Kamran
- Neurosceince Institute, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | | | - Ayman Zakaria
- Neurosceince Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neurosceince Institute, Hamad Medical Corporation, Doha, Qatar
| | - Satya Patro
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Li J, Iwai Y, Isaacs TJ, Ma SJ, Elmore SNC, Kamran S, Oladeru OT. Palliative Care among Incarcerated Populations: A National Survey of Radiation Oncologists' Perspectives and Experiences. Int J Radiat Oncol Biol Phys 2023; 117:e36. [PMID: 37785237 DOI: 10.1016/j.ijrobp.2023.06.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Incarcerated individuals carry a high disease burden, including cancer which is now the leading cause of illness-related deaths. Disparities in access to screening, care coordination, timely treatment, and comorbidities have been identified as contributors to late-stage diagnosis and poor cancer-related outcomes. As the first of its kind, we assessed oncologists' knowledge, attitudes, and practices (KAP) in providing cancer care to incarcerated patients. MATERIALS/METHODS A KAP survey on incarcerated patients with cancer was developed and piloted with volunteer radiation oncologists. Following IRB approval, the KAP survey questionnaire included physicians' demographics and Likert scale questions on practice patterns and experiences caring for incarcerated patients. The survey was distributed to 150 medical and radiation oncologists randomly selected from national societies' membership directories (ASTRO and ASCO). Data collection took place from 7/2020-12/2021, and descriptive statistics were used for analysis. RESULTS Of the 75 surveyed radiation oncologists (RO), 34 responded with a response rate of 45% among the specialty cohort. Most RO (59%) incorrectly identified "heart disease" as the leading cause of death among incarcerated patients, followed by "substance use disorder" (19%); only 9% correctly reported "cancer" as the leading cause of death. Most RO reported caring for a patient who underwent cancer treatment while incarcerated (70%) or recently incarcerated (within 6 months of release; 63%). 38% (n = 10/26) indicated incarcerated patients presented with delayed diagnosis at consultation. 58% (n = 14/24) reported that ≥50% of their patients who were incarcerated presented with cancer-related pain, and 82% (n = 18/22) indicated that ≥50% of their patients had a history of opioid use disorder. Yet 38% (n = 9/24) reported their clinic adequately treated cancer-related pain for incarcerated patients, while 54% (n = 13/24) reported their clinic needed improvement. CONCLUSION Most radiation oncologists have experience providing cancer care for incarcerated patients and acknowledge disparities in later-stage disease presentation in this patient population. Interventions are needed to ensure cancer-related pain is appropriately managed among patients experiencing incarceration. Further studies are required to understand practice patterns and ensure equitable cancer treatment for carceral populations.
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Affiliation(s)
- J Li
- State University of New York Upstate Medical University, Syracuse, NY
| | - Y Iwai
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - T J Isaacs
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - S J Ma
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - S N C Elmore
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - S Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - O T Oladeru
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Petropoulos IN, Al-Shibani F, Bitirgen G, Ponirakis G, Khan A, Gad H, Mahfoud ZR, Altarawneh H, Rehman MH, John K, Al-Merekhi D, George P, Uca AU, Ozkagnici A, Ibrahim F, Francis R, Canibano B, Deleu D, El-Sotouhy A, Vattoth S, Own A, Shuaib A, Akhtar N, Kamran S, Malik RA. Corneal axonal loss as an imaging biomarker of neurodegeneration in multiple sclerosis: a longitudinal study. Ther Adv Neurol Disord 2023; 16:17562864221118731. [PMID: 36776530 PMCID: PMC9909084 DOI: 10.1177/17562864221118731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/23/2022] [Indexed: 02/09/2023] Open
Abstract
Background Resourceful endpoints of axonal loss are needed to predict the course of multiple sclerosis (MS). Corneal confocal microscopy (CCM) can detect axonal loss in patients with clinically isolated syndrome and established MS, which relates to neurological disability. Objective To assess corneal axonal loss over time in relation to retinal atrophy, and neurological and radiological abnormalities in MS. Methods Patients with relapsing-remitting (RRMS) (n = 68) or secondary progressive MS (SPMS) (n = 15) underwent CCM and optical coherence tomography. Corneal nerve fibre density (CNFD-fibres/mm2), corneal nerve branch density (CNBD-branches/mm2), corneal nerve fibre length (CNFL-mm/mm2) and retinal nerve fibre layer (RNFL-μm) thickness were quantified along with neurological and radiological assessments at baseline and after 2 years of follow-up. Age-matched, healthy controls (n = 20) were also assessed. Results In patients with RRMS compared with controls at baseline, CNFD (p = 0.004) and RNFL thickness (p < 0.001) were lower, and CNBD (p = 0.003) was higher. In patients with SPMS compared with controls, CNFD (p < 0.001), CNFL (p = 0.04) and RNFL thickness (p < 0.001) were lower. For identifying RRMS, CNBD had the highest area under the receiver operating characteristic (AUROC) curve (0.99); and for SPMS, CNFD had the highest AUROC (0.95). At follow-up, there was a further significant decrease in CNFD (p = 0.04), CNBD (p = 0.001), CNFL (p = 0.008) and RNFL (p = 0.002) in RRMS; in CNFD (p = 0.04) and CNBD (p = 0.002) in SPMS; and in CNBD (p = 0.01) in SPMS compared with RRMS. Follow-up corneal nerve loss was greater in patients with new enhancing lesions and optic neuritis history. Conclusion Progressive corneal and retinal axonal loss was identified in patients with MS, especially those with more active disease. CCM may serve as an imaging biomarker of axonal loss in MS.
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Affiliation(s)
| | - Fatima Al-Shibani
- Division of Research, Weill Cornell Medicine–Qatar of Cornell University, Doha, Qatar
| | - Gulfidan Bitirgen
- Department of Ophthalmology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Georgios Ponirakis
- Division of Research, Weill Cornell Medicine–Qatar of Cornell University, Doha, Qatar
| | - Adnan Khan
- Division of Research, Weill Cornell Medicine–Qatar of Cornell University, Doha, Qatar
| | - Hoda Gad
- Division of Research, Weill Cornell Medicine–Qatar of Cornell University, Doha, Qatar
| | - Ziyad R. Mahfoud
- Division of Medical Education, Weill Cornell Medicine–Qatar of Cornell University, Doha, Qatar,Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Heba Altarawneh
- Division of Research, Weill Cornell Medicine–Qatar of Cornell University, Doha, Qatar
| | | | - Karen John
- Division of Research, Weill Cornell Medicine–Qatar of Cornell University, Doha, Qatar
| | - Dhabia Al-Merekhi
- Division of Research, Weill Cornell Medicine–Qatar of Cornell University, Doha, Qatar
| | - Pooja George
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ali Ulvi Uca
- Department of Neurology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ahmet Ozkagnici
- Department of Neurology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Faiza Ibrahim
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Reny Francis
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Surjith Vattoth
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
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12
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Salam A, Shuaib A, Kamran S, Hassanin I, Shahid N, Al-Darwish MS, Bibi R, Saqqur M, Amir N, Miller ET. Effect of the Preparatory School FAST Stroke Educational Program. J Neurosci Nurs 2022; 54:202-207. [PMID: 35796665 DOI: 10.1097/jnn.0000000000000665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT BACKGROUND: The aim of this study was to assess the effectiveness of FAST stroke educational program among all preparatory school students in the state of Qatar. METHODS: The pretest-posttest experimental research design was used to evaluate the effectiveness of the FAST educational program in Qatar. A 30-minute audiovisual presentation was given to improve knowledge of stroke. We included grade 7 to 9 students during the academic year 2018-2019. The FAST program consisted of a pretest, an educational intervention, and immediate and long-term posttests at 2 months. RESULTS: A sample of 1244 students completed presurvey and immediate postsurvey, with an average age of 13.5 (1.12) years (range, 11-18 years) and 655 (53%) females. Students had significantly ( P < .01) greater knowledge of stroke signs, symptoms, and risk factors at intermediate posttest (5.9 [2.6] and 6.2 [2.4]) and at 2 months posttest (5.6 [2.8] and 5.6 [2.7]) compared with pretest (4.8 [2.6] and 4.9 [2.6], respectively). Students also had a higher self-efficacy to seek assistance, which was sustained from pretest to long-term posttest. CONCLUSION: The FAST program improved stroke knowledge that was retained at 2 months.
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Safan AS, Imam Y, Akhtar N, Al‐Taweel H, Zakaria A, Quateen A, Own A, Kamran S. Acute ischemic stroke and convexity subarachnoid hemorrhage in large vessel atherosclerotic stenosis: Case series and review of the literature. Clin Case Rep 2022; 10:e5968. [PMID: 35765289 PMCID: PMC9207224 DOI: 10.1002/ccr3.5968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Atraumatic convexity subarachnoid hemorrhage (cSAH) is a rare non‐aneurysmal SAH, commonly due to ipsilateral internal carotid artery (ICA) stenosis. It is unusual for the cSAH to occur contralaterally to the infarct. We report two cases of acute ischemic stroke associated with contralateral and ipsilateral cSAH that had different presentations.
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Affiliation(s)
- Abeer Sabry Safan
- Department of Neurology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
| | - Yahia Imam
- Department of Neurology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
- Weill Cornell Medicine Doha Qatar
| | - Naveed Akhtar
- Department of Neurology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
- Weill Cornell Medicine Doha Qatar
| | | | - Ayman Zakaria
- Department of Neuroradiology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
| | - Aiman Quateen
- Department of Neuroradiology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
| | - Ahmed Own
- Department of Neurology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
- Department of Neuroradiology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
| | - Saadat Kamran
- Department of Neurology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
- Weill Cornell Medicine Doha Qatar
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15
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Khan MM, Shaikh N, Yousaf Z, Sultan H, Sadek G, Khan A, Kamran S, Ahmed AZ, Albanna W, Belkhair S, Ayyad A. Risk Factors for Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage: A Tertiary Care Center Experience. Asian J Neurosurg 2022; 17:242-247. [PMID: 36120624 PMCID: PMC9473800 DOI: 10.1055/s-0042-1750838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives
Cerebral vasospasm in subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality. There is a lack of consensus on the risk factors leading to cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). In this retrospective study, our objective was to determine the association of risk factors for cerebral vasospasm aSAH.
Methods
A total of 259 charts of aSAH patients consecutively admitted to the surgical intensive care unit of Hamad General Hospital from January 2007 to December 2016 were reviewed and included. The patient's demographic data, including comorbidities like hypertension (HTN), was recorded. Variables of interest included measurements of the neurological deficit on admission, the severity of SAH, treatment modality, and the initial computerized tomography scan of the head for intraventricular hemorrhage, intracerebral hemorrhage, or hydrocephalus. Multivariate analysis and multiple logistic regression analyzed the relationship to identify the association of independent variables.
Results
Out of the 259 patients, 34% (
n
= 87) suffered from cerebral vasospasm. The severity of SAH was associated with the development of cerebral vasospasm (
p
< 0.05). The presence of HTN and neurological deficits on admission were associated with an increased risk of cerebral vasospasm (
p
< 0.05,
p
< 0.01, respectively). Hydrocephalus requiring treatment using external ventricular drains decreased the risk of cerebral vasospasm (
p
< 0.05). Intraventricular and intracerebral hemorrhage were not associated with cerebral vasospasm (
p
= 0.25,
p
= 0.16). The endovascular treatment of cerebral aneurysms was associated with an increased risk of cerebral vasospasm (
p
< 0.05).
Conclusion
Cerebral vasospasm is common among patients admitted with aSAH. It is significantly associated with the history of HTN, the neurological deficit on admission that corelates more strongly to the motor deficit on admission, the severity of hemorrhage (modified Fischer score), and endovascular treatment. External ventricular drainage was associated with a decrease in cerebral vasospasm. The present study's findings shed light on cerebral vasospasm's risk factors in the country and the region.
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Affiliation(s)
| | - Nissar Shaikh
- Surgical Intensive Care Unit, Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hussain Sultan
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | - George Sadek
- Weill Cornell Medicine, Education City, Al Luqta St, Ar-Rayyan, Qatar
| | - Adnan Khan
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Weill Cornell Medicine, Education City, Al Luqta St, Ar-Rayyan, Qatar
- Department of Neurology, Hamad Medical Corporation, Doha, Qatar
| | - Ayman Z. Ahmed
- Department of Neurology, Hamad Medical Corporation, Doha, Qatar
- Department of Neurosurgery, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Walid Albanna
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - Sirajeddin Belkhair
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
- Department of Neurosurgery, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ali Ayyad
- Department of Neurosurgery, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
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16
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Imam Y, Al-salahat A, Aljurdi S, Mahfoud Z, Reyes CZ, Akhtar N, Abunaib M, Al-Orphaly M, Kim SW, Khodair R, Thekkumpurath T, Abumustafa R, Al-Motawa A, Sameer S, Elsetouhy A, Own A, Kamran S. Stroke in airplane passengers: A study from a large international Hub. J Stroke Cerebrovasc Dis 2022; 31:106452. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/12/2022] [Indexed: 11/27/2022] Open
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17
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Akhtar N, Singh R, Kamran S, Babu B, Sivasankaran S, Joseph S, Morgan D, Shuaib A. Diabetes: Chronic Metformin Treatment and Outcome Following Acute Stroke. Front Neurol 2022; 13:849607. [PMID: 35557626 PMCID: PMC9087832 DOI: 10.3389/fneur.2022.849607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Aim To evaluate if in patients with known diabetes, pretreatment metformin will lead to less severe stroke, better outcome, and lower mortality following acute stroke. Methods The Qatar stroke database was interrogated for stroke severity and outcome in patients with ischemic stroke. Outcome was compared in nondiabetic vs. diabetic patients and in diabetic patients on metformin vs. other hypoglycemic agents. The National Institute of Health Stroke Scale was used to measure stroke severity and 90-day modified Rankin scale (mRS) score to determine outcome following acute stroke. Results In total, 4,897 acute stroke patients [nondiabetic: 2,740 (56%) and diabetic: 2,157 (44%)] were evaluated. There were no significant differences in age, risk factors, stroke severity and type, or thrombolysis between the two groups. At 90 days, mRS (shift analysis) showed significantly poor outcome in diabetic patients (p < 0.001) but no differences in mortality. In the diabetic group, 1,132 patients were on metformin and 1,025 on other hypoglycemic agents. mRS shift analysis showed a significantly better outcome in metformin-treated patients (p < 0.001) and lower mortality (8.1 vs. 4.6% p < 0.001). Multivariate negative binomial analyses showed that the presence of diabetes negatively affected the outcome (90-day mRS) by factor 0.17 (incidence risk ratio, IRR, 1.17; CI [1.08-1.26]; p < 0.001) when all independent variables were held constant. In diabetic patients, pre-stroke treatment with metformin improved the outcome (90-day mRS) by factor 0.14 (IRR 0.86 [CI 0.75-0.97] p = 0.006). Conclusion Similar to previous reports, our study shows that diabetes adversely affects stroke outcome. The use of prior metformin is associated with better outcome in patients with ischemic stroke and results in lower mortality. The positive effects of metformin require further research to better understand its mechanism.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- 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
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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18
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Khan A, De Boever P, Gerrits N, Akhtar N, Saqqur M, Ponirakis G, Gad H, Petropoulos IN, Shuaib A, Faber JE, Kamran S, Malik RA. Retinal vessel multifractals predict pial collateral status in patients with acute ischemic stroke. PLoS One 2022; 17:e0267837. [PMID: 35511879 PMCID: PMC9070887 DOI: 10.1371/journal.pone.0267837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 04/16/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Pial collateral blood flow is a major determinant of the outcomes of acute ischemic stroke. This study was undertaken to determine whether retinal vessel metrics can predict the pial collateral status and stroke outcomes in patients. METHODS Thirty-five patients with acute stroke secondary to middle cerebral artery (MCA) occlusion underwent grading of their pial collateral status from computed tomography angiography and retinal vessel analysis from retinal fundus images. RESULTS The NIHSS (14.7 ± 5.5 vs 10.1 ± 5.8, p = 0.026) and mRS (2.9 ± 1.6 vs 1.9 ± 1.3, p = 0.048) scores were higher at admission in patients with poor compared to good pial collaterals. Retinal vessel multifractals: D0 (1.673±0.028vs1.652±0.025, p = 0.028), D1 (1.609±0.027vs1.590±0.025, p = 0.044) and f(α)max (1.674±0.027vs1.652±0.024, p = 0.019) were higher in patients with poor compared to good pial collaterals. Furthermore, support vector machine learning achieved a fair sensitivity (0.743) and specificity (0.707) for differentiating patients with poor from good pial collaterals. Age (p = 0.702), BMI (p = 0.422), total cholesterol (p = 0.842), triglycerides (p = 0.673), LDL (p = 0.952), HDL (p = 0.366), systolic blood pressure (p = 0.727), HbA1c (p = 0.261) and standard retinal metrics including CRAE (p = 0.084), CRVE (p = 0.946), AVR (p = 0.148), tortuosity index (p = 0.790), monofractal Df (p = 0.576), lacunarity (p = 0.531), curve asymmetry (p = 0.679) and singularity length (p = 0.937) did not differ between patients with poor compared to good pial collaterals. CONCLUSIONS This is the first translational study to show increased retinal vessel multifractal dimensions in patients with acute ischemic stroke and poor pial collaterals. A retinal vessel classifier was developed to differentiate between patients with poor and good pial collaterals and may allow rapid non-invasive identification of patients with poor pial collaterals.
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Affiliation(s)
- Adnan Khan
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Patrick De Boever
- Department of Biology, University of Antwerp, Antwerp, Wilrijk, Belgium
- Center of Environmental Sciences, Hasselt University, Diepenbeek, Belgium
- VITO (Flemish Institute for Technological Research), Health Unit, Mol, Belgium
| | - Nele Gerrits
- VITO (Flemish Institute for Technological Research), Health Unit, Mol, Belgium
| | - Naveed Akhtar
- Institute of Neuroscience, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- Trillium Hospital, University of Toronto at Mississauga, Mississauga, ON, Canada
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Hoda Gad
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Ashfaq Shuaib
- Institute of Neuroscience, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - James E. Faber
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Saadat Kamran
- Institute of Neuroscience, Hamad Medical Corporation, Doha, Qatar
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Khan A, Parray A, Akhtar N, Agouni A, Kamran S, Pananchikkal SV, Priyanka R, Gad H, Ponirakis G, Petropoulos IN, Chen KH, Tayyab K, Saqqur M, Shuaib A, Malik RA. Corneal nerve loss in patients with TIA and acute ischemic stroke in relation to circulating markers of inflammation and vascular integrity. Sci Rep 2022; 12:3332. [PMID: 35228650 PMCID: PMC8885663 DOI: 10.1038/s41598-022-07353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/14/2022] [Indexed: 12/01/2022] Open
Abstract
Vascular and inflammatory mechanisms are implicated in the development of cerebrovascular disease and corneal nerve loss occurs in patients with transient ischemic attack (TIA) and acute ischemic stroke (AIS). We have assessed whether serum markers of inflammation and vascular integrity are associated with the severity of corneal nerve loss in patients with TIA and AIS. Corneal confocal microscopy (CCM) was performed to quantify corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL) in 105 patients with TIA (n = 24) or AIS (n = 81) and age matched control subjects (n = 56). Circulating levels of IL-6, MMP-2, MMP-9, E-Selectin, P-Selectin and VEGF were quantified in patients within 48 h of presentation with a TIA or AIS. CNFL (P = 0.000, P = 0.000), CNFD (P = 0.122, P = 0.000) and CNBD (P = 0.002, P = 0.000) were reduced in patients with TIA and AIS compared to controls, respectively with no difference between patients with AIS and TIA. The NIHSS Score (P = 0.000), IL-6 (P = 0.011) and E-Selectin (P = 0.032) were higher in patients with AIS compared to TIA with no difference in MMP-2 (P = 0.636), MMP-9 (P = 0.098), P-Selectin (P = 0.395) and VEGF (P = 0.831). CNFL (r = 0.218, P = 0.026) and CNFD (r = 0.230, P = 0.019) correlated with IL-6 and multiple regression analysis showed a positive association of CNFL and CNFD with IL-6 (P = 0.041, P = 0.043). Patients with TIA and AIS have evidence of corneal nerve loss and elevated IL6 and E-selectin levels. Larger longitudinal studies are required to determine the association between inflammatory and vascular markers and corneal nerve fiber loss in patients with cerebrovascular disease.
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Affiliation(s)
- Adnan Khan
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Aijaz Parray
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Naveed Akhtar
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Abdelali Agouni
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Saadat Kamran
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Sajitha V Pananchikkal
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Ruth Priyanka
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Hoda Gad
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Georgios Ponirakis
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ioannis N Petropoulos
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Kuan-Han Chen
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Kausar Tayyab
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Maher Saqqur
- Department of Neurology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Ashfaq Shuaib
- Stroke Program, Department of Neurology, University of Alberta, Alberta, Canada
| | - Rayaz A Malik
- Department of Medicine, Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar.
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23
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Bhutta ZA, AKHTAR NAVEED, Pathan SA, Puolakka T, Harris T, Ganesan GSS, Kamran S, Thomas SH, Cameron P, Castren MK. Abstract TP195: A Comprehensive Epidemiology Of Stroke In A Multi Ethnic Society: An Analysis Of A Nationwide Stroke Data From 2014 - 2020. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The prevalence of stroke is progressively increasing in developing countries owing to the increase in vascular risk factors in the population. Risk factors vary significantly in different population groups leading to variations in disease progression, management and outcomes. This study aims to describe the epidemiology, prevalent risk factors and outcomes in a multi ethnic society of Qatar.
Methods:
We conducted a retrospective cohort study that included all patients with suspected stroke admitted to Hamad General Hospital, Doha Qatar between April 30, 2014 till September 15, 2020.
Results:
A total of 11,892 patients were admitted during this period with suspected stroke. Of these, Ischemic stroke (IS; 48.8%), Transient ischemic attack (TIA; 10.3%), Intracerebral hemorrhage (ICH; 10.9%), Stroke mimics (28.6%) and Cerebral venous sinus thrombosis (CVST; 1.3%). Mean age was 53.1
+
14.1 and a male to female ratio of 3:1. Study population was majorly Asian (56.8%) and Arab (36%); while African (4.5%), Caucasian (2.6%) and Others (0.1%) formed minority of the population. Asian population (South Asian; 49.7
+
11.6 and Far Eastern; 47.4
+
9.9) were younger as compared to Arabs (58.9
+
15.9). Majority of the patients were hypertensive (66.8%), diabetic (47.9%) and dyslipidemic (45.9%) on admission, while cardiac diseases (14.7%) and DVT (0.3%) were observed in fewer patients. Patients with a history of prior stroke were 11.7%, while 0.9% had a prior TIA. In IS patients, 31.7% of the patients arrived ED within the 4.5-hour thrombolysis window, 12.5% received thrombolysis and 4.6% received thrombectomy. The average Door-to-Needle time for IS patients was 58.9
+
39.5 minutes. The average length of stay was 5.2
+
9.0 days with 71.5% discharged home, 13.8% transferred to rehabilitation, 9.3% to other specialties, 3% to long term care and 2.4% suffered in-hospital mortality.
Conclusion:
The patients suffering Stroke in Qatar are relatively younger than western population. Highly prevalent vascular risk factors could explain younger presentation and relatively high burden of stroke. Further analysis of epidemiological differences between ethnic subgroups can help tailoring effective preventive and management policies to reduce the burden of disease.
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Affiliation(s)
| | | | | | - Tuukka Puolakka
- Dept of Emergency Medicine and Services, Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
| | - Tim Harris
- Emergency Medicine, Hamad Med Corp, Doha, Qatar
| | | | - Saadat Kamran
- Hamad General Hosp, Weil Cornell Sch of Medicine, Qatar, Doha, Qatar
| | | | - Peter Cameron
- The Alfred Hosp, Emergency and Trauma Cntr , Monash Univ, Melbourne, Australia
| | - Maaret K Castren
- Dept of Emergency Medicine and Services, Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
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24
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Bhutta ZA, AKHTAR NAVEED, Pathan SA, Puolakka T, Harris T, Ganesan GSS, Kamran S, Thomas SH, Cameron P, Castren MK. Abstract TP71: Characteristics And Demographics Of Patients Using Emergency Medical Services For Suspected Acute Stroke And Its Impact On Long-term Outcomes In A Multi Ethnic Population. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Acute ischemic stroke (IS) patients who receive IV thrombolysis are more likely to have good long-term prognosis. Unfortunately, more than two-third of IS patients present outside the therapeutic window. The use of emergency medical services (EMS) can reduce pre-hospital delay and increase likelihood of treatment with t-PA. We aim to determine the characteristic variations amongst the suspected acute stroke patients using EMS.
Methods:
In this retrospective observational study, all suspected acute stroke patients admitted to Hamad General Hospital from April 30, 2014 to September 15, 2020 were included. We evaluated demographics, clinical features, impact on treatment and associated factors in EMS versus non-EMS group.
Results:
During the study period, 11892 patients presented as suspected acute stroke. Of these, 65.1% used EMS (EMS-group). Mean age in EMS group was 53.4
+
14.1 versus 52.6
+
14.0 in non-EMS group (p = 0.003). Male to female ratio in both groups was 3:1. The proportion of patients who used EMS were higher in the Asian (66.8%), African (66.8%) and Caucasian (66.6%) population as compared to Arabs (61.9%). EMS use in Qatari population (59.2%) was relatively low. Intracerebral hemorrhage patients (82.4%) had a significantly higher EMS use followed by IS (65.7%) and cerebral venous thrombosis (64.7%); p<0.001. Symptom onset time of less than 4.5 hours at presentation was reported by 41% in EMS-group versus 24.3% in Non-EMS group. Patients with prior stroke (65.5%) and transient ischemic attack (58.4%) preferred EMS as compared to Non-EMS group (34.5% and 41.5%). Patients with unilateral weakness (66.4%) aphasia (78.2%), neglect (78.2%), dysarthria (68.4%), loss of consciousness (83.3%) and seizures (83.9%) had a higher use of EMS versus non-EMS group. The thrombolysis rate in EMS group was high vs non-EMS (82.4% vs 17.6%; p<0.001) with a door-to-needle time significantly lower in the EMS group (56.4
+
38.2 vs 75.7
+
43.8; p<0.001).
Conclusion:
EMS use facilitate rapid transfer, timely stroke evaluation and management of patients who need time-critical care. Patient characteristics and demographics, clinical symptoms and stroke type are associated with early stroke recognition and EMS use leading to higher recanalization rate.
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Affiliation(s)
| | | | | | - Tuukka Puolakka
- Dept of Emergency Medicine and Services, Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
| | - Tim Harris
- Emergency Medicine, Hamad Med Corp, Doha, Qatar
| | | | - Saadat Kamran
- Hamad General Hosp, Weil Cornell Sch of Medicine, Qatar, Doha, Qatar
| | | | - Peter Cameron
- Emergency Medicine, The Alfred Hosp, Emergency and Trauma Cntr , Monash Univ, Melbourne, Australia
| | - Maaret K Castren
- Dept of Emergency Medicine and Services, Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
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25
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Ali Y, Imam Y, Ahmedullah HS, Akhtar N, Kamran S, Al Maslmani M, Al Khal AL, Own A, Deleu D. Complicated Neurotuberculosis with sinus venous thrombosis: A case-report. IDCases 2022; 27:e01374. [PMID: 35079572 PMCID: PMC8777086 DOI: 10.1016/j.idcr.2022.e01374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 01/02/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Neurotuberculosis comprises around 6% of systemic tuberculosis. It targets a younger population, and it often leads to severe neurological complications or death. CASE REPORT We report a young gentleman with a clinically defined tuberculous meningitis (TBM) and multiple neurological complication associated with TBM occurring simultaneously. This includes hydrocephalus requiring a ventriculoperitoneal shunt, vasculitic infarcts, cranial nerve palsies, TB granuloma and cerebral venous thrombosis. The cerebrospinal fluid polymerase chain reaction for tuberculosis as well as cultures remained negative repeatedly. The patient was treated with anti-tuberculous medication in addition to steroids based on validated scoring systems suggestive of TBM and made a good recovery. CONCLUSION This report highlights the different complication seen with TBM and the importance of using clinical criteria to guide management plan particularly when cultures are negative.
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Affiliation(s)
- Yousra Ali
- Department of Medicine, Hamad Medical Corporation Doha, Qatar
| | - Yahia Imam
- Neuroscience Institute, Hamad Medical Corporation Doha, Qatar
- Weil Cornell Medicine, Doha, Qatar
| | | | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation Doha, Qatar
- Weil Cornell Medicine, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation Doha, Qatar
- Weil Cornell Medicine, Doha, Qatar
| | - Muna Al Maslmani
- Weil Cornell Medicine, Doha, Qatar
- Center for Communicable Disease, Doha, Qatar
| | - A. Latif Al Khal
- Weil Cornell Medicine, Doha, Qatar
- Center for Communicable Disease, Doha, Qatar
| | - Ahmed Own
- Neuroscience Institute, Hamad Medical Corporation Doha, Qatar
| | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation Doha, Qatar
- Weil Cornell Medicine, Doha, Qatar
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26
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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27
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Petropoulos IN, Fitzgerald KC, Oakley J, Ponirakis G, Khan A, Gad H, George P, Deleu D, Canibano BG, Akhtar N, Shuaib A, Own A, Malik T, Russakoff DB, Mankowski JL, Misra SL, McGhee CNJ, Calabresi P, Saidha S, Kamran S, Malik RA. Corneal confocal microscopy demonstrates axonal loss in different courses of multiple sclerosis. Sci Rep 2021; 11:21688. [PMID: 34737384 PMCID: PMC8568943 DOI: 10.1038/s41598-021-01226-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022] Open
Abstract
Axonal loss is the main determinant of disease progression in multiple sclerosis (MS). This study aimed to assess the utility of corneal confocal microscopy (CCM) in detecting corneal axonal loss in different courses of MS. The results were confirmed by two independent segmentation methods. 72 subjects (144 eyes) [(clinically isolated syndrome (n = 9); relapsing–remitting MS (n = 20); secondary-progressive MS (n = 22); and age-matched, healthy controls (n = 21)] underwent CCM and assessment of their disability status. Two independent algorithms (ACCMetrics; and Voxeleron deepNerve) were used to quantify corneal nerve fiber density (CNFD) (ACCMetrics only), corneal nerve fiber length (CNFL) and corneal nerve fractal dimension (CNFrD). Data are expressed as mean ± standard deviation with 95% confidence interval (CI). Compared to controls, patients with MS had significantly lower CNFD (34.76 ± 5.57 vs. 19.85 ± 6.75 fibers/mm2, 95% CI − 18.24 to − 11.59, P < .0001), CNFL [for ACCMetrics: 19.75 ± 2.39 vs. 12.40 ± 3.30 mm/mm2, 95% CI − 8.94 to − 5.77, P < .0001; for deepNerve: 21.98 ± 2.76 vs. 14.40 ± 4.17 mm/mm2, 95% CI − 9.55 to − 5.6, P < .0001] and CNFrD [for ACCMetrics: 1.52 ± 0.02 vs. 1.45 ± 0.04, 95% CI − 0.09 to − 0.05, P < .0001; for deepNerve: 1.29 ± 0.03 vs. 1.19 ± 0.07, 95% − 0.13 to − 0.07, P < .0001]. Corneal nerve parameters were comparably reduced in different courses of MS. There was excellent reproducibility between the algorithms. Significant corneal axonal loss is detected in different courses of MS including patients with clinically isolated syndrome.
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Affiliation(s)
- Ioannis N Petropoulos
- Research Division, Qatar Foundation, Weill Cornell Medicine-Qatar of Cornell University, PO Box 24144, Education City, Doha, Qatar
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Georgios Ponirakis
- Research Division, Qatar Foundation, Weill Cornell Medicine-Qatar of Cornell University, PO Box 24144, Education City, Doha, Qatar
| | - Adnan Khan
- Research Division, Qatar Foundation, Weill Cornell Medicine-Qatar of Cornell University, PO Box 24144, Education City, Doha, Qatar
| | - Hoda Gad
- Research Division, Qatar Foundation, Weill Cornell Medicine-Qatar of Cornell University, PO Box 24144, Education City, Doha, Qatar
| | - Pooja George
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Dirk Deleu
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | | | - Naveed Akhtar
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar.,Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ahmed Own
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Taimur Malik
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Joseph L Mankowski
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stuti L Misra
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Peter Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Saadat Kamran
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Rayaz A Malik
- Research Division, Qatar Foundation, Weill Cornell Medicine-Qatar of Cornell University, PO Box 24144, Education City, Doha, Qatar.
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28
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Kamran S, Akhtar N, Ben Abid F, Almaslaman M, Perkins J. Increased cerebral venous sinus thrombosis during COVID-19 lockdown. J Neurol Sci 2021. [PMCID: PMC8498558 DOI: 10.1016/j.jns.2021.119655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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29
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Kamran S, Akhtar N, Singh R, Perkins J. Association of major adverse cardiovascular events in stroke patients with cardiac wall motion abnormalities. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Kamran S, Akhtar N, Singh R, Imam Y, Haroon KH, Amir N, Hussain S, Al Jerdi S, Ojha L, Own A, Muhammad A, Perkins JD. Association of Major Adverse Cardiovascular Events in Patients With Stroke and Cardiac Wall Motion Abnormalities. J Am Heart Assoc 2021; 10:e020888. [PMID: 34259032 PMCID: PMC8483461 DOI: 10.1161/jaha.121.020888] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background The association of cardiac wall motion abnormalities (CWMAs) in patients with stroke who have major adverse cardiovascular events (MACE) remains unclear. The purpose of this study was to estimate the 50‐month risk of MACE, including stroke recurrence, acute coronary events, and vascular death in patients with stroke who have CWMAs. Methods and Results We performed a retrospective analysis of prospectively collected acute stroke data (acute stroke and transient ischemic attack) over 50 months by electronic medical records. Data included demographic and clinical information, vascular imaging, and echocardiography data including CWMAs and MACE. Of a total of 2653 patients with acute stroke/transient ischemic attack, CWMA was observed in 355 (13.4%). In patients with CWMAs, the embolic stroke of undetermined source (50.7%) was the most frequent index stroke subtype and stroke recurrences (P=0.001). In multivariate Cox regression after adjustment for demographics, traditional risk, and confounding factors, CWMA was independently associated with a higher risk of MACE (adjusted hazard ratio [HR], 1.74; 95% CI, 1.37–2.21 [P=0.001]). Similarly, CWMA independently conferred an increased risk for ischemic stroke recurrence (adjusted HR, 1.50; 95% CI, 1.01–2.17 [P=0.04]), risk of acute coronary events (aHR, 2.50; 95% CI, 1.83–3.40 [P=0.001]) and vascular death (adjusted HR, 1.57; 95% CI, 1.04–2.40 [P=0.03]), in comparison to the patients with stroke without CWMA. Conclusions In a multiethnic cohort of ischemic stroke with CWMA, CWMA was associated with 1.7‐fold higher risks of MACE independent of established risk factors. Embolic stroke of undetermined source was the most common stroke association with CWMA. Patients with stroke should be screened for CWMA to identify those at higher risk of MACE.
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Affiliation(s)
- Saadat Kamran
- Neuroscience Institute Hamad General Hospital Doha Qatar.,Weill Cornell Medical School Doha Qatar
| | - Naveed Akhtar
- Neuroscience Institute Hamad General Hospital Doha Qatar.,Weill Cornell Medical School Doha Qatar
| | - Rajvir Singh
- Heart Hospital Hamad Medical Corporation Doha Qatar
| | - Yahya Imam
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | | | - Noman Amir
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Suhail Hussain
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | | | - Laxmi Ojha
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Ahmed Own
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Ahmad Muhammad
- Neuroscience Institute Hamad General Hospital Doha Qatar.,Weill Cornell Medical School Doha Qatar
| | - Jonathan D Perkins
- Perception Movement Action Research Consortium University of Edinburgh United Kingdom
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31
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Salahouddin T, Petropoulos IN, Ferdousi M, Ponirakis G, Asghar O, Alam U, Kamran S, Mahfoud ZR, Efron N, Malik RA, Qidwai UA. Artificial Intelligence-Based Classification of Diabetic Peripheral Neuropathy From Corneal Confocal Microscopy Images. Diabetes Care 2021; 44:e151-e153. [PMID: 34083322 PMCID: PMC8323170 DOI: 10.2337/dc20-2012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 04/25/2021] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - Maryam Ferdousi
- Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, U.K
| | | | - Omar Asghar
- Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, U.K
| | - Uazman Alam
- Pain Research Institute and Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, U.K.,Department of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, U.K.,Liverpool University Hospital NHS Foundation Trust, Liverpool, U.K
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad R Mahfoud
- Division of Medical Education, Weill Cornell Medicine, Doha, Qatar.,Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Rayaz A Malik
- Division of Research, Weill Cornell Medicine, Doha, Qatar .,Faculty of Biology, Medicine and Health, University of Manchester, Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, U.K
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32
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Khan A, Li Y, Ponirakis G, Akhtar N, Gad H, George P, Ibrahim FM, Petropoulos IN, Canibano BG, Deleu D, Shuaib A, Kamran S, Malik RA. Corneal Immune Cells Are Increased in Patients With Multiple Sclerosis. Transl Vis Sci Technol 2021; 10:19. [PMID: 34003997 PMCID: PMC8083118 DOI: 10.1167/tvst.10.4.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose Corneal confocal microscopy (CCM) is an ophthalmic imaging technique that has been used to identify increased corneal immune cells in patients with immune-mediated peripheral neuropathy. Given that multiple sclerosis has an immune-mediated etiology, we have compared corneal immune cell (IC) density and near-nerve distance in different subtypes of patients with multiple sclerosis (MS) to controls. Methods This is a blinded, cross-sectional study conducted at a tertiary hospital. Patients with clinically isolated syndrome (CIS) (n = 9), relapsing-remitting multiple sclerosis (RRMS) (n = 43), secondary progressive multiple sclerosis (SPMS) (n = 22), and control subjects (n = 20) underwent CCM. The total, mature, and immature corneal IC density and their nearest nerve distance were quantified. Results The total IC density was higher in patients with MS (P = 0.02), RRMS (P = 0.01), and SPMS (P = 0.04) but not CIS (P = 0.99) compared to controls. Immature IC density was higher in patients with MS (P = 0.03) and RRMS (P = 0.02) but not SPMS (P = 0.10) or CIS (P = 0.99) compared to controls. Mature IC density (P = 0.15) did not differ between patients with MS and controls. The immature IC near-nerve distance was significantly greater in patients with MS (P = 0.001), RRMS (P = 0.007), and SPMS (P = 0.002) compared to controls. Immature IC density correlated with the Symbol Digit Modalities Test (r = –0.281, P = 0.02) and near-nerve distance correlated with the Expanded Disability Status Scale (r = 0.289, P = 0.005). Conclusions In vivo CCM demonstrates an increase in immature IC density and the near-nerve distance in patients with MS. These observations merit further studies to assess the utility of CCM in assessing neuroimmune alterations in MS. Translational Relevance Multiple sclerosis is an immune-mediated neurodegenerative disease. Dendritic cells mediate communication between the innate and adaptive immune systems. We have used in vivo CCM to show increased corneal ICs and suggest it may act as an imaging biomarker for disease status in patients with MS.
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Affiliation(s)
- Adnan Khan
- Weill Cornell Medicine-Qatar, Research Division, Doha, Qatar
| | - Yi Li
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Naveed Akhtar
- Department of Neurology, Hamad General Hospital, Doha, Qatar
| | - Hoda Gad
- Weill Cornell Medicine-Qatar, Research Division, Doha, Qatar
| | - Pooja George
- Department of Neurology, Hamad General Hospital, Doha, Qatar
| | - Faiza M Ibrahim
- Department of Neurology, Hamad General Hospital, Doha, Qatar
| | | | | | - Dirk Deleu
- Department of Neurology, Hamad General Hospital, Doha, Qatar
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Saadat Kamran
- Department of Neurology, Hamad General Hospital, Doha, Qatar
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Research Division, Doha, Qatar.,Institute of Cardiovascular Science, University of Manchester, Manchester, UK
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33
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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34
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Khan A, Kamran S, Boever PD, Gerrits N, Saqqur M, Petropoulos IN, Ponirakis G, AKHTAR NAVEED, Shuaib A, Malik R. Abstract MP59: Retinal Vascular Metrics Predict Pial Collateral Status in Patients With Acute Ischemic Stroke. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.mp59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The extent of the pial collateral circulation may determine outcomes in an acute ischemic stroke. Experimental studies suggest that retinal vessel metrics and geometric patterning may predict the pial collateral status. We have undertaken a translational study to quantify and relate retinal vascular metrics to the grade of pial collaterals in patients with acute ischemic stroke.
Method:
35 patients admitted with acute stroke underwent computed tomography angiography (OCT) and were graded as having good (n=20)(47.55 ± 10.65 years) or poor (n=15) (48.93 ± 10.91 years) pial collaterals and compared to healthy controls (n=21)(44.26 ± 10.15 years). Retinal images were generated using OCT and central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), artery-to-vein ratio (AVR), segmented fractal analysis and lacunarity, tortuosity index and fractal dimensions (capacity D
0
, information D
1
and correlation D
2
, curve asymmetry, singularity length and f-alfa-max using MONA software) were quantified.
Results:
Age (
p
=0.709), BMI (
p
=0.451), total cholesterol (
p
=0.845), triglycerides (
p
=0.679), LDL (
p
=0.953), HDL (
p
=0.361) and HbA
1c
(
p
=0.210) were comparable but the national institute of health stroke scale (
p
=0.031) and modified Rankin Scale (
p
=0.048) were higher in patients with poor compared to good collaterals. CRAE (
p
=0.114), CRVE (
p
=0.946), AVR (
p
=0.114), lacunarity (
p
=0.442), tortuosity index (
p
=0.681), fractal analysis (
p
=0.656), curve asymmetry (
p
=0.619) and singularity length (
p
=0.944) did not differ between patients with poor compared to good collaterals. However, fractal capacity D
0
(1.673 ± 0.029 vs 1.654 ± 0.025,
p
=0.042), fractal information D
1
(1.610 ± 0.027 vs 1.591 ± 0.024,
p
=0.036), fractal correlation D
2
(1.581± 0.028 vs 1.564 ± 0.024,
p
=0.060), and f alfa max (1.674 ± 0.027 vs 1.654 ± 0.025,
p
=0.030) were higher in patients with poor compared to good collaterals.
Conclusion:
This study shows differences in retinal vessel fractal dimensions between acute stroke patients with poor compared to good pial collaterals. This represents a non-invasive imaging method to define the pial collateral status and develop personalized intervention management strategies in acute ischemic stroke patients.
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Affiliation(s)
- Adnan Khan
- WEILL CORNELL MEDICINE in Qatar, Doha, Qatar
| | - Saadat Kamran
- Hamad Geeral Hosp, Weil Cornell Sch of Medicine, Qatar, Doha, Qatar
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35
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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 2020; 30:105435. [PMID: 33171425 PMCID: PMC7605738 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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36
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Imam YZ, Kamran S, Saqqur M, Ibrahim F, Chandra P, Perkins JD, Malik RA, Akhtar N, Al-Jerdi S, Deleu D, Elalamy O, Osman Y, Malikyan G, Elkhider H, Elmakki S, ElSheikh L, Mhjob N, Abdelmoneim MS, Alkhawad N, Own A, Shuaib A. Stroke in the adult Qatari population (Q-stroke) a hospital-based retrospective cohort study. PLoS One 2020; 15:e0238865. [PMID: 32956364 PMCID: PMC7505434 DOI: 10.1371/journal.pone.0238865] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Studies assessing the burden of stroke in Qataris are limited. We aim to study stroke in the Qatari population. METHODS A retrospective review was undertaken of all Qatari adults presenting with stroke to Hamad Medical Corporation over a 5-year period. Descriptive statistics were used to summarize demographic and all other clinical characteristics of the patients. The primary outcome was the incidence of stroke in the Qatari patients. Comparison was made between the sexes. RESULTS 862 patients were included, with 58.9% being male. The average incidence of stroke over the 5-year period was 92.04 per 100,000 adult Qatari population. The mean age of the cohort was 64.3±14.4 years, (range 19-105 years). The mean age of first ever cerebrovascular event was 63.2±14.5 years. The diagnosis was ischemic stroke in (73.7%), transient ischemic attack in (13.8%), intracerebral hemorrhage (ICH) in (11.6%), subarachnoid hemorrhage in (0.7%) and (0.2%) cerebral venous sinus thrombosis. Small vessel disease was the most common cause of ischemic stroke accounting for (46.5%), followed by large artery atherosclerosis (24.5%). Hypertension (82.7%) and diabetes (71.6%) were particularly prevalent in this cohort. Females were older (65.8±14.1 vs 63.4±14.5 years), had more hypertension and diabetes and more disability or death at 90 days (p<0.05) compared to Qatari males. CONCLUSION Stroke occurs at a significantly lower age in Qataris compared to the western population. This study has uncovered sex differences that need to be studied further.
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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
| | - Maher Saqqur
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Faisal Ibrahim
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Jon D. Perkins
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Osama Elalamy
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yasir Osman
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Gayane Malikyan
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Elkhider
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Suha Elmakki
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Lubna ElSheikh
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Noha Mhjob
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Nima Alkhawad
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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Akhtar N, Bhutta Z, Kamran S, Babu B, Jose N, Joseph S, Morgan D, Francis R, Own A, Shuaib A. Stroke Mimics: A five-year follow-up study from the Qatar Stroke Database. J Stroke Cerebrovasc Dis 2020; 29:105110. [PMID: 32912536 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/02/2020] [Accepted: 06/28/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Mimics comprise a third of patients presenting with an acute stroke. There is limited information on their natural history. METHODS We evaluate long term major cardiovascular events (MACE) in stroke mimics in a prospective database from Qatar. RESULTS Between Feb 2014 and Jan 2019, 481 patients (male: 238; female: 243) mean age 57.5 years (±18.0), with 399 (83%) medical mimics and 82 (17%) functional mimics were evaluated. Imaging revealed previous old stroke in 26.6% and small vessel disease in 5%. MACE occurred in 57 (11.9%) and there were 31 deaths (6.4%) with majority of deaths (5.6%) from cardiovascular causes. MACE was significantly higher in patients with previous stroke, p < 0.0001), coronary artery disease, p = 0.002), diabetic, p = 0.01), and hypertensive on admission, p < 0.0001. MACE were also significantly higher in patients where imaging showed a previous stroke, p = 0.006). CONCLUSION The occurrence of MACE during follow-up suggests that patients with existing vascular disease require aggressive management of vascular risk factors.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Zain Bhutta
- Department of Accident and Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Namitha Jose
- 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.
| | - Reny Francis
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Ahmed Own
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Ashfaq Shuaib
- Department of Medicine (Stroke Program), University of Alberta, Edmonton, Alberta, Canada.
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Parray A, Ma Y, Alam M, Akhtar N, Salam A, Mir F, Qadri S, Pananchikkal SV, Priyanka R, Kamran S, Winship IR, Shuaib A. An increase in AMPK/e-NOS signaling and attenuation of MMP-9 may contribute to remote ischemic perconditioning associated neuroprotection in rat model of focal ischemia. Brain Res 2020; 1740:146860. [PMID: 32353433 DOI: 10.1016/j.brainres.2020.146860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/13/2020] [Accepted: 04/25/2020] [Indexed: 12/20/2022]
Abstract
Remote ischemic perconditioning (RIPerC) results in collateral enhancement and a reduction in middle cerebral artery occlusion (MCAO) induced ischemia. RIPerC likely activates multiple metabolic protective mechanisms, including effects on matrix metalloproteinases (MMPs) and protein kinases. Here we explore if RIPerC improves neuroprotection and collateral flow by modifying the activities of MMP-9 and AMPK/e-NOS. Age matched adult male Sprague Dawley rats were subjected to MCAO followed one hour later by RIPerC (3 cycles of 15 min ischemia). Animals were euthanized 24 h post-MCAO. Haematoxylin and Eosin (H&E) staining 24 h post-MCAO revealed a significant (p < 0.02) reduction in the infarction volume in RIPerC treated animals (24.9 ± 5.4%) relative to MCAO controls (42.5 ± 4.2, %). TUNEL staining showed a 42.6% reduction in the apoptotic cells with RIPerC treatment (p < 0.01). Immunoblotting in congruence with RT-PCR and Zymography showed that RIPerC significantly reduced MMP-9 expression and activity in RIPerC + MCAO group compared to MCAO group (218.3 ± 19.1% vs. 148.9 ± 12.05% (p < 0.01). Immunoblotting revealed that RIPerC was associated with a significant 2.5-fold increase in activation of p-AMPK compared to the MCAO group (p < 0.01) which was also associated with a significant increase in the e-NOS activity (p < 0.01). RIPerC resulted in reduction of infarction volume, decreased apoptotic cell death and attenuated MMP-9 activity. This together with the increased activity of p-AMPK and increase in p-eNOS may, in part explain the neuroprotection and sustained increase in blood flow observed with RIPerC following acute stroke.
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Affiliation(s)
- Aijaz Parray
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Yongli Ma
- Department of Psychiatry, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - Mustafa Alam
- Department of Medicine, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - Naveed Akhtar
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Abdul Salam
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Fayaz Mir
- Qatar Metabolic Institute, Academic Health System, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Shahnaz Qadri
- Department of Sustainability, College of Science and Engineering, Hamad Bin Khalifa University, Education City, Doha, Qatar
| | - Sajitha V Pananchikkal
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Ruth Priyanka
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Saadat Kamran
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Ian R Winship
- Department of Psychiatry, University of Alberta, Edmonton, Alberta T6G 2R3, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - Ashfaq Shuaib
- The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar; Department of Psychiatry, University of Alberta, Edmonton, Alberta T6G 2R3, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta T6G 2R3, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2R3, Canada.
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Kamran S, Singh R, Akhtar N, George P, Salam A, Babu B, Own A, Hamid T, Perkins JD. Left Heart Factors in Embolic Stroke of Undetermined Source in a Multiethnic Asian and North African Cohort. J Am Heart Assoc 2020; 9:e016534. [PMID: 32750304 PMCID: PMC7792276 DOI: 10.1161/jaha.120.016534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Cardiac features diverge in Asians; however, it is not known how these differences relate to embolic stroke of unknown source (ESUS) in Southeast Asian and Eastern Mediterranean regions. Methods and Results A retrospective analysis of prospectively collected acute ischemic stroke data from 2014 to 2018 was performed. Stroke subtypes were noncardioembolic stroke (large‐vessel and small‐vessel disease; n=1348), cardioembolic stroke (n=532), and ESUS (n=656). Subtypes were compared by demographic, clinical, and echocardiographic factors. In multivariate logistic regression, patients with ESUS in comparison with noncardioembolic stroke were twice as likely to have left ventricular diastolic dysfunction (P=0.001), 3 times the odds of global hypokinesia (P=0.001), and >7 times the odds of left ventricular wall motion abnormalities (P=0.001). In the second model comparing ESUS with cardioembolic stroke, patients with ESUS were 3 times more likely to have left ventricular wall motion abnormalities (P=0.001) and 1.5 times more likely to have left ventricular diastolic dysfunction grade I (P=0.009), and 3 times more likely to have left ventricular diastolic dysfunction grades II and III (P=0.009), whereas age (P=0.001) and left atrial volume index (P=0.004) showed an inverse relation with ESUS. ESUS in patients ≥61 years old had higher levels of traditional risk factors such as coronary artery disease, but the coronary artery disease was not significantly different in ESUS age groups (P=0.80) despite higher left ventricular wall motion abnormalities (P=0.001). Conclusions Patients with ESUS and noncardioembolic stroke were younger than patients with cardioembolic stroke. While a third of the patients with ESUS >45 years old had coronary artery disease, it was unrecognized or underreported in the older ESUS age group (≥61 years old). In patients with ESUS from Southeast Asia and Eastern Mediterranean regions, left ventricular wall motion abnormalities and left ventricular diastolic dysfunction were related to ESUS.
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Affiliation(s)
- Saadat Kamran
- Neuroscience Institute Hamad General Hospital Doha Qatar.,Weill Cornell Medicine Doha Qatar
| | - Rajvir Singh
- Acute Care Surgery Department Hamad General Hospital Doha Qatar
| | - Naveed Akhtar
- Neuroscience Institute Hamad General Hospital Doha Qatar.,Weill Cornell Medicine Doha Qatar
| | - Pooja George
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Abdul Salam
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Blessy Babu
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Ahmed Own
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Tahir Hamid
- Heart Hospital Hamad Medical Corporation Doha Qatar
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Imam YZ, Mohamed MF, Abdelmoneim MS, Santos M, Alkhawad N, Salam A, Amir N, Saqqur M, Muhammad A, Elsoutohy A, Kamran S, Akhtar N, Kiliyanni AS, Own A, Deleu D, Shuaib A. Prospective study to optimize the health of patients with TIAS (transient ischemic attack) and stroke admitted to the Hamad General Hospital. Medicine (Baltimore) 2020; 99:e20694. [PMID: 32664066 PMCID: PMC7360328 DOI: 10.1097/md.0000000000020694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Recurrent ischemic strokes (IS) make up to one-third of all strokes. Nine out of 10 strokes are due to modifiable risk factors. Thus, it seems that standard management strategies of modifiable risk factors are yet to improve. Hence, we planned a randomized controlled trial assessing nurses or pharmacists-led aggressive control of comorbidities and their prognostic impact on IS and transient ischemic attacks (TIA). METHODS/DESIGN Prospective study to optimize the health of patients with TIAs and stroke admitted to the Hamad General Hospital (PROMOTE HEALTH) is an assessor-blinded, open-label, randomized, two-arm, controlled trial. Eligible patients have IS or TIA, and an additional modifiable risk factor (Hypertension or dyslipidemia) attending the stroke ward or clinic at the Weill Cornell-affiliated Hamad General Hospital. Stroke specialists will offer the control group the currently practiced best risk factor management strategies. Whereas, in the intervention arm, with the assistance of a nurse and a pharmacist, we will make aggressive attempts to meet targets of defined risk factors. The primary outcomes are the mean difference in blood pressure (BP) and low-density lipoprotein. Whereas myocardial infarction, recurrent stroke events, and mortality serve as the study's secondary outcomes. We require 200 patients per study arm to achieve a power of 80% and an alpha level of <0.05. The Medical Research Center and the Institutional Review Board have approved the study, and it was prospectively registered in a trial registry. DISCUSSION A significant proportion of strokes are due to modifiable preventable risk factors. Despite having the right preventive strategies aimed at mitigating these risk factors, a sizeable proportion of strokes are due to recurring events. This prompted the medical community to evaluate aggressive means of addressing these risk factors. The nurse or pharmacist-led management of comorbidities has been proven to be of value in the management of diabetes and hypertension. It will be of value to demonstrate the effectiveness of utilizing this additional task force in aggressively managing IS or TIA patients with an overarching goal of improving their prognosis. If our intervention proves to be efficacious, this would have a substantial impact on the current stroke practices and guidelines. Additionally, it will invite further research in the area. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT02868723, last updated on September 2018.
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Affiliation(s)
- Yahia Z. Imam
- Neuroscience Institute, Hamad Medical Corporation
- Weill Cornell Medicine-Qatar
| | | | | | - Mark Santos
- Neuroscience Institute, Hamad Medical Corporation
| | | | - Abdul Salam
- Neuroscience Institute, Hamad Medical Corporation
| | - Numan Amir
- Neuroscience Institute, Hamad Medical Corporation
| | - Maher Saqqur
- Neuroscience Institute, Hamad Medical Corporation
- Weill Cornell Medicine-Qatar
| | - Ahmad Muhammad
- Neuroscience Institute, Hamad Medical Corporation
- Weill Cornell Medicine-Qatar
| | - Ahmed Elsoutohy
- Neuroscience Institute, Hamad Medical Corporation
- Weill Cornell Medicine-Qatar
| | | | | | - Abdul Salim Kiliyanni
- Radiology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroscience Institute, Hamad Medical Corporation
| | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation
- Weill Cornell Medicine-Qatar
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Akhtar N, Kamran S, Elkhider H, Al-Makki S, Mhjob N, ElShiekh L, AlHussain H, Ali M, Khodair R, Wadiwala F, Salam A, Deleu D, Francis R, Shuaib A. Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome. PLoS One 2020; 15:e0231448. [PMID: 32330144 PMCID: PMC7182193 DOI: 10.1371/journal.pone.0231448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/24/2020] [Indexed: 12/02/2022] Open
Abstract
Background and purpose Patients with acute stroke and mild or rapidly improving symptoms frequently show progression. The role of reperfusion treatment in such patients is not clear. We hypothesized that progression was most likely in patients with cortical localization and such patients may benefit from thrombolysis. Material and methods We interrogated Hamad Stroke Database to evaluate 90-days outcome in patients with acute ischemic stroke admitted within 4 hours and a NIHSS score of ≤6. Evaluation was based on localization (lacunar or cortical), multi-model imaging abnormalities and whether they received rt-PA. The 90-day mRS was used to determine outcome. Results During study period 6381 patients were admitted with acute stroke. Mild stroke within 4 hours was diagnosed in 506 [no thrombolysis: 381(lacunar: 213; cortical: 168), thrombolysis: 125 (lacunar: 45; cortical: 80)]. The rt-PA treated patients had significantly higher NIHSS (2.94±3.9 versus 1.28±2.46, p<0.0001), increased rates of complications (16.0% versus 3.9%, p<0.0001) and longer hospital stay (6.05±8.1 versus 3.78±3.6 days; p<0.001). In patients with cortical stroke, intracranial arterial occlusions (11.6% vs 3.9%, p<0.0001) and CTP mismatch (22.2% vs 4.4%, p<0.0001) were more frequent in rt-PA treated patients. Discharge mRS (33.6% versus 13.9%, p<0.001) and 90-days mRS (23.2% versus 11.8%, p = 0.002) was significantly worse in patients with cortical stroke (rt-PA-treated and untreated patients). Conclusions The outcome in patients with mild stroke depends on lesion location (lacunar versus cortical) and severity of symptoms. Patients who receive rt-PA have significantly larger deficits, increased imaging abnormalities and higher rates of hospital complication, explaining the poor outcome in such subjects.
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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
| | - Hisham Elkhider
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Soha Al-Makki
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Noha Mhjob
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Lubna ElShiekh
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Hassan AlHussain
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Musab Ali
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rola Khodair
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Faisal Wadiwala
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Abdul Salam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Dirk Deleu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Reny Francis
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Stroke Program, University of Alberta, Edmonton, Canada
- * E-mail: ,
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Khan A, Akhtar N, Kamran S, Almuhannadi H, Ponirakis G, Petropoulos IN, Babu B, Jose NR, Ibrahim RG, Gad H, Bourke P, Saqqur M, Shuaib A, Malik RA. Corneal confocal microscopy identifies greater corneal nerve damage in patients with a recurrent compared to first ischemic stroke. PLoS One 2020; 15:e0231987. [PMID: 32320450 PMCID: PMC7176137 DOI: 10.1371/journal.pone.0231987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/03/2020] [Indexed: 01/01/2023] Open
Abstract
Objectives Corneal nerve damage may be a surrogate marker for the risk of ischemic stroke. This study was undertaken to determine if there is greater corneal nerve damage in patients with recurrent ischemic stroke. Methods Corneal confocal microscopy (CCM) was used to quantify corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL) and corneal nerve fiber tortuosity (CNFT) in 31 patients with recurrent ischemic stroke, 165 patients with a first acute ischemic stroke and 23 healthy control subjects. Results Triglycerides (P = 0.004, P = 0.017), systolic BP (P = 0.000, P = 0.000), diastolic BP (P = 0.000, P = 0.000) and HbA1c (P = 0.000, P = 0.000) were significantly higher in patients with first and recurrent stroke compared to controls. There was no difference in age, BMI, HbA1c, total cholesterol, triglycerides, LDL, HDL, systolic and diastolic BP between patients with a first and recurrent ischemic stroke. However, CNFD was significantly lower (24.98±7.31 vs 29.07±7.58 vs 37.91±7.13, P<0.05) and CNFT was significantly higher (0.085±0.042 vs 0.064±0.037 vs 0.039±0.022, P<0.05) in patients with recurrent stroke compared to first stroke and healthy controls. CNBD (42.21±24.65 vs 50.46±27.68 vs 87.24±45.85, P<0.001) and CNFL (15.66±5.70, P<0.001 vs 17.38±5.06, P = 0.003) were equally reduced in patients with first and recurrent stroke compared to controls (22.72±5.14). Conclusions Corneal confocal microscopy identified greater corneal nerve fibre loss in patients with recurrent stroke compared to patients with first stroke, despite comparable risk factors. Longitudinal studies are required to determine the prognostic utility of corneal nerve fiber loss in identifying patients at risk of recurrent ischemic stroke.
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Affiliation(s)
- Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Naveed Akhtar
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Blessy Babu
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Namitha R. Jose
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Rumissa G. Ibrahim
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Paula Bourke
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
- Department of Neurology, Stroke Program, University of Alberta, Alberta, Canada
| | - Ashfaq Shuaib
- Department of Neurology, Stroke Program, University of Alberta, Alberta, Canada
| | - Rayaz A. Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- * E-mail:
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Perkins JD, Akhtar N, George P, Salam A, Bandey H, Babu B, Bourke PJ, Kamran S. Prevalence, Characteristics and Risk Factors for Embolic Stroke of Undetermined Source in West and South Asia and North African Population Residing in Qatar. J Stroke Cerebrovasc Dis 2020; 29:104666. [PMID: 32165099 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/08/2020] [Accepted: 01/11/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Embolic stroke of undetermined source (ESUS) is an important contributor to stroke worldwide. Little is known about ESUS in developing parts of the world such as South Asia, West Asia and North Africa despite the high stroke burden in these areas. The purpose of the study was to characterize the prevalence, demographic, risk factor and clinical aspects of ESUS in patients from South Asia, West Asia and North Africa residing in Qatar. METHODS Data were retrospectively collected on 3103 stoke patients. Risk factors and clinical features of the ESUS group were compared to all other strokes using Chi-square or student's t-tests. Logistic regression was used to identify factors associated with ESUS. ESUS patients were compared based on ethnicity using Chi-square or one-way ANOVA. RESULTS 634 patients (30·9%, 95% CI (28·9%-32·9%) met the ESUS criteria. Mean age was 56·3 years ± 13·7 and South Asian ESUS patients were younger than West Asians or North Africans (67·1 ± 13·5 versus 52·1 ± 10·8 versus 53·5 ± 14·2, P = .001). Smoking, diastolic function, prior antiplatelets and wall motion abnormalities were more common in ESUS. Logistic regression showed that South Asian ethnicity (OR 1·50, CI 1·14-1·97, P = ·003), diastolic dysfunction (OR 1·47, CI 1·23-1·75, P = ·005), global (OR 1·79, CI 1·41-2·26, P = ·001) and focal (OR 5·48, CI 3·79-7·92, P = ·001) wall motion abnormalities, predicted ESUS. CONCLUSIONS ESUS is a major cause of stroke in patients from West Asia, South Asia and North Africa residing in Qatar. The clinical profile and risk factors for ESUS vary based on ethnicity. In South Asians, ESUS occurs at a younger age and is most likely cardiogenic in origin.
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Affiliation(s)
- Jon D Perkins
- PMARC, University of Edinburgh, Edinburgh, UK; Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar; Weill Cornell-School of Medicine, Doha, Qatar
| | - Pooja George
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Abdul Salam
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Heba Bandey
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Paula J Bourke
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar; Weill Cornell-School of Medicine, Doha, Qatar.
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Kamran S, Akhtar N, George P, Singh R, Imam Y, Salam A, Babu B, Burke P, Own A, Vattoth S, Perkins J, Parray A, Qadri S, Hamid T. Embolic Pattern of Stroke Associated with Cardiac Wall Motion Abnormalities; Narrowing the Embolic Stroke of Undetermined Source Category. J Stroke Cerebrovasc Dis 2020; 29:104509. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/29/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022] Open
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Akhtar N, Kamran S, Singh R, Bhutta Z, Morgan D, Joseph S, Bourke P, Saqqur M, Imam Y, Amir N, Babu B, Ojha L, Jose N, Shuaib A. Abstract WP352: Factors Affecting Short and Long-Term Outcome of Patients Diagnosed as Stroke Mimic at Index Event. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wp352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Stroke mimics (SM) is a stroke-like clinical picture due to a disease other than cerebrovascular diseases. The causes of SM are diverse. Distinguishing SM from stroke is important to avoid unnecessary acute treatment and secondary prevention. PURPOSE: We hypothesized to evaluate short and long-term outcomes in terms of major adverse cardiovascular events (MACE) in patients who presented with SM.
Methods:
We evaluated a prospective cohort of Qatari patients with confirmed diagnosis of SM who presented to our hospital as suspected acute stroke between January 2014 and February 2019. We investigated the associated risk factors, short- and long-term risk of MACE in these patients. We calculated the modified Rankin score (mRS) at discharge and 90-days (short-term) and MACE (long-term) outcomes. To determine the independent predictor for MACE, the Cox proportional hazards regression analysis was used and summarized as hazard ratio and 95% confidential interval.
Results:
A total of 481 Qatari patients (mean age 57.5 ±18.0; 56.3% male) with diagnosis of SM were identified, of whom 126 (26.2%) patients were found to have MACE during follow up (36.7 months (95% CI 35.5-37.8). Patients who develop MACE were older (62.4 ±17.5 vs 55.7 ±17.9, p<0.001). Hypertension, diabetes and prior stroke and coronary artery disease was significantly more common in patients with MACE. High NIHSS on admission (2.5 ±4.1 vs 1.2 ±3.0, p<0.001), high glucose (7.5 ±2.2 vs 6.8 ±2.0, p= 0.005), lower HDL (1.0 ±0.3 vs 1.2 ±0.3, p<0.001) and extended length of stay at index event (3.9 ±5.6 vs 2.4 ±2.1, p<0.001) was higher in MACE. Patients with MACE had significantly worse outcome at discharge (46.0 vs 23.7%, p<0.001) and at 90-days (38.1 vs 0.4%, p<0.001). Once corrected, the long-term MACE-free survival function did not show any statistical difference between two groups
Conclusions:
Stroke mimics if associated with cardiovascular risk factors carry a poorer short and long-term prognosis after the first presentation. More aggressive reduction of cardiovascular risk may help in preventing such major cardiovascular events.
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Akhtar N, Kamran S, Singh R, Bhutta Z, Morgan D, Joseph S, Bourke P, Saqqur M, Imam Y, Amir N, Babu B, Ojha L, Jose N, Shuaib A. Abstract TP301: Gender Differences in Short- and Long-Term Outcome of Patients With Suspected Acute Stroke. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
There are gender differences in the short-term prognosis following acute stroke suggesting that outcome is less favorable in women. Factors contributing to this poor outcome include preexisting morbidity, stroke severity and higher age. Most previous studies have looked at short-term prognosis. PURPOSE: We investigated whether gender differences have a differential impact on incidence of short-term outcome and long-term major adverse cardiovascular events (MACE) including stroke, myocardial infarction, unstable angina, coronary revascularization procedure, and death in patients with suspected acute stroke.
Methods:
The study used a prospective cohort of Qatari patients with suspected acute stroke between January 2014 and February 2019. We calculated the modified Rankin score (mRS) at discharge and 90-days (short-term) and MACE (long-term) outcomes in both genders. To determine the independent predictor for MACE, the Cox proportional hazards regression analysis was used and summarized as hazard ratio and 95% confidential interval.
Results:
A total of 1372 patients identified. At 90-days, women found to have significantly poorer outcome (34.0% vs 23.4%, p<0.001) mortality (8.5% vs 5.2%, p<0.03) overall. MACE was present in 30.5% (418/1372) during follow-up (57.2% males and 54.3% females, p=0.32). Median follow-up was 44.6 months for females and 47.2 months for males. Mean age in MACE group was significantly higher (65.5±15.3 vs 60.1±15.9, p< 0.001). Hypertension, diabetes, prior history of stroke, coronary artery disease, and atrial fibrillation on admission was more significant in MACE group, while obesity (BMI ≥ 30 kg/m2) was more common in non-MACE group. Patients with MACE had higher NIHSS on admission (6.1±7.4 vs 3.5±5.3, p<0.001), HbA1c (7.7±2.3 vs 7.4±2.3, p=0.02) and poorer prognosis (44.5% vs 18.6%, p<0.001) and higher mortality at 90-days. Once corrected, the hazard regression analysis showed that no difference in MACE between the two genders.
Conclusion:
Our results show that despite higher mortality and poor outcome at 90-days, the long-term outcome in women did not show any significant difference from men in this cohort. This may be related to older age and presence of cardiovascular risk factors.
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Affiliation(s)
| | | | | | - Zain Bhutta
- Neuroscience Dept, Hamad Med Corp, Doha, Qatar
| | | | | | | | | | - Yahia Imam
- Neuroscience Dept, Hamad Med Corp, Doha, Qatar
| | - Numan Amir
- Neuroscience Dept, Hamad Med Corp, Doha, Qatar
| | - Blessy Babu
- Neuroscience Dept, Hamad Med Corp, Doha, Qatar
| | - Laxmi Ojha
- Neuroscience Dept, Hamad Med Corp, Doha, Qatar
| | | | - Ashfaq Shuaib
- Neuroscience Dept, Univ of Alberta, Edmonton, Canada
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Kamran S, Khan A, Salam A, Akhtar N, Petropoulos I, Ponirakis G, Babu B, George P, Shuaib A, Malik RA. Cornea: A Window to White Matter Changes in Stroke; Corneal Confocal Microscopy a Surrogate Marker for the Presence and Severity of White Matter Hyperintensities in Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:104543. [PMID: 31902645 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/14/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The presence of white matter hyperintensities (WMH) on MRI imaging confers an increased risk of stroke, dementia, and death. Corneal confocal microscopy (CCM) can detect nerve injury non-invasively and may be a useful surrogate marker for WMH. The objective is to determine whether corneal nerve pathology identified using CCM is associated with the presence of WMH in patients with acute ischemic stroke. METHODS This is a cross-sectional study where 196 consecutive individuals with acute ischemic stroke were enrolled and underwent neurological examination, MRI brain imaging and CCM. Participants underwent blinded quantification of WMH and corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL). RESULTS The prevalence of hypertension [P = .013] was significantly higher and CNFD [P = .031] was significantly lower in patients with WMH compared to those without WMH. CNFD and CNFL were significantly lower in patients with DM without WMH [P = .008, P = .019] and in patients with DM and WMH [P = .042, P = .024] compared to patients without DM or WMH, respectively. In a multivariate model, a 1-unit decrease in the CNFD increased the risk of WMH by 6%, after adjusting for age, DM, gender, dyslipidemia, metabolic syndrome, smoking, and HbA1c. DM was associated with a decrease in all CCM parameters but was not a significant independent factor associated with WMH. CONCLUSIONS CCM demonstrates corneal nerve pathology, which is associated with the presence of WMH in participants with acute ischemic stroke. CCM may be a useful surrogate imaging marker for the presence and severity of WMHs.
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Affiliation(s)
- Saadat Kamran
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar; Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.
| | - Adnan Khan
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Abdul Salam
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar; Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Blessy Babu
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Pooja George
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
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Kamran S, Akhtar N, Salam A, Alboudi A, Kamran K, Imam YB, Amir N, Ali M, Haroon KH, Muhammad A, Ahmad A, Ayyad A, Elalamy O, Inshasi J, Shuaib A. CT pattern of Infarct location and not infarct volume determines outcome after decompressive hemicraniectomy for Malignant Middle Cerebral Artery Stroke. Sci Rep 2019; 9:17090. [PMID: 31745169 PMCID: PMC6863897 DOI: 10.1038/s41598-019-53556-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/04/2019] [Indexed: 11/25/2022] Open
Abstract
Malignant middle cerebral artery [MMCA] infarction has a different topographic distribution that might confound the relationship between lesion volume and outcome. Retrospective study to determine the multivariable relationship between computerized tomographic [CT] infarct location, volume and outcomes in decompressive hemicraniectomy [DHC] for MMCA infarction. The MCA infarctions were classified into four subgroups by CT, subtotal, complete MCA [co-MCA], Subtotal MCA with additional infarction [Subtotal MCAAI] and co-MCA with additional infarction [Co-MCAAI]. Maximum infarct volume [MIV] was measured on the pre-operative CT. Functional outcome was measured by the modified Rankin Scale [mRS] dichotomized as favourable 0–3 and unfavourable ≥4, at three months. In 137 patients, from least favourable to favourable outcome were co-MCAAI, subtotal MCAAI, co-MCA and subtotal MCA infarction. Co-MCAAI had the worst outcome, 56/57 patients with additional infarction had mRS ≥ 4. Multiple comparisons Scheffe test showed no significant difference in MIV of subtotal infarction, co-MCA, Subtotal MCAAI but the outcome was significantly different. Multivariate analysis confirmed MCAAI [7.027 (2.56–19.28), p = 0.000] as the most significant predictor of poor outcomes whereas MIV was not significant [OR, 0.99 (0.99–01.00), p = 0.594]. Other significant independent predictors were age ≥ 55 years 12.14 (2.60–56.02), p = 0.001 and uncal herniation 4.98(1.53–16.19), p = 0.007]. Our data shows the contribution of CT infarction location in determining the functional outcome after DHC. Subgroups of patients undergoing DHC had different outcomes despite comparable infarction volumes.
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Affiliation(s)
- Saadat Kamran
- Neuroscience Institute (Stroke Center of Excellence), Weil Cornell School of Medicine, Doha, Qatar. .,Hamad Medical Corporation, Doha, Qatar, Weil Cornell School of Medicine, Doha, Qatar.
| | - Naveed Akhtar
- Neuroscience Institute (Stroke Center of Excellence), Weil Cornell School of Medicine, Doha, Qatar.,Hamad Medical Corporation, Doha, Qatar, Weil Cornell School of Medicine, Doha, Qatar
| | - Abdul Salam
- Neuroscience Institute (Stroke Center of Excellence), Weil Cornell School of Medicine, Doha, Qatar
| | | | - Kainat Kamran
- School of Liberal Arts, University of Illinois, Chicago, USA
| | - Yahiya Bashir Imam
- Neuroscience Institute (Stroke Center of Excellence), Weil Cornell School of Medicine, Doha, Qatar
| | - Numan Amir
- Neuroscience Institute (Stroke Center of Excellence), Weil Cornell School of Medicine, Doha, Qatar
| | - Musab Ali
- Neuroscience Institute (Stroke Center of Excellence), Weil Cornell School of Medicine, Doha, Qatar
| | - Khawaja Hasan Haroon
- Neuroscience Institute (Stroke Center of Excellence), Weil Cornell School of Medicine, Doha, Qatar
| | - Ahmad Muhammad
- Neuroscience Institute (Stroke Center of Excellence), Weil Cornell School of Medicine, Doha, Qatar
| | | | - Ali Ayyad
- Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany
| | - Osama Elalamy
- Neuroscience Institute (Stroke Center of Excellence), Weil Cornell School of Medicine, Doha, Qatar
| | | | - Ashfaq Shuaib
- Neuroscience Institute (Stroke Center of Excellence), Weil Cornell School of Medicine, Doha, Qatar
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Salam A, Kamran S, Bibi R, Korashy HM, Parray A, Mannai AA, Ansari AA, Kanikicharla KK, Gashi AZ, Shuaib A. Meteorological Factors and Seasonal Stroke Rates: A Four-year Comprehensive Study. J Stroke Cerebrovasc Dis 2019; 28:2324-2331. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/05/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022] Open
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