Clinical and pathogenetic approaches to early rehabilitation of ischaemic stroke patients

Stroke is the most important medical and social problem, both worldwide and in Uzbekistan, owing to its high morbidity, mortality and disability rates. Uzbekistan's official statistical authorities consider cerebrovascular disease (CVD) to be a single nosological form, without distinguishing it from stroke. Given that the structure of CVDs includes both acute cerebrovascular disorders (ACS) (various types and subtypes of ischemic and hemorrhagic stroke) and chronic CVDs (various forms of so-called dyscirculatory encephalopathy), reliable epidemiological data on stroke prevalence in Uzbekistan are not available. According to the Ministry of Health of the Republic of Uzbekistan, there were 62876 cases of stroke in Uzbekistan in 2019. 15% were fatal, 10-15% relapsed and 55-70% became disabled.

Representation of Women in Stroke Clinical Trials: A Review of 281 Trials Involving More Than 500,000 Participants

Objective:Women have been under-represented in clinical trials areas of cardiovascular disease but there is less certainty over the level of disparity specifically in stroke. We examined the participation of women in trials according to stroke prevalence in the population.Methods:Published randomized controlled trials with ≥100 participants enrolled between 1990 and 2020 were identified from ClinicalTrials.gov. To quantify sex disparites in enrolment we calculated the participation to prevalence ratio (PPR), defined as the percentage of women participating in a trial against the prevalence of women in the disease population.Results:There were 281 stroke trials eligible for analyses with a total of 588,887 participants, of whom 37.4 % were women. Overall, women were represented at a lower proportion relative to their prevalence in the underlying population (mean PPR 0.84; 95% confidence interval [CI] (0.81 to 0.87)). The greatest differences were observed in trials of intracerebral hemorrhage (PPR 0.73; 95% CI 0.71 to 0.74), trials with a mean age of participants <70 years (PPR 0.81; 95% CI (0.78 to 0.84)), non-acute interventions (PPR 0.80; 95% CI (0.76 to 0.84)) and rehabilitation trials (PPR 0.77; 95% CI 0.71 to 0.83)). These findings did not significantly change over the period from 1990 to 2020 (p for trend = 0.201).Conclusion:Women are disproportionately underrepresented in stroke trials relative to the burden of disease in the population. Clear guidance and effective implementation strategies are required to improve the inclusion of women and thus broader knowledge of the impact of interventions in clinical trials.

Comparison the Impact on TENS and Conventional Physiotherapy in Stroke Patients with Upper Limb Dysfunctions: A Research Protocol

Background: Stroke is a sudden neurological explosion resulting from poor blood flow perfusion to the brain. Stroke prevalence rates in India are expected to range from eighty-four to two hundred sixty-two strokes every 100,000 persons in remote regions and from three hundred thirty-four to four hundred twenty-four strokes every 100,000 persons in metropolitan areas. It causes brain cells to die abruptly due to inadequate oxygen and is a neurological condition characterized by blood flow blockage. Aim & Objective: to examine the impact of TENS (Transcutaneous Electrical Nerve Stimulation), EMS (Electrical Muscle Stimulation), and ROM (Range of Motion) exercises on upper-limb functioning in hemi paretic stroke victims. Methods: The current study subjects (n=39) would be stroke survivors. Patients will be divided into three groups: group A will receive TENS, group B will receive EMS, and group C will get ROM exercises. The protocol will cover 2 weeks of treatment. We will assess upper limb functioning, activities of everyday living (ADLs), and mental condition at frequent intervals. By using the MHQ (Michigan Hand Outcomes Questionnaire), Hand Grip Strength (HGS), Brunnstrom Hand Function Recovery stages. Results: The successful completion of this study will provide evidence on the best treatment strategy for stroke patients to improve their upper extremity motor function using individual TENS, EMS, or ROM exercises. Conclusion: This study will be beneficial to treat Stroke patients with upper limb dysfunction by treating by TENS modality which might be an option for EMS treatment.

Shedding Light on the Causes and Characteristics of Stroke in Lebanon: A Systematic Review of Literature

Background: The prevalence and severity of stroke in Lebanon has increased over the past decade and stroke is currently the second leading cause of death in the country. Methods: We systematically reviewed existing research on stroke prevalence, risk factors, mortality and morbidity of stroke, stroke treatment, and stroke education to assess the epidemiology of stroke in Lebanon. A literature search was conducted on the PubMed database for articles presenting data in any of these 5 categories in Lebanon, as well as articles discussing the Middle East and North Africa region generally. Results: A high prevalence of modifiable risk factors (cigarette and waterpipe smoking) and risk factors that could be mitigated by lifestyle changes (obesity and hypertension) were found in Lebanon. Stroke mortality rates and risk factors of mortality were consistent with global trends, though the cost of treatment in Lebanon was significantly higher than in other developing nations. Conclusion: Urgent public health initiatives are needed to educate the public about the dangers of modifiable stroke risk factors and to reduce the burden of stroke in Lebanon.

Prevalence of stroke survival in rural communities living in northern Peru

Background and purpose Stroke is the leading cause of neurological impairment in the South American Andean region. However, the epidemiology of stroke in the region has been poorly characterized. Methods We conducted a staged three-phase population-based study applying a validated eight-question neurological survey in 80 rural villages in Tumbes, northern Peru, then confirmed presence or absence of stroke through a neurologist’s examination to estimate the prevalence of stroke. Results Our survey covered 90% of the population (22,278/24,854 individuals, mean age 30±21.28, 48.45% females), and prevalence of stroke was 7.05/1,000 inhabitants. After direct standardization to WHO’s world standard population, adjusted prevalence of stroke was 6.94/1,000 inhabitants. Participants aged ≥85 years had higher stroke prevalence (>50/1000 inhabitants) compared to other stratified ages, and some unusual cases of stroke were found among individuals aged 25–34 years. The lowest age reported for a first stroke event was 16.8 years. High blood pressure (aPR 4.2 [2.7–6.4], p>0.001), and sedentary lifestyle (aPR 1.6 [1.0–2.6], p = 0.045) were more prevalent in people with stroke. Conclusions The age-standardized prevalence of stroke in this rural coastal Peruvian population was slightly higher than previously reported in studies from surrounding rural South American settings, but lower than in rural African and Asian regions. The death rate from stroke was much higher than in industrialized and middle-income countries.

Endovascular Treatment in Acute Ischemic Stroke Adoption and Practice: A Single-Center Indonesian Experience

Indonesia is facing increasing stroke prevalence in the past 5 years. Ischemic stroke imposes economic and productivity burden if it is not addressed properly. Endovascular treatment studies are conducted in developed countries where facilities and cost do not count in therapy consideration if it is indicated. Developing countries like Indonesia should work hard to provide the best hyperacute stroke care with protocol deviation and limitation. This is the first review on endovascular treatment practice in a top single-center hospital in Indonesia. Further improvement is needed to catch up with state-of-the-art hyperacute ischemic stroke treatment.

Prevalence and Risk Factors of Stroke in Bangladesh: A Nationwide Population-Based Survey

BackgroundThis community survey was conducted to estimate the prevalence of stroke and its associated common risk factors among the Bangladeshi population.MethodsThis was a population-based cross-sectional study, carried out in 8 administrative divisions and 64 districts to estimate the prevalence of stroke throughout the country. The study adopted a two-stage cluster random sampling approach. The calculated sample size was 25,287. A semi-structured questionnaire was used to identify suspected stroke patients who were subsequently confirmed by consultant neurologists.ResultIn the first stage, Interviewers identified 561 respondents as suspected stroke in 64 districts. Of the 25,287 respondents, 54.9% were male. The mean age was 39.9 years. In the second stage of the study; among all the respondents, 288 were confirmed as stroke patients which provided a prevalence of 11.39 per 1000 population. The highest stroke prevalence (14.71 per thousand) was found in the Mymensingh division and the lowest (7.62 per thousand) found in the Rajshahi division. It was 30.10 per thousand in the age group of more than 60 years. The prevalence of stroke among males was twice that of females (13.62 versus 8.68 per thousand). The prevalence was slightly higher in rural areas (11.85 versus 11.07). Out of a total of 288 cases, 79.7% (213) patients had an ischemic stroke, 15.7% (42) had hemorrhagic, and 4.6% (12) were diagnosed as subarachnoid hemorrhage. The majority of the stroke patients had hypertension (79.2%), followed by dyslipidemia (38.9%), tobacco use in any form (37.2%), diabetes (28.8%), ischemic heart disease (20.1%).ConclusionWe have found a stroke prevalence of 11.39 per 1000 population, the highest being in the Mymensingh division. The prevalence was much higher in the elderly and male population. More than three fourth had an ischemic stroke. Hypertension, dyslipidemia, tobacco use, diabetes, ischemic heart disease are the most common risk factors observed among stroke patients.Summary BoxAlready Known:▪The prevalence of stroke in Bangladesh was found to be 3 per thousand.▪Hypertension, diabetes, dyslipidemia, smoking, and ischemic heart disease were common risk factors.New Findings:▪This is the first-ever nationwide survey in Bangladesh that revealed a stroke prevalence of 11.39 per thousand.▪There was a wide regional variation of stroke prevalence.▪The prevalence was twice among males.Impact of the study result:▪The study result will help the policymakers in deciding what to do for which regions of this country to handle the stroke burden.▪It will also help the clinicians to identify common risk factors among stroke patients.

Metabolic Syndrome in Patients With First-ever Ischemic Stroke: Prevalence and Association With Coronary Heart Disease

Background: Most studies of metabolic syndrome (MetS) and coronary heart disease (CHD) have been carried out in the general population, and their association among stroke patients has been rarely explored. We seek to describe the prevalence of MetS among patients with acute ischemic stroke and to assess its association with CHD. Methods: This hospital-based study included 1851 patients with first-ever acute ischaemic stroke (mean age 61.2 years, 36.5% women) who were hospitalized into two university hospitals in Shandong, China (January 2016-February 2017). Data were collected through interviews, physical examinations, and laboratory tests. MetS was defined following the National Cholesterol Education Program (NCEP) criteria, the International Diabetes Federation (IDF) criteria, and the Chinese Diabetes Society (CDS) criteria. CHD was defined according to clinical and electrocardiogram examinations. Binary logistic regression was performed to determine the associations between MetS and CHD. Results: The overall prevalence of MetS was 34.0% by NECP criteria, 47.8% by IDF criteria, and 32.9% by CDS criteria. The prevalence of MetS decreased with age and was higher in women than men (p<0.05). Abdominal obesity, high blood pressure, high triglycerides, and low HDL-C were significantly associated with CHD (multi-adjusted OR range: 1.27-1.43, p<0.05). Compared with those without MetS, the multi-adjusted OR (95% CI) of CHD associated with MetS defined by the NECP criteria, IDF criteria, and CDS criteria was 1.29 (1.04-1.59), 1.46 (1.20-1.78), and 1.29 (1.05-1.59), respectively. In addition, having 1-2 abnormal components (vs. none) was associated with CHD (OR range: 1.63-1.73, p<0.05). Conclusions: MetS affects over one-third of patients with first-ever ischemic stroke. MetS is associated with an increased likelihood of CHD in stroke patients, but treating MetS as a binary entity would underestimate its association with CHD.

Abstract P873: Structural Racism in Columbus, Ohio Associated With Stroke Prevalence

Introduction: Racial disparities exist in stroke and stroke outcomes. However, the fundamental cause for these disparities are not biological differences, but structural racism. Using the Home Owners’ Loan Corporation (HOLC) ‘redlining’ scores, as indicator of structural lending practices from middle of the last century, we hypothesize that census tracts with high historic redlining are associated with higher stroke prevalence. Methods: Weighted historic redlining scores (HRS) were calculated using the proportion of 1930s HOLC residential security grades contained within 2010 census tract boundaries of Columbus, Ohio. Stroke prevalence (adults >=18) was obtained at the census tract-level from the CDC’s 500 Cities Project. Sociodemographic factors, as measured by census tract level information (American Community Survey 2014-2018), were considered mediators in the causal association between historic redlining (measured in 1936) and stroke prevalence (measured in 2017) and were not controlled for in regression analysis. The functional form of the association was non-linear, so stroke prevalence within quartiles of the HRS were compared using linear regression instead of a continuous score. Results: Higher HRS, representing greater redlining, were associated with greater prevalence of stroke when comparing the highest to the lowest quartile of HRS (Figure). Census tracts in the highest quartile of HRS had 1.48% higher stroke prevalence compared to those in the lowest quartile (95% CI: 0.23-2.74). No other interquartile differences were observed. Conclusions: Historic redlining practices are a form of structural racism that established geographic systems of disadvantage and consequently, poor health outcomes. Our findings demonstrate disparate stroke prevalence by degree of historic redlining in census tracts across Columbus, Ohio. While ecologic, this study demonstrates the need to acknowledge that racism, not race, drive stroke disparities.

Abstract P888: Is There a Racial/Ethnic Disparity Among Stroke Patients With Covid-19?

Background and Purpose: Cerebrovascular prevalence is high in patients with coronavirus disease 2019 (COVID-19). However, racial disparities have not been systematically explored in this population. Methods: We performed a retrospective, observational study of stroke prevalence in all patients with COVID-19 who visited emergency department (ED) up to August 13, 2020 in the United States. We used multivariable logistic regression to compare the odds of stroke in black patients with COVID-19 compared to their non-black counterpart while adjusting for the major confounders. Results: Among 8815 patients with ED visits with COVID-19, 77 (0.87 %) had ischemic stroke. The median age of patients with stroke was 64 years (SD: 2 years); 28 (43%) were men, 55 (71%) had hypertension, and 29 (50%) were black. After adjustment for age, sex, hypertension, diabetes, obesity, drinking and smoking, the likelihood of stroke was higher in black than non-black patients (adjusted odds ratio, 2.76; 95% CI, 1.13-7.15, p=0.03). Conclusions: Racial disparities in the prevalence of stroke among patients with COVID-19 exist, with blacks carrying greatest burden.