Recent advances in management of cerebrovascular diseases

A comprehensive approach to managing the vascular risk factors in both primary and secondary stroke prevention settings can lower the risk of first and recurrent stroke. Recent studies highlight the benefits of blood pressure treatment in the elderly, use of statins in healthy subjects with normal low-density lipoprotein levels, and comparison of various anti-platelet agents. For acute stroke the efficacy of thrombolysis beyond 3 hours has recently been shown

Epidemiology and outcomes of out-of-hospital cardiac arrest in Qatar : A nationwide observational study

This is a pre-copyedited, author-produced pdf of an article accepted for publication in International Journal of Cardiology following peer review. The version of record, 'Epidemiology and outcomes of out-of-hospital cardiac arrest in Qatar: A nationwide observational study', F. B. Irfan, et.a., International Journal of Cardiology, Vol 223, pp 1007-1013, November 2016, first published on line on August 24, 2016, is available on line via doi: http;//dx.doi.org/10.1016/j.ijcard.2016.08.299 © 2016 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Background Out-of-hospital cardiac arrest (OHCA) studies from the Middle East and Asian region are limited. This study describes the epidemiology, emergency health services, and outcomes of OHCA in Qatar. Methods This was a prospective nationwide population-based observational study on OHCA patients in Qatar according to Utstein style guidelines, from June 2012 to May 2013. Data was collected from various sources; the national emergency medical service, 4 emergency departments, and 8 public hospitals. Results The annual crude incidence of presumed cardiac OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence was 87.8 per 100,000 population. Of the 447 OHCA patients included in the final analysis, most were male (n = 360, 80.5%) with median age of 51 years (IQR = 39–66). Frequently observed nationalities were Qatari (n = 89, 19.9%), Indian (n = 74, 16.6%) and Nepalese (n = 52, 11.6%). Bystander cardiopulmonary resuscitation (CPR) was carried out in 92 (20.6%) OHCA patients. Survival rate was 8.1% (n = 36) and multivariable logistic regression indicated that initial shockable rhythm (OR 13.4, 95% CI 5.4–33.3, p = 0.001) was associated with higher odds of survival while male gender (OR 0.27, 95% CI 0.1–0.8, p = 0.01) and advanced cardiac life support (ACLS) (OR 0.15, 95% CI 0.04–0.5, p = 0.02) were associated with lower odds of survival. Conclusions Standardized incidence and survival rates were comparable to Western countries. Although expatriates comprise more than 80% of the population, Qataris contributed 20% of the total cardiac arrests observed. There are significant opportunities to improve outcomes, including community-based CPR and defibrillation training.Peer reviewe

High Resting Heart Rate Is Associated with Cardiovascular Death in Patients with Stroke, Independent of Sex

INTRODUCTION: High resting heart rate (HRHR) is a surrogate marker of increased sympathetic outflow. In acute stroke patients, HRHR is more commonly observed in women than in men. We analyzed whether HRHR (>86 bpm) adds incremental prognostic value for stroke outcomes in women. METHODS: We analyzed data of 6,024 patients (2,568 women, mean age 68.98 years) with acute ischemic stroke from the Virtual International Stroke Trials Archive (VISTA). RESULTS: Patients with HRHR were more often female (45.3 vs. 41.8%, p = 0.017), younger (66.0 ± 13.2 vs. 67.8 ± 12.6 years, p < 0.001), had higher baseline systolic blood pressure and more often diabetes. The primary composite endpoint of recurrent ischemic stroke, transient ischemic attack, myocardial infarction, or cardiovascular death within 90 days occurred more often in patients with HRHR (19.3 vs. 14.6%, p < 0.001). HRHR was associated with worse functional outcome at 90 days as assessed by modified Rankin Scale (mRS90: 3.03 ± 1.98 vs. 2.82 ± 1.94, p = 0.001). As exclusion of deceased patients (mRS90 of 6) resulted in a loss of association of HRHR with mRS90, it can be assumed that HRHR is mainly associated with poststroke vascular mortality, but not disability. Female sex was not associated with the primary endpoint but with adverse functional outcome measured by mRS90. CONCLUSION: HRHR was associated with adverse events and mortality after stroke. Despite a higher prevalence of HRHR in women, they did not reach the primary endpoint more often. However, women had a worse functional outcome (mRS) 3 months after stroke, independent of HRHR

There Is Selective Increase in Pro-thrombotic Circulating Extracellular Vesicles in Acute Ischemic Stroke and Transient Ischemic Attack: A Study of Patients From the Middle East and Southeast Asia.

Stroke attacks were found to be present at a younger age in patients from Southeast Asia (SE) and the Middle East (ME) resident in the state of Qatar. Extracellular vesicles (EVs), which are small membrane vesicles with pro-thrombotic properties, may contribute to the high risk of stroke in this population. Thus, total and cell-specific medium size EVs were counted by flow cytometry in platelet-free plasma from healthy volunteers and patients with transient ischemic attacks (TIA) and acute ischemic stroke (AIS) from SE and ME. Acutely, within 48 h of attacks, there was an increase in total endothelial EVs in TIA (6.73 ± 1.77; = 0.0156; = 21) and AIS (11.23 ± 1.95; = 0.0007; = 66) patients compared to controls (2.04 ± 0.78; = 24). Similar increases were also evident in EVs originating from platelets, erythrocytes, granulocytes, and leukocytes. Compared to controls, there was also an increase in EVs derived from activated endothelial cells, platelets, granulocytes, leukocytes, and pro-coagulant EVs (Annexin V) at 5 and 30-days following the acute events, while a decrease was observed in erythrocyte-derived EVs. This is the first study characterizing EVs in TIA and AIS patients from ME and SE showing an increase in EVs associated with endothelial and platelet cell activation, which may contribute to the elevated risk of stroke at a younger age in this population.Qatar University high collaborative grant (QUCG-CPH-2018\2019-2

Editorial: Remote Ischemic Conditioning (Pre, Per, and Post) as an Emerging Strategy of Neuroprotection in Ischemic Stroke

EDITORIAL articleThis study was funded by Carlos III Health Institute and cofunded by European Union (ERDF A way to make Europe) Project (PI17-01725) and the RICORS Research Network to FP, NIH Funding (R01 NS099455, 1UO1NS113356, and R01 NS112511) to DH, Italian Ministry of Health - PRIN 2017CY3J3W to SB. French National Minsitry of Health Grant 2014 AOR13032 to FP, TE is the Chief Investigator for the Remote ischaemic conditioning after stroke trial (RECAST), RECAST-2, and RECAST-3 funded through the NIHR Efficacy and Mechanism Evaluation (EME) Programme, Award ID NIHR128240

Short-term functional outcomes of patients with acute intracerebral hemorrhage in the native and expatriate population

ObjectivesFunctional outcomes in patients with intracerebral hemorrhage (ICH) have not been well characterized in the Middle East and North Africa Region. We report the 30 and 90-day clinical outcomes in the native and expatriate of Qatar with ICH.MethodsWe evaluated the Glasgow Coma Scale (GCS), NIHSS, and imaging in the Qatar Stroke Registry (2013–22). The outcome measures were a modified Rankin Scale (mRS) at 90 days and mortality at 30 and 90 days. Unfavorable outcome was defined as mRS of 4–6. We performed non-parametric ROC analyses to measure the concordance index (C-index) to assess the goodness-of-fit of ICH score for predicting 30 day and 90-day mortality and functional outcome.Results1,660 patients (median age of 49 (41.5–58) years; male 83.1%, expatriates 77.5%) with ICH, including supratentorial deep in 65.2%, cortical in 16.2%, infratentorial 16% and primary intraventricular in 2.5% were studied. The median baseline ICH volume was 7.5 (3.2–15.8) ml. An unfavorable outcome was seen in 673 (40.5%) patients at 90 days. The unfavorable 90-day outcome (mRS 4–6) was 49.2% in the native population vs. 44.4% in Africans, 39.0% in South Asian, 35.3% in Far Eastern, and 7.7% in Caucasians, p < 0.001. Mortality at 30 days and 90 days was 10.4 and 15.1%. Increasing age [OR (95% CI), 1.02 (1.00–1.03)], lower GCS [0.77 (0.73–0.80)], prior use of antiplatelet medications [1.82 (1.19–2.08)], higher ICH volume [1.03 (1.02–1.04)], and presence of any intraventricular hemorrhage [1.57(1.19–2.08)], were associated with unfavorable outcome.ConclusionIn this relatively younger ICH cohort more than 75% were expatriates. The ICH volume, 90-day unfavorable outcome and mortality was lower in the expatriates compared to the local Arab population, likely related to the younger age and smaller size of the hemorrhages. Prognostic scoring systems may have to be modified in this population to avoid early withdrawal of care

Ethnic differences in out-of-hospital cardiac arrest among Middle Eastern Arabs and North African populations living in Qatar

Peer reviewe