Ischemic stroke in Morocco: A systematic review

Abstract Background: To main objective of this systematic review is to determine; the epidemiological and the etiological profile, the influential factors of the prehospital delay, thrombolysis management, the acute and 3-month mortality rate and the genetic aspect of ischemic stroke in Morocco.Methods: A systematic review was conducted according to the recommendations of the "Preferred reporting items for systematic reviews and meta-analyses" (PRISMA) through the consultation of the Pubmed, Sciencedirect, Scopus, Clinicalkey, and Google scholar databases for the raking of the gray literature during the period between 2009 and 2018. The protocol of the review was registered in the PROSPERO register (CRD42018115206).These studies were assessed based on: Age, sex ratio, risk factors, etiological profile according to Trial of ORG classification 10172 in Acute Stroke Treatment (TOAST), prehospital delay average and it’s influential factors, thrombolyzed patients proportion, acute and 3-month mortality and the genetic factors of ischemic stroke in Morocco.Results: Twenty-nine (n = 29) studies were selected. And the average age ranged from 49±15.28 to 67.3 ± 9.91 years. Also, a male predominance was recorded in 13 studies of all ages. High blood pressure, diabetes, smoking and heart disease are the four main risk factors identified throughout the studies. Atherosclerosis and cardioembolic origin seem to be the main etiologies of cerebral ischemia. And the average prehospital time ranged from 26 to 61.95 hours. In addition, the proportion of thrombolyzed patients ranged from 1.8% according to the Azdad et al (2012) study to 2.9% according to the Rachdi’s (2015) study. Finally, the mortality rate in the acute phase varied between 3 and 13%. And the 3-month mortality ranged from 4.30 to 32.5%. It is also important to note that most of studies have a reduced sample size, conduced in hospital environment, and with no confidence interval.Conclusions: Ischemic stroke is affecting more and more the young population with male predominance. Moreover, the long prehospital delay and the low proportion of thrombolysed patients are alarming, indicating the need to deepen investigations on the determinants that influence patient’s access to care in Morocco in order to improve the management of this pathology.

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Ischemic stroke in Morocco: a systematic review

BMC Neurology ◽

10.1186/s12883-019-1558-1 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Ahmed Kharbach ◽

Majdouline Obtel ◽

Laila Lahlou ◽

Jehanne Aasfara ◽

Nour Mekaoui ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Ischemic Stroke ◽

Mortality Rate ◽

Meta Analysis ◽

Influential Factors ◽

Hospital Environment ◽

Stroke Treatment ◽

Male Predominance ◽

Prehospital Delay

Abstract Background The aim of this systematic review is to determine the epidemiological and etiological profiles, the influential factors of the prehospital delay, thrombolysis management, the acute and 3-month mortality rate and the genetic aspect of ischemic stroke in Morocco. Methods The present work is a systematic review that was conducted according to the recommendations of the “Preferred reporting items for systematic reviews and meta-analysis”. We used Pubmed, Sciencedirect, Scopus, Clinicalkey, and Google scholar databases for the raking of the gray literature during the time frame 2009 and 2018. The protocol of the review was registered in the PROSPERO register (CRD42018115206). These studies were analyzed based on: Age, sex ratio, risk factors, etiological profile according to Trial of ORG classification 10,172 in Acute Stroke Treatment, prehospital delay average and its influential factors, thrombolyzed patients’ proportion, acute and 3-month mortality and the genetic factors of ischemic stroke in Morocco. Results Twenty-nine (n = 29) studies were selected. The average age ranged from 49 ± 15.2 to 67.3 ± 9.9 years old. Moreover, we reported male predominance within all ages in 13 studies. High blood pressure, diabetes, smoking and heart disease were the four identified main risk factors by the prementioned studies. Atherosclerosis and cardioembolic were the main described etiologies of cerebral ischemia, and the average prehospital time ranged from 26 to 61.9 h. The proportion of thrombolysed patients ranged from 1.8% to 2.9%, the mortality rate varied in the acute phase from 3 to 13%, and the 3-month mortality ranged from 4.3 to 32.5%. It is also important to highlight that most of these studies, which were conducted in hospital environment, have a reduced sample size and no confidence interval. Conclusions Ischemic stroke is affecting more likely the young population with male predominance. Moreover, the long prehospital delay and the low proportion of thrombolysed patients are alarming. This indicates the need to investigate in depth the key factors influencing the access to care for Moroccan patients in order to improve the management of this neurologic deficit in Morocco.

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Ischemic stroke in Morocco: A systematic review

10.21203/rs.2.14651/v2 ◽

2019 ◽

Author(s):

Ahmed Kharbach ◽

Obtel Majdouline ◽

Laila Lahlou ◽

Jehanne Aasfara ◽

Nour Mekaoui ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Ischemic Stroke ◽

Mortality Rate ◽

Acute Stroke ◽

Influential Factors ◽

Stroke Treatment ◽

Male Predominance ◽

Prehospital Delay ◽

Acute Stroke Treatment

Abstract Background: The aim of this systematic review is to determine; the epidemiological and etiological profiles, the influential factors of the prehospital delay, thrombolysis management, the acute and 3-month mortality rate and the genetic aspect of ischemic stroke in Morocco.Methods: The present work is a systematic review that was conducted according to the recommendations of the "Preferred reporting items for systematic reviews and meta-analysis". We used Pubmed, Sciencedirect, Scopus, Clinicalkey, and Google scholar databases for the raking of the gray literature during the period between 2009 and 2018. The protocol of the review was registered in the PROSPERO register (CRD42018115206). These studies were analyzed based on: Age, sex ratio, risk factors, etiological profile according to Trial of ORG classification 10172 in Acute Stroke Treatment, prehospital delay average and it’s influential factors, thrombolyzed patients proportion, acute and 3-month mortality and the genetic factors of ischemic stroke in Morocco. Results: Twenty-nine (n = 29) studies were selected. The average age ranged from 49±15.2 to 67.3 ± 9.9 years old. Moreover, we reported male predominance within all ages in 13 studies. High blood pressure, diabetes, smoking and heart disease were the four identified main risk factors by these studies. Atherosclerosis and cardioembolic were the main described etiologies of cerebral ischemia, and the average prehospital time ranged from 26 to 61.9 hours. The proportion of thrombolysed patients ranged from 1.8% to 2.9%, the mortality rate varied in the acute phase from 3 to 13%, and the 3-month mortality ranged from 4.3 to 32.5%. It is also important to highlight that most of these studies have a reduced sample size, conducted in hospital environment, and no confidence interval was reported. Conclusions: Ischemic stroke is affecting more likely the young population with male predominance. Moreover, the long prehospital delay and the low proportion of thrombolysed patients are alarming. Indicating, thus, the need to investigate in depth the key factors influencing the access to care for Moroccan patients in order to improve the management of this neurologic deficit in Morocco. Key words: Ischemic stroke, Trial of ORG classification 10172 in Acute Stroke Treatment classification, prehospital delay, thrombolysis, Morocco.

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Lack of Associations Between PAI-1 and FXIII Polymorphisms and Arterial Ischemic Stroke in Children: A Systematic Review and Meta-Analysis

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029619869500 ◽

2019 ◽

Vol 25 ◽

pp. 107602961986950 ◽

Cited By ~ 1

Author(s):

Beata Sarecka-Hujar ◽

Ilona Kopyta ◽

Michał Skrzypek

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Ischemic Stroke ◽

Plasminogen Activator ◽

Meta Analysis ◽

Plasminogen Activator Inhibitor ◽

Arterial Ischemic Stroke ◽

Meta Analyses ◽

Activator Inhibitor ◽

Pai 1

The role of genetic risk factors for ischemic stroke seems to be in particular significance in pediatric patients. Numerous polymorphic variants of genes encoding proteins, that is, plasminogen activator inhibitor as well as coagulation factors, involved in the coagulation cascade may be related to arterial ischemic stroke (AIS) both in adults and children. We performed systematic review and 2 meta-analyses to assess possible correlations between common plasminogen activator inhibitor ( PAI-1) and FXIII polymorphisms and ischemic stroke in children. We searched PubMed to identify available data published before October 2018 using appropriate keywords and inclusion criteria. Finally, 12 case–control studies were included: 8 analyzing PAI-1 polymorphism (600 children with stroke and 2152 controls) and 4— FXIII polymorphism (358 children with stroke and 451 controls). R and Comprehensive Meta-Analysis software were used to analyze the impact of the particular polymorphism in the following models: dominant, recessive, additive, and allelic. No publication bias was observed in both meta-analyses. In case of PAI-1 polymorphism, we observed no relation between 4G4G genotype of 4G allele and ischemic stroke in children. We also demonstrated lack of association between FXIII polymorphism and childhood ischemic stroke. In children with AIS, the PAI-1 and FXIII polymorphisms are not risk factors for the disease.

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The physiopathology of spontaneous hemorrhagic stroke: a systematic review

Reviews in the Neurosciences ◽

10.1515/revneuro-2020-0131 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Alcivan Batista de Morais Filho ◽

Thiago Luis de Holanda Rego ◽

Letícia de Lima Mendonça ◽

Sulyanne Saraiva de Almeida ◽

Mariana Lima da Nóbrega ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Natural History ◽

Hemorrhagic Stroke ◽

Recent Literature ◽

Clinical Manifestations ◽

The Road ◽

History Of

Abstract Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.

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Saprochaete clavata Infection in Immunosuppressed Patients: Systematic Review of Cases and Report of the First Oral Manifestation, Focusing on Differential Diagnosis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052385 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2385

Author(s):

Carlo Lajolo ◽

Rupe Cosimo ◽

Schiavelli Anna ◽

Gioco Gioele ◽

Metafuni Elisabetta ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Acute Myeloid Leukemia ◽

Differential Diagnosis ◽

Myeloid Leukemia ◽

Oral Manifestation ◽

First Case ◽

Immunosuppressed Patients ◽

Meta Analyses ◽

Acute Myeloid

Background: Saprochaete clavata infection is an emerging issue in immunosuppressed patients, causing fulminant fungaemia. The purpose of this systematic review of cases is to retrieve all cases of S. clavata infection and describe oral lesions as the first manifestation of S. clavata infection. Methods: We report the first case of intraoral S. clavata infection in Acute Myeloid Leukemia (AML) affected subject, presenting as multiple grayish rapidly growing ulcerated swellings, and provide a review of all published cases of infection caused by S. clavata, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, conducted by searching SCOPUS, Medline, and CENTRAL databases. Only articles in English were considered. Individual patient data were analyzed to identify risk factors for S. clavata infection. Results: Seventeen of 68 retrieved articles were included in the review reporting data on 96 patients (mean age 51.8 years, 57 males and 38 females). Most cases were disseminated (86) with a 60.2% mortality rate. Ninety-five were hematological patients, with AML being the most common (57 cases). Conclusions:S. clavata infection in immunosuppressed patients has a poor prognosis: middle-age patients, male gender and Acute Myeloid Leukemia should be considered risk factors. In immunosuppressed patients, the clinical presentation can be particularly unusual, imposing difficult differential diagnosis, as in the reported case.

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Risk Factors for Ischemic Stroke and its Subtypes in Chinese vs. Caucasians: Systematic Review and Meta-Analysis

International Journal of Stroke ◽

10.1111/ijs.12508 ◽

2015 ◽

Vol 10 (4) ◽

pp. 485-493 ◽

Cited By ~ 33

Author(s):

Chung-Fen Tsai ◽

Niall Anderson ◽

Brenda Thomas ◽

Cathie L. M. Sudlow

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Ischemic Stroke ◽

Meta Analysis

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Prevalence of large vessel occlusion in patients presenting with acute ischemic stroke: a 10-year systematic review of the literature

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014239 ◽

2018 ◽

Vol 11 (3) ◽

pp. 241-245 ◽

Cited By ~ 22

Author(s):

Nikita Lakomkin ◽

Mandip Dhamoon ◽

Kirsten Carroll ◽

Inder Paul Singh ◽

Stanley Tuhrim ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Review Of The Literature ◽

Qualitative Synthesis ◽

Vessel Occlusion ◽

Number Of Patients ◽

Meta Analyses

BackgroundAccurate assessment of the prevalence of large vessel occlusion (LVO) in patients presenting with acute ischemic stroke (AIS) is critical for optimal resource allocation in neurovascular intervention.ObjectiveTo perform a systematic review of the literature in order to identify the proportion of patients with AIS presenting with LVO on image analysis.MethodsA systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in order to identify studies reporting LVO rates for patients presenting with AIS. Studies that included patients younger than 18 years, were non-clinical, or did not report LVO rates in the context of a consecutive AIS series were excluded. Characteristics regarding presentation, diagnosis, and LVO classification were recorded for each paper.ResultsSixteen studies, spanning a total of 11 763 patients assessed for stroke, were included in the qualitative synthesis. The majority (10/16) of articles reported LVO rates exceeding 30% in patients presenting with AIS. There was substantial variability in the LVO definitions used, with nine unique classification schemes among the 16 studies. The mean prevalence of LVO was 31.1% across all studies, and 29.3% when weighted by the number of patients included in each study.ConclusionsDespite the wide variability in LVO classification, the majority of studies in the last 10 years report a high prevalence of LVO in patients presenting with AIS. These rates of LVO may have implications for the volume of patients with AIS who may benefit from endovascular therapy.

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Etiology of ischemic stroke among young adults of Serbia

Vojnosanitetski pregled ◽

10.2298/vsp0811803j ◽

2008 ◽

Vol 65 (11) ◽

pp. 803-809 ◽

Cited By ~ 8

Author(s):

Dejana Jovanovic ◽

Ljiljana Beslac-Bumbasirevic ◽

Ranko Raicevic ◽

Jasna Zidverc-Trajkovic ◽

Marko Ercegovac

Keyword(s):

Risk Factors ◽

Young Adults ◽

Ischemic Stroke ◽

Heart Diseases ◽

Developed Countries ◽

Large Artery ◽

Stroke Treatment ◽

Prosthetic Valves ◽

Number Of Patients ◽

Coagulation Inhibitors

Background/Aim. Etiology of ischemic stroke (IS) among young adults varies among countries. The aim of the study was to investigate the causes and risk factors of IS in the young adults of Serbia. Methods. A total of 865 patients with IS, aged 15 to 45 years, were treated throughout the period 1989-2005. Etiologic diagnostic tests were performed on the patient by the patient basis and according to their availability at the time of investigation. The most likely cause of stroke was categorized according to the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. Results. There were 486 men and 379 women, with 19% of the patients ? 30 years old. Large artery arteriosclerosis and small artery disease were confirmed in 14% of the patients, and embolism and other determined causes in 20%. Undetermined causes made up 32% of the patients, mostly those (26%) with incomplete investigations. Smoking (37%), hypertension (35%) and hyperlipidemia (35%) were the most common risk factors. Rheumatic heart diseases and prosthetic valves were the most common causes of IS. Arterial dissections and coagulation inhibitors deficiency were detected in a small number of patients. Conclusion. Etiology of IS among Serbian young adults shares characteristics of those in both western and less developed countries.

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Abstract 3884: Stroke Subtypes in Hispanic Patients in the NINDS Stroke Genetics Network (SiGN): A Comparison of Two Classification Systems

Stroke ◽

10.1161/str.43.suppl_1.a3884 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Michael Katsnelson ◽

Tatjana Rundek ◽

Ralph Sacco ◽

Hannah Gardener ◽

Shaneela Malik ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Classification Systems ◽

Blood Collection ◽

Large Artery ◽

Stroke Subtype ◽

Reliable Determination ◽

Stroke Treatment ◽

Stroke Subtypes ◽

Small Artery Occlusion

Objectives: Identification of gene variants of stroke subtypes is important for the development of tailored ischemic stroke therapies among various ethnic groups. Valid and reliable determination of ischemic stroke subtype is essential for achieving this goal and to standardize a classification scheme across multi-center studies and different populations. Causative Classification System for Ischemic Stroke (CCS) is a novel computerized subclassification tool developed to improve reliability and accuracy of classifying stroke types. The CCS algorithm relies on both phenotypic and causative stroke variables. A Hispanic subset of the SiGN, an important and distinct target population with greater risk of certain stroke subtypes, was evaluated with Trial of Org 10172 in Acute Stroke Treatment (TOAST) and CCS and the agreement between the two classification systems was analyzed. Methods: Over 6000 subjects at 15 sites across US and Europe were enrolled, with TOAST and CCS locally adjudicated. Blood collection and central data quality control (10% central readjudication) were performed on all participants. A subset of Hispanics was analyzed for the purpose of this study and the agreement between the TOAST and CCS were assessed by kappa statistic. Findings: Hispanics (n=595, 10.9%) compared to non-Hispanics (n=5457) were more likely to be younger (63.7 vs. 64.0), male (55% vs. 46%) and have fewer of the traditional stroke risk factors HTN (54% vs. 64%), Afib (11% vs. 14%), DM(23% vs. 25%), CAD(16% vs. 20%) and smoking(19% vs. 22%). While the TOAST showed no differences between stroke subtypes for Hispanic vs. non-Hispanics, in CCS, Hispanics were classified with more of large vessel (22% vs. 20%), cardioembolic (37% vs. 30%) and small vessel strokes (13% vs. 9%) and fewer with undetermined etiology (28% vs. 40%) as compared to non-Hispanics. TOAST and CCS offered moderate correlation across all stroke types in Hispanics: kappa of 0.66 for large artery atherosclerosis, 0.58 for cardioembolic, and 0.58 for small artery occlusion. Conclusion: CCS offers a more sensitive and accurate system for subphenotyping of strokes in Hispanics who tended to have relatively fewer risk factors and unclassified strokes. Further studies correlating the two classification systems and their relation to genotyping data are warranted.

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Prevalence of and risk factors for Plasmodium spp. co-infection with hepatitis B virus: a systematic review and meta-analysis

Malaria Journal ◽

10.1186/s12936-020-03428-w ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Kwuntida Uthaisar Kotepui ◽

Manas Kotepui

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Hepatitis B Virus ◽

Meta Analysis ◽

Infection Group ◽

Pooled Prevalence ◽

B Virus ◽

The Difference ◽

Meta Analyses

Abstract Background Plasmodium spp. and hepatitis B virus (HBV) are among the most common infectious diseases in underdeveloped countries. This study aimed to determine the prevalence of Plasmodium spp. and HBV co-infection in people living in endemic areas of both diseases and to assess the risk factors related to this co-infection. Methods The PubMed, Web of Science, and Scopus databases were searched. Observational cross-sectional studies and retrospective studies assessing the prevalence of Plasmodium species and HBV co-infection were examined. The methodological quality of the included studies was assessed with the Newcastle-Ottawa Scale (NOS), a tool for assessing the quality of nonrandomized studies in meta-analyses, and heterogeneity among the included studies was assessed with Cochran's Q test and the I2 (inconsistency) statistic. The pooled prevalence of the co-infection and its 95% confidence interval (CI) were estimated using the random-effects model, depending on the amount of heterogeneity there was among the included studies. The pooled odds ratio (OR) represented the difference in qualitative variables, whereas the pooled mean difference (MD) represented the difference in quantitative variables. Meta-analyses of the potential risk factors for Plasmodium spp. and HBV co-infection, including patient age and gender, were identified and represented as pooled odds ratios (OR) and 95% CIs. Publication bias among the included studies was assessed by visual inspection of a funnel plot to search for asymmetry. Results Twenty-two studies were included in the present systematic review and meta-analysis. Overall, the pooled prevalence estimate of Plasmodium spp. and HBV co-infection was 6% (95% CI 4–7%, Cochran's Q statistic < 0.001, I2: 95.8%), with prevalences of 10% in Gambia (95% CI: 8–12%, weight: 4.95%), 8% in Italy (95% CI 5–12%, weight: 3.8%), 7% in Nigeria (95% CI 4–10%, weight: 53.5%), and 4% in Brazil (95% CI 2–5%, weight: 19.9%). The pooled prevalence estimate of Plasmodium spp. and HBV co-infection was higher in studies published before 2015 (7%, 95% CI 4–9%, Cochran's Q statistic < 0.001, I2: 96%) than in those published since 2015 (3%, 95% CI 1–5%, Cochran's Q statistic < 0.001, I2: 81.3%). No difference in age and risk of Plasmodium spp. and HBV co-infection group was found between the Plasmodium spp. and HBV co-infection and the Plasmodium monoinfection group (p: 0.48, OR: 1.33, 95% CI 0.60–2.96). No difference in gender and risk of Plasmodium spp. and HBV co-infection group was found between the Plasmodium spp. and HBV co-infection and HBV co-infection group and the Plasmodium monoinfection group (p: 0.09, OR: 2.79, 95% CI 0.86–9.10). No differences in mean aspartate aminotransferase (AST), mean alanine aminotransferase (ALT), or mean total bilirubin levels were found (p > 0.05) between the Plasmodium spp. and HBV co-infection group and the Plasmodium monoinfection group. Conclusions The present study revealed the prevalence of Plasmodium spp. and HBV co-infection, which will help in understanding co-infection and designing treatment strategies. Future studies assessing the interaction between Plasmodium spp. and HBV are recommended.

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