Aspects épidémio-cliniques des manifestations thrombotiques au cours de la COVID- 19 au sein des hôpitaux militaires de Libreville et d'Akanda, Gabon / Epidemiology and clinical aspects of thrombotic manifestations during COVID-19 at the military hospitals of Libreville and Akanda, Gabon

Décrire les aspects épidémio-cliniques des manifestations thrombotiques au cours de la COVID-19 au sein des hôpitaux militaires de Libreville et Akanda, Gabon. Méthodes : Nous avons mené une étude rétrospective et descriptive multicentrique d'une durée de 7 mois, du 01er septembre 2021 au 31 mars 2022, portant sur les patients admis dans les unités de réanimation des hôpitaux d'instruction des armées de Libreville (HIAOBO) et d'Akanda (HIAA), pour COVID-19 documentée ou suspectée. Résultats : Durant la période d'étude, 167 patients ont été́ admis pour infection à SARS-CoV-2, parmi lesquels, 18 ont présentés des manifestations thromboemboliques (10,8%). La moyenne d'âge était de 54,7±6.4 ans. Il y avait une large prédominance masculine avec un sexe ratio à 2. Nous avons noté́ 9 cas d'embolie pulmonaire (50%), 5 cas d'accidents vasculaires cérébraux ischémiques (28%), 1 cas de thrombose veineuse profonde de membre inferieur (6%), 1 cas de thrombose veineuse cérébrale (6%), 1 cas de thrombose de la veine mésentérique (6%) et 1 cas de thrombose de la veine porte (6%). Les D-dimères étaient élevés chez tous les patients. Les globules blancs étaient élevés (>10000/mm3 ) chez 12 patients (67%). Les plaquettes étaient inférieures à 150000/mm3 pour 6 patients (33%). Tous les patients avaient une pneumonie à SARS-CoV-2 et la moyenne d'atteinte deslésions pulmonaires était estimée à 45%. Neuf patients étaient décédés (50%) au cours de l'hospitalisation. Conclusion : L'infection par le SARS-CoV-2 constitue vraisemblablement une prédisposition à la survenue d'un événement thrombotique. L'incidence des manifestations thrombotiques chez les patients atteints de COVID-19 reste élevée, renforçant ainsi la prescription systématique d'une anticoagulation prophylactique

Awareness of Stroke among University Employees in Kigali, Rwanda: A Cross Sectional Study

Background Awareness of stroke is important for appropriate and timely stroke prevention and management. Objective To assess the level of awareness about the risk factors, signs, and appropriate responses for stroke among university employees in Rwanda. Methods We employed a quantitative descriptive cross-sectional approach. We involved 92 participants, and a self-administered questionnaire to collect data. We computed descriptive statistics and used the Chi-Square test to assess any differences in stroke awareness. Results We found that 12% and 15.2% of the participants were not aware of any risk factor and warning sign of stroke respectively. Regarding the reaction in case a warning sign of stroke was noticed, 9.8% of the participants indicated that they would do nothing or advise the victim to take rest at home. The limited awareness was significantly higher in the administrative than academic employees for both risk factors (p=0.002) and warning signs (p=0.006), but not for the appropriate responses to stroke (p=0.426). Conclusion A significant proportion of the participants were not aware of any stroke risk factor, warning sign and appropriate responses. It is important to conduct further similar studies and implement stroke education interventions in university communities

Determinants of visit-to-visit systolic blood pressure variability among Ghanaians with hypertension and diabetes mellitus

Objective: To identify the determinants of systolic blood pressure variability (SBPV) among Ghanaians. Design: We undertook a secondary analysis of data collected in a prospective study Setting: The study involved patients with hypertension and or diabetes receiving care in five hospitals in Ghana Main outcome measures: We assessed determinants of SBPV among 2,785 Ghanaian patients. We calculated the standard deviation (SD) of systolic BP recordings of 3 to 10 visits per patient over 18 months as a measure of SBPV. A multivariate linear regression analysis was fitted to identify factors independently associated with risk visit-to-visit SBP standard deviation. Results: The mean SD of individual patient visit-to-visit SBP overall was 14.8±6.3 mm Hg. Those with hypertension and diabetes had the highest SD of 15.4 ±6.2 mm Hg followed by 15.2 ±6.5 mm Hg among those with hypertension only and then 12.0 ± 5.2 mm Hg among those with diabetes only, p<0.0001. Factors independently associated with SBPV with adjusted ß coefficients (95% CI) included age: 0.06 (0.03 ­ 0.08) for each year rise in age, eGFR -0.03 (-0.05 - -0.02) for each ml/min rise, low monthly income of <210 Ghana cedis 1.45 (0.43-2.46), and secondary level of education -1.10 (-1.69, -0.50). Antihypertensive classes were associated with SBPV, the strongest associations being hydralazine 2.35 (0.03 ­ 4.68) and Methyldopa 3.08 (2.39 ­ 3.77). Conclusion: Several socio-demographic and clinical factors are associated with SBPV. Future studies should assess the contribution of SBPV to CVD outcomes among indigenous Africans and identify actionable targets.

Aspects cliniques et pronostiques des accidents vasculaires cérébraux en réanimation au Cameroun / Clinical and prognostic aspects of stroke in a Cameroonian intensive care unit

Introduction. L'accident vasculaire cérébral (AVC) est une pathologie fréquente. Le but de l'étude était de décrire les aspects pronostiques des AVC en réanimation. Patients et Méthodes. Il s'agissait d'une étude longitudinale descriptive et analytique, qui s'est déroulée de janvier à avril 2019. Nous avons recruté dans les services de réanimation de trois hôpitaux universitaires de Yaoundé. Etait inclus, tout patient hospitalisé en réanimation pour prise en charge d'un AVC, ayant réalisé un scanner cérébral. Le consentement était obtenu auprès du patient ou d'un parent. Les variables étaient les données sociodémographiques, les données cliniques et pronostiques.Les données étaient analysées à partir du logiciel Epi info 3.5.4 et Microsoft Office Excel 2013. Les proportions étaient comparées par le test de Chi carré ou le test exact de Fisher. Les médianes étaient comparées par le test de MannWhitney. La survie était représentée par une courbe de Kaplan Meier. Résultats. Au total, 34 patients étaient inclus. L'âge moyen était de 59,9±9,7 ans. Le sex-ratio était de 0,7. Le délai moyen d'admission était de 4,5±4,84 jours. L'hypertension artérielle était le facteur de risque dominant (42,5%). Une altération de la conscience était fréquente (73,5%). L'hémiplégie constituait le principal signe neurologique focal. L'AVC hémorragique était retrouvé chez 58,8% des patients. Deux patients étaient intubés (5,88%). Dix-huit décès étaient enregistrés (52,9%). La durée moyenne du séjour était de 21,8±19,4 jours. Les facteurs pronostiques étaient le score de Glasgow <8 (P=0,01), le score de NIHSS≥15 (P=0,001), l'hyperthermie (P=0,04), la présence de trouble de la déglutition à l'entrée (P=0,01) et l'effet de masse au scanner cérébral (P=0,01). Conclusion. Les AVC restent une affection fréquente dans notre pays. La mortalité est élevée.Elle est liée à la gravité clinique et la survenue des complications

Background. Stroke is a frequent pathology. The aim of the study was to describe the clinical, and prognostic aspects of stroke in the intensive care unit (ICU). Patients and Methods. This was a longitudinal descriptive and analytical study, which took place from January to April 2019. We recruited from the intensive care units of three university hospitals in Yaoundé. Any patient hospitalised in the ICU for stroke management who had undergone a brain scan was included. Consent was obtained from the patient or a relative. The variables were socio-demographic data, clinical data, therapeutic data and outcome. Data were analysed using Epi info 3.5.4 and Microsoft Office Excel 2013. Proportions were compared using the Chi-square test or Fisher's exact test. Medians were compared by the Mann-Whitney test. Survival was represented by a Kaplan Meier curve. Results. A total of 34 patients were included. The mean age was 59.9±9.7 years. The sex ratio was 0.7. The mean time to admission was 4.5 days ±4.84. Hypertension was the dominant risk factor (42.5%). Altered consciousness was common (73.5%). Hemiplegia was the main focal neurological sign. Hemorrhagic stroke was found in 58.8% of the patients. All patients received general measures. Two patients were intubated (5.88%). Eighteen deaths were recorded (52.9%). The average length of stay was 21.8±19.4 days. Prognostic factors were Glasgow score <8 (P=0.01), NIHSS score≥15 (P=0.001), hyperthermia (P=0.04), presence of swallowing disorder at admission (P=0.01) and mass effect on brain scan (P=0.01). Conclusion. Stroke remains a frequent condition in our country. Mortality is high. It is related to the clinical severity and the occurrence of complications.

Stroke-related knowledge and attitudes among university students in Northeast Nigeria

te public knowledge of stroke, but the impact in Nigeria is notwell known. This study assessed stroke-related knowledge andattitudes among university students in Nigeria, where health stud-ies are parts of college curricula. This was a cross-sectional studyof students at three universities in Northeast Nigeria. Using ques-tionnaire survey, we assessed biographical data and participantknowledge of the primary site, warning signs and risk factors ofstroke. Responses were graded on a knowledge score, where ≥2.5points indicated adequate knowledge. Data were analyzed with theSPSS version 21 program. We studied 824 participants, 67.1%males. Males were older than females (mean age ± SD: 27.42±5.58years versus 26.27±5.31 years; P = 0.009; 95% CI: 0.29 ­ 1.99)and 14.5% participants had stroke lectures during general studies.Major sources of stroke knowledge were personal discussions(44.6%) and internet websites (24.5%). Only 15.7% participantscorrectly identified the brain as the primary site of stroke, whileknowledge of one or more stroke warning signs and risk factorswere noted in 42.2% and 49.6%, respectively. Mean knowledgescore was 1.08 ± 0.99. Adequate knowledge of stroke was noted in13.2% participants, and was higher in females (17.7% versus10.7%; P = 0.01). Logistic regression analysis showed significantassociations between adequate knowledge of stroke with femalesex (OR 1.8; 95% CI: 1.2 ­ 2.8; P = 0.008) and a history of strokein close relatives (OR 1.7; 95% CI: 1.1 ­ 2.6; P = 0.025) but notwith age, academic discipline or stroke lectures. University stu-dents in Northeast Nigeria have low knowledge of stroke, which isworse in males. Although health issues are taught at universities,little is taught on stroke, suggesting a need to prioritize strokeknowledge in the universities little is taught on stroke, suggeting a need to prioritize stroke knowlegde in the university curriculum .

Pattern of neurological disorders managed in neurology clinics in Kano, Nigeria

To determine the pattern of neurological disorders managed in some neurology clinics in Kano, Nigeria. Materials and Methods: A five-year retrospective descriptive survey (2016-2020) of patients with neurological disorders attending neurology out-patient clinics at three selected hospitals in Kano metropolis. A research proforma was used to collect information on socio-demographic and health characteristics of the participants. Case folders and outpatient registers were used as a source of information about the patients. Data obtained was analyzed using IBM Statistical package for social science (SPSS) version 20 and results presented using descriptive statistics of frequency and percentage. Results: Out of the 433 cases with neurological disorders surveyed, 58% were adult and 42% were pediatric. Males (54.3%) were found to be more affected. Majority (83.4%) of the participants were from an urban area, with married (79.7%) individuals mostly affected. Stroke was the most prevalent (33.7%) neurological disorder. Hypokinesia (5.1%) and hyperkinesia(3%) as a primary and secondary movement disorder respectively were the most prevalent forms of movement disorder. Psychotic symptoms, weakness, paresthesia, fever, vomiting and convulsion were the most common manifestations that comes with the neurological disorders. Of the common neurological disorders, stroke was most associated with motor (56.2%), sensory (36.4%) and psychiatric (43.5%) manifestations. Conclusion: Paediatric age group contributed close to half of neurological disorders. Stroke was the most prevalent form of neurological disorder and most associated with motor, sensory and psychiatric manifestations. Hypokinesia and hyperkinesia had close prevalence and were the most common primary and secondary movement disorders respectively.

Prevalence of cerebrovascular accident and its associated risk factors among patients admitted into the neurological ward of university of Benin teaching hospital

Stroke is the second leading cause of death, accounting for 11.13 % of total deaths, and the main cause of disability worldwide. Objective: To determine the prevalence of stroke, its associated risk factors and survival rate among patients admitted to the neurological ward of University of Benin Teaching Hospital, Benin City, Edo State. Methods: A retrospective descriptive survey of patients admitted to the neurological ward of University of Benin Teaching Hospital, Benin City, Edo State from 2015 to 2020. A proforma was used to collect relevant data from medical records. Data was analyzed with IBM SPSS Statistics version 23, using descriptive and inferential statistics at 5% level of significance. Result: The average prevalence of cerebrovascular accident over the six years under review was 58.9%. Highest (69.3%) prevalence was recorded in 2018. Males (52.9%) were more affected than females and the age range 70-89 years was most affected (47.6%). The commonest comorbidities were hypertension and diabetes mellitus. Survival rate was high during the period under review, it was at the least in 2016 at 67.1% and highest in 2019 at 76%. Multiple logistic regression shows that patients who had CVA at below 30 years old were less likely to survive (OR;0.06: CI: 0.000-0.114; p = 0.001). Being married conferred a greater likelihood of surviving a CVA (OR;5.34: CI: 1.135 -25.135; p = 0.034) than being unmarried (OR;2.89: CI: 2.702-49.673; p = 0.004). Tertiary level of education conferred the greatest likelihood of surviving a CVA (OR;8.00: CI: 24.401-1168.674; p = 0.000). Conclusion: The prevalence of stroke from this study was high. Hypertension and diabetes mellitus were the most common risk factors associated with stroke. In-hospital stroke survival rate was high. The findings from this study can support advocacy for more efficient community-based programs geared towards awareness creation about stroke, its risk factors and prevention.

Facteurs de risque et étiologies des AVC de l'adulte jeune au CHU de Bogodogo à Ouagadougou / Risk factors and etiologies of stroke in young adults in Bogodogo university hospital, Ouagadougou

Introduction: Les accidents vasculaires cérébraux (AVC) sont des pathologies graves survenant le plus souvent chez le sujet âgé. Le but de ce travail était d'étudier les facteurs de risque et les étiologies de l'AVC de l'adulte jeune. Patients et méthodes : Il s'est agi d'une étude transversale et rétrospective incluant tous les sujets d'âge compris entre 15 et 45 ans, hospitalisés pour AVC dans le service de neurologie du CHU de Bogodogo entre le 1er Avril 2017 et le 31 Mars 2019 et ayant un dossier complet. Résultats : Quarante-quatre cas d'AVC concernaient les sujets jeunes, soit 8,46% de l'ensemble des AVC. On notait 59,1% d'AVC ischémique et 40,9% d'AVC hémorragique. L'âge moyen était de37,45± 5,94 ans. Le sex-ratio était 2,14. La sédentarité (72,22%), l'HTA (59,09%) et le diabète (25%) étaient les principaux facteurs de risque. L'étiologie a été retrouvée chez 77,27% des patients. Il s'agissait principalement de l'athérosclérose et les cardiopathies emboligènes pour l'AVC ischémique et de l'HTA pour l'AVC hémorragique. Conclusion: Les AVC du sujet jeune sont relativement peu fréquents au CHU de Bogodogo. Une prévention des facteurs de risque vasculaire permettrait d'éviter une augmentation de leur fréquence

Introduction: Stroke is a common and serious disease occurring most often in the elderly. The aim if our study was to describe risk factors and causes of stroke in young adults. Patients and methods: This were a retrospective study including patients whose age was between 15 and 45 years, hospitalized in the neurology department of the Bogodogo University Hospital for stroke between April 1, 2017, and March 31, 2019. Results: Forty-four stroke cases involved young adults, it represented 8.46% of total stroke. Among those cases, 59,1% was ischemic stroke and 40,9% was hemorrhagic stroke. The Mean age was37,45± 5,94 years. The sex-ratio was 2,14. Physical inactivity (72,22%), high blood pressure (59,09%) and diabetes (25%) were the main risk factors. etiologies were found in 77,27% of cases. They were dominated by atherosclerosis and cardio embolism in ischemic stroke, and by high blood pressure in hemorrhagic stroke. Conclusion: Stroke in young adults at Bogodogo University Hospital is relatively infrequent. Prevention of risk factors would prevent an increase in its frequency

Aspects épidémiologiques, cliniques et facteurs pronostiques des accidents vasculaires cérébraux ischémiques chez le sujet âgé à Bobo-Dioulasso, Burkina Faso / Epidemiological, clinical and prognosis aspects of ischemic stroke in the elderly in Bobo-Dioulasso, Burkina Faso

Contexte et objectif. Le risque d'accident vasculaire cérébral (AVC) augmente avec l'âge. Notre objectif était d'identifier les caractéristiques épidémiologiques, cliniques et les facteurs liés au pronostic vital des sujets âgés hospitalisés pour AVC ischémique (AVCI) au Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso. Méthodes. Il s'est agi d'une étude rétrospective portant sur une période allant du 1er janvier 2017 au 31 décembre 2019 et concernant tous les patients âgés de 65 ans et plus hospitalisés pour AVCI. Résultats. Au total, 153 dossiers médicaux ont été colligés. L'âge moyen était de 73,9 ans. Le sex-ratio M/F était de 1,25. Les facteurs de risque cardiovasculaire étaient principalement l'hypertension artérielle chronique (61,4 %), l'alcoolisme (21,5 %), le diabète (14,3 %), et l'antécédent d'AVC (13,7 %). Le déficit moteur était le principal motif de consultation. La pathologie athéromateuse était la principale étiologie. La durée moyenne d'hospitalisation était de 16,2 jours. Le taux de mortalité intrahospitalière était de 16,9 %. La médiane de survie était de 53 jours. Les facteurs prédictifs de la mortalité étaient l'âge (p= 0,017; HR= 2,81; IC 95 %: 1,21-6,54) et le coma (p= 0,010; HR= 4,68; IC 95 %: 2,05- 43,94). Conclusion. L'AVCI chez la personne âgée à BoboDioulasso est marqué par une mortalité intrahospitalière élevée. L'optimisation de la prise en charge des patients âgés pourrait contribuer à la réduction significative de la mortalité des AVC.

Context and objective. Strokes risk increases with age. The most common one is ischemic stroke. Our objective was to identify epidemiological, clinical features and the factors linked to the prognosis for survival of older patients hospitalized for ischemic stroke in Sourô Sanou Teaching Hospital of Bobo-Dioulasso. Methods. This was an analytical historical study on older patients aged ≥ 65 years, hospitalized for ischemic stroke at Sourô Sanou Teaching Hospital of Bobo-Dioulasso during the period from January 1st , 2017 to December 31st, 2019. Results. A total of 153 patients has been involved in this study. The intrahospital ischemic stroke frequency was 68. 61 % of all strokes in elderly. The average age was 73.98 years. The sex ratio M/F was 1.25. Chronic high blood pressure (61.43 %), alcoholism (21.56 %), diabetes (14.37 %), and history of stroke (13.72 %) were the most frequent cerebrovascular risk factors in past medical history. The motor deficit represented the main reason for consultation. Atheromatous pathology was the main etiology. The mean duration of hospitalization was 16.21 days. The intrahospital mortality was 16. 99 %. Median survival was 53 days. The predictive factors of mortality were the age (p= 0.017; HR= 2.81; IC 95 %: 1.21-6.54) and coma (p= 0.010; HR= 4.68; IC95 %: 2.05-43.94). Conclusion. Stroke in the elderly at Bobo-Dioulasso is responsible for a high death rate. Optimization of management for elderly patients could contribute to a significant reduction of stroke mortality

Roll Back Stroke: The Way Forward for Physicians and Patients

The 6-lettered word "Stroke" is an ancient disease, likened Biblicallyto "666" in Revelation 13 verse 18. Globally, it is the commonestcause of acquired long-term disability. While its incidence has beendeclining in high-, low/middle-income countries (LMICs) have witnessed an increase. This increase is driven byepidemiologic-transition/modernizatio n-complex, healthcaredisparities, and increasing prevalence of vascular risk-factors. Despitethe disproportionate burden of stroke in LMICs, these countrieshave the lowest rate of access to acute reperfusion-interventions leadingto greater stroke-related morbidity /mortality. Effective primordial,primary, secondary, and quaternary prevention-strategies coordinated at all levels of care are needed to reduce stroke incidenceand poor outcomes. The World Stroke Organization (WSO) hasproposed achieving global primary prevention through 1) Population-wide approach to limiting stroke risk-factors exposure, 2) App-basedmotivational population-wide approach to mitigating stroke risk-fa cto rs, 3 ) u se of lo w-co st co mbi n at io n /po ly- p il l to tre at hypertension/dyslipidemia and 4) addressing behavioural risk-factorsthrough interventions by community health-workers.The need to set-up stroke-units, post-hospitalisation rehabilitation-centres, stroke-registers/registries, stroke-clubs, and encouragecommunity health-education, must be emphasised for optimal care inLMIC.13 Community Health Empowerment (CHE) withthe AcronymBE FAST / STRoke as warning signs of stroke must be emphasised(B: Balance-loss; E: Eye vision-loss; F: Facial Asymmetry; A: Armweakness; S: Speech difficulties; T: Time is brain; Or first 3-lettersof STRoke ­ Can Patient Smile? Talk? Or Raise-arm?). Strokehemorheology/blood-flow and treatment involve 3Ps' of pathogenicprinciples/strategies (Passenger, Passage, Power). Its complicationsinclude the 10D's: Death, Disability, Depression, Dementia, Delirium,Dysphagia, Dehydration, Deep-Venous Thrombosis, Decubitus-ulcers, Dysphasia, Seizures.

Prévalence et létalité du diabète chez les patients hospitalisés pour Covid-19 dans la wilaya de Tlemcen: Analyse des facteurs associés à la mortalité / Prevalence and lethality of diabetes in patients hospitalised for Covid-19 in Tlemcen: Analysis of associated factors with mortality

OBJECTIFS : Notre travail a pour objectifs de déterminer la prévalence et la létalité du diabète chez les patients hospitalisés pour Covid-19 dans la wilaya de Tlemcen, et d'identifier les paramètres propres au diabétique qui sont associés à la mortalité. PATIENTS ET METHODES : Etude prospective observationnelle incluant les patients adultes admis pour Covid-19 au CHU de Tlemcen du 1er avril au 31 octobre 2020. Les principales données cliniques incluant symptômes, comorbidités et paramètres de sévérité ont été recueillies sur une fiche clinique. Le diagnostic de Covid-19 a été suspecté sur la clinique et confirmé par scanner thoracique sur les lésions radiologiques typiques ou par test RT-PCR. Le diagnostic du diabète a été établi sur la déclaration du patient et le traitement en cours et la glycémie veineuse. Nous avons contacté les patients par téléphone et demandé l'envoi par internet des documents médicaux pour avoir un bilan du diabète avant le Covid. Le critère d'évaluation principal était la mortalité intra hospitalière. RESULTATS : parmi les 4537 patients hospitalisés pour Covid-19, nous avons recensé 390 diabétiques dont 164 ont été joignables. L'analyse a porté sur 163 patients dont 106 hommes. L'âge moyen était de 63 ans. Le type 2 a été retrouvé chez 96% des patients. La moyenne de la durée du diabète est de 9 ans. Le diabète a été découvert fortuitement chez 14 patients (8,6%). Les traitements antidiabétiques incluaient metformine (73%), sulfamides (37%) et insuline (38%). La prévalence du diabète déclaré était de 8,7%. La mortalité chez les diabétiques était de 9,2%. En analyse multivariée ajustée sur l'âge, le sexe et la durée du diabète, les variables associées au décès étaient : l'antécédent d'accident vasculaire cérébral (AVC) (p =0,02) et la prise d'inhibiteurs de l'enzyme de conversion (IEC) (p = 0,007). CONCLUSION : Dans notre cohorte de patients infectés par la Covid-19, la prévalence et la mortalité du diabète étaient relativement élevées. L'antécédent d'AVC et la prise d'IEC étaient associés à la mortalité.

OBJECTIVES : The objectives of our study are to determine the prevalence and lethality of diabetes among patients hospitalized for Covid-19 in the province of Tlemcen and to identify the specific parameters to diabetics that are associated with mortality. PATIENTS AND METHODS: Prospective observational study including adult patients admitted for Covid-19 at academic Hospital of Tlemcen from April 1 to October 31, 2020. The main clinical data including symptoms, comorbidities and severity parameters were collected on a clinical file. The diagnosis of Covid-19 was suspected on the clinical presentation and confirmed by chest scanner on typical radiological lesions or by RT-PCR test. The diagnosis of diabetes was established on the statement of the patient and the current treatment and venous blood sugar. We contacted patients by phone and requested that medical documents be sent via the Internet to have an accurate diabetes assessment before the Covid. The primary endpoint is in-hospital mortality. RESULTS: 4537 patients were hospitalized for Covid-19. 390 diabetics identified of which 164 were reachable. The analysis included 163 patients, of whom 106 men. The average age is 63 years. Type 2 diabetes is found in 96%. The average duration of diabetes is 9 years. Diabetes was discovered in 14 patients (8.6%). Antidiabetic treatments included metformin (73%), sulfonylureas (37%) and insulin (38%). The prevalence of declared diabetes is 8.7%. Mortality among diabetics is 9.2%. Variables associated with death on multivariate analysis adjusted on age, sex and duration of diabetes, were history of stroke (pvalue =0,02) and angiotensin-converting enzyme taking (p-value =0,007). CONCLUSION: In our cohort of patients infected with Covid-19, the prevalence and mortality of diabetes is relatively high. Stroke and angiotensin-converting enzyme were associated with mortality.

Caregivers' Perceptions of Burden and Health- Promoting Behaviours among Informal Caregivers of Cancer and Stroke Patients Attending Tertiary Care Facilities in South- South Nigeria

Family caregivers' role in cancer and stroke care is overly burdensome. Studies have considered burden and predictors of burden but the influence of caregiving burden on health - promoting behaviours among cancer and stroke family caregivers in Nigeria is scarce. The purpose of this study was to determine the influence of caregivers' perceptions of burden and health-promoting behaviours on informal caregivers of cancer/ stroke patients attending tertiary care facilities in South- South Nigeria. A descriptive cross-sectional survey was employed among 410 purposively selected cancer/ stroke patients' family caregivers in tertiary care facilities, South- South Nigeria. A standardized Zarit burden interview scale and structured questionnaire were used to measure burden and determine health-promoting behaviours respectively. Descriptive (means, standard deviation and percentages) and inferential (ANOVA) statistics with a Fisher's protected t- test at 0.05 level of significance were used for data analysis. The respondents experienced severe (F= 14.02; P= 0.810) burden in caregiving to cancer/ stroke patients. The influence of health- promoting behaviours (primary, secondary and tertiary preventions) among caregivers of cancer/ stroke is significantly high in the tertiary care facilities, South-South, Nigeria. Caregivers of cancer and stroke patients experienced severe levels of burden and health-promoting-behaviours in terms of prevention at the primary, secondary and tertiary activities were significantly high among respondents. This calls for knowledge mobilization and dissemination in Nigeria and beyond.

Niveau de connaissance et conceptions d'une population urbaine au sud du Bénin sur les accidents vasculaires cérebraux / NA

Une meilleure connaissance sur les accidents vasculaires cérébraux (AVC) pourrait en améliorer la prévention. Objectif : Etudier le niveau de connaissance (NC) et la conception des sujets adultes de la ville de Cotonou, sur les AVC. Méthodologie : Il s'agit d'une étude transversale à visée descriptive et analytique, menée du 10 janvier au 27 avril 2018. L'échantillonnage était en grappes, ayant porté sur les sujets sans trouble psychiatrique connu, non professionnels de la santé et consentants à participer à l'étude dans cinq quartiers chacun de quatre arrondissements tirés au sort parmi les treize de la ville de Cotonou. Des propositions de réponses leur ont été faites concernant la définition, les manifestations, les facteurs de risque, la prévention, le traitement et le pronostic de l'AVC. De ces réponses aux questions, le NC des sujets a été catégorisé. Résultats : Il s'agissait de sujets scolarisés jusqu'au niveau universitaire (85,25%). Leur NC sur les AVC n'était pas bon (19,25%). Leurs sources d'informations sur les AVC étaient les médias (39,9%), parents et amis (34,3%). Leurs conceptions sur l'AVC étaient diverses : maladie dite spécifique aux riches (24,75%), aux adultes (20,75%) ; maladie due à la volonté de Dieu (17,75%), l'infidélité du (ou de la) conjoint(e) (8,75%), l'envoûtement (8,25%) ; maladie prévenue grâce à la foi en Dieu (30,5%), le respect des coutumes (10,5%) et traitée par les médicaments et tisanes (37%), les prières (33,75%). Les sujets avaient une attitude d'aide (80,8%), de compassion (67%) et de sympathie (63,5%) à l'endroit des victimes d'AVC. Le NC était associé à l'âge du sujet et sa capacité à identifier le cerveau comme organe affecté. Discussion-Conclusion : Des séances de communication pour un changement de comportement autour de l'AVC seront très utiles au Bénin.

Knowledge level and conceptions of an urban population in south of Benin about stroke Better knowledge about stroke could improve it prevention. Objective: To study the level of knowledge (LK) and the conception of adult subjects of Cotonou, on stroke. Methodology: This is a cross-sectional study with a descriptive and analytical aim, carried out from January 10 to April 27, 2018. The sampling was in clusters, focused on subjects without known psychiatric disorder, non-health professionals and who consented to participate to the study in five areas for each of four districts drawn at random from the thirteen districts of Cotonou. Proposals answers were made to them concerning definition, manifestations, risk factors, prevention, treatment and prognosis of stroke. From these answers to questions, the LK of subjects was categorized. Results: These were subjects educated up to university level (85.25%). Their LK on stroke was not good (19.25%). Their sources of information about stroke were medias (39.9%), parents and friends (34.3%). Their views on stroke were diverse: disease known as specific to rich persons (24.75%), to adults (20.75%); illness due to the will of God (17.75%), infidelity of spouse (8.75%), bewitchment (8.25%); disease prevented by the faith in God (30.5%), respect for customs (10.5%) and treated with medicines and herbal teas (37%), prayers (33.75%). Subjects had an attitude of help (80.8%), compassion (67%) and sympathy (63.5%) to victims of stroke. LK was associated with subject's age and ability to identify brain as the affected organ. Discussion-Conclusion: Communication sessions for behavior change concerning stroke will be very useful in Ben

Functional outcome of stroke inpatients according to human immunodeficiency virus status: a feasibility study

Background: Stroke in human immunodeficiency virus positive (HIV+) individuals is becoming an increasing concern. Being significantly younger than typical stroke patients, the impact of functional challenges on quality of life and burden on society becomes more eminent. Objectives: This feasibility study aims to determine the requirements for a large descriptive cohort, to adequately describe the functional outcome of stroke patients with varying HIV status. Method: All stroke patients meeting the inclusion criteria were recruited over a 6-month period at a South African inpatient rehabilitation centre. Data were collected on admission and discharge using outcome measures including the Barthel Index (BI), Berg Balance Scale (BBS) and the use of assistive devices used to describe independence with activities of daily living (ADL), mobility and safety post-stroke. Statistical analysis was performed using Stata version 14.2. Results: The feasibility study identified appropriate procedures and barriers to a successful study in addition to describing preliminary data on participant demographics, relevant medical history and functional outcomes post-stroke. Limitations that affected feasibility included minimal recruitment sites, length of data collection period, timely communication of participant discharge plans and dates, and confirmation of participant HIV status. An appropriate comparison between sub-groups could not be made because of disproportionate group sizes, median age differences and no assessor blinding. Conclusion: To increase generalisability and the understanding of the unique HIV+ stroke profile, multiple recruitment sites, longer data collection periods, assessor blinding and age-matched groups with HIV status confirmation are recommended

Self-motivation, functional ability and participation among stroke survivors' resident in Ibadan metropolis, Nigeria

Background:Stroke is a leading cause of death both globally, and in Africa. The attendant effect of the stroke is disability, loss of function and psychosocial issues. Studies have been carried out on different rehabilitation outcomes such as participation, self-motivation and functional ability related to stroke survivors. There is however a dearth of studies exploring the relationships among self-motivation, functional ability and participation of stroke survivors, particularly in our African community.Objectives:Relationship among participation, self-motivation and functional ability of stroke survivors residing in Ibadan was investigated.Methods:This was a cross-sectional survey which involved 44 consenting stroke survivors. Clinical and demographic information were documented. Self-motivation, functional ability and participation of the stroke survivors were assessed with the Self-Motivation Inventory, Fugl-Meyer Assessment of Motor Recovery after Stroke; and London Handicap Scale respectively. Data was analysed with descriptive statistics and inferential statistics of Spearman Rank Correlation at p= 0.05.Results:There was a statistically significant positive correlation between the time since onset of stroke scores and participation (p= 0.02) and between the stroke survivors' functional ability and participation scores (p=0.001). Conversely there was no significant relationship between the participants' functional ability and time since onset of stroke scores (p= 0.62), between stroke survivors' self-motivation and time since onset of stroke scores (p= 0.41), between self-motivation and participation (p=0.80) and between self-motivation and functional ability scores (p= 0.80)Conclusions:Whereas self-motivation appeared non-related to functional ability and participation, a more exploration of the subject matter is still necessary for a conclusive inference to be drawn, especially in view of the sample size involved in this present study

Relationship between sociodemographic characteristics of stroke survivors and poststroke motor performance

Background: Motor impairment is a frequent presentation of stroke leading to partial or total loss of function of a body part usually limbs. Objective: This study investigated poststroke motor performance and its association with sociodemographic and clinical characteristics of stroke survivors. Materials and Methods: Ninety-four stroke survivors from two selected physiotherapy clinics in Maiduguri participated in this study. Data form was used to obtain information on sociodemographic and clinical characteristics of the participants while the Short-Form Fugl Meyer scale was used to obtain the information on motor performance of the participants. Descriptive statistics of mean, standard deviation, frequency, and percentage were used to summarize the data. Chi-square test of association was used to analyze motor performance and its association with sociodemographic and clinical characteristics of the participants. Results: The mean age and poststroke duration of the participants were 52.65 ± 12.70 years and 26.32 ± 32.70 months, respectively. Of the entire participants, 55 (58.5%) were male, 49 (52.1%) were employed, and 33 (35.1%) had Qur'anic education. Forty (42.6%) had a duration of stroke between 3 and 12 months. Gender (χ2 = 12.72, P = 0.002) and educational level (χ2 = 17.77, P = 0.023) were significantly associated with motor performance. Age, employment status, and duration of stroke showed no significant association with motor performance. Conclusion: The outcome of this study suggests that female gender and "no educational" attainment were associated with poor motor performance among stroke survivors in Maiduguri. Gender and educational level can influence motor impairment after stroke and should represent an essential part of assessment during stroke rehabilitation

Admission hyperglycemia and associated risk factors among patients with acute stroke in intensive care units in Kinshasa, the Democratic Republic of the Congo

Context and objective. Despite being established as a correlate of unfavorable outcome in acute stroke, little is known about the burden and associated risk factors of admission hyperglycemia in acute stroke in sub-Saharan Africa. The present study aimed to assess its frequency and associated risk factors in Congolese patients admitted in Intensive Care Units (ICUs) in the acute phase of stroke. Methods. A multicenter (6 ICUs) prospective cohort study including consecutive patients with acute stroke was undertaken from July 15th, 2017 to March 15th, 2018.The Glasgow Coma Scale helped to determine the severety of the disease at admission. Stress hyperglycemia was considered for a random blood glucose levels at admission ˃140 mg/dL in patients without type 2 diabetes mellitus (T2DM). Independent factors associated with admission hyperglycemia were assessed using logistic regression analysis. Results. Out of 194 patients (mean age 58.7±13.1 years; 64% males, 74.7% light to moderate stroke severity; 59% hemorrhagic stroke) enrolled, admission hyperglycemia was found in 106 (54.6%) of patients (mean age 60.1 ± 14.3 years; 67% men, 67% hypertension) with 77 (72.6%) and 29 (27.4 %) of them having stress and chronic hyperglycemia, respectively. Independent predictors of admission hyperglycemia were age [aOR 1.98; 95%CI 1.17-3.36), GCS < 8 (aOR 3.83; 95% CI 1.99-7.35) and diabetes (aOR 9.02; 95%CI 3.38-14.05). Conclusion. More than half of critically ill patients exhibit admission hyperglycemia with age, severity of stroke and known diabetes as its main associated risk factors

Cerebrovascular accidents indicative of COVID-19 infection: about 4 observations in Guinea

Introduction: coronavirus is a virus with potential to target the nervous and respiratory systems. The aim of this work is to establish the prevalence of strokes in COVID19 positive patients in Guinea. Methods: all patients with stroke confirmed by brain imaging and COVID-positive PCR were included in this study. Retrospective patient data were obtained from medical records. Informed consent was obtained. Results: the RT-PCR confirmed the initial diagnosis and the chest CT scan provided a good diagnostic orientation. Brain imaging identified ischemic brain lesions. We report the case of four patients with stroke and a COVID-19 incidental finding in Guinea.Conclusion: this work shows that the onset of ischemic stroke associated with COVID-19 is generally delayed, but can occur both early and late in the course of the disease. More attention is needed because the early symptoms of viral attack are not just pulmonary