Incidence and prevalence of stroke and its risk factors in the Philippines: A systematic review

Background@#Various epidemiologic studies reported different stroke incidence and prevalence rates in the Philippines. Thus, there is a need to synthesize existing information on these indicators to depict more accurate evidence on the burden on stroke in the country. @*Objective@#The objective of this systematic review is to provide evidence on the incidence and prevalence of stroke in the Philippines, as well as its associated risk factors. @*Methods@#PubMed and HERDIN were searched for available full-text Philippine epidemiologic studies on stroke incidence and prevalence, whether population or hospital-based, and its associated risk factors. We used three tools for risk of bias assessment, namely, the Newcastle Ottawa Scale for cohort studies, the Quality assessment checklist of Hoy et al. for cross-sectional prevalence studies, and the AXIS tool for general cross-sectional studies. @*Results@#A total of 14 studies were included in this review. Based on these studies, the national stroke incidence rate ranged from 3.95% to 5.61%, while the national stroke prevalence rate ranged from 0.486% to 6.0%. Hypertension remains the commonly reported risk factor of stroke alongside diabetes, smoking, and high cholesterol level. @*Conclusions@#Despite limitations, we were able to perform a complete assessment of the risk of bias in included studies which provide information on the studies with reliable information. Based on this systematic review, there is variability on data and limited studies on the national epidemiology of stroke in the Philippines. It is recommended that the national government consider establishing a system such as a national registry for better data collection and analysis.

Stroke in patients with COVID-19 infection in a tertiary hospital: A retrospective study

Introduction@#Stroke can be a complication and/or a presenting sign of COVID-19 infection. Although there is growing evidence on stroke in COVID-19 infection, only a few of these studies were done in Asia and there is very scarce evidence in the local setting. @*Objective@#This study aimed to characterize the clinical profile, management, and functional outcome of patients with acute stroke and COVID-19 infection. @*Methods@#This was a single-center retrospective study from March 30 to October 20, 2020. The demographic characteristics, respiratory symptoms, risk factors, neuroimaging, stroke characteristics, ancillary test results, treatment given, and functional outcome were obtained through a review of medical records. Computation of the mean, standard deviation, median, interquartile range, total count, and percentage was done for data analysis. @*Results@#Out of 2,018 patients with COVID-19 infection, 41 (2%) developed an acute stroke. The mean age of patients was 59.05 ± 14.04 years. Majority were men (n=24, 59%). Ischemic stroke (n=28, 68%) was the most common stroke with the anterior circulation commonly involved (n=21, 72%). The most common risk factors were hypertension (n=31, n=76%), cigarette smoking (n=18, 44%), dyslipidemia (n=16, 39%), and ethanol use (n=16, 39%). Among those with stroke and COVID-19 infection, 42% had mild infection and 29% had critical disease. The inflammatory markers were elevated in these patients. Upon discharge, 83% had a poor functional outcome (mRS 3–6). The overall mortality rate was high (n=24, 59%) with pulmonary cause as the most common cause of death. @*Conclusion@#Ischemic stroke was the most common stroke type in patients infected with COVID-19. The common risk factors were hypertension, dyslipidemia, smoking, ethanol use, and diabetes mellitus. The functional outcome was generally poor and the mortality rate was high. More studies are needed that compare these subsets of patients with a control group, including a longer follow up.