ABSTRACT
Introduction: stroke is a cerebrovascular disease. Early reperfusion in neurovascular units can reduce its morbidity and mortality. Even when neurovascular units exist, patients usually arrive late in the emergency department. to the purpose of this study was to determine prehospital delay in patients with acute ischemic stroke and associated factors. Methods: we conducted a retrospective cross-sectional study in the neurology department of the Fann University Hospital in Dakar from January 1s t to June 30th, 2020. We included patients younger than 80 years seen in the emergency unit for ischemic stroke. The median time to presentation was calculated based on the time of stroke onset and that of arrival at the hospital. Multivariate analysis was used to determine factors associated with prehospital delay. Results: a total of 56 patients were enrolled, among whom 58.6% arrived at the hospital in less than 3 hours. Of them, 37.5% presented to a level 3 or 4 hospital first. Less than 34% of our patient presented to a level 2-3 hospital in less than 3 hours. Based on bi- and multivariate analysis, being married (OR = 7.2 [CI à 95%: 1.5 - 35.8]), being a female (OR = 5.5 [CI à 95%: 1.5 - 19.8]) and having stroke during week days (OR = 4.3 [CI à 95%: 1.3-13.9]) were associated with prehospital delay. Conclusion: most of our patients arrived late at a level 2 or 3 hospital. Being a married woman increased the risk of late arrival. This study highlights the importance of improving awareness in order to increase the proportion of patients potentially eligible for revascularization.
Subject(s)
Emergency Medical Services , Ischemic Stroke , Stroke , Cross-Sectional Studies , Emergency Service, Hospital , Female , Hospitals, Teaching , Humans , Retrospective Studies , Senegal , Stroke/therapy , Time FactorsABSTRACT
INTRODUCTION: Medication-overuse headaches (MOHs) are the least studied of all headaches in Africa. METHODS: We conducted a longitudinal study in order to describe our experience with patients placed in Neurology Outpatient observation in Brazzaville over a period of 4 years, from September 2010 to August 2014. All patients with chronic primary headaches, according to the International Classification of Headache Disorders (ICHD) (2nd edition), were included in the study. All patient with secondary headaches or who hadn't given consent were excluded. The patients were divided into two groups: those who had progressed to medication-overuse and those who didn't meet the criteria for medication-overuse (without-MOH). The variables used were the sociodemographic characteristics of patients, the clinical features of primary headaches and MOH treatment. RESULTS: The study population was constituted by 193 patients out of 212. The average age of patients was 42 ± 14 years, of whom 66.32% were women. MOH rate was 35.75%. The associated factors were: early age (p=0.003), concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol (p=0.0001) as well as self-medication (p<0.0001). By contrast, higher education (p<0.0001) and the use of NSAID alone (0.002) were protective factors against the onset of MOH. Ambulatory withdrawal was the most practiced treatment and amitriptyline was the most commonly used medication. CONCLUSION: Medication-overuse headaches are frequent in patients placed in Neurology Outpatient observation in Africa and deserve identification for a better management.
Subject(s)
Headache Disorders, Secondary/epidemiology , Headache Disorders/epidemiology , Adolescent , Adult , Age Factors , Aged , Congo , Educational Status , Female , Headache Disorders/therapy , Headache Disorders, Secondary/therapy , Humans , Longitudinal Studies , Male , Middle Aged , Protective Factors , Risk Factors , Young AdultABSTRACT
Introduction: les céphalées par abus médicamenteux (CAM) restent le type de céphalées le moins étudié en Afrique.Méthodes: dans le but de rapporter l'expérience Brazzavilloise, nous avons mené une étude longitudinale durant 4 ans, de septembre 2010 à août 2014, en consultation de neurologie à Brazzaville. Nous avons inclus tous les patients présentant des céphalées primaires chroniques selon la classification International Classification of Headache Disorders-2 (ICHD-2). Tout patient présentant des céphalées secondaires ou n'ayant pas donné son consentement a été exclu. Les patients ont été divisés en deux groupes: ceux ayant évolué vers une CAM, et ceux qui ne présentent pas des critères d'abus médicamenteux (sans-CAM). Les variables d'études ont été sociodémographiques, les caractéristiques de la céphalée primaire initiale et la prise en charge de la CAM.Résultats: sur 212 patients inclus, 193 ont constitué notre population d'étude. L'âge moyen de 42±14 ans, dont 66,32% de femmes. La fréquence des CAM était de 35,75%. Les facteurs associés identifiés étaient: l'âge jeune (p=0,003), l'utilisation de l'association antiinflammatoire non stéroïdien (AINS) et paracétamol (p=0,0001) et l'automédication (p<0,0001). Par contre, le niveau d'instruction supérieur (p<0,0001) et l'utilisation de l'AINS seul (0,002) étaient protecteurs contre la survenue de la CAM. Le sevrage ambulatoire a été le plus pratiqué, l'amitriptyline reste le médicament le plus utilisé.Conclusion: les CAM sont fréquentes en consultation de neurologie en Afrique et méritent d'être identifiées pour une meilleure prise en charge
