Door to Needle Count Down: A 3-Years Experience in an Egyptian University Stroke Center.

BACKGROUND: The purpose of this study is to share our experience in changing hospital strategies to achieve rapid thrombolysis in acute ischemic stroke (AIS) patients in 2 university stroke centers. Rapid reperfusion by shortening door to needle time (DTN) reduces morbidity and mortality for patients with AIS. Our aim is to evaluate the effect of applying certain logistic strategies to reduce DTN for thrombolysis and its impact on clinical outcome. METHODS: In this retrospective registry-based observational study from the SITS-ISTR Dataset, we studied AIS patients admitted to 2 stroke centers in Ain Shams University over 3 successive years from 2016 till 2018. We analyzed change of DTN and outcome at 3 months by modified Rankin scale over these 3 years. RESULTS: By the end of the 3 year period there was a 6.1% increase in number of patients receiving thrombolysis. There was a significant decrease of median DTN by 41%, and increase in percentage of patients receiving recombinant tissue plasminogen activator within a shorter DTN. Also, the number of patients with a favorable outcome (modified Rankin scale≤2) increased by 23.3%. There was insignificant difference regarding mortality rate. CONCLUSION: Applying a goal-directed corrective strategy to improve quality of service can, in a short time, reduce DTN and improve patient outcome.

Concepts behind epilepsy among Egyptian patients. Is it a disease or a possession?!

BACKGROUND: Many epileptic patients visit traditional healers secondary to unaffordability, inaccessibility of medical service and being refractory. This may lead to delay in seeking medical advice and may influence prognosis. OBJECTIVES: Studying concepts behind epilepsy among Egyptian epilepsy sufferers including beliefs behind epilepsy and whether there is difference in these beliefs as regards gender, education and urban to rural socioeconomic status. METHODS: A semi structured questionnaire designed according to the guidelines of the 9th edition of research methods in psychology and applied to 393 cases presenting to epilepsy clinics at three hospitals representing rural delta, capital, and upper rural Egypt between November 2019 and April 2020. Inclusion criteria included a fulfillment of the international league against epilepsy operational definition and availability of an electroencephalogram supporting the diagnosis of epilepsy. RESULTS: 30 % of patients visited traditional healers within the course of their illness with males accounting for 55.9 %, and relatives' impact was more obvious in this decision (83.9 % visited traditional healers secondary to a relative influence). 43.2 % of traditional healers' visitors had a basic education. Low education level was significantly correlated with visiting traditional healers (rho=-0.126, p = 0.012). 43 patients (36.4 %) received traditional therapy and only 3 patients (2.5 %) out of them improved. More males (55.9 %) than females (29.5 %) were found to seek non-medical help with no significant difference (p = 0.852). Additionally, it was noticed that males who lived in rural areas visited traditional healers significantly more than those who lived in urban (72.2 % vs 27.3 %, p = 0.011) while in females, it seems that residency did not affect traditional healers seeking behavior (50 % urban vs 50 % rural). Rural residents were seeking non-medical advice more than urban (28.3 % vs 22 %, p < 0.001) as well as receiving traditional treatments (19.7 % vs 11 %, p = 0.017). CONCLUSIONS: Seeking traditional healers in epilepsy sufferers is not uncommon in Egypt. Education, gender, and residency may affect concepts and beliefs regarding epilepsy. Although awareness of epilepsy as a medical condition is also questionable, yet it is needed.

Factors related to time of stroke onset versus time of hospital arrival: A SITS registry-based study in an Egyptian stroke center.

BACKGROUND: High-quality data on time of stroke onset and time of hospital arrival is required for proper evaluation of points of delay that might hinder access to medical care after the onset of stroke symptoms. PURPOSE: Based on (SITS Dataset) in Egyptian stroke patients, we aimed to explore factors related to time of onset versus time of hospital arrival for acute ischemic stroke (AIS). MATERIAL AND METHODS: We included 1,450 AIS patients from two stroke centers of Ain Shams University, Cairo, Egypt. We divided the day to four quarters and evaluated relationship between different factors and time of stroke onset and time of hospital arrival. The factors included: age, sex, duration from stroke onset to hospital arrival, type of management, type of stroke (TOAST classification), National Institute of Health Stroke Scale (NIHSS) on admission and favorable outcome modified Rankin Scale (mRS ≤2). RESULTS: Pre-hospital: highest stroke incidence was in the first and fourth quarters. There was no significant difference in the mean age, sex, type of stroke in relation to time of onset. NIHSS was significantly less in onset in third quarter of the day. Percentage of patients who received thrombolytic therapy was higher with onset in the first 2 quarters of the day (p = <0.001). In-hospital: there was no difference in percentage of patients who received thrombolytic therapy nor in outcome across 4 quarters of arrival to hospital. CONCLUSION: Pre-hospital factors still need adjustment to improve percentage of thrombolysis, while in-hospital factors showed consistent performance.

Urban Versus Rural Egypt: Stroke Risk Factors and Clinical Profile: Cross-Sectional Observational Study.

BACKGROUND: Egypt is a densely populated country with living habits and health care services that differ from urban to rural regions. We aimed to study how characteristics of stroke vary among these regions. METHODS: This is a cross-sectional observational study of ischemic stroke, thus hemorrhagic and venous strokes were excluded. A total of 1475 ischemic stroke patients were recruited for analysis from a tertiary hospital in Cairo representing urban area and from a secondary care hospital in Suhag representing rural region. RESULTS: Analysis was done for 1143 ischemic stroke patients from urban and 332 from rural area. Onset to door was shorter in urban. Urban patients showed an older age and higher prevalence of hypertension and diabetes (65.9%, 48.6% respectively), while rural patients were characterized by female preponderance (51.5%), more dyslipidemia, smoking 44.6%, stroke in young 20.5%, atrial fibrillation 23.8% % and recurrent stroke 44.3%. Rural cases showed a severer deficit at onset and poorer outcome. CONCLUSION: Vascular risk factors, stroke type, and presentation tend to differ in Egypt according to the geographic distribution whether urban or rural. Studying patterns of such difference may aid in planning specific targeted preventive and therapeutic strategies for stroke in urban and rural Egypt.