Objective: We analysed the Qatar stroke registry for ethnic variations in patients admitted with cerebrovascular disease at Hamad General Hospital, Qatar. Methods: Patients admitted with acute stroke from January 2014 to December 2015, enrolled in the registry were included in the study. We evaluated the clinical presentation, risk factors, and outcome at discharge and 90 days postdischarge in relation to the patient's ethnic background. Results: A total of 1727 patients were enrolled in the Hamad General Hospital stroke registry (Middle Eastern 594 (34.4%), South East Asian 924 (53.5%) and Far Eastern 209 (12.1%)). There were significant differences in risk factors, clinical presentation and prognosis. Compared to Middle Eastern patients, Far Eastern patients were younger (62.8 AE 13.7 vs. 48.9 AE 9.1 years; p < 0.001). Diabetes and hypertension were significantly more common in Middle Eastern patients (358 (60.3%), 458 (77.1%)) compared to South East Asian patients (420 (45.5%), 596 (64.5%)) and Far Eastern patients (57 (27.3%), 154 (73.7%)), respectively (p < 0.001). Stroke was more severe in the Far Eastern group (median (interquartile range)-5.0 (2-11.5)) compared to the Middle Eastern group (median (interquartile range)-4.0 (1-8)) and South East Asian (median (interquartile range)-4.0 (2-9)), p ¼ 0.011. Mortality at 90 days was highest in patients from the Far East (15/209 (8.2%)) compared to the Middle East (35/594 (6.5%)) and South East Asia (33/924 (4.0)), p ¼ 0.028. Patients from the Far East had significantly higher rates of intracranial hemorrhage compared to the Middle East and South East Asia (70/209 (33.5%), 77/594 (13.0%), and 169/924 (18.3%)), respectively (p < 0.001). Conclusion: The early age at presentation and the poor control of risk factors, especially in patients from South East Asia and the Far East requires attention.

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Background and Purpose— Usefulness of multidisciplinary stroke units in acute stroke patients is well established. There is extensive western literature on usefulness of stroke units in outcome, but limited evidence from the rest of the world. We aim to evaluate the impact of establishing a stroke unit on outcome in patients presenting to a tertiary care facility. Methods— This is a retrospective study of 1003 patients with acute stroke admitted to Hamad General Hospital, Qatar, between January 2014 and February 2015. Patients directly admitted to intensive care unit (132) were excluded. We compared outcomes of pre- and poststroke ward (SW) establishment and in SW patients versus those of general medical wards. Results— Before the establishment of the SW, 175 patients were admitted to the hospital. From April 2014 to February 2015, 696 patients were admitted (SW, 545; medical ward, 151). There was a significant reduction in length of stay from 14.7±27.7 to 6.2±20.2 days ( P =0.0001) and incidence of complications (23.6% versus 6.4%, P =0.0001) after implementation of stroke-specific protocols. Prognosis at discharge (modified Rankin Scale 0–2 in 56.0% versus 70.4%, P =0.001) and at 90 days (modified Rankin Scale 0–2 in 70.6% versus 95.0%, P =0.001) also significantly improved. Compared with medical ward patients, outcome was significantly better in SW patients with fewer complications (10.9% versus 5.0%, P =0.013) and shorter length of stay (8.9±30.7 versus 5.4±16.1 days, P =0.05). Conclusions— Establishing a distinct SW is essential for achieving full benefits of stroke protocols implementation. SW patients have significantly fewer complications and better prognosis when compared with patients in medical wards.

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Corneal confocal microscopy is a rapid noninvasive ophthalmic imaging technique that identifies corneal nerve fiber loss in patients with acute ischemic stroke.

ObjectiveDepression occurs in approximately 30 percent of stroke patients, leading to increased disability, lower quality of life and increased mortality. Given new recommendations to assess depression in acute stroke patients this study evaluated rates of acute post stroke depression at a Primary Stroke Center in Doha, Qatar.MethodsAcute stroke patients (n = 233) were given the PHQ-9 and the Mini-Cog test by stroke unit nurses within the first few days post stroke. This was part of a clinical improvement project conducted from March 2016 thru March 2017.ResultsApproximately 20% of acute post stroke patients (46/233) scored in the moderately depressed range on the Patient Health Questionnaire (PHQ-9 ≥10 with item 1 and/or 2 endorsed). Nationality and dysarthria were significantly associated with depression. Females were twice as likely to be depressed. A significantly greater number of Middle Eastern and African patients were depressed (30.18%) than Southeast Asian and Western Pacific patients (16.76%). A PHQ-2 cut off of 2 was optimal with sensitivity of 91.3 and specificity of 71.6.ConclusionsAlmost 20% of acute stroke patients were moderately depressed on the PHQ-9, with Middle Eastern/African patients almost twice as likely to be depressed. This may reflect higher baseline pre-stroke depression levels in those of Middle Eastern/African background, perhaps due to greater levels or stress or trauma exposure in these groups. Dysarthria was found to be significantly associated with depression. Initial screening with the PHQ-2 using a cut-off of 2 (versus the cut-off of 3 used in primary care settings) may be beneficial. Based on these results acute post stroke depression screening is recommended in the Middle East, coupled with culturally sensitive psychiatric care.

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IntroductionThe COVID-19 pandemic has resulted in a dramatic unexplained decline in hospital admissions due to acute coronary syndromes and stroke. Several theories have emerged aiming to explain this decline, mostly revolving around the fear of contracting the disease and thus avoiding hospital visits.AimsIn this study, we aim to examine the impact of the COVID-19 pandemic on stroke admissions to a tertiary care centre in Qatar.MethodsThe Hamad General Hospital stroke database was interrogated for stroke admissions between September 2019 and May 2020. The number of stroke admissions, stroke subtypes and short-term outcomes was compared between the ‘pre-COVID-19’ period (September 2019 to February 2020) and the COVID-19 pandemic period (March to May 2020).ResultsWe observed a significant decline in monthly admissions in March (157), April (128) and May (135) compared with the pre-COVID-19 6-month average (229) (p=0.024). The reduction in admissions was most evident in functional stroke mimics. The average admissions decreased from 87 to 34 per month (p=0.0001). Although there were no significant differences in admissions due to ischaemic stroke (IS), intracranial haemorrhage or transient ischaemic attacks between the two periods, we noted a relative decrease in IS due to small vessel disease and an increase in those due to large vessel atherosclerosis in March to May 2020.ConclusionsThe decline in overall stroke admissions during the COVID-19 pandemic is most likely related to concerns of contracting the infection, evidenced mainly by a decline in admissions of stroke mimics. However, a relative increase in large vessel occlusions raises suspicion of pathophysiological effects of the virus, and requires further investigation.