Adherence to Antithrombotic Treatment and Ischemic Stroke Recurrence in Egypt and Germany: A Comparative Analysis.

BACKGROUND: The burden of stroke weighs heavily in developing countries where recurrence rates clearly exceed that of developed countries. The impact of nonadherence to antithrombotic treatment within this context has been poorly investigated. OBJECTIVE: The objective of this study was to evaluate patients with recurrent ischemic stroke in Egypt and Germany with focus on stroke subtype distribution and adherence to antithrombotic therapy. METHODS: We conducted a comparative cross-sectional retrospective cohort study enrolling consecutive patients hospitalized for recurrent ischemic stroke in 2017 in 2 academic centers. Data were collected on demographics, risk factors, stroke subtypes, and medication adherence. Nonadherence to antithrombotic agents was analyzed at the time point of index stroke (recurrent stroke). Predictors of nonadherence were analyzed using logistic regression. RESULTS: A total of 373 Egyptian and 468 German patients with ischemic stroke were included. The proportion of recurrent ischemic stroke among all patients was higher in the Egyptian cohort compared to the German cohort (33 vs. 10%, p < 0.05). Small-vessel occlusion stroke was the most frequent subtype in Egyptians, with a significantly greater proportion than in Germans (45 vs. 26%, p < 0.05). Nonadherence to antiplatelets at the time point of the recurrent stroke was higher in Egyptians than in Germans (82 vs. 19%, p < 0.001). Low educational attainment among Egyptians (OR 0.14, 95% CI [0.00-0.19], p < 0.01) and high comorbidity scores among Germans (OR 2.45, 95% CI [1.06-5.66], p < 0.05) were found to be predictors of nonadherence to antithrombotic treatment. CONCLUSIONS: The large stroke recurrence burden in Egypt may be partly explained by differing adherence to secondary preventative antithrombotic pharmacotherapy. Predictors of medication nonadherence have to be addressed to reduce stroke recurrence disparities.

Outcome of living donor liver transplantation in patients with preoperative portal vein thrombosis.

BACKGROUND AND STUDY AIMS: Portal vein thrombosis (PVT) is no longer an absolute contraindication for living donor liver transplantation (LDLT). This study aimed to assess the short-term outcomes of LDLT and compare the 1-year survival rates between patients with and without preoperative PVT. PATIENTS AND METHODS: This combined prospective and retrospective cohort study was conducted on patients who underwent LDLT at Ain Shams Centre for Organ Transplantation (ASCOT) between 2008 and 2020. The study included 60 patients with PVT and 60 patients without PVT. The two groups were compared in terms of preoperative data, operative details, postoperative complications, and 1-year survival. RESULTS: Most patients with PVT were Child C (65%) and had higher model for end stage liver disease scores (16.23 ± 4.03) compared to the non-PVT group (13.9 ± 4.5). The PVT group showed longer cold ischemic time (CIT), hospital stay, and intensive care unit stay and significantly shorter 1-year survival rate (63.3%) compared to the non-PVT group (86.7%) (P = 0.003). Those with PVT grades I, II, and III had 1-year survival rates of 72.5%, 50%, and 40%, respectively. CONCLUSION: Preoperative PVT reduces the 1-year survival after transplantation, with patients with higher PVT grades exhibiting lower 1-year survival. LDLT for PVT still remains challenging and requires further studies.

Seroprevalence of COVID-19 infection in the Emirate of Abu Dhabi, United Arab Emirates: a population-based cross-sectional study.

BACKGROUND: The United Arab Emirates (UAE) was the first country in the Middle East to report severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Serosurveys are essential to understanding the extent of virus transmission. This cross-sectional study aims to assess the seroprevalence of SARS-CoV-2 infection in the Emirate of Abu Dhabi. METHODS: Between 19 July and 14 August 2020, 4487 households were selected using a random sample stratified by region and citizenship of the head of household (UAE citizen or non-citizen). A cluster sample of 40 labour camps was selected. Data on socio-demographic characteristics, risk factors and symptoms compatible with coronavirus disease 2019 (COVID-19) were collected. Each participant was first tested by Roche Elecsys® Anti-SARS-CoV-2 assay, followed, when reactive, by the LIAISON® SARS-CoV-2 S1/S2 IgG assay. RESULTS: Among 8831 individuals from households, seroprevalence was 10·4% [95% confidence intervals (CIs) 9·5-11·4], with higher seroprevalence in Abu Dhabi and Al Ain regions compared with those in Al Dhafra. In households, we found no sex difference and UAE citizens had lower seroprevalence compared with those of other nationalities. Among 4855 workers residing in labour camps, seroprevalence was 68·6% (95% CI 61·7-74·7), with higher seroprevalence among workers from Southeast Asia. In households, individuals with higher body mass indexes demonstrated higher seroprevalences than individuals with normal weight. Anosmia and ageusia were strongly associated with seropositivity. CONCLUSIONS: The majority of household populations in the Emirate of Abu Dhabi remained unexposed to SARS-CoV-2. In labour camps, SARS-CoV-2 transmission was high. Effective public health measures should be maintained.

Endoscopic third ventriculostomy before tumor surgery in children with posterior fossa tumors, CCHE experience.

OBJECTIVE: This is a retrospective study to evaluate the effectiveness of endoscopic third ventriculostomy (ETV) performed in children with posterior fossa tumors and hydrocephalus in an attempt to classify the selected cases who could benefit from ETV as a permanent CSF diversion procedure. METHODS: During the period between January 2008 and December 2008, 40 patients with posterior fossa tumors and associated hydrocephalus were treated inside the Children's Cancer Hospital, Egypt (CCHE)-with ETV in order to relieve the increased intracranial pressure while awaiting their definite tumor surgery. RESULTS: ETV was successful in relieving hydrocephalus clinically and radiologically in 26 patients with different posterior fossa pathologies, with the highest success rate in glioma (100%), followed by 50% in ependymoma and 47.6% in medulloblatoma. In the other 14 cases, preoperative ETV failed in permanently resolving hydrocephalus and patients required the insertion of a ventriculoperitoneal (VP) shunt after their posterior fossa surgery and during their follow-up period. CONCLUSION: ETV should be considered as an alternative procedure to VP shunt in controlling severe hydrocephalus related to posterior fossa tumors, to relieve symptoms quickly during the preoperative period while patients await their definite tumor excision. Patients with ependymomas and gliomas, with totally excised tumors, are better candidates for ETV than those with medulloblastomas. However, ETV cannot always prevent postoperative hydrocephalus in all cases of posterior fossa tumor, the thing that makes using postoperative VP shunt an alternative.

Telovelar Approach to Pediatric Fourth Ventricle Tumors: Feasibility and Outcome.

AIM: To describe our institution’s experience with the telovelar approach as well as factors governing radicality and outcome for pediatric fourth ventricle tumors. MATERIAL AND METHODS: During March 2015â€"January 2017, 44 children with fourth ventricular tumors were operated using the telovelar approach. Radicality, neurological outcome, complications, and survival rates were evaluated. Statistical analysis was performed to determine factors associated with radicality and neurological outcome. RESULTS: Gross tumor removal was achieved in 37 patients (84.1%). All patients required cerebrospinal fluid (CSF) diversion through a ventriculoperitoneal shunt. Six patients (13.6%) developed cerebellar mutism, 4 patients (9.1%) developed bulbar paralysis (lower cranial nerve palsy), and 13 patients (30.2%) had tumor recurrence. Medulloblastoma was associated with the highest risk of cerebellar mutism (p=0.040). A poor prognosis (according to overall and progression-free survival rates) was associated with subtotal resection (p=0.020), large cell/anaplastic medulloblastoma and anaplastic ependymoma (p=0.038), highrisk medulloblastoma (p=0.005), and CSF seeding (p < 0.001). CONCLUSION: The telovelar approach provides an adequate anatomical exposure of the fourth ventricle and allows early visualization and protection of its floor (brainstem). It facilitates adequate radicality and is associated with a lower incidence of cerebellar mutism and other approach-related complications. The working angle, particularly to the rostral part of the fourth ventricle, can be increased by removing the posterior arch of the atlas.