Comparison of stroke knowledge before and after education in Ethiopia (The ask project)

Background: In order to address the growing burden of stroke in Africa, it is essential to have teaching tools that are accessible to a wide variety of communities. Resources for stroke, recognition of symptoms, steps to assist a stroke victim, or any educational tools are scarce. In order to increase education about stroke, we introduced a stroke education intervention in Bahir Dar, Ethiopia in the Amharic language. The aim of the intervention was to see if stroke knowledge and recognition of stroke symptoms increased post-education. Methods: An anonymous pre-test questionnaire was given to identify their baseline stroke knowledge, and then participants viewed the video about stroke. The Amharic BE-FAST acronym was introduced in the video to evaluate participants’ retention of stroke symptoms, while emphasizing the importance of rapid response. Participants were given a survey to post-test survey of their short-term memory recall, along with another satisfaction survey. Results: Over 50% of participants remembered all five letters of the Amharic BE-FAST acronym, nearly 80% answered that they learned about stroke prevention, 90% were satisfied with the video, and 98% thought it should be available widely to the general public. The data presented showed that there was an improvement in stroke education retention with the use of the stroke education video. Conclusions: The Amharic BE-FAST acronym demonstrated to be an effective tool in communicating the symptoms of stroke from English to Amharic. Stroke education was well received, which provided insight on how to design and implement new medical concepts in native languages.   French title:Connaissances sur les accidents vasulaires cerebraux avant et apres une education en Éthiopie (Projet ask)   Introduction: Afin de faire face au fardeau croissant des AVC en Afrique, il est essentiel de disposer d'outils pédagogiques accssibles à une grande variété de communautés. Les ressources pour l'AVC, la reconnaissance des symptômes, les étapes pour aider une victime d'AVC ou tout autre outil éducatif sont rares. Afin d'accroître l'éducation sur l'AVC, nous avons introduit une intervention d'éducation sur l'AVC à Bahir Dar, en Ethiopie, en langue amharique. Le but de l'intervention était de voir si la connaissance et la reconnaissance des symptômes de l'AVC augmentaient après l'éducation. Méthodes: Un questionnaire pré-test anonyme a été donné pour identifier leurs connaissances de base sur l'AVC, puis les participants ont visionné la vidéo sur l'AVC. L'acronyme amharique BE-FAST a été introduit dans la vidéo pour évaluer la rétention des symptômes d'AVC par les participants, tout en soulignant l'importance d'une réponse rapide. Les participants ont reçu une enquête pour post-test de leur mémoire à court terme, ainsi qu'une autre enquête de satisfaction. Résultats: Plus de 50% des participants se sont souvenus des cinq lettres de l'acronyme amharique BE-FAST, près de 80% ont répondu avoir appris la prévention des AVC, 90% étaient satisfaits de la vidéo et 98% pensaient qu'elle devrait être largement accessible au grand public. Les données présentées ont montré qu'il y avait une amélioration de la rétention de l'éducation sur l'AVC grâce à l'utilisation de la vidéo d'éducation sur l'AVC. Conclusion: L'acronyme amharique BE-FAST s'est révélé être un outil efficace pour communiquer les symptômes de l'AVC de l'anglais à l'amharique. L'éducation sur l'AVC a été bien accueillie, ce qui a permis de comprendre comment concevoir et mettre en oeuvre de nouveaux concepts médicaux dans les langues maternelles

Abstract Number ‐ 225: COVID‐19 As A Potential Inducer Of Antiphospholipid Syndrome In A Patient With Acute Ischemic Stroke

Introduction COVID‐19 has been linked to hypercoagulability and acute ischemic stroke, though the precise mechanism is not well understood [1]. Various mechanisms have been suggested, including the potential release of autoantibodies‐ either via self‐production or exacerbation of the release of already produced autoantibodies [2‐3]. Antiphospholipid antibodies have been identified in severe disease [3‐4] and implicated in thrombosis [1‐2], though the significance is unclear. In this report, we describe a young woman with asymptomatic COVID‐19 presenting with acute ischemic stroke and postulate it was a manifestation of activated autoimmunity from COVID‐19. Methods Case Report Results A 22 year‐old previously healthy woman presented with acute onset dysarthria and right upper extremity weakness and numbness. On presentation, blood pressure was 158/101. NIHSS was 2 for right upper extremity drift and decreased sensation. Neurologic exam was otherwise unremarkable. Thrombolytic therapy was not administered given presentation outside the time window. CT head showed scattered left centrum semiovale hypodensities without hemorrhage. MRI brain demonstrated multifocal areas of diffusion restriction in the left centrum semiovale, anterior frontal lobe, and parietal lobe. CT angiogram demonstrated a possible thrombus at the left carotid bifurcation which was redemonstrated on MR angiography of the neck. No atherosclerotic plaque, hemodynamically significant stenosis, nor other vascular abnormality were appreciated. Heparin drip was started. Hemoglobin was 6.9 for which 1 unit of packed red blood cells was transfused. White blood cell count was 9.02. Platelet count was 761. PT/INR and PTT were 13.4/1.2 and 30.1. HIV was negative, RPR was positive at 1:128 titer, and COVID PCR was positive. She did not experience respiratory symptoms. Urine drug screen was positive for cannabinoids. LDL was 66. Transthoracic echo demonstrated minimal right to left shunting, suggesting patent foramen ovale. Ejection fraction was 60–65% and chamber sizes were normal. Bilateral lower extremity ultrasound was negative for deep vein thrombosis as a potential embolic source given cardiac shunt. Given history of miscarriage and extensive family history of sickle cell trait, possible lupus anticoagulant, and thrombosis at young ages, hypercoagulable workup was sent. Sickle cell preparation and ANA were negative. ESR was 12. High sensitivity CRP was 2.71. Anticardiolipin IgM antibody was elevated significantly at 125.9 MPL and IgG antibody was indeterminately elevated at 19.2 GPL. Beta‐2 glycoprotein IgM antibodies were also elevated at 42 SMUnits. Atypical neurosyphilis was considered given positive titer, middle cerebral artery distribution, and young age, but deemed unlikely given embolic rather than inflammatory stroke pattern [5]. Ultimately, with a possible diagnosis of antiphospholipid syndrome, anticoagulation was transitioned to warfarin via enoxaparin bridge with plan for repeat hypercoagulable workup as outpatient. Conclusions COVID‐19 has been observed in association with hypercoagulable states such as deep venous thrombosis and stroke. Here we present a case of COVID‐19 associated ischemic stroke with concomitant antiphospholipid antibodies. This case highlights the potential for even asymptomatic/mild COVID‐19 to induce autoimmunity through modulation of host antibody activity. This may be more profound in those with a predisposition to thrombosis. Autoimmunity should be considered in cases of concurrent COVID‐19 and acute ischemic stroke without clear etiology

A Brief Survey of Medical Practitioner Knowledge and Attitudes Regarding Autism Spectrum Disorder in Bahir Dar, Ethiopia

Background: Autism spectrum disorder (ASD) continues to climb in prevalence worldwide. Developed nations have focused on aligning their medical and research communities in order to investigate the mechanisms of pathogenesis, diagnosis, and societal impact of this disorder. A simultaneous rise of ASD has impacted developing nations, such as Ethiopia, without a commensurate ability to research the knowledge, beliefs, resources, and training regarding this condition in the country.Materials and Methods: We administered a brief survey during a medical conference in Bahir Dar, Ethiopia, to investigate some of the education, information, and experiences with ASD within a small sample of medical and mental health providers in Ethiopia.Results: The data provided insight into the following areas pertaining to ASD in Ethiopia: perceived causes, knowledge, training, and areas of need.Conclusion: Understanding local beliefs for causes and cures, as well as gaining indigenous opinions regarding what is needed for ASD education and resources in their nation, is the first step towards understanding the impact of this disorder and the approach to its treatment in Ethiopia

Mechanical Thrombectomy Global Access for Stroke (Mt-Glass): A Mission Thrombectomy (Mt-2020 Plus) Study

BACKGROUND: Despite the well-established potent benefit of mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke, access to MT has not been studied globally. We conducted a worldwide survey of countries on 6 continents to define MT access (MTA), the disparities in MTA, and its determinants on a global scale. METHODS: Our survey was conducted in 75 countries through the Mission Thrombectomy 2020+ global network between November 22, 2020, and February 28, 2021. The primary end points were the current annual MTA, MT operator availability, and MT center availability. MTA was defined as the estimated proportion of patients with LVO receiving MT in a given region annually. The availability metrics were defined as ([current MT operators×50/current annual number of estimated thrombectomy-eligible LVOs]×100 = MT operator availability) and ([current MT centers×150/current annual number of estimated thrombectomy-eligible LVOs]×100= MT center availability). The metrics used optimal MT volume per operator as 50 and an optimal MT volume per center as 150. Multivariable-adjusted generalized linear models were used to evaluate factors associated with MTA. RESULTS: We received 887 responses from 67 countries. The median global MTA was 2.79% (interquartile range, 0.70-11.74). MTA was \u3c1.0% for 18 (27%) countries and 0 for 7 (10%) countries. There was a 460-fold disparity between the highest and lowest nonzero MTA regions and low-income countries had 88% lower MTA compared with high-income countries. The global MT operator availability was 16.5% of optimal and the MT center availability was 20.8% of optimal. On multivariable regression, country income level (low or lower-middle versus high: odds ratio, 0.08 [95% CI, 0.04-0.12]), MT operator availability (odds ratio, 3.35 [95% CI, 2.07-5.42]), MT center availability (odds ratio, 2.86 [95% CI, 1.84-4.48]), and presence of prehospital acute stroke bypass protocol (odds ratio, 4.00 [95% CI, 1.70-9.42]) were significantly associated with increased odds of MTA. CONCLUSIONS: Access to MT on a global level is extremely low, with enormous disparities between countries by income level. The significant determinants of MT access are the country\u27s per capita gross national income, prehospital LVO triage policy, and MT operator and center availability