Publications by authors named "Mohammad Saadatnia"

95 Publications

Effects of greater occipital nerve block with local anesthetic and triamcinolone for treatment of medication overuse headache: an open-label, parallel, randomized, controlled clinical trial.

Neurol Sci 2021 May 4. Epub 2021 May 4.

Isfahan Neurosciences Research Center, Al Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Aim: There is a paucity of evidence and consensus on exactly how to carry out the detoxification process. To examine the effect of a greater occipital nerve block (GONB) in the detoxification process, we conducted an open-label, parallel, randomized, controlled clinical trial.

Materials And Methods: In order to conduct this study, 54 medication-overuse headache (MOH) patients were recruited and allocated randomly to group A (n = 27) or B (n = 27). In both groups, patients underwent detoxification processes without any acute migraine medication or analgesics. During the run-in period, all patients in both groups received the same education, managed by a neurologist and nutritionist. All patients were offered maximally 300 mL of promethazine syrup (5 mg/5 mL) to be taken 10 mg every 8 h during the first 10 days of the study. A 2-mL syringe containing 1 mL of lidocaine 2% and 1 mL of triamcinolone 40 mg/mL was prepared for each patient of group A for conducting GONB. Characteristics of headache attacks, including headache severity, frequency, and duration, were assessed at baseline and after 3 months of intervention.

Results: Twenty-six patients in group A (96.3%) and twenty-three in group B (85.2%) completed detoxification, and were thus cured of MOH (P = 0.351). The present study revealed that GONB with local anesthetic and triamcinolone significantly improved the characteristics of headache, including frequency (- 13.66 in group A and - 7.55 in group B), duration (- 7.92 in group A and - 5.88 in group B), and severity (- 3.44 in group A vs. - 1.33 in group B) in group A compared to control (all P value < 0.05).

Conclusions: Although both detoxification programs were effective, detoxification with GONB resulted in better outcomes.

Trial Registration: Iranian Registry of Clinical Trials (registration number; IRCT20150906023922N2).
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http://dx.doi.org/10.1007/s10072-021-05295-yDOI Listing
May 2021

The association between adherence to the MIND diet and stroke: a case-control study.

Nutr Neurosci 2021 Apr 30:1-6. Epub 2021 Apr 30.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Although some components of MIND diet were associated with stroke, no information is available on the association between adherence to the MIND diet and odds of stroke. This study was conducted to investigate the association between adherence to the MIND diet and odds of stroke among Iranian adults.

Methods: This case-control study was done on 193 hospitalized stroke cases and 195 hospital-based controls in Al-Zahra hospital, Isfahan, Iran. Dietary intakes of study participants were assessed using a validated 168-item food frequency questionnaire (FFQ). The MIND diet score was computed based on participants' dietary intakes obtained from FFQ. Stroke was confirmed by a trained neurologist using standard imaging methods.

Results: After controlling for age, sex, energy intake, physical activity, smoking, hypertension, diabetes, dyslipidemia, and heart disease, there was no significant association between adherence to the MIND diet and stroke (OR: 0.54; 95% CI: 0.26, 1.12). However, after further adjustment for BMI, we found that those with the greatest adherence to the MIND diet were less likely to have stroke compared with those with the lowest adherence; such that greater adherence to the MIND diet was associated with a 59% reduced odds of stroke (OR: 0.41; 95% CI: 0.18-0.94).

Conclusion: In conclusion, we found that adherence to the MIND diet was inversely associated with odds of stroke in a case-control study. Further studies are required to confirm these findings.
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http://dx.doi.org/10.1080/1028415X.2021.1918982DOI Listing
April 2021

Public Stroke Knowledge, Awareness, and Response to Acute Stroke in Isfahan Iran: What is Less or Misinterpreted in Developing Countries.

J Stroke Cerebrovasc Dis 2021 Jun 19;30(6):105670. Epub 2021 Mar 19.

Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Considering the high burden of stroke in developing countries, it is important for the community to have adequate information and awareness of this disease. In this study, the baseline knowledge of an Iranian population towards stroke has been evaluated.

Method: This study was conducted in a governmental hospital in Isfahan, Iran. The participants were selected from the companions of non-cardio-vascular hospitalized patients. A self-administered questionnaire was designed for gathering information RESULTS: A total of 630 questionnaires were analysed. Hypertension and stress were the most frequently identified risk factors (recognised by 83.7% and 75.8% respectively), while pregnancy, oral contraceptives, and anti-coagulants were the least (recognised by 3.5%, 14.2% and 15.8% respectively). Knowledge of other important risk factors such as cardiac diseases was also relatively low (39.4%). Sudden visual difficulties and irrelevant speech were the least identified warning signs of stroke (45.3% and 34.6% respectively), however, knowledge towards all other warning signs was moderately good (each identified by 60-70%). Importantly only 44.2% of respondents were aware that stroke treatment should be started within the first 3 hours. Participants tended to have moderately good insight of most stroke complications and rehabilitation (60-70%). Urban residence, high level of education and knowing someone with a history of stroke were significant predictors of a higher level of stroke awareness.

Conclusion: The findings of this study indicate that there is a need to improve general knowledge of cardiac and hypercoagulable related risk factors. Furthermore, understanding of the importance of time critical stroke management and the ineffectiveness of traditional medicine needs to be raised in the general community.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105670DOI Listing
June 2021

Correction to: Stem Cell-Derived Exosomes as Treatment for Stroke: a Systematic Review.

Stem Cell Rev Rep 2021 Apr;17(2):439

Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1007/s12015-021-10153-7DOI Listing
April 2021

Global impact of COVID-19 on stroke care.

Int J Stroke 2021 Mar 29:1747493021991652. Epub 2021 Mar 29.

Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA.

Background: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide.

Aims: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March-31 May 2020) compared with two control three-month periods (immediately preceding and one year prior).

Methods: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers.

Results: The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, -19.7 to -18.7), 11.5% (95%CI, -12.6 to -10.6), and 12.7% (95%CI, -13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (-20.5%) had greater declines in mechanical thrombectomy volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p < 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions.

Conclusion: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes.
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http://dx.doi.org/10.1177/1747493021991652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010375PMC
March 2021

Longitudinal Modeling of Non-Pharmacological Factors Related to Frequency, Severity and Duration in Both Migraine and Tension-Type Headaches.

J Res Health Sci 2020 Oct 24;20(4):e00495. Epub 2020 Oct 24.

Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Frequency, severity, and duration of attacks are some major parameters in headache management, affected by some other factors. Ignoring these factors in headache-related studies can lead to incorrect results. We aimed to model both socio-demographic characteristics and headache-associated symptoms related to frequency, severity and duration of headache attacks.

Study Design: A longitudinal panel study.

Methods: Overall, 275 migraines or tension Type Headache (TTH) patients were visited at three different times in 2012 in Isfahan, Iran. On the first visit socio-demographic characteristics and headache symptoms of the patients were asked. In all of the visits, headache frequency, severity and attack duration were recorded.

Results: Frequency of headaches was influenced by headache type, age, job status, working hours, residency, disease duration, laterality, and type of pain onset. In terms of intensity, headaches were more severe in patients with migraine-type; those suffering from longer headache history; and those who suffered from vomiting, photophobia, and phonophobia. On the other hand patients with migraine, married people, women and patients suffering from vomiting experienced longer headache attacks.

Conclusion: Headache type (migraine/TTH), age, job status, residency, years of headache, laterality, type of onset, nausea, vomiting, photophobia, and phonophobia were the factors to be considered in the studies that would apply frequency, severity, and duration of headache attacks in order to evaluate headache management.
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http://dx.doi.org/10.34172/jrhs.2020.29DOI Listing
October 2020

Stem Cell-Derived Exosomes as Treatment for Stroke: a Systematic Review.

Stem Cell Rev Rep 2021 Apr;17(2):428-438

Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The therapeutic potential of stem cells may largely be mediated by paracrine factors contained in exosomes released from intracellular endosomes. A systematic review was performed to identify the effects of stem cell-derived exosomes for their ability to induce restorative effects in animal models of stroke.

Methods: PubMed, Scopus, and ISI Web of Science databases were searched for all available articles testing stem cell-derived exosomes as therapeutic interventions in animal models of stroke until April 2020. The STAIR scale was used to assess the quality of the included studies.

Results: A total of 994 published articles were identified in the systematic search. After screening for eligibility, a total of 16 datasets were included. Type of cerebral ischemia was transient in majority studies and most studies used rat or mice adipose tissue-derived stem cells/bone marrow-derived stem cells. Eight studies indicated improved functional recovery while 8 were able to show reduced infarct volume as a result of exosome therapy. The beneficial effects were mainly attributed to reduced inflammation and oxidative stress, enhanced neurogenesis, angiogenesis, and neurite remodeling. Also, 4 studies demonstrated that exosomes hold great promise as an endogenous drug delivery nano-system.

Conclusion: In preclinical studies, use of stem cell-derived exosomes is strongly associated with improved neurological recovery and reduced brain infarct volume following stroke. Improved preclinical study quality in terms of treatment allocation reporting, randomization and blinding will accelerate needed progress towards clinical trials that should assess feasibility and safety of this therapeutic approach in humans. Graphical abstract.
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http://dx.doi.org/10.1007/s12015-020-10024-7DOI Listing
April 2021

The Effect of Home Base Physical Activity Program based on the BASNEF Model on Motor Recovery in Patients with Stroke.

Home Health Care Serv Q 2020 Jul-Sep;39(3):154-167. Epub 2020 May 13.

Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences , Isfahan, Iran.

The present study aimed to determine the effect of education based on the BASNEF model on the physical activity and improvement of motor activity in patients with stroke. This randomized control trial study was conducted on 40 patients with acute ischemic stroke admitted to a teaching hospital in Isfahan, Iran from August 2017 to September 2018. The patients were randomly divided into intervention and control groups. The intervention included personal education and a manual CD of physical activity for the intervention group. After education, the mean scores of the BASNEF model's constructs in the intervention group were significantly higher than those of the control group ( < .001). Furthermore, the motor ability of the intervention group in upper and lower extremities was significantly higher than that of the control group ( < .001). Interventions based on educational models can increase the motivation of patients with stroke in performing recommended physical activity.
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http://dx.doi.org/10.1080/01621424.2020.1765938DOI Listing
May 2020

Implementation of home-based health promotion program to improve flow-mediated dilation among patients with subacute stroke.

J Educ Health Promot 2020 28;9:41. Epub 2020 Feb 28.

Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Introduction: Stroke causes physiologic functional changes such as vascular resistance and arterial remodeling. This study aimed to explore the effects of 3-month regular home-based exercise rehabilitation on brachial flow-mediated dilation (FMD), daily physical activity, and upper and lower extremity sensorimotor of the acute ischemic stroke patients.

Materials And Methods: This randomized control trial was done from August 2017 to September 2018. Patients with unilateral ischemic stroke were recruited from inpatient wards at an educational hospital. Patients were randomly assigned to the home-based rehabilitation program (intervention group) or usual care (control group). Fugl-Meyer upper and lower extremity sensorimotor score and Barthel score were evaluated in both the groups before and 3 months after baseline assessment. Furthermore, brachial artery vasomotor reactivity (FMD) hemiparetic arm assessed vascular health. The intervention group received home-based rehabilitation exercise program for 3 months. The control group did not receive home-based rehabilitation program and incentive telephone call. All data were collected and analyzed by SPSS software (version 20) and appropriate statistical tests.

Results: Forty ischemic stroke patients (twenty in the intervention group and twenty in the control group) were examined. Results showed that Barthel score and Fugl-Meyer upper and lower extremity score and FMD in the intervention group were significantly higher than the control group after 3-month home-based exercise rehabilitation ( < 0/001).

Conclusion: Twelve-week regular home-based exercise training was well tolerated by the intervention group. After this period, improvements were reported in brachial FMD as well as daily physical activity and upper and lower extremity functional capacity.
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http://dx.doi.org/10.4103/jehp.jehp_583_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161693PMC
February 2020

Dietary total antioxidant capacity in relation to stroke among Iranian adults.

Nutr Neurosci 2020 Jun 28;23(6):465-470. Epub 2019 Jul 28.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

This study was conducted to investigate the association between dietary TAC and odds of stroke among Iranian adults. This case-control study was done on 195 hospitalized stroke cases and 195 hospital-based controls in Al-Zahra hospital, Isfahan, Iran. Dietary TAC was estimated using the ferric-reducing antioxidant power (FRAP) international databases. Stroke was confirmed by a trained neurologist using standard imaging methods. Mean dietary TAC was not significantly different comparing cases and controls (10.2 ± 6.0 vs. 10.4 ± 4.8, = 0.61). However, after adjustment for potential confounders including dietary intakes of fiber and omega-3 fatty acids, we found an almost significant inverse association between dietary TAC and odds of stroke; such that each unit increase in dietary TAC was associated with 29% reduced odds of stroke (OR: 0.71; 95% CI: 0.50-1.01, = 0.06). When we examined the association across tertiles of dietary TAC, we found that after controlling for potential confounders, those in the top tertile of dietary TAC were 51% less likely to have a stroke than those in the bottom tertile (0.49; 0.23-1.00). We found an almost significant inverse association between dietary TAC and odds of stroke.
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http://dx.doi.org/10.1080/1028415X.2018.1520478DOI Listing
June 2020

Asian Study of Cerebral Venous Thrombosis.

J Stroke Cerebrovasc Dis 2019 Oct 24;28(10):104247. Epub 2019 Jul 24.

Department of Medicine, Aga Khan University, Karachi, Pakistan.

Background/objective: Most of the studies and registries related to cerebral venous thrombosis (CVT) are reported from European countries and the United States. The objective of the present study is to identify risk factors, presentation, and outcome of CVT in Asian patients.

Methods: Asian CVT registry is a prospective multinational observational study that included patients (aged > 16 years) with symptomatic CVT.

Results: Eight hundred and twelve patients (59% women) from 20 centers in 9 Asian countries were included. Mean age of the patients was 31 years. Motor weakness in limbs was present in 325 (40%) patients. One hundred and eighty (22.1%) patients had a normal Glasgow coma scale (GCS) at presentation, and another 529 patients (65%) had GCS between 11 and 14. The rest (103; 13%) had a GCS of less than 10 at presentation. Permanent risk factors were present in 264 (33%) patients, transient in 342 (42%) patients, both in 43 (5%) patients and no risk factors were found in 163 (20%) patients. Anemia was present in 51%, use of oral contraceptive pills (OCP) was present in 12% women and a hypercoaguable state was present in more than 40% of those tested. One hundred and forty-three cases (18%) were in women who were either pregnant (18; 2%) or in the puerperium (up to 6 weeks postpartum; N = 125; 15%). A total of 86 (10.5%) patients were diagnosed with infection in any part of the body. The most common MRI finding was local brain edema or ischemia (53.3%) followed by hemorrhage (26.7%). Twenty-seven patients (3.3%) died during hospital stay. The mRS score at discharge was available for 661 (81%) patients. Of these, 577 (87.3%) had good functional outcome at discharge. Motor weakness at presentation, GCS of 9 or less and mental status disorder were the strongest independent predictors of mortality at last follow-up among patients with CVT.

Conclusions: Important differences were identified as compared to western data including younger age, high frequency of anemia, low use of OCP, and high frequency of hypercoaguable states. Functional outcome at discharge was good.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.06.005DOI Listing
October 2019

Adherence to Alternative Healthy Eating Index (AHEI-2010) is not associated with risk of stroke in Iranian adults: A case-control study.

Int J Vitam Nutr Res 2021 Jan 1;91(1-2):48-55. Epub 2019 Jul 1.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

Stroke is a major global health problem that contributes to a significant burden of morbidity and mortality. The association of several foods and nutrients with stroke has been well-established. However, the effect of the whole diet on stroke is poorly understood. In this work, we aimed to examine the association between the quality of whole diet, as measured using Alternate Healthy Eating Index-2010 (AHEI-2010), and risk of stroke in Iranian adults. In this hospital-based case-control study, 193 stroke patients (diagnosed based on clinical and brain CT findings) and 193 controls with no history of cerebrovascular diseases or neurologic disorders were included. The participants' dietary intakes were examined using a validated 168-item semi-quantitative food frequency questionnaire. AHEI-2010 was constructed based on earlier studies. Participants were classified according to tertiles of AHEI-2010 scores and multivariate logistic regression was used to evaluate the association between whole diet quality and risk of stroke. Individuals with greater adherence to AHEI-2010 had a higher intake of fruits, vegetables, nuts and legumes, whole grains and carbohydrate, and a lower intake of trans-fatty acids, sugar-sweetened beverages, total energy and fat (P < 0.05). After adjusting for potential confounders, adherence to AHEI-2010 was not significantly associated with a reduced risk of stroke (OR: 0.92; 95% CI: 0.56-1.51). We found that adherence to AHEI-2010 was not associated with risk of stroke in Iranian adults. Further prospective studies are warranted to validate this finding and clarify the relationship between whole diet and stroke.
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http://dx.doi.org/10.1024/0300-9831/a000603DOI Listing
January 2021

Can MiR-503 be used as a marker in diabetic patients with ischemic stroke?

BMC Endocr Disord 2019 Apr 29;19(1):42. Epub 2019 Apr 29.

Applied Physiology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Some microRNAs are involved in diabetes pathology and some are known to have role in stroke. MiR-503 causes endothelial dysfunction in diabetic patients, predisposing to ischemia. There has been no study evaluating Mir-503 level in diabetic patients with or without ischemic stroke.

Methods: We designed a cross-sectional study to assess and compare serum level of MiR-503 in 4 groups of diabetic patients with ischemic stroke (I), non-diabetic patients with stroke (II), diabetic patients (III), and healthy controls (IV) in acute phase and 3 months later.

Results: Our data analysis showed that mean relative expression of MiR-503 in group (I) was significantly higher than 3 other groups (p < 0.05). The level of miR-503 was related to the patients' fasting blood glucose, Cholesterol level, NIHSS score and acute-phase modified Rankin Scale (mRS) (r = 0.49, p = 0.001, r = 0.5, p = 0.009, r = 0.45, p = 0.009, r = 0.48, p = 0.003, CI = 95%). Relative expression of miR in patients with mRS ≤ 2 (good outcome) was lower than in patients with mRS > 2 (poor outcome) (p = 0.008). After 3 months, level of miR decreased significantly only in group (I) (p = 0.002). Mean relative expression of miR-503 in chronic phase was not significantly different among groups (p-value> 0.05). There was no relation between miRNA level and mRS in chronic phase.

Conclusion: Hyperglycemia and ischemia together raise the level of MiR-503 acutely but it does not remain at high level after 3 months. Although higher miR was related to more disability in acute phase, it does not affect long-term outcome in ischemic patients. As MiR-503 is stable enough in blood it can be used as a potential diagnostic marker of an ischemic stroke in diabetic patient. Its level also is an indicator of stroke severity and patients' short-term outcome. It is recommended to study whether antagomiR-503 is a new therapeutic agent reducing the severity of and disability due to stroke.
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http://dx.doi.org/10.1186/s12902-019-0371-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489259PMC
April 2019

Comparison of acute ischemic stroke evaluation and the etiologic subtypes between university and nonuniversity hospitals in Isfahan, Iran.

Int J Stroke 2019 08 12;14(6):613-619. Epub 2019 Mar 12.

1 Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background And Purpose: Performing a proper causative workup for ischemic stroke patients is essential as it guides the direction of primary and secondary preventions. We aim to investigate the etiological evaluation of these patients in university and nonuniversity hospitals.

Method: We enrolled subjects from the Persian Registry of Cardiovascular Disease-stroke. Stroke patients were categorized base on an etiological-based classification (Trial of Org 10172 in Acute Stroke Treatment or TOAST) into five groups. We also separated patients with ischemic stroke of undetermined etiology due to incomplete standard evaluation from ischemic stroke of undetermined etiology due to negative standard evaluation. The etiological subtypes and diagnostic evaluations were compared between the two hospital groups.

Result: Ischemic stroke of undetermined etiology was the most common subtype overall (43%). The prevalence of ischemic stroke of undetermined etiology (incomplete standard evaluation) was significantly higher in patients evaluated in nonuniversity hospitals versus university hospital (46.2% vs. 22.3%). Patients with ischemic stroke of undetermined etiology (negative standard evaluation) and large-artery atherosclerosis were significantly more prevalent in university hospitals (10.3% vs. 4.6% and 13.9% vs. 4.4%, respectively). All diagnostic workups were performed more significantly for university hospital patients. Patients with Ischemic stroke of undetermined etiology (negative standard evaluation). Patients were significantly younger (64.91 ± 14.44 vs. 71.42 ± 12.93) and had lower prevalence of risk factors such as hypertension (48.5% vs. 65.4%) and diabetes (19.4% vs. 33.1%) than patients in ischemic stroke of undetermined etiology (incomplete standard evaluation) subgroup. University hospital patients had better clinical outcomes in terms of mortality and degree of disability during one-year follow-up.

Conclusion: The high clinical burden of ischemic stroke of undetermined etiology especially in nonuniversity hospitals shows the rational for promoting ischemic stroke evaluation and providing specialized stroke centers for these hospitals in a developing country like Iran.
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http://dx.doi.org/10.1177/1747493019828648DOI Listing
August 2019

Seizure in cerebral venous and sinus thrombosis.

Epilepsia Open 2018 Sep 8;3(3):316-322. Epub 2018 Jun 8.

Department of Neurology Mazandaran University of Medical Sciences Sari Iran.

Many conflicting issues exist about seizure in the setting of cerebral venous and sinus thrombosis (CVST). In this article we aimed to address the existing data regarding incidence, characteristics, predictors, treatment, and prognosis of acute and late seizures in patients with CVST and to prepare more practical information for clinicians. PubMed, Embase, Web of science and Cochrane databases were searched within 1966-2016 using relevant keywords. A total of 63 papers met the inclusion criteria. Seizures are classified as acute symptomatic seizures (ASS; first 14 days) and post-CVST epilepsy (PCE; after 14 days). The incidence had been reported in a wide range of 6.9-76% for ASS and 4-16% for PCE. Focal and generalized seizures were observed with different predominance. ASS commonly occurred in patients with loss of consciousness, focal neurological deficits, supratentorial lesions and thrombosis in superior sagittal sinus, straight sinus, and cortical veins. PCE had been predisposed by occurrence of ASS, motor deficit, and supratentorial lesions, particularly hemorrhage. Most experts believe that primary prophylaxis with antiepileptic drugs in the acute phase is not indicated. However, the initiation of prophylaxis after the first seizure in patients with supratentorial lesions or focal neurological deficit should be recommended. The quality of current evidence is low and most conclusions are based on expert opinions. More accurate reports of seizure semiology, detailed antiepileptic treatment plans, and outcomes are necessary to answer the existing questions.
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http://dx.doi.org/10.1002/epi4.12229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119760PMC
September 2018

Ten-year trend in stroke incidence and its subtypes in Isfahan, Iran during 2003-2013.

Iran J Neurol 2017 Oct;16(4):201-209

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

As there was no evidence of long-term studies on stroke trend, stroke subtypes and its relationships to stroke risk factors and demographic characteristics in Iran, we aimed to evaluate the 10-year trend of stroke incidence and stroke subtypes in Isfahan, Iran. In a hospital-based retrospective study, 24186 cases with the first-ever stroke were analyzed. We assessed the incidence trend of annual stroke and its subtypes [ischemic stroke (IS) subarachnoid hemorrhage (SAH), and intracranial hemorrhage (ICH)] during the years 2003 to 2013 by sex, and studied the association of demographic and major stroke risk factors with incidence and mortality rate of stroke. The mean age was 69.46 ± 14.87 years, and 49.29% of patients were women. IS was the most frequent type among all the types of strokes (76.18%). Stroke and its subtypes had decreasing incidence trend during the study period, except for SAH that increased. In addition, stroke and its subtypes had decreasing mortality trend during the study period, except for SAH that did not change anymore. Stroke mortality and incidence rates were lower in urban inhabitants compared to residents of rural areas [odds ratio (OR) = 0.763, P < 0.001]. Despite the relatively high incidence of stroke over the study period, the incidence rate of stroke, especially ICH subtype, had a decreasing trend over the last decade in Isfahan. However, given the current young population in Iran, we can expect that the incidence of stroke would have an escalating trend in future.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937006PMC
October 2017

Carotid arterial stent implantation follow-up and results in 50 patients: preliminary report.

Electron Physician 2018 Feb 25;10(2):6400-6405. Epub 2018 Feb 25.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Carotid artery stenting (CAS) is considered as a safe and effective procedure for treatment of carotid artery stenosis. Evaluation of this procedure's complications is essential for proper clinical decision-making.

Objective: This study aimed to evaluate the cardiovascular events after CAS among our patients in Isfahan, Iran.

Methods: This case-series study was conducted on fifty patients from December 2013 to May 2016. These patients were referred to the cardiology centers of Isfahan, Iran by a neurologist, for stenting of extracranial carotid arteries. The second step was examining the patients by cardiac interventionist. Stenting was performed on symptomatic patients with carotid artery stenosis of more than 50 percent or asymptomatic patients with more than 70 percent carotid artery stenosis on Doppler ultrasonography. Neurologic evaluation was performed at baseline, during hospital stay, and follow-up. Transient ischemic attack (TIA)/Stroke and Myocardial infarction (MI) questionnaires were filled out by a cardiologist over telephone interviews with the patients, for follow-up of one month, six months and at the end of study. Carotid Doppler ultrasonography was performed before and 6 months after stenting for evaluation of restenosis. Indeed, during the follow-up study, the major adverse cardiac events (MACE) were evaluated. All data were analyzed through SPSS v.17.

Results: The mean age of patients was 70.73 (±14.01) years old (range: 48-89 years old). Composite endpoint of death, stroke, and MI was totally 8 percent. The rate of carotid arterial restenosis (Luminal arterial narrowing>50%) was 8%.

Conclusions: Despite the fact that carotid stenting is new in our center, our results can be compared to other important studies.
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http://dx.doi.org/10.19082/6400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878036PMC
February 2018

Factors Influencing the Incidence of Papilledema in Patients with Cerebral Venous Thrombosis.

Adv Biomed Res 2017 26;6:165. Epub 2017 Dec 26.

Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Cerebral venous thrombosis (CVT) is an uncommon cerebrovascular disease with a wide spectrum of symptoms and severity. This study analyzes the factors influencing the incidence of papilledema in patients with cerebral venous thrombosis.

Materials And Methods: In this research 65 patients with CVT were examined between 2011 and 2013, and the patients were followed up one, three, six, and twelve months after the initial diagnosis. They were separated into two groups according to presence or absence of papilledema. We analyzed the frequency of symptoms and risk factors of cerebral venous thrombosis and the intensity of papilledema as time passed, as also the frequency of the involved sinus, in two groups of patients with and without papilledema.

Results: This study showed that the most common symptom was headache, with a frequency of 92.3% and the least common symptoms were ataxia and quadriparesis, with a frequency of 1.5%. The most common risk factors were high waist circumference (WC) and oral contraceptive pil (OCP) use, and also in patients with papilledema the intensity is reduced as time passes.

Conclusion: This investigation showed that there was no significant relation between the frequency of risk factors and symptoms and intensity of papilledema as time passed in the two groups. The results showed that the most common sinuses involved in patients with papilledema were sagittal and lateral sinuses, which included 66.7%, and the most common sinus involved in patients without papilledema, which was the lateral sinus that included 40%.
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http://dx.doi.org/10.4103/2277-9175.221464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767807PMC
December 2017

Persian Registry Of cardioVascular diseasE (PROVE): Design and methodology.

ARYA Atheroscler 2017 Sep;13(5):236-244

Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Our aim was to create and establish a database called "Persian Registry Of cardioVascular diseasE (PROVE)" in order to be used for future research and in addition, as a tool to develop national guidelines for diagnosis, treatment, and prevention of cardiovascular disease (CVD). In this paper, the design and methodology of the PROVE pilot study will be discussed, launched in Isfahan, Iran, in 2015-2016.

Methods: Through establishing PROVE, patients' data were collected from hospitals and outpatient clinics prospectively or retrospectively and followed up for a maximum of three years based on the type of CVDs. The inclusion criteria were as patients with acute coronary syndrome (ACS), ST elevation myocardial infarction (STEMI), stroke, atrial fibrillation (AF), heart failure (HF), congenital heart disease (CHD), percutaneous coronary intervention (PCI), and chronic ischemic cardiovascular disease (CICD). Specific protocols, questionnaires, and glossaries were developed for each registry. In order to ensure the validation of the protocols, questionnaires, data collection, management, and analysis, a well-established quality control (QC) protocol was developed and implemented. Data confidentiality was considered.

Results: In order to register patients with ACS, STEMI, stroke, HF, PCI, and CICD, the hospital recorded data were used, whereas, in case of AF and CHD registries, the data were collected from hospitals and outpatient clinics. During the pilot phase of the study in Isfahan, from March 2015 to September 2016, 9427 patients were registered as ACS including 809 as STEMI, 1195 patients with HF, 363 with AF, 761 with stroke, 1136 with CHD, 1200 with PCI, and 9 with CICD. Data collection and management were performed under the supervision of the QC group.

Conclusion: PROVE was developed and implemented in Isfahan as a pilot study, in order to be implemented at national level in future. It provides a valuable source of valid data that could be used for future research, re-evaluation of current CVD management and more specifically, gap analysis and as a tool for assessment of the type of CVDs, prevention, treatment, and control by health care decision makers.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774796PMC
September 2017

Vitamin D Status in Small Vessel and Large Vessel Ischemic Stroke Patients: A Case-control Study.

Adv Biomed Res 2017 30;6:146. Epub 2017 Nov 30.

Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Vitamin D insufficiency is a globally widespread issue. Recent studies have reported a high prevalence of Vitamin D deficiency in Middle-East countries. Studies have shown negative effects of Vitamin D deficiency on endothelium and related diseases such as ischemic brain stroke. Here, we assessed Vitamin D status in patients with different types of ischemic brain stroke and control group.

Materials And Methods: Seventy-five patients (49.3% small vessel, 50.7% large vessel) and 75 controls, matched for age (68.01 ± 10.94 vs. 67.64 ± 10.24) and sex (42 male and 33 female) were recruited. 25(OH) D levels were measured by Chemiluminescence immunoassay. 25(OH) D status was considered as severely, moderately, or mildly deficient and normal with 25(OH) D levels of less than 5, 5-10, 10-16, and >16 ng/ml, respectively.

Results: Mean ± standard error concentration of 25(OH) D in cases and controls were 17.7 ± 1.5 and 26.9 ± 1.6 ( = 0.0001), respectively. Mild, moderate, and severe Vitamin D deficiency were observed in 10.8%, 32.4%, 8.1% vs. 34.3%, 31.5%, 9.5% of small vessel and large vessel group, respectively. 21.7% of the controls were Vitamin D deficient. Vitamin D deficiency was significantly associated with higher risk for ischemic stroke, ( = 0.000, OR = 7.17, 95% confidence interval: 3.36-15.29). 25(OH) D levels were significantly higher in control group comparing to small vessel (26.9 ± 1.6 vs. 20.59 ± 2.6 < 0.05) and large vessel (26.9 ± 1.6 vs. 13.4 ± 1.3 < 0.001) stroke patients. Small vessel group had significantly higher levels of Vitamin D than large vessel ( < 0.05).

Conclusion: Vitamin D deficiency significantly increases the risk of ischemic stroke, favoring the types with the pathogenesis of large vessel strokes.
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http://dx.doi.org/10.4103/2277-9175.219411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735556PMC
November 2017

Opium Addiction and Ischemic Stroke in Isfahan, Iran: A Case-Control Study.

Eur Neurol 2018 22;79(1-2):82-85. Epub 2017 Dec 22.

Isfahan Neurosciences Research Center, Alzahra Research Institute, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The effect of opium addiction (OA) on cerebrovascular disease is controversial. The aim of this study was to clarify this relationship in Iranian patients with ischemic stroke.

Methods: In a case-control study, 672 patients with ischemic stroke and 293 controls without a previous history of cerebrovascular or cardiovascular diseases were compared. OA as well as other risk factors such as diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, tobacco smoking (TS) were compared between the 2 groups.

Results: OA percentage, TS, TS amount (pack/year), HTN and DM history were significantly higher in the case group compared to controls (p < 0.05). After regression analysis between risk factors, a significant difference remained between 2 groups with regards to HTN (OR 4.21, 95% CI 3.05-5.81, p < 0.001), TS (OR 2.33, 95% CI 1.51-3.59, p < 0.001), and OA (OR 2.36, 95% CI 1.16-4.85, p = 0.018).

Conclusion: Our study showed OA is a risk factor for stroke. However, a follow-up study with a larger cohort is required to confirm the results.
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http://dx.doi.org/10.1159/000485098DOI Listing
January 2019

Carotenoids as Potential Antioxidant Agents in Stroke Prevention: A Systematic Review.

Int J Prev Med 2017 14;8:70. Epub 2017 Sep 14.

Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Stroke and other cerebrovascular diseases are among the most common causes of death worldwide. Prevention of modifiable risk factors is a cost-effective approach to decrease the risk of stroke. Oxidative stress is regarded as the major flexible operative agent in ischemic brain damage. This review presents recent scientific advances in understanding the role of carotenoids as antioxidants in lowering stroke risk based on observational studies. We searched Medline using the following terms: (Carotenoids [MeSH] OR Carotenes [tiab] OR Carotene [tiab] OR "lycopene [Supplementary Concept]" [MeSH] OR lycopene [tiab] OR beta-Carotene [tiab]) AND (stroke [MeSH] OR stroke [tiab] OR "Cerebrovascular Accident" [tiab] OR "Cerebrovascular Apoplexy" [tiab] OR "Brain Vascular Accident" [tiab] OR "Cerebrovascular Stroke" [tiab]) AND ("oxidative stress" [MeSH] OR "oxidative stress"[tiab]). This search considered papers that had been published between 2000 and 2017. Recent studies indicated that high dietary intake of six main carotenoids (i.e., lycopene, <- and-carotene, lutein, zeaxanthin, and astaxanthin) was associated with reduced risk of stroke and other cardiovascular outcomes. However, the main mechanism of the action of these nutrients was not identified, and multiple mechanisms except antioxidant activity were suggested to be involved in the observed beneficial effects. The dietary intake of six major carotenoids should be promoted as this may have a substantial positive effect on stroke prevention and stroke mortality reduction.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_112_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625359PMC
September 2017

Seasonal and Monthly variation in stroke and its subtypes-10 Year Hospital-Based Study.

Mater Sociomed 2017 Jun;29(2):119-123

Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Background And Objectives: There is no evidence of long-term studies of seasonal variations in stroke in Iran. Hence, the aim of this study was to determine the seasonal and monthly variation of 28-day mortality in Isfahan, Iran.

Methods: From 2003 to 2013, In a Hospital-based retrospective study, 24186 cases with first-ever stroke were analyzed in Isfahan. Multinomial logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI) for seasonal and monthly 28-day mortality for stroke in general and three subtypes of stroke including intracranial hemorrhage (ICH), ischemic (IS) and subarachnoid hemorrhage (SAH).

Results: In this study, unadjusted and adjusted odds ratios of seasonal 28-day mortality of stroke was highest in the winter and lowest in the summer. Although, differences were not statistically significant. For total and IS stroke, the unadjusted 28-day mortality ratio (UMR) was significant in February (1.19, 95% CI 1.00 -1.42, P= 0.04) as compared to March. Whereas after adjusted, for total stroke, 28-day mortality was significantly lowest in May (0.746, 95% CI 0.575-0.97, p=0.029), June (0.777, 95% CI 0.60-0.99, p=0.49) and July (0.771, 95% CI 0.59-0.99 p=0.049) as compared to March. The AMR between months were not significant in SAH and IS.

Conclusion: Our findings demonstrate clear obvious monthly variation of 28-day mortality of stroke and its subtypes in Isfahan but no seasonal variations were observed.
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http://dx.doi.org/10.5455/msm.2017.29.119-123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544452PMC
June 2017

Modified Atkins diet in adult with refractory epilepsy: A controlled randomized clinical trial.

Iran J Neurol 2017 Apr;16(2):72-77

Isfahan Neurosciences Research Center, Alzahra Research Institute, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran.

The usefulness of the modified Atkins diet (mAD) in refractory epilepsy in adults has been rarely investigated. We aimed to evaluate the efficacy of mAD in adult with refractory epilepsy. In a controlled randomized clinical trial, we enrolled 66 refractory adult epileptic cases from February 2010 to December 2012. The patients were randomly divided into two groups, case groups (22 patients) used antiepileptic drugs and mAD and control group (32 patients) only use antiepileptic drugs. The primary outcome was at least 50% decrement in seizure frequency after 2 months of therapy. No significant difference was shown in our data between groups regarding baseline characteristic. The differences of mean seizure attack after 2 months (P < 0.001). (17.6%) had > 50% seizure decrease at 1 and after 2 months and 12 (35.3%) had 50% decrease in seizure frequency. Furthermore, in mAD group, the mean urinary ketone positivity was 1.75 ± 0.28 and increasing liver enzyme was shown 5 cases (14.7%) in mAD group and 5 cases (15.6%) in control group (P < 0.050). The mAD may be effective as a cotherapy treatment for adults with refractory epilepsy and decrease 2.19 times seizure frequency in comparison with control groups. Trials with the more tolerant dietary regime, with larger sample size and longer duration, should be performed in future.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526780PMC
April 2017

Polymorphisms at activated protein C cleavage sites of factor V: Are they important in the absence of factor V Leiden?

Iran J Neurol 2017 Jan;16(1):30-33

Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Activated protein C (APC) inactivates factor V (FV) by cleavage of its heavy chain at Arg306, Arg506, Arg679, and Lys994. Mutational changes, which abolish APC cleavage sites, may predispose thrombosis by altering the inactivation process of FV. FV Leiden (FVL) (Arg506Glu) has been demonstrated as a strong risk factor for thrombosis. In the current study, we have studied whether mutations in the cleavage sites of FV for APC, not due to FVL, would have a role in presenting APC resistance (APCR) and initiation of a cerebral thrombotic event. A group of 22 patients with a history of cerebral venous thrombosis (CVT), who were not carriers of FVL enrolled in the study. The patients who had conditions associated with acquired APCR were excluded from the study. APCR test was performed on the remaining 16 patients, which showed APCR in 4 plasma samples. DNA sequencing was performed on four exons of FV of APCR patients, encoding Arg306, Arg506, Arg679, and Lys994. Mutations were not found within nucleotides encoding the cleavage sites; neither was found within their close upstream and downstream sequences. Our results show that polymorphisms affecting cleavage sites of FV other than Arg506Glu it would be less likely to be the basis for APCR and its increased thrombosis susceptibility. In addition, it emphasizes on the importance of screening for APCR in the patients diagnosed with CVT.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506753PMC
January 2017

A case-control study on egg consumption and risk of stroke among Iranian population.

J Health Popul Nutr 2017 06 5;36(1):28. Epub 2017 Jun 5.

Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Most available data that linked intake of egg to risk of stroke came from western countries, with conflicting findings. We aimed to examine the association between egg consumption and risk of stroke among Iranian adults.

Methods: In a hospital-based case-control study, 195 stroke patients, hospitalized in Alzahra University Hospital, were selected as cases and 195 control subjects, from patients hospitalized in other wards with no history of cerebrovascular diseases or neurologic disorders, were recruited. A validated 168-item food frequency questionnaire (FFQ) was used to assess participants' usual dietary intake, including egg consumption, over the previous year. Other required information was gathered by the use of questionnaires.

Results: Consumption of eggs was associated with lower odds of stroke, such that after adjustment for potential confounders, those in the highest category of egg intake (>2 eggs/week) were 77% lower odds to have stroke, compared with those with the lowest category of egg intake (<1 egg/week) (OR 0.23; 95% CI 0.11-0.45). Further controlling for body mass index strengthened the association (OR 0.20; 95% CI 0.09-0.41).

Conclusions: We found evidence indicating that high intake of eggs (>2 eggs/week) during the past 1 year was associated with a lower risk of stroke. Further prospective studies are required to confirm these findings.
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http://dx.doi.org/10.1186/s41043-017-0104-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460545PMC
June 2017

Tissue plasminogen activator; identifying major barriers related to intravenous injection in ischemic acute cerebral infraction.

J Res Med Sci 2017 16;22:19. Epub 2017 Feb 16.

Isfahan Kidney Transplantation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: According to previous publications, in patients with acute ischemic cerebral infarction, thrombolytic therapy using intravenous tissue plasminogen activator (IV-tPA) necessitates precise documentation of symptoms' onset. The aim of this study was to identify major barriers related to the IV-tPA injection in such patients.

Materials And Methods: Between the year 2014-2015, patients with definitive diagnosis of acute cerebral infarction ( = 180) who attended the neurology ward located at the Isfahan Alzahra Hospital were studied. To investigate barriers related to door to IV-tPA needle time, personal reasons, and criteria for inclusion or exclusion of patients, three questionnaire forms were designed based on the Food and Drug Administration-approved indications or contraindications.

Results: The mean age of males versus females was 60 versus 77.5 years (ranged 23-93 . 29-70 years), respectively. Out of total population, only 10.7% transferred to hospital in <4.5 h after the onset of symptoms. Regarding to eligibility for IV-tPA, 68.9% of total population have had criteria for such treatment. Concerning to both items such as transferring to hospital in <4.5 h after the onset of symptoms and eligibility for IV-tPA, only 6.6% of total population met the criteria for such management. There was ignorance or inattention to symptoms in 75% of population studied. There was a mean of 195.92 ± 6.65 min (182.8-209.04 min) for door to IV-tPA needle time.

Conclusion: Despite the international guidelines for IV-tPA injection within 3-4.5 h of ischemic stroke symptoms' onset, the results of this study revealed that falling time due to ignorance of symptoms, literacy, and living alone might need further attention. As a result, to decrease death and disability, educational programs related to the symptoms' onset by consultant neurologist in Isfahan/Iran seem to be advantageous.
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http://dx.doi.org/10.4103/1735-1995.200318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367212PMC
February 2017

Watershed Infarct in Beta-Thalassemia Major Patient.

Case Rep Neurol Med 2017 27;2017:2736402. Epub 2017 Mar 27.

Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran.

. The mechanism of stroke in beta-thalassemia was reported previously as cardioembolic and hypercoagulable state. However, there is no report of watershed infarct in beta-thalassemia anemia. . We present an adult -thalassemia major patient with manifest asymptomatic chronic left carotid occlusion who suffered watershed infarct. . In the presence of asymptomatic chronic left internal carotid occlusion, we assumed that severe anemia (hemoglobin = 3) at admission leads to watershed infarct. . Watershed infarct seems to be the cause of stroke in cases of -thalassemia major with severe anemia. Blood transfusion can be applied in the setting of acute brain ischemia in such high risk patients.
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http://dx.doi.org/10.1155/2017/2736402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385913PMC
March 2017

The role of endothelial progenitor cells in transient ischemic attack patients for future cerebrovascular events.

J Res Med Sci 2016 14;21:47. Epub 2016 Jun 14.

Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The role of endothelial progenitor cells (EPCs) in the maintenance of vascularization following ischemic brain after experimental stroke has been established. Accordingly, in this study, we evaluated the role of circulating EPCs in transient ischemic attack (TIA) patients for future cerebrovascular (CV) events.

Materials And Methods: The level of circulating EPCs (staining markers: CD34, CD309) were determined using flow cytometry at 24 h after TIA in thirty consecutive patients. The EPCs level was also evaluated once in thirty healthy volunteers. Over a period of 12 months, all patients were evaluated by an experienced neurologist for recurrent TIA, stroke or death induced by CV disorders.

Results: Circulating EPCs increased in patients group following the first attack of TIA when compared with controls. By analysis of covariance, cardiovascular event history, hyperlipidemia, and statin therapy remained significant independent predictors of EPCs. The mean (standard deviation) duration of follow-up was 10.5 (3.1) months (range, 2-12 months). During follow-up, a total of three patients died due to CV accident and four patients experienced again recurrent TIA. By analyzing data with Cox regression, EPC did not predict the future CV events in TIA patients.

Conclusion: Increased incidence of future CV events did not occur in those patients with elevated EPCs in the first attack of TIA. The significant predicting factors of EPCs were cardiovascular event history, hyperlipidemia, and statin therapy.
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http://dx.doi.org/10.4103/1735-1995.183995DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122111PMC
June 2016

Inflammation and endothelium response in epileptic patients: A case-control study.

Adv Biomed Res 2016 30;5:131. Epub 2016 Aug 30.

Isfahan Neurosciences Research Center, Isfahan Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Blood brain barrier (BBB) permeability plays an important role in the brain impairments. The barrier is composed of endothelium cells, due to the presence of tight junctions that connect endothelium cells. The failure of BBB function has triggering chronic or acute seizures through brain inflammation and BBB permeability. Seizure induces vasodilation, BBB leakage and up-regulation of vascular cell adhesion molecules which able to bind integrins blood leukocytes.

Materials And Methods: In this case-control study we included 40 epileptic patients who were sampled during a seizure as a case group and 20 healthy subjects as a healthy control group. Plasma levels of the inflammation and endothelium markers including intercellular adhesion molecule (ICAM), vascular adhesion molecule (VCAM), interleukin 1 beta (IL-1β) and C-reactive protein (CRP) were measured by enzyme-linked immunosorbent assays (ELISAs).

Results: The ICAM and VCAM concentration in the epileptic patients (135.8 ± 5.35) (52.04 ± 4.24) were significantly higher than healthy control group (110.32 ± 5.04) (23.38 ± 3.01) (P < 0.005). IL-1 beta concentration was not significantly different between groups (P = 0.594). However, CRP level was significantly up-regulated in epileptic patients (P < 0.005).

Conclusion: Epileptic patients have BBB leakage and dysfunction as the up-regulation of the endothelium cytokines showed. The BBB leakage may be the result of the inflammatory impairment.
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http://dx.doi.org/10.4103/2277-9175.187370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025927PMC
September 2016