Publications by authors named "Mojdeh Ghabaee"

24 Publications

  • Page 1 of 1

Advanced weight-bearing mat exercises combined with functional electrical stimulation to improve the ability of wheelchair-dependent people with spinal cord injury to transfer and attain independence in activities of daily living: a randomized controlled trial.

Spinal Cord 2020 Jan 16;58(1):78-85. Epub 2019 Jul 16.

Departments of Medicine and Endocrinology, Austin Health, The University of Melbourne, Melbourne, VIC, Australia.

Study Design: Randomized controlled trial.

Objective: To determine the effects of advanced weight-bearing mat exercises (AWMEs) with/without functional electrical stimulation (FES) of the quadriceps and gastrocnemius muscles on the ability of wheelchair-dependent people with spinal cord injury (SCI) to transfer and attain independence in activities of daily living (ADLs).

Setting: An outpatient clinic, Iran.

Methods: People with traumatic chronic paraplegia (N = 16) were randomly allocated to three groups. The exercise group (EX; N = 5) performed AWMEs of quadruped unilateral reaching and tall-kneeling for 24 weeks (3 days/week). Sessions were increased from 10 min to 54 min over the 24-week period. The exercise-FES group (EX + FES; N = 5) performed AWMEs simultaneously with FES of the quadriceps and gastrocnemius muscles. The control group performed no exercise and no FES (N = 6). The primary outcomes were the total Spinal Cord Independence Measure-III (SCIM-III) to reflect independence with ADL, and the sum of the four SCIM-III transfer items to reflect ability to transfer. There were six other outcomes.

Results: The mean (95% CI) between-group differences of the four transfer items of the SCIM-III for the EX vs. control group was 1.8 points (0.2-3.4), and for the EX + FES vs. control group was 2 points (0.4-3.6). The equivalent differences for the total SCIM-III scores were 2.7 points (-0.6-6.0) and 4.1 points (0.8-7.4), respectively. There were no significant between-group differences for any other outcomes.

Conclusions: Advanced weight-bearing mat exercises improve the ability of wheelchair-dependent people with SCI to transfer and attain independence in ADL.
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http://dx.doi.org/10.1038/s41393-019-0328-7DOI Listing
January 2020

Altered Expression of miR-326 in T Cell-derived Exosomes of Patients with Relapsing-remitting Multiple Sclerosis.

Iran J Allergy Asthma Immunol 2019 Feb;18(1):108-113

Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran AND Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

 Invasion of auto-reactive CD4+ T cells especially Th17 into central nervous system (CNS) is an underlying pathogenic mechanism in multiple sclerosis (MS). CD4+ T cells release exosomes which are enriched in microRNAs, reflective of cell's physiological or pathological condition. Thus exosomes could be potent agents to provide quantitative and qualitative information about involved cells in MS. We investigated the expression of pathogenic microRNAs in T cells-derived exosomes of MS patients or healthy controls. Conventional T cells (Tconv) derived from relapsing-remitting (RR) MS patients (n=10) and healthy controls (n=10) were purified and cultured for 3 days by soluble anti-CD3/CD28. Exosomes were purified from cultured-T cells supernatants. The expression levels of exosomal miR-146a, miR-29a, miR-155, and miR-326 were quantified by real-time PCR. A statistically significant increased expression of miR-326 in Tconv-derived exosomes was observed in RRMS patients as compared with controls (7.5±1.88vs 2.51±0.9 p=0.03), On the contrary, no differences were found in the expression levels of miR-155, miR-146a, and miR-29a, in Tconv-derived exosomes of  patients as compared with controls (p>0.05). Our results point to altered expression in exosome-derived microRNAs. MiR-326 was previously shown to play a role in the immunopathogenesis of MS by inducing TH17 differentiation and maturation. Therefore, miR-326 containing exosomes might also be a potential clinical target in course of MS. Moreover, the deregulation of this miRNA in exosomes may serve as a diagnostic and prognostic biomarker.
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February 2019

Smart Acute Stroke Quality Registry Design-Data Elements Identification.

J Registry Manag Spring 2018;45(1):43-47

Introduction: Stroke is one of the most important health problems around the world. Care quality improvement in the acute phase is significantly influential on stroke prognosis. An acute stroke quality registry that is integrated with a guideline-based support tool is a powerful system for measuring and improving care quality. As the first step in registry system design, the goal of this study was to identify relative data elements.

Methods: A list of common data elements taken from the National Institute of Neurological Disorders and Stroke and a list of data elements for paper-based medical records were first evaluated, then compared with each other. In parallel, a literature review was conducted to explore the main data elements in acute stroke registries. Considering quality improvement as the main purpose, a second study was undertaken to identify the measures of acute stroke care quality. For guideline-based smart diagnosis of patients' eligibility for thrombolytic treatment (as a clinical support tool), clinical guidelines of the American Heart Association were assessed, and appropriate eligibility criteria were identified. Finally, a questionnaire was prepared based on the identified data elements. The questionnaire was distributed among 17 neurology physicians for identification of essential data elements (minimum data sets).

Results: Patient-centric data elements were identified and classified into 3 categories: (1) data elements identified based on acute stroke care quality measures; (2) data elements for diagnosis of patients' eligibility for tissue plasminogen activator treatment based on clinical guidelines; and (3) essential data elements based on paper medical records. After duplication removal, the 3 categories of data elements were integrated. Finally, essential data elements were identified using the neurology clinical experts' survey.

Conclusion: Compared to traditional disease registries, quality improvement registries cover much more detailed data elements. Integration of medical record data elements with care quality measures, as well as guideline-based criteria, results in a powerful source of data for more exact studies and analysis by clinical support tools. Identifying essential data elements as a mandatory part of the system helps with more accurate data entry, and can also be considered a ready-to-use item for other relative systems.
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October 2018

Acute Stroke Registry Planning Experiences.

J Registry Manag Spring 2018;45(1):37-42

Background: Stroke is a serious health threat around the world, particularly in developing countries. As a preventive action, disease registries have long been used in developed countries. Based on the globally accepted evidence, disease registries have an impressive positive impact on different dimensions of health care systems. In order to develop an acute stroke registry, acute stroke registry planning experiences in the world are assessed in this paper.

Methods: There were 4 main factors in the planning phase to be assessed: determination of goal, scope, registration type, and consideration of technical aspects. Electronic databases were examined to find 27 relevant English-language articles focusing on acute stroke registry development. Based on the literature review, the main data sets and care quality measures of acute stroke registries were identified.

Results: The main purposes of developing an acute stroke registry are improvement of care quality, epidemiology assessment, and evaluation of health care system outcomes. Most of the registries focus on improving care quality. The number of multicenter, Web-based, and prospective registries were significantly higher than other types of registries. Only 1 of the registry systems implemented clinical support tools. Among 12 data sets identified to be considered as registry, 7 were highly used. Among the 14 care quality measures in acute ischemic stroke, the mostly used measure was the rate of early thrombolytic therapy.

Conclusion: Establishment of a Web-based, prospective registry system for the acute phase of stroke seems useful for monitoring the rate of early thrombolytic therapy. The establishment of a clinical guideline-based support tool for diagnosis of patients' eligibility for thrombolytic treatment is suggested. As observed in this research, time is a very important factor in care quality improvement, particularly in the acute phase of stroke, for achievement of a more qualified care and a more serious surveillance on prehospital and hospital emergency systems.
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October 2018

Immunomodulatory function of Treg-derived exosomes is impaired in patients with relapsing-remitting multiple sclerosis.

Immunol Res 2018 08;66(4):513-520

Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Poorsina St., 16 Azar St., Enghelab Ave., Tehran, Iran.

Multiple sclerosis (MS) is an autoimmune disease which is characterized by neuroaxonal degeneration in the central nervous system. Impaired function of regulatory T cells (Tregs) is believed to be an underlying pathogenic mechanism in MS. Tregs is able to release exosomes, which contain a considerable amount of protein and RNA. Exosomes are capable of transporting their content to other cells where the released content exerts biological functions. Here, we investigated whether Tregs exosomes of RRMS patients or healthy controls might regulate the proliferation or survival of T lymphocytes. Regulatory T cells derived from MS patients or healthy controls were cultured for 3 days and exosomes were purified from supernatants. Treg-derived exosomes were co-cultured with conventional T cells (Tconv). The percentages of Tconv proliferation and apoptosis were measured. Our findings showed that the percentage of proliferation suppression induced by exosomes in patients compared to healthy controls was 8.04 ± 1.17 and 12.5 ± 1.22, respectively, p value = 0.035. Moreover, the rate of Tconv apoptosis induced by exosome of MS patient was less than healthy controls (0.68 ± 0.12 vs. 1.29 ± 0.13; p value = 0.015). Overall, Treg-derived exosomes from MS patients and healthy controls suppressed the proliferation and induced apoptosis in Tconv. However, the effect of MS-derived exosomes was significantly less than healthy controls. Our results point to an alternative Treg inhibitory mechanism which might be important in immunopathogenesis of MS. Although, the cause of the exosomal defect in MS patients is unclear, manipulation of patients' Treg-derived exosomes to restore their suppressive activity might be considered as a potential therapeutic approach. Graphical abstract ᅟ.
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http://dx.doi.org/10.1007/s12026-018-9008-5DOI Listing
August 2018

The Evaluation of a Web-Based Stroke Quality Registry System.

J Registry Manag 2018 ;45(4):173-176

Quality registry systems are very useful and have many benefits for clinical experts. Assessing the user experience while working with such a system is one of the most important steps in their development. An evaluation of the quality of the user experience allows designers to improve the system's usability and efficiency. Various usability engineering approaches may be used to analyze and improve the functionality of a Web-based registry system. User experience questionnaires (UEQs) are a reliable and validated tool that have been used to evaluate many systems. The UEQ questionnaire can be linked to the system and users can evaluate the system online. Thus, the gathering of questionnaire data can be a continuous process, allowing for ongoing analysis of the quality of the user experience, leading to a more user-friendly system. Our research focused on the evaluation phase of registry system development and indicated how we can evaluate the quality of the user experience of a registry system. In this paper, a Web-based stroke quality registry system was evaluated through a usability assessment methodology with a UEQ. The results may be applicable to other registry systems.
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January 2018

A Survey on Migraine Prevalence in Patients with Inflammatory Bowel Disease - A Single Centre Experience.

Middle East J Dig Dis 2016 Oct;8(4):282-288

Associate Professor, Neurology Department, Tehran University of Medical Sciences, Tehran, Iran.

BACKGROUND It is hypothesized that migraine may be related to inflammatory bowel disease (IBD), therefore in this cross-sectional study we evaluated the prevalence of migraine in patients with IBD. METHODS In this cross-sectional study 80 patients with IBD and 80 patients without IBD referring to a private gastroenterology clinic from May to January 2014 were evaluated regarding the prevalence of migraine, severity of migraine based on Headache Impact Test (HIT-6), and habits related to headache. RESULTS 160 participants with the mean age of 35 years were evaluated. The prevalence of migraine in the case group was significantly higher than the control (21.3% vs. 8.8%, =0.027). Moreover, duration of each attack (hours) in IBD group was significantly higher than the control group (<0.001) while the duration of migraine involvement (months) and number of attacks was higher in the control group (=0.019 and 0.048, respectively). Headache other than migraine in the control group was significantly higher than the IBD group(<0.001). Disability in the case group was more than the control group but the difference was not significant. The correlation between the severity of disability related to migraine (based on HIT-6) and severity of IBD (based on May oscore & Crohn's disease activity index (CDAI)) was not significant (r=0.16, =0.58). Moreover the correlation between the duration of IBD and migraineprevalence was not significant (r=-0.14, =0.19). CONCLUSION We found that the prevalence of migraine in patients with IBD is significantly more than normal population. More studies are needed to highlight the correlation between migraine and IBD.
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http://dx.doi.org/10.15171/mejdd.2016.37DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5145295PMC
October 2016

Is the Acute and Short-Term Effect of Whole-Body Vibration the Same on the H-Reflex Recruitment Curve and Agility?

J Sport Rehabil 2016 Dec 24;25(4):348-356. Epub 2016 Aug 24.

Context: Despite the widespread use of whole-body vibration (WBV), especially in recent years, its neurophysiological mechanism is still unclear and it is yet to be determined whether acute and short-term WBV exposure produce neurogenic enhancement for agility.

Objective: To compare the acute and short-term effects of WBV on the H-reflex-recruitment curve and agility.

Design: Cross-over study.

Setting: Clinical electrophysiology laboratory.

Participants: 20 nonathlete male volunteers (mean age 24.85 ± 3.03 y).

Main Outcome Measures: Subjects were randomly divided into 2 groups, H-reflex and agility. In the sham protocol, subjects stood on the turned-off vibration plate while maintaining the semisquat position, and then, after a 2-wk washout, vibration-training sessions were performed in the same position with a frequency of 30 Hz and an amplitude of 3 mm. H-reflex-recruitment curve was recorded and the agility test of a shuttle run was performed before and after the first session and also 48 h after the 11th session in both sham and vibration-training protocols.

Results: Acute effects of WBV training caused a significant decrease of threshold amplitude and H-max/M-max (P = .01 and P = .04, respectively). Short-term WBV training significantly decreased the threshold intensity of the soleus H-reflex-recruitment curve (P = .01) and caused a decrease and increase respectively, in the threshold intensity and the area under the recruitment curve.

Conclusions: The results suggest an inhibitory effect of acute WBV training on the H-reflex response.
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http://dx.doi.org/10.1123/jsr.2015-0021DOI Listing
December 2016

Evaluation of APR1 Gene Expression in Candida albicans Strains Isolated From Patients With Multiple Sclerosis.

Jundishapur J Microbiol 2016 May 9;9(5):e33292. Epub 2016 Apr 9.

Department of Pathology, University of Otago, Christchurch, New Zealand.

Background: Intracellular aspartic proteinase A enzyme is expressed by the APR1 gene and is one of the important factors in the development of systemic candidiasis caused by Candida albicans.

Objectives: The aim of this study was to evaluate the expression of the APR1 gene in C. albicans isolates obtained from patients with multiple sclerosis (MS) and from controls.

Patients And Methods: The samples were obtained from 135 MS patients with candidiasis and 100 matched controls of healthy individuals during 2010 - 2011. The clinical and control isolates of C. albicans obtained from individuals were cultured onto sabouraud dextrose agar (SDA). The evaluation of APR1 gene expression was performed using the reverse transcriptase-polymerase chain reaction (RT-PCR) method.

Results: There was a statistically significant difference in APR1 gene expression of C. albicans strains between MS patients (mean ± SD: 0.5208 ± 0.11518) and the control group (mean ± SD: 0.7603 ± 0.11405) (P = 0.000). Significant correlations were found between the APR1 gene expression of C. albicans strains from MS patients with regard to age and the expanded disability status scale (EDSS) (P = 0.000). The mean values of EDSS were 1.6074 ± 0.1081 after antifungal treatment and 2.2519 ± 0.1323 before antifungal treatment (P = 0.000). No significant correlation was observed between the APR1 gene expression with regard to sex and MS subtypes.

Conclusions: The results suggested that APR1 gene expression in C. albicans strains isolated from MS patients may be an important factor for invasive C. albicans strains in the progression of MS disease.
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http://dx.doi.org/10.5812/jjm.33292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976647PMC
May 2016

The role of Candida albicans in the severity of multiple sclerosis.

Mycoses 2016 Nov;59(11):697-704

Medical Internship, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.

The purpose of this study was to compare the specific activity of proteinase A in Candida albicans (C. albicans) between multiple sclerosis (MS) patients and controls. A total of 135 and 100 C. albicans strains were isolated from superficial surfaces of MS patients and healthy controls. Analytical models (regression and neural network) were applied to predict the severity of MS considering specific enzyme activity (SEA) and other factors which affect the expanded disability status scale (EDSS). The SEA of C. albicans in MS patients (3466.95 ± 277.25 μmol min mg ) was significantly more than that of healthy controls (1108.98 ± 294.51 μmol min mg ) that was confirmed by regression model (P < 0.001). The SEA had a positive correlation with the severity of MS (P < 0.001, r = 0.65). Analytical models showed that SEA played the most important role (among all included factors that affect on EDSS) in the severity of MS. The SEA of C. albicans in MS patients was significantly more than the healthy controls. The results suggest that the level of SEA of proteinase A and probably the capacity of C. albicans isolates to invade the host tissue is associated with the severity of MS.
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http://dx.doi.org/10.1111/myc.12489DOI Listing
November 2016

Sex Differences in Neuroanatomy of the Human Mirror Neuron System: Impact on Functional Recovery of Ischemic Hemiparetic Patients.

Iran Red Crescent Med J 2015 Aug 24;17(8):e28363. Epub 2015 Aug 24.

Department of Anatomy and Cell Biology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

Background: Considering the higher activity of mirror neuron system in females, they frequently have better performance in empathy, interpersonal sensitivity, and emotional recognition compared to males.

Objectives: The purpose of this study was to assess whether gender difference in neuroanatomy of the human mirror neuron system has any impact on functional recovery of ischemic hemiparetic patients.

Patients And Methods: This single-blind clinical trial was conducted on 24 patients with cerebrovascular accident (CVA) in the age range of 45 - 60 years, referring at a rehabilitation center in Tehran, Iran, during 2013 - 2014. Sampling method was stratified random sampling. The subjects were assigned to 2 groups of 12 males and 12 females. Then, each group was randomly divided into 2 groups (totally 4 groups, n = 6 for each group): women watching functional movies, control women, men watching functional movies, and control men. Movies were shown to patients and then, they were evaluated by Timed Up and Go (TUG), Six-minute walk test (SMW), Barthel index (BI), and Berg balance scale (BBS).

Results: Comparison of all variables related to functional activities of all groups before and after watching movies revealed significant differences. The highest percentage of change and improvement was observed in groups 1 and 3 watching the functional movies (P = 0.0001). Percentage of improvement in women of groups 1 and 2 was higher than men in groups 3 and 4 (P = 0.0003). The changes in group of females watching the functional movies (group 1) were significantly greater than in other groups (P < 0.0001).

Conclusions: The Sex differences in the neuroanatomy of the human mirror neuron system affect functional recovery of patients with hemiparesis. The improvement in studied women was found to be significantly greater than studied men. The results indicate a higher chance of recovery among hemiparetic women, especially those watching functional movies.
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http://dx.doi.org/10.5812/ircmj.28363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586897PMC
August 2015

Pharmacokinetic and pharmacodynamic properties of the new AEDs: A review article.

Iran J Neurol 2013 ;12(4):157-65

Professor, Department of Neurology, Imam Khomeini Hospital, Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran.

The new-AEDs, whose developments were motivated following the discovery of the valproate and its marketing in the U.S in 1978, have presented more therapeutic options. There are approximately twenty four FDA-approved antiepileptic drugs for use in patients with epilepsy, five of which were identified and have come on to the market between 2009 and 2012. The new-AEDs are of interest, not due to their efficacy, but rather owing to better tolerance, favorable pharmacokinetic profile, fewer interactions, and in some instances, lesser protein binding. No standard AED or those in developing have all properties of an ideal antiepileptic drug, thus to achieve desirable outcome, physicians should be aware of pharmacokinetics (PKs) and pharmacodynamics (PDs) of drugs. This review describes briefly the major features of the new AEDs.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3829309PMC
June 2014

Predictive ability of C-reactive protein for early mortality after ischemic stroke: comparison with NIHSS score.

Acta Neurol Belg 2014 Mar 23;114(1):41-5. Epub 2013 Aug 23.

Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, P.O. Box 14197, Tehran, Iran,

We aimed to compare the association of high-sensitivity C-reactive protein (CRP) and National Institutes of Health Stroke Scale (NIHSS) score with mortality risk and to determine the optimal threshold of CRP for prediction of mortality in ischemic-stroke patients. A series of 162 patients with first-ever ischemic-stroke admitted within 24 h after onset of symptoms was enrolled. CRP and NIHSS score were estimated on admission and their predictive abilities for mortality at 7 days were determined by logistic-regression analyses. Receiver-Operating Characteristic (ROC) curves were depicted to identify the optimal cut-off of CRP, using the maximum Youden-index and the shortest-distance methods. Deceased patients had higher levels of CRP and NIHSS on admission (8.87 ± 7.11 vs. 2.20 ± 4.71 mg/l for CRP, and 17.31 ± 6.36 vs. 8.70 ± 4.85 U for NIHSS, respectively, P < 0.01). CRP and NIHSS were correlated with each other (r (2) = 0.39, P < 0.001) and were also independently associated with increased risk of mortality [odds ratios (95 % confidence interval) of 1.16 (1.05-1.28) and 1.20 (1.07-1.35) for CRP and NIHSS, respectively, P < 0.01]. The areas under the ROC curves of CRP and NIHSS for mortality were 0.82 and 0.84, respectively. The CRP value of 2.2 mg/l was identified as the optimal cut-off value for prediction of mortality within 7 days (sensitivity: 0.81, specificity: 0.80). Thus, CRP as an independent predictor of mortality following ischemic-stroke is comparable with NIHSS and the value of 2.2 mg/l yields the optimum sensitivity and specificity for mortality prediction.
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http://dx.doi.org/10.1007/s13760-013-0238-yDOI Listing
March 2014

A simple risk score for early ischemic stroke mortality derived from National Institutes of Health Stroke Scale: a discriminant analysis.

Clin Neurol Neurosurg 2013 Jul 4;115(7):1036-9. Epub 2012 Dec 4.

Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: The aim of the current study was to design a new simpler form of National Institutes of Health Stroke Scale (NIHSS) for use in emergency settings, and compare its predictive ability with original NIHSS score for mortality.

Methods: A total of 152 consecutive patients with first ever ischemic stroke admitted to a university affiliated hospital were recruited. NIHSS score on admission was estimated and the predictive ability of NIHSS items for mortality at 28 days was evaluated by logistic regression. Stepwise discriminant analysis was performed on NIHSS items to obtain a discriminant function with the best discriminative ability for mortality. Further, receiver operating characteristics (ROC) curves were depicted to compare the new determined discriminant function with the original NIHSS score.

Results: Cumulative rate of mortality was 11.8% for 28-day follow-up period. Among NIHSS items, scores of visual field, limb ataxia and extinction neglect were not associated with mortality (P>0.05). On the contrary, level of consciousness-commands, language and gaze were determined as independent indicators of mortality (P<0.05), and their coefficients on discriminant function were equal to 0.65, 0.44 and 0.30, respectively. In addition, area under the ROC curve of the calculated discriminant function was not statistically different from NIHSS score (P>0.05).

Conclusions: The suggested discriminant function, comprising NIHSS items of level of consciousness-commands, language and gaze, can predict 28-day mortality after ischemic stroke in a similar way to the original NIHSS score and can provide a baseline for stroke severity in emergency settings.
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http://dx.doi.org/10.1016/j.clineuro.2012.10.034DOI Listing
July 2013

Primary angiitis of the central nervous system.

Acta Med Iran 2012 ;50(3):216-21

Department of Neurology, Iranian Center of Neurological Research, Imam Khomeini Hospital, Tehran University of Medical Sciences, Iran.

Primary angiitis of the central nervous system (PACNS) is an idiopathic disorder (vasculitis) restricted to the central nervous system (CNS). It often presents with focal neurological deficits suggesting stroke or a combination of confusion and headache. We herein report three cases with various combinations of fever, partial seizure, encephalopathy, paresis, headache and ataxia. One of them was initially treated as herpes simplex meningoencephalitis, but further investigations revealed primary angiitis. Primary angiitis of the CNS has protean manifestations and should always be considered in patients suspicious to have CNS infection or stroke, particularly who does not respond to the routine treatments. Clinical data, exclusion of differential diagnoses and typical angiography seem to be enough to justify the diagnosis in the majority of cases.
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July 2012

Predictive role of high sensitive C-reactive protein in early onset mortality after ischemic stroke.

Iran J Neurol 2012 ;11(4):135-9

Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran.

Background: High sensitive C-reactive protein (hs-CRP) is a systemic inflammatory marker that is produced in a large amount by hepatocytes in response to interleukin-1 (IL-1), IL-6 and tumor necrosis factor after ischemic stroke.

Methods: Measurement of hs-CRP in the first 24 hours of onset in 162 patients suffering from ischemic stroke was done. Relation of CRP with the risk of early mortality, National Institutes of Health Stroke Scale (NIHSS), stroke subtypes and other factors was determined.

Results: Regarding to ROC curve analysis, appropriate cut-off point for predicting patients' short time mortality was equal to 2.15 mg/dl in this study. Significantly increased rate of mortality by 13.3 times was seen in patients with simultaneous CRP > 2.15 mg/dl and NIHSS > 10.

Conclusion: The Result of this study showed that there is a direct association between hs-CRP and mortality within the first week after stroke. Measuring hs-CRP within the first hours after stroke increases the predicting rate of early mortality risk with cut-off point of 2.15.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3829262PMC
November 2013

Neuronal death by repetitive cortical spreading depression in juvenile rat brain.

Exp Neurol 2012 Jan 19;233(1):438-46. Epub 2011 Nov 19.

Shefa Neuroscience Research Center, Tehran, Iran.

Spreading depression (SD) is an intrinsic bioelectrical property of the human central nervous system, which plays a key role in neurological disorders. In the present study, we investigated whether experimentally induced repetitive SD caused neuronal death in cortical and subcortical regions of the juvenile rat brain. The animals were anesthetized and the electrodes as well as a cannula were implanted over the brain. Repetitive cortical SD events were induced by KCl injection. The brains were removed after 4 weeks. Repetitive SD enhanced the production of dark neurons, reduced the mean volume of normal neurons, increased the number of apoptotic neurons, and enhanced expression of the NR(2B) subunit of NMDA receptors as well as the GluR1 subunit of AMPA receptors in various regions of the juvenile rat brain. In addition, induction of repetitive SD enhanced long-term potentiation in CA1 hippocampal area. We observed a correlation between cell injury/neuronal death induced by repetitive SD and changes in glutamate receptor expression. The data indicate that repetitive cortical SD in juvenile rats causes neuronal damage in both cortical and subcortical areas of the brain. This may play an important role in the pathophysiology of SD-related neurological disorders, especially in children.
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http://dx.doi.org/10.1016/j.expneurol.2011.11.017DOI Listing
January 2012

The underlying factor structure of National Institutes of Health Stroke scale: an exploratory factor analysis.

Int J Neurosci 2012 Mar 29;122(3):140-4. Epub 2011 Nov 29.

Iranian Center of Neurological Research, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

The underlying structure of National Institutes of Health Stroke Scale (NIHSS) as the most widely used scale in clinical trials has been the focus of little attention. The aim of the current study was to elucidate the clustering pattern of NIHSS items in ischemic stroke patients. A series of 152 consecutive patients with first-ever ischemic strokes admitted to a university affiliated hospital were enrolled. NIHSS score was estimated on admission and correlation coefficients between its items were calculated. Further, exploratory factor analysis was used to study the clustering pattern of NIHSS items. Extinction neglect, visual field, and facial palsy were weakly associated with other NIHSS items. Factor analysis led to a four-factor structure. Factors 1 and 3 were determined by left brain function as items of right arm and leg motor, language and dysarthria loaded on both of them. By contrast, factor 2 reflected right brain involvement. Since visual field and ataxia loaded on factor 4, this factor was primarily associated with posterior strokes. Our study shows that a four-factor structure model is plausible for NIHSS. Further, for the first time, a single distinct factor is identified for posterior strokes.
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http://dx.doi.org/10.3109/00207454.2011.633721DOI Listing
March 2012

Serum and cerebrospinal fluid antioxidant activity and lipid peroxidation in Guillain-Barre syndrome and multiple sclerosis patients.

Int J Neurosci 2010 Apr;120(4):301-4

Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran.

Oxidative stress through the changes in the levels of reactive oxygen species and antioxidative parameters can cause various neurological disorders. The aim of the present study was to show antioxidant activity (AOA) and malondialdehyde (MDA) levels in affected people with Guillain-Barre syndrome (GBS) and multiple sclerosis (MS). A total of 15 GBS patients, 13 MS patients, and 15 age and sex matched controls were included in this study. MDA and AOA values were determined in both cerebrospinal fluid (CSF) and serum, spectrophotometrically. We have shown an increase in the values of MDA in the CSF of both GBS and MS patients (0.32 +/- 0.073 and 0.22 +/- 0.06 micromol/L) compared to the control (undetectable levels). Furthermore, a significant decrease in the serum MDA levels was shown in both GBS and MS patients (0.81 +/- 0.18 and 0.73 +/- 0.18 micromol/L) when compared to the control (1.7 +/- 0.46 micromol/L). A decrease was shown for serum AOA in both GBS (1.7 +/- 0.21 mmol/L) and MS patients (2.6 +/- 0.62 mmol/L) when compared to the control (3.2 +/- 0.17 mmol/L). However, a significant increase in the values of CSF AOA was shown in both MS and GBS patients (1.47 +/- 0.19 and 1.42 +/- 0.26 mmol/L) compared to the control (0.71 +/- 0.19 mmol/L). An imbalance between the levels of AOA and MDA in both CSF and serum can be followed in both MS and GBS patients.
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http://dx.doi.org/10.3109/00207451003695690DOI Listing
April 2010

Could Helicobacter pylori play an important role in axonal type of Guillain-Barré syndrome pathogenesis?

Clin Neurol Neurosurg 2010 Apr 16;112(3):193-8. Epub 2009 Dec 16.

Iranian Center of Neurological Research, Neurology Department, Tehran University of Medical Sciences, Iran.

In this case-control study, ELISA and Western blot with whole bacterial protein lysate were performed on serum and cerebrospinal fluid (CSF) of 15 controls and 15 patients. According to Griffin subtypes, 10 of our patients were in acute inflammatory demyelinating polyradiculoneuropathy (AIDP) group, 3 in acute motor axonal neuropathy (AMAN) group, and 2 in acute motor sensory axonal neuropathy (AMSAN) subtype. 86.6% of patients were positive for Helicobacter pylori (H. pylori) IgG. Serum anti-H. pylori IgG of patients and controls were significantly different. CSF anti-H. pylori IgG was significantly higher in patients than controls. In patients, the titer of anti-H. pylori IgG in serum was significantly higher than CSF, which may indicate extra-neural antibody synthesis. CSF IgG titer was higher in patients having axonal pattern. Western blot was positive in CSF of 13 patients and negative in all controls. There was a correlation between the number of antibody types against H. pylori particles and the titer of anti-H. pylori IgG in CSF and serum. Also, antibody against cytotoxin associated protein (CagA) was associated with primary axonal pattern. The association between the presence of anti-CagA and primary axonal pattern, is in favor of the relation between axonal neuropathy and H. pylori infection.
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http://dx.doi.org/10.1016/j.clineuro.2009.11.008DOI Listing
April 2010

Mitochondrial mutation in Iranian patients with multiple sclerosis, correlation between haplogroups H, A and clinical manifestations.

Cell Mol Neurobiol 2009 May 14;29(3):341-6. Epub 2008 Nov 14.

Department of Neurology, Iranian Center of Neurological Research, Tehran University of Medical Sciences, Keshavarz Blvd., Tehran, Iran.

As multiple sclerosis (MS) has long been known to be associated with Leber, hereditary optic neuropathy (LHON), a disease caused by mitochondrial (mtDNA) mutations, in this study we assessed possible involvement of mtDNA point mutation in MS patients. Fifty-two MS patients whose disease was confirmed with revised McDonald criteria and referred to Iranian Center of Neurological Research of Imam Khomeini hospital during 2006-2007 entered the study. Secondary mtDNA mutations, age, gender, clinical disability according to expanded disability status scale (EDSS), course of the disease, and presenting symptoms were the variables investigated in this study. DNA purification was performed by Diatom DNA Extraction Kit. Analysis of data was done by SPSS V11.5. The prevalent mutations with frequency of 19.2% were J, L, and T haplogroups. Haplotype A was more prevalent in patients with younger age of onset (P-value = 0.012) and high proportion of haplogroup H was associated with optic nerve involvement (P-value = 0.015). No motor symptoms were seen in haplogroup H patients. There is no significant relationship between duration of the disease and EDSS in different mutation of mtDNA.
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http://dx.doi.org/10.1007/s10571-008-9325-7DOI Listing
May 2009

Analysis of HLA DR2&DQ6 (DRB1*1501, DQA1*0102, DQB1*0602) haplotypes in Iranian patients with multiple sclerosis.

Cell Mol Neurobiol 2009 Feb 26;29(1):109-14. Epub 2008 Aug 26.

Department of Neurology, Iranian Center of Neurological Research, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Multiple sclerosis (MS) is prototype of inflammatory demyelinating disease of the central nervous system .The etiology of MS remains unclear, but according to current data the disease develops in genetically susceptible individuals and may require additional environmental triggers. The human leukocyte antigen (HLA) class II alleles (DRB1*1501, DQA1*0102, DQB1*0602) may have the strongest genetic effect in MS. In this study, the role of these alleles were investigated in 183 Iranian patients with multiple sclerosis and compared with 100 healthy individuals. HLA typing for DRB1*1501, DQA1*0102, DQB1*0602 was performed by polymerase chain reaction (PCR) amplification with sequence-specific primers (PCR-SSP) method. The results show that, HLA DR B1*1501 was significantly more frequent among MS patients (46% vs. 20%, PV = 0.0006) but DQA1*0102 haplotype was negatively associated with MS (30% vs. 50%, PV = 0.0049) and no significant association was found with DQB1*0602 and MS patients in comparison with control group (24% and 30%, PV = 0.43). No significant correlation was observed among these alleles with sex, type of disease; initial symptoms, expanded disability status scale (EDSS), as well as age at onset and familial MS. This study therefore indicates that there is no association of above HLA haplotypes with clinical presentation, disease duration, and disability in Iranian patients with MS which is in line with other previous studies in different ethnic groups.
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http://dx.doi.org/10.1007/s10571-008-9302-1DOI Listing
February 2009

Mitochondrial D-loop variation in Persian multiple sclerosis patients: K and A haplogroups as a risk factor!!

Cell Mol Neurobiol 2006 Mar 6;26(2):119-25. Epub 2006 May 6.

Institute of Biochemistry and Biophysics, University of Tehran, Iran.

: Multiple Sclerosis (MS) is a multifocal demyelinating central nervous system disorder in which interplay between genes and the environment are supposed to be involved. Mitochondrial DNA (mtDNA) has the only non-coding regions at the displacement loop (D-loop) region that contains two hypervariable segments (HVS-I and HVS-II) with high polymorphism. mtDNA has already been fully sequenced and many subsequent publications have showed polymorphic sites, haplogroups and haplotypes. Haplogroups could have important implications to understand association between mutability of the mitochondrial genome and disease. To assess relationship between mtDNA haplogroups and MS, we have sequenced the mtDNA HVS-I in 54 MS patients and 100 control subjects. We have found that haplogroups A and K are significantly more abundant in MS patients (P=0.042 for haplogroup A and P=0.0005 for haplogroup K). Thus, these two haplogroups might act synergistically to increase the penetrance of MS disease.
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http://dx.doi.org/10.1007/s10571-006-9026-zDOI Listing
March 2006