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Khodaie F, Moghadasi AN, Hosseinnataj A, Baghbanian SM, Ashtari F, Razazian N, Poursadeghfard M, Majdi-Nasab N, Hatamian H, Hoseini S, Nahayati MA, Nabavi SM, Faraji F, Harirchian MH, Mir NHN, Moghadam NB, Sharifipour E, Bayati A, Kamali H, Mozhdehipanah H, Jalali N, Abotorabi-Zarchi M, Kamyari N, Nikbakht R, Azimi A, Navardi S, Heidari H, Sahraian MA, Eskandarieh S. Time interval between the onset of symptoms and diagnosis of multiple sclerosis and the influential factors: A national registry-based study. Clin Neurol Neurosurg 2024; 239:108221. [PMID: 38447483 DOI: 10.1016/j.clineuro.2024.108221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The time to diagnosis of multiple sclerosis (MS) is of great importance for early treatment, thereby reducing the disability and burden of the disease. The purpose of this study was to determine the time from the onset of clinical symptoms to the diagnosis of MS and to evaluate the factors associated with a late diagnosis in Iranian MS patients. METHODS The present cross-sectional study was conducted on patients with MS who were registered in the National MS Registry System of Iran (NMSRI). RESULTS Overall, 23291 MS patients registered in 18 provinces of Iran were included in this study. The mean (standard deviation) interval between the onset of the disease and diagnosis of MS was 13.42 (32.40) months, and the median was one month. The diagnostic interval of 41.6% of patients was less than one month, and 14.8% of them had a one-month time to diagnosis. Patients with an age of onset below 18 years and those diagnosed after the age of 50 years had a longer time to diagnosis (P<0.001). Patients with primary progressive MS (PPMS) had the longest time to diagnose and those with relapsing-remitting MS (RRMS) had the shortest time (P<0.001). The results of negative binominal regression showed that the average rate of delay in diagnosis in women was 12% less than that in men. The average delay in diagnosis in patients with a positive family history of MS was 23% more than that in others. The rate of delay in the diagnosis of patients with PPMS and secondary progressive MS was 2.22 and 1.66 times higher, respectively, compared with RRMS. CONCLUSION The findings of the present study revealed that more than half of the MS patients were diagnosed within a one-month interval from the symptom onset, which is an acceptable period. More attention should be paid to patients' access to medical facilities and MS specialists.
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Affiliation(s)
- Faezeh Khodaie
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Hosseinnataj
- Department of Biostatistics and Epidemiology, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Fereshteh Ashtari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nazanin Razazian
- Department of Neurology, School of Medicine, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Poursadeghfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nastaran Majdi-Nasab
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hamidreza Hatamian
- Department of Neurology, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Hoseini
- Department of Neurology, School of Medicine, Neurosciences Research Center, Aging Research Institute, Imam Reza Medical Research & Training Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Ali Nahayati
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Massood Nabavi
- Department of Regenerative Medicine, Royan Institute for Stem Cell Technology and Biology, Tehran, Iran
| | - Fardin Faraji
- Department of Neurology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Mohammad Hossein Harirchian
- Department of Neurology, School of Medicine, Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Hosseni Nejad Mir
- Department of Internal Medicine, School of Medicine, Shohadaye Ashayer Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Nahid Beladi Moghadam
- Department of Neurology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Sharifipour
- Department of Neurology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asghar Bayati
- Department of Neurology, Shahrekord University of Medical Sciences and Health Services, Shahrekord, Iran
| | - Hoda Kamali
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Nazanin Jalali
- Department of Neurology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | | | - Naser Kamyari
- Department of Biostatistics and Epidemiology, School of Health, Abadan University of Medical Sciences, Abadan, Iran
| | - Roya Nikbakht
- Department of Biostatistics and Epidemiology, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirreza Azimi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Navardi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hora Heidari
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Ghadiri F, Sahraian MA, Ashtari F, Baghbanian SM, Majdi-Nasab N, Hatamian H, Faraji F, Bayati A, Sharifipour E, Jalali N, Mozhdehipanah H, Kamali H, Ayoubi S, Eskandarieh S, Naser Moghadasi A. Economic and Social Standing of Individuals in Iran Diagnosed with Multiple Sclerosis. Arch Iran Med 2023; 26:413-418. [PMID: 38301102 PMCID: PMC10685736 DOI: 10.34172/aim.2023.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/25/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) may be affected by socioeconomic status (SES). This study aims to explore the determinants of SES among Iranian patients with MS and examine how these factors relate to disability and disease progression. METHODS All patients with MS listed in the nationwide MS registry of Iran (NMSRI) until January 8, 2022, were included in this population-based study. RESULTS Among the 5153 patients, most were female (74.5%), married (70.8%), and did not hold an academic degree (53.8%). Unemployment (OR: 3.75) and being unmarried (OR: 2.60) were significantly associated with Expanded Disability Status Scale (EDSS)≥6, and the time to progression was shorter in the unemployed group (P value: 0.03). There was also a significant negative correlation between the time to progression and the age at disease onset. CONCLUSION The study suggests that providing financial and social support to MS patients and their families through investment could reduce both individual and societal burdens.
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Affiliation(s)
- Fereshteh Ghadiri
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Ashtari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Nastaran Majdi-Nasab
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hamidreza Hatamian
- Department of Neurology, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Fardin Faraji
- Department of Neurology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Asghar Bayati
- Department of Neurology, Shahrekord University of Medical Sciences and Health Services, Shahrekord, Iran
| | - Ehsan Sharifipour
- Department of Neurology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Jalali
- Department of Neurology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | | | - Hoda Kamali
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeideh Ayoubi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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3
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Harandi AA, Kimia N, Medghalchi A, Sharifipour E, Pakdaman H, Siavoshi F, Barough SS, Esfandani A, Hosseini MH. Cerebral hemodynamic response to generalized anxiety disorder. Psychiatry Res Neuroimaging 2023; 333:111654. [PMID: 37229961 DOI: 10.1016/j.pscychresns.2023.111654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is the least studied among anxiety disorders. Therefore, we aimed to compare the cervical blood flow velocities using doppler ultrasonography in untreated chronic GAD patients and healthy individuals. MATERIAL AND METHODS In this study, thirty-eight GAD patients were enrolled. And thirty-eight healthy volunteers were recruited as control participants. The common carotid artery (CCA), internal carotid artery (ICA), and vertebral artery (VA) of both sides were explored. Also, we trained machine learning models based on cervical arteries characteristics to diagnose GAD patients. RESULTS Patients with chronic untreated GAD showed a significant increase in peak systolic velocity (PSV) bilaterally in the CCA and the ICA (P value < 0.05). In GAD patients, the end-diastolic velocity (EDV) of bilateral CCA, VA, and left ICA was significantly decreased. The Resistive Index (RI) showed a significant increase in all patients with GAD. Moreover, the Support Vector Machine (SVM) model showed the best accuracy in identifying anxiety disorder. CONCLUSION GAD is associated with hemodynamic alterations of extracranial cervical arteries. With a larger sample size and more generalized data, it is possible to make a robust machine learning-based model for GAD diagnosis.
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Affiliation(s)
- Ali Amini Harandi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Negin Kimia
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aida Medghalchi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Sharifipour
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Pakdaman
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Siavoshi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Akram Esfandani
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mohammadian R, Tarighatnia A, Sharifipour E, Nourizadeh E, Parvizi R, Applegate CT, Nader ND. Carotid artery stenting prior to coronary artery bypass grafting in patients with carotid stenosis: Clinical outcomes. Interv Neuroradiol 2023; 29:30-36. [PMID: 35331026 PMCID: PMC9893238 DOI: 10.1177/15910199221067665] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Management of patients undergoing coronary artery bypass grafting (CABG) with obstructive disease of the carotid arteries is still a matter of debate. We compared the results of staged carotid artery stenting (CAS) before CABG in patients with carotid lesions. MATERIALS AND METHOD Patients with significant carotid artery disease who were deemed to simultaneously suffer from an obstructive coronary artery disease requiring CABG from 2008 to 2018 were screened and enrolled in this study. We performed a staged CAS in cases with ≥60% stenosis and neurological symptoms or asymptomatic patients with ≥80% carotid artery stenosis. Patients with bilateral carotid lesions received sequential CAS within three weeks. Six weeks after the CAS procedure, all patients underwent CABG. RESULTS A total of 142 patients were included. Eighty-five of these had neurological symptoms, while the remaining 40% were asymptomatic. Thirty-one patients underwent sequential CAS for bilateral lesions. The cerebrovascular event (CVE) following CAS (3 patients) and CABG (3 patients) was 4.2%. There was only a single case of mortality in this cohort. Although it was not statistically significant, CVE after CABG was more frequent in patients with bilateral carotid disease. CONCLUSIONS Our results showed that staged CAS could be performed with minimal adverse outcomes in patients suffering from a simultaneous occlusive disease of carotids and coronary arteries before CABG. Bilateral CAS will further decrease cerebrovascular events and could be performed consequently or concomitantly.
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Affiliation(s)
- Reza Mohammadian
- Radiology Department, East Clinical University Hospital, Stradins
University, Riga, Latvia
| | - Ali Tarighatnia
- Department Interventional Radiology, Aalinasab Hospital, ISSO,
Tabriz, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom
University of Medical Sciences, Qom, Iran
| | | | - Rezayat Parvizi
- Cardiovascular Research Center, Tabriz University of Medical
Sciences, Shahid Madani Heart Center, Tabriz, Iran
| | - Camille T. Applegate
- Jacobs School of Medicine and Biomedical
Sciences, 955 Main Street, Buffalo, NY 14203, USA
| | - Nader D. Nader
- Dept. of Anesthesiology & Surgery, Jacobs School of Medicine and Biomedical
Sciences, UB-Gateway Building, 77 Goodell Street, Suite 550, Buffalo, NY
14203
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5
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Ghadiri F, Sahraian MA, Razazian N, Ashtari F, Poursadeghfard M, Nabavi SM, Navardi S, Baghbanian SM, Shaygannejad V, Harirchian MH, Beladimoghadam N, Majdinasab N, Hosseini S, Azimi A, Kamali H, Sharifipour E, Hosseini Nejad Mir N, Bayati A, Nahayati MA, Heidari H, Mozhdehipanah H, Ghalyanchi Langroodi H, Jalali N, Ayoubi S, Asadollahzadeh E, Ebadi Z, Eskandarieh S, Naser Moghadasi A. Late-onset multiple sclerosis in Iran: A report on demographic and disease characteristics. Mult Scler Relat Disord 2023; 70:104493. [PMID: 36638768 DOI: 10.1016/j.msard.2022.104493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Today, it is estimated that around 5% of multiple sclerosis (MS) patients are in the late-onset category (age at disease onset ≥ 50). Diagnosis and treatment in this group could be challenging. Here, we report the latest update on the characteristics of Iranian patients with late-onset MS (LOMS). METHODS This cross-sectional study used the information provided by the nationwide MS registry of Iran (NMSRI). The registrars from 14 provinces entered data of patients with a confirmed diagnosis of MS by neurologists. Patients with disease onset at or later than 50 years of age were considered LOMS. RESULTS Of 20,036 records, the late-onset category included 321 patients (1.6%). The age-standardized LOMS prevalence was around 75 per 100,000 people. 215 patients (67%) were female. Median Expanded Disability Status Scale (EDSS) was 3 (interquartile range: 1.5-5). The majority of the cases (56%) suffered from relapsing-remitting (RR) course while 20% were diagnosed with primary progressive (PP) MS. Significantly higher proportion of male sex, PPMS, and higher EDSS were seen in the late-onset group compared with early-onset and adult-onset cases (p-value < 0.05). Seventy-five (23%) patients did not receive any disease-modifying treatment. DISCUSSION The more prominent degenerative pathology of LOMS may be the underlying mechanism of the observed differences in comparison to non-LOMS. CONCLUSION There are substantial differences and knowledge gaps regarding LOMS which could be the subject of further research.
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Affiliation(s)
- Fereshteh Ghadiri
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Razazian
- Department of Neurology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fereshteh Ashtari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Poursadeghfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Massood Nabavi
- Department of Regenerative Medicine, Royan Institute for Stem Cell Technology and Biology, Tehran, Iran
| | - Samira Navardi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Beladimoghadam
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nastaran Majdinasab
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Samaneh Hosseini
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirreza Azimi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Kamali
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ehsan Sharifipour
- Department of Neurology, School of Medicine, Neuroscience Research Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Nahid Hosseini Nejad Mir
- Department of Internal Medicine, School of Medicine, Shohadaye Ashayer Hospital, Lorestan, University of Medical Sciences, Khorramabad, Iran
| | - Asghar Bayati
- Department of Neurology, Shahrekord University of Medical Sciences and Health Services, Shahrekord, Iran
| | - Mohammad Ali Nahayati
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hora Heidari
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Nazanin Jalali
- Department of Neurology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Saeideh Ayoubi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Asadollahzadeh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ebadi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Pakdaman H, Amini Harandi A, Gharagozli K, Siavoshi F, Shirzadeh Barough S, Sharifipour E, Esfandani A, Ilkhani S, Tabatabaei FS, Sobhanian SA. A Long-term Study of NeuroAid (MLC601, MLC901) in Patients with Alzheimer's Disease; An Extension 8-year Follow-up Study. Curr Aging Sci 2023; 16:234-239. [PMID: 36843256 DOI: 10.2174/1874609816666230224111759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/09/2023] [Accepted: 01/23/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND MLC601 and MLC901 showed neuroprotective and neuroregenerative properties and positive results in the treatment of dementia and cognitive impairment. This study aimed to investigate the long-term benefits of monotherapy with MLC601 and MLC901 in patients with Alzheimer's disease (AD). METHODS In this study, patients with AD, diagnosed by DSM-IV criteria, were enrolled. Patients have received MLC601 for four years, and their regimen has changed to MLC901 for another four years. Recruited patients were followed to assess the efficacy and safety first of MLC601 and MLC901. Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale- Cognitive Subscale (ADAS-Cog) were used to assess cognitive function. Safety was evaluated by monitoring adverse events (AEs) and abnormal findings in physical examinations or lab tests. RESULTS At the end of the trial, the changes in the mean (±SD) MMSE and ADAS-Cog scores were 5.1 (3.09) and 12.5 (10.89), respectively. Both scores showed a significant change in repeated measure analysis, with the ADAS-Cog score indicating a higher change than the MMSE score (P < 0.001). CONCLUSION For more than eight years, we studied monotherapy with NeuroAid (MLC601, MLC901) in patients with AD. The study contributes further to the long-term safety and efficacy data of MLC in patients with AD.
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Affiliation(s)
- Hossein Pakdaman
- Department of Neurology, Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Amini Harandi
- Department of Neurology, Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Koroush Gharagozli
- Department of Neurology, Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Siavoshi
- Department of Neurology, Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siavash Shirzadeh Barough
- Department of Neurology, Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Sharifipour
- Department of Neurology, Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Esfandani
- Department of Neurology, Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saba Ilkhani
- Department of Neurology, Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sadat Tabatabaei
- Department of Neurology, Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Sobhanian
- Department of Neurology, Islamic Azad University Tehran Medical Sciences, Tehran, Iran
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Adeli SH, Beigi AM, Ahmadpour S, Habibi MA, Pashaei MR, Sharifipour E, Shakeri M, Asghari A. Effects of Pregabalin as a Neural Pathway Inhibitor for the Treatment of Resistant Subacute and Chronic Cough: A Pilot Clinical Trials Study. Rev Recent Clin Trials 2023; 18:269-274. [PMID: 37888808 DOI: 10.2174/0115748871262516230919070559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/07/2023] [Accepted: 08/25/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Cough hypersensitivity syndrome is one of the causes of chronic cough. Small clinical trials have suggested the effects of pregabalin as a neural pathway inhibitor in treating subacute and chronic cough resistance. METHODS This study is an 8-week, pilot study randomized, double-blind clinical trial on 30 patients' resistant to treatment of the underlying cause who were referred to an ultra-specialized lung clinic, Shahid Beheshti Hospital, between 2021-2022. The samples were randomly divided into control (dextromethorphan and placebo) and intervention (dextromethorphan and pregabalin). Patients were evaluated at the beginning, during, and after eight weeks of treatment, using the modified standard Leicester Cough Questionnaire (LCQ) regarding the changes and the rate of recovery compared to before Participation in the study. FINDINGS The quality of life score of patients eight weeks after treatment had a significant difference and was higher in the intervention group (In the pregabalin group) than in the control group (p =0.006). The recovery rate of cough in 26% of patients was equal to 70%, but others were reported up to 50%. CONCLUSION Pregabalin increases the quality of life in patients with subacute and chronic cough resistant to standard treatment and increases the rate of recovery in these patients.
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Affiliation(s)
- Seyed Hasan Adeli
- Clinical Research Development Center, Qom University of Medical Sciences, Shahid Beheshti Hospital, Qom, Iran
| | - Abolfazl Mohammad Beigi
- Professor of Epidemiology Department of Biostatistics and Epidemiology, School of Health Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran
| | - Sajjad Ahmadpour
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Science, Urmia, Iran
| | - Mohammad Amin Habibi
- Iranien tissue Bank, Cell, Gene, and Therapy Institute, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Reza Pashaei
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Science, Urmia, Iran
- Department of Internal Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Ehsan Sharifipour
- Clinical Research Development Center, Qom University of Medical Sciences, Shahid Beheshti Hospital, Qom, Iran
| | - Mansoureh Shakeri
- Clinical Research Development Center, Qom University of Medical Sciences, Shahid Beheshti Hospital, Qom, Iran
| | - Akram Asghari
- Clinical Research Development Center, Qom University of Medical Sciences, Shahid Beheshti Hospital, Qom, Iran
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Paybast S, Mohamadian R, Emami A, Jameie M, Shahrab F, Zamani F, Sharifipour E. Safety and efficacy of endovascular thrombolysis in patients with acute cerebral venous sinus thrombosis: A systematic review. Interv Neuroradiol 2022:15910199221143418. [PMID: 36471504 DOI: 10.1177/15910199221143418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Cerebral venous sinus thrombosis (CVST) is an uncommon but fatal cause of stroke worldwide. Endovascular treatments could be life-saving in patients who don't treat with anticoagulants as a mainstay of treatment. Currently, there is no consensus considering the safety, efficacy, and also selected approaches of endovascular intervention for these patients. This systematic review evaluates the literature on endovascular thrombolysis (EVT) in CVST patients. MATERIALS AND METHODS A comprehensive search was conducted through PubMed and Scopus databases between 2010 and 2021, with additional sources identified through cross-referencing. The primary outcomes were the safety and efficacy of EVT in CVST, including catheter-related and non-catheter-related complications, clinical outcomes, and radiological outcomes. RESULTS A total of 10 studies comprising 339 patients were included. Most of the patients presented with headaches (86.72%) and/or focal neurologic deficits (45.43%) (modified Rankin Scale of 5 in 55.88%). Acquired coagulopathy and/or consuming estrogen/progesterone medication were the most frequent predisposing factors (45.59%). At presentation, 68.84% had multi-sinus involvement, and 28.90% had venous infarcts and/or intracranial hemorrhage (ICH). The overall complication rate was 10.3%, with a 2.94%, 1.47%, and 1.17% rate of ICH, herniation, and intracranial edema, respectively. The complete and partial postoperative radiographic resolution was reported in 89.97% of patients, increasing to 95.21% during the follow-up. Additionally, 72.22% of patients had no or mild neurologic deficit at discharge, rising to 91.18% at the last follow-up. The overall mortality rate was 7.07%. CONCLUSIONS EVT can be an effective and safe treatment option for patients with refractory CVST or contraindications to systemic anticoagulation.
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Affiliation(s)
- Sepideh Paybast
- Neurology Department and Stroke Unit, Shohada-Tajrish Tertiary University Hospital, 48504Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Mohamadian
- Radiology Department, 87255Eastern Clinical University Hospital, Stradins University, Riga, Latvia
| | - Ali Emami
- Research Committee, 48491Qazvin University of Medical Sciences, Qazvin, Iran
| | - Melika Jameie
- Neurology Department and Stroke Unit, Shohada-Tajrish Tertiary University Hospital, 48504Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshteh Shahrab
- 154202Neuroscience Research Center of Qom University of Medical Sciences, Qom, Iran
| | - Farideh Zamani
- 154202Neuroscience Research Center of Qom University of Medical Sciences, Qom, Iran
| | - Ehsan Sharifipour
- Neurology Department and Stroke Unit, Shohada-Tajrish Tertiary University Hospital, 48504Shahid-Beheshti University of Medical Sciences, Tehran, Iran
- 154202Neuroscience Research Center of Qom University of Medical Sciences, Qom, Iran
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9
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Shiri I, Salimi Y, Pakbin M, Hajianfar G, Avval AH, Sanaat A, Mostafaei S, Akhavanallaf A, Saberi A, Mansouri Z, Askari D, Ghasemian M, Sharifipour E, Sandoughdaran S, Sohrabi A, Sadati E, Livani S, Iranpour P, Kolahi S, Khateri M, Bijari S, Atashzar MR, Shayesteh SP, Khosravi B, Babaei MR, Jenabi E, Hasanian M, Shahhamzeh A, Foroghi Ghomi SY, Mozafari A, Teimouri A, Movaseghi F, Ahmari A, Goharpey N, Bozorgmehr R, Shirzad-Aski H, Mortazavi R, Karimi J, Mortazavi N, Besharat S, Afsharpad M, Abdollahi H, Geramifar P, Radmard AR, Arabi H, Rezaei-Kalantari K, Oveisi M, Rahmim A, Zaidi H. COVID-19 prognostic modeling using CT radiomic features and machine learning algorithms: Analysis of a multi-institutional dataset of 14,339 patients. Comput Biol Med 2022; 145:105467. [PMID: 35378436 PMCID: PMC8964015 DOI: 10.1016/j.compbiomed.2022.105467] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND We aimed to analyze the prognostic power of CT-based radiomics models using data of 14,339 COVID-19 patients. METHODS Whole lung segmentations were performed automatically using a deep learning-based model to extract 107 intensity and texture radiomics features. We used four feature selection algorithms and seven classifiers. We evaluated the models using ten different splitting and cross-validation strategies, including non-harmonized and ComBat-harmonized datasets. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were reported. RESULTS In the test dataset (4,301) consisting of CT and/or RT-PCR positive cases, AUC, sensitivity, and specificity of 0.83 ± 0.01 (CI95%: 0.81-0.85), 0.81, and 0.72, respectively, were obtained by ANOVA feature selector + Random Forest (RF) classifier. Similar results were achieved in RT-PCR-only positive test sets (3,644). In ComBat harmonized dataset, Relief feature selector + RF classifier resulted in the highest performance of AUC, reaching 0.83 ± 0.01 (CI95%: 0.81-0.85), with a sensitivity and specificity of 0.77 and 0.74, respectively. ComBat harmonization did not depict statistically significant improvement compared to a non-harmonized dataset. In leave-one-center-out, the combination of ANOVA feature selector and RF classifier resulted in the highest performance. CONCLUSION Lung CT radiomics features can be used for robust prognostic modeling of COVID-19. The predictive power of the proposed CT radiomics model is more reliable when using a large multicentric heterogeneous dataset, and may be used prospectively in clinical setting to manage COVID-19 patients.
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Affiliation(s)
- Isaac Shiri
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, 1211, Switzerland
| | - Yazdan Salimi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, 1211, Switzerland
| | - Masoumeh Pakbin
- Imaging Department, Qom University of Medical Sciences, Qum, Iran
| | - Ghasem Hajianfar
- Rajaie Cardiovascular, Medical & Research Center, Iran University of Medical Science, Tehran, Iran
| | | | - Amirhossein Sanaat
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, 1211, Switzerland
| | - Shayan Mostafaei
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Azadeh Akhavanallaf
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, 1211, Switzerland
| | - Abdollah Saberi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, 1211, Switzerland
| | - Zahra Mansouri
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, 1211, Switzerland
| | - Dariush Askari
- Department of Radiology Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Ghasemian
- Department of Radiology, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qum, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qum, Iran
| | - Saleh Sandoughdaran
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Sohrabi
- Cancer Control Research Center, Cancer Control Foundation, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Sadati
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Somayeh Livani
- Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Pooya Iranpour
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahriar Kolahi
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziar Khateri
- Department of Medical Radiation Engineering, Science and Research Branch, Islamic Azad University, Tehran, Tehran, Iran
| | - Salar Bijari
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Reza Atashzar
- Department of Immunology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Sajad P. Shayesteh
- Department of Physiology, Pharmacology and Medical Physics, Alborz University of Medical Sciences, Karaj, Iran
| | - Bardia Khosravi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Babaei
- Department of Interventional Radiology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Elnaz Jenabi
- Research Centre for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hasanian
- Department of Radiology, Arak University of Medical Sciences, Arak, Iran
| | - Alireza Shahhamzeh
- Clinical Research Development Center, Qom University of Medical Sciences, Qum, Iran
| | - Seyaed Yaser Foroghi Ghomi
- Clinical Research Development Center, Shahid Beheshti Hospital, Qom University Of Medical Sciences, Qom, Iran
| | - Abolfazl Mozafari
- Department of Medical Sciences, Qom Branch, Islamic Azad University, Qum, Iran
| | - Arash Teimouri
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Movaseghi
- Department of Medical Sciences, Qom Branch, Islamic Azad University, Qum, Iran
| | - Azin Ahmari
- Ayatolah Khansary Hospital, Arak University of Medical Sciences, Arak, Iran
| | - Neda Goharpey
- Department of Radiation Oncology, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rama Bozorgmehr
- Clinical Research Development Unit, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Roozbeh Mortazavi
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jalal Karimi
- Department of Infectious Disease, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Nazanin Mortazavi
- Dental Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sima Besharat
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mandana Afsharpad
- Cancer Control Research Center, Cancer Control Foundation, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Abdollahi
- Department of Radiologic Technology, Faculty of Allied Medical Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Parham Geramifar
- Research Centre for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Arabi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, 1211, Switzerland
| | - Kiara Rezaei-Kalantari
- Rajaie Cardiovascular, Medical & Research Center, Iran University of Medical Science, Tehran, Iran
| | - Mehrdad Oveisi
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Arman Rahmim
- Departments of Radiology and Physics, University of British Columbia, Vancouver, BC, Canada,Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, 1211, Switzerland,Geneva University Neurocenter, Geneva University, Geneva, Switzerland,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands,Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark,Corresponding author. Geneva University Hospital Division of Nuclear Medicine and Molecular Imaging, CH-1211, Geneva, Switzerland
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10
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Ghadiri F, Sahraian MA, Baghbanian SM, Ashtari F, Razazian N, Majdinasab N, Poursadeghfard M, Hatamian H, Harirchian MH, Beladimoghadam N, Azimi A, Sharifipour E, Hosseini S, Bayat A, Kamali H, Hosseni Nejad Mir N, Faraji F, Mozhdehipanah H, Modara F, Navardi S, Heidari H, Ayoubi S, Naser Moghadasi A, Eskandarieh S. Prescription trends of disease-modifying treatments for multiple sclerosis in Iran over the past 30 years. Mult Scler Relat Disord 2022; 61:103777. [PMID: 35390594 DOI: 10.1016/j.msard.2022.103777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/02/2022] [Accepted: 03/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Iran, as a middle income country, is one of the places with high and rising prevalence of multiple sclerosis (MS). Regarding the substantial economic burden, reviewing the trend in prescribed disease modifying treatments (DMTs) could be of help. Here we studied the DMT information of nearly 14000 MS cases and its trends change for 30 years to improve health services to patients. METHODS The population base of this descriptive-analytical (cross-sectional) study consisted of all MS patients in the nationwide MS registry of Iran (NMSRI), up to August 1, 2021. Registrars from 15 provinces, 24 cities, 13 hospitals,8 MS associations, 16 private offices, and 7 clinics had entered the data. RESULTS Overall, 14316 cases were enrolled. The majority (76.1%) were female. The youngest and eldest patients were 5 and 78 years old, respectively. Diagnosis delay was under one year in most cases (median: 0, IQR: 0 - 1). Most (61.4%) had RRMS. Generally, platform injectables (IFN beta, glatiramer acetate) were the most used DMTs until 2010. It seems that introduction of newer agents (antiCD20s and oral DMTs) resulted in a decrease in the use of former drugs since around 2015. Some unusual practices are prominent such as using not approved DMTs for PPMS over the years, or administering high efficacy drugs like natalizumab for CIS. The results indicate the remaining popularity of first line injectable DMTs in female and pediatric patients. DISCUSSION Mean age (SD) at onset in our study (29 ± 8.8) is near the statistics in Asia and Oceania (28 ± 0.7). Concerns about COVID-19 had a noticeable impact on administering high efficacy drugs like rituximab and fingolimod. However, in male patients this approach has not been the case. It may be related to more aggressive disease course in this group. The other possible explanation could be planning for pregnancy in female cases. The popularity of platform injectable drugs in pediatric MS may be related to its favorable safety profile over the years. Another point in this group, is the superiority of rituximab over other highly efficient medications.
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Affiliation(s)
- Fereshteh Ghadiri
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fereshteh Ashtari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nazanin Razazian
- Department of Neurology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nastaran Majdinasab
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Poursadeghfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamidreza Hatamian
- Department of Neurology, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Beladimoghadam
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirreza Azimi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Sharifipour
- Department of Neurology, School of Medicine, Neuroscience Research Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Samaneh Hosseini
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Asghar Bayat
- Department of Neurology, Shahrekord University of Medical Sciences and Health Services, Shahrekord, Iran
| | - Hoda Kamali
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Nahid Hosseni Nejad Mir
- Department of Internal Medicine, School of Medicine, Shohadaye Ashayer Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fardin Faraji
- Department of Neurology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | | | - Farhad Modara
- School of Medicine, Shahid Mostafa Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Samira Navardi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hora Heidari
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeideh Ayoubi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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11
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Hashemilar M, Tohidi P, Forghani N, Sadeghi-Hokmabadi E, Sharifipour E. Cerebral border zone infarctions: An etiologic study. Curr J Neurol 2022; 21:1-6. [PMID: 38011470 PMCID: PMC9527865 DOI: 10.18502/cjn.v21i1.9353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2023]
Abstract
Background: Cerebral border zone infarctions (BZIs) are a subtype of acute ischemic stroke that occur at the junction between two major cerebral arterial territories. Internal and external BZIs are defined based on the known patterns in brain magnetic resonance imaging (MRI). However, the etiology and pathophysiology of these two types of BZI are still debated. This study aimed to determine the etiologic differences of two types of BZI to guide tailor appropriate treatment strategies for these patients. Methods: In this prospective study, patients with BZIs were enrolled from patients with acute ischemic stroke admitted to the hospitals affiliated with Tabriz University of Medical Sciences, Tabriz, Iran, from 2017 to 2019. Appropriate clinical and laboratory workups were applied to determine possible etiologies of ischemic stroke according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system. Results: The study included 106 patients with BZI, 53 patients in each group. Both types of BZI were more frequent in males. However, there was no significant difference between the two types concerning sex, age, and profile of major stroke risk factors. The results showed no correlation between the type of BZI and hemodynamic factors (P = 0.086). However, large artery atherosclerosis (LAA) was the most frequent etiology within each subtype of BZI; LAA in internal (P = 0.016) and cardioembolism (P = 0.046) in external BZI were more frequent etiologic subtypes of cerebral infarction. Conclusion: LAA might be the most common etiology for internal and external cerebral BZIs. Cardioembolism might have a more important etiologic role in the external subtype.
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Affiliation(s)
- Mazyar Hashemilar
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parla Tohidi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasrin Forghani
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elyar Sadeghi-Hokmabadi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
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12
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Aghaie B, Norouzadeh R, Sharifipour E, Koohpaei A, Negarandeh R, Abbasinia M. The Experiences of Intensive Care Nurses in Advocacy of COVID-19 Patients. J Patient Exp 2021; 8:23743735211056534. [PMID: 34869839 PMCID: PMC8640290 DOI: 10.1177/23743735211056534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The lack of face-to-face interactions with families, the increase in the number of patients admitted to the ICU, nursing staff shortages, and inadequate personal protective equipment has created many challenges for nurses in advocacy of the COVID-19 patient with life-threatening conditions. This study aimed to explore the experiences of intensive care nurses in the advocacy of COVID-19 patients. This study was performed using a qualitative content analysis method with Graneheim and Lundman approach, Iran, 2020. Data were collected through semi-structured interviews with eighteen clinical nurses from the intensive care units of three hospitals. Themes extracted from the nurses’ statements were promoting patient safety (informing physicians about the complications and consequences of treatment, preventing medical errors, protecting patients from threats), respecting the patients’ values (providing comfort at the end of life, providing a comfortable environment, commitment to confidentiality, cultural observance, respect for individualism, fair care), and informing (clarifying clinical conditions, describing available services, and being the patients’ voice). ICU nurses in health crises such as COVID-19 as patient advocates should promote patient safety, respect patients’ values, and inform them. The results of this study could help enhance the active role of intensive care nurses in the advocacy of COVID-19 patients.
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Affiliation(s)
- Bahman Aghaie
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | | | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Alireza Koohpaei
- Occupational Health and Safety at Work Department, Health Faculty, Qom University of Medical Sciences, Qom, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Faculty, Shahed University, Tehran, Iran
| | - Mohammad Abbasinia
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
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13
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Sangari A, Akhoundzadeh K, Vahedian M, Sharifipour E. Effect of pre-hospital notification on delays and neurological outcomes in acute ischemic stroke. Australas Emerg Care 2021; 25:172-175. [PMID: 34810150 DOI: 10.1016/j.auec.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Since timely thrombolytic therapy is a crucial variable in acute ischemic stroke recovery, health care systems are trying to find new interventions to reduce treatment delay in order to improve neurological function. In Iran, SAMA code as a pre-hospital notification plan has been developed to help emergent stroke treatment. This study aimed to compare delay to thrombolysis therapy and neurological outcomes between SAMA-transported and self-transported patients in ischemic stroke. METHODS In this retrospective cohort study, the data of 185 stroke patients treated with intravenous thrombolysis from Mar 2016 to May 2020 were collected. P-value < 0.05 was considered as significant. RESULTS The results showed that delays reduced in SAMA-transported patient compared to that in self-transported patients. There was a significant difference in Onset to Needle time, Door to Needle Time, and Door to CT Time but not Onset to Door time between SAMA-transported and self-transported patients (P values: 0.001, 0.000, 0.001, and 0.22 respectively). However, there was no significant difference between two groups in terms of neurologic deficit severity. CONCLUSIONS Although pre-hospital notification could partially reduce treatment delays in stroke, that reduction was not enough to impact on neurologic deficit recovery. It seems more reduction in delay is needed to significantly improve neurological dysfunctions.
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Affiliation(s)
| | - Kobra Akhoundzadeh
- Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran.
| | - Mostafa Vahedian
- Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran.
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran.
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14
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Salimi Y, Shiri I, Akhavanallaf A, Mansouri Z, Saberi Manesh A, Sanaat A, Pakbin M, Askari D, Sandoughdaran S, Sharifipour E, Arabi H, Zaidi H. Deep learning-based fully automated Z-axis coverage range definition from scout scans to eliminate overscanning in chest CT imaging. Insights Imaging 2021; 12:162. [PMID: 34743251 PMCID: PMC8572075 DOI: 10.1186/s13244-021-01105-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/09/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite the prevalence of chest CT in the clinic, concerns about unoptimized protocols delivering high radiation doses to patients still remain. This study aimed to assess the additional radiation dose associated with overscanning in chest CT and to develop an automated deep learning-assisted scan range selection technique to reduce radiation dose to patients. RESULTS A significant overscanning range (31 ± 24) mm was observed in clinical setting for over 95% of the cases. The average Dice coefficient for lung segmentation was 0.96 and 0.97 for anterior-posterior (AP) and lateral projections, respectively. By considering the exact lung coverage as the ground truth, and AP and lateral projections as input, The DL-based approach resulted in errors of 0.08 ± 1.46 and - 1.5 ± 4.1 mm in superior and inferior directions, respectively. In contrast, the error on external scout views was - 0.7 ± 4.08 and 0.01 ± 14.97 mm for superior and inferior directions, respectively.The ED reduction achieved by automated scan range selection was 21% in the test group. The evaluation of a large multi-centric chest CT dataset revealed unnecessary ED of more than 2 mSv per scan and 67% increase in the thyroid absorbed dose. CONCLUSION The proposed DL-based solution outperformed previous automatic methods with acceptable accuracy, even in complicated and challenging cases. The generizability of the model was demonstrated by fine-tuning the model on AP scout views and achieving acceptable results. The method can reduce the unoptimized dose to patients by exclunding unnecessary organs from field of view.
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Affiliation(s)
- Yazdan Salimi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva, Switzerland
| | - Isaac Shiri
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva, Switzerland
| | - Azadeh Akhavanallaf
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva, Switzerland
| | - Zahra Mansouri
- Department of Biomedical Engineering and Medical Physics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdollah Saberi Manesh
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva, Switzerland
| | - Amirhossein Sanaat
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva, Switzerland
| | - Masoumeh Pakbin
- Imaging Department, Qom University of Medical Sciences, Qom, Iran
| | - Dariush Askari
- Department of Radiology Technology, Shahid Beheshti University of Medical, Tehran, Iran
| | - Saleh Sandoughdaran
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Hossein Arabi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva, Switzerland
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva, Switzerland.
- Geneva University Neurocenter, Geneva University, Geneva, Switzerland.
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark.
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15
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Hashemilar M, Partovi A, Forghani N, Sharifipour E. Comparison of transcranial doppler ultrasound indices in large and small vessel disease cerebral infarction. Curr J Neurol 2021; 20:229-234. [PMID: 38011485 PMCID: PMC9107575 DOI: 10.18502/cjn.v20i4.8349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2023]
Abstract
Background: Atherosclerotic involvement of large and small cerebral arteries leading to infarction is among the most prevalent subtypes of stroke worldwide. The hemodynamic changes due to these arterial pathologies can be studied non-invasively and in real-time by using transcranial Doppler (TCD) techniques. TCD indices of the studied arteries may guide the clinician in differentiating these two underlying arterial pathologies. Methods: A cross-sectional study of patients with small and large vessel types of cerebral infraction based on the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) stroke classification was undertaken in the inpatient population of neurology service of Razi Hospital, Tabriz, Iran, from October 2018 to October 2019. After clinical diagnosis, all cases underwent TCD studies, brain magnetic resonance imaging (MRI), and brain and cervical four-vessel magnetic resonance angiography (MRA). The results of TCD indices related to major arteries of the circle of Willis were tabulated and compared between large and small vessel subtypes of cerebral infarction. Results: A statistically significant difference between right middle cerebral artery (MCA) pulsatility index (PI), left MCA PI, right internal carotid artery (ICA) PI, end-diastolic velocity (EDV), left ICA PI, left ICA EDV, left anterior cerebral artery (ACA) PI, and right vertebral artery (VA) PI measures of the two groups was seen (P < 0.05). In comparison to the large vessel group, left ACA, right VA, and bilateral MCAs and ICAs in the small-vessel stroke group demonstrated an elevated PI. Conclusion: A significant increase of PI occurs in the majority of intracranial arteries of patients with small vessel stroke. This makes PI a valuable marker for differentiating strokes with different underlying pathophysiologies.
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Affiliation(s)
- Mazyar Hashemilar
- Neurosciences Research Center AND Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afshin Partovi
- Neurosciences Research Center AND Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasrin Forghani
- Neurosciences Research Center AND Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
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16
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Sadeghi-Hokmabadi E, Ghoreishi A, Rikhtegar R, Sariaslani P, Rafie S, Vakilian A, Sharifipour E, Mehrpour M, Saadatnia M, Mirza-Aghazadeh-Attari M, Farhoudi M. Low-dose versus standard-dose alteplase for intravenous thrombolysis in patients with acute ischemic stroke in Iran: Results from the safe implementation of treatments in stroke registry. Curr J Neurol 2021; 20:208-213. [PMID: 38011433 PMCID: PMC9107572 DOI: 10.18502/cjn.v20i4.8346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 06/06/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022]
Abstract
Background: Rates of intracranial hemorrhage (ICH) after intravenous thrombolysis (IVT) differ depending on ethnicity, one reason that few Eastern countries have approved a lower dose of alteplase. Data in this regard are scarce in the Middle Eastern region. Methods: The present retrospective study was performed on data extracted from the Safe Implementation of Treatments in Stroke (SITS) registry. Computed tomography (CT) image analysis was based on the SITS-Monitoring Study (SITS-MOST) definition for symptomatic ICH (SICH). Functional outcome at 3 months was assessed using the modified Rankin Scale (mRS). Multivariate logistic regression including adjusted analysis was used for comparison between groups. Results: Of 6615 patients, 1055 were enrolled. A total of 86% (n = 906) received a standard dose and 14% (n = 149) received a low dose of alteplase. Favorable 3-month outcome was achieved in 481 (53%) patients in the standard group and 71 (48%) patients in the low-dose group [adjusted odds ratio (AOR) = 1.24, 95% confidence interval (CI): 0.87-1.75, P = 0.218]. SICH occurred in 14 (1.5%) patients in the standard group and 3 (2%) patients in the low-dose group [odds ratio (OR) = 2.77, 95% CI: 0.36-21.04, P = 0.120]. At 3 months, mortality occurred in 145 (16.0%) patients in the standard group and 29 (19.4%) patients in the low-dose group (OR = 1.22, 95% CI: 0.78-1.91, P = 0.346). Conclusion: Low-dose compared to standard-dose alteplase for patients with acute ischemic stroke (AIS) was not associated with fewer hemorrhagic events and there was no significant difference in the favorable 3-month outcome (mRS: 0-2) or mortality rate.
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Affiliation(s)
- Elyar Sadeghi-Hokmabadi
- Neurosciences Research Center AND Division of Neurology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdoreza Ghoreishi
- Stroke Research Group, Vali-e-Asr Hospital AND Department of Neurology and Stroke Unit, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Reza Rikhtegar
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, School of Medicine, Essen University Hospital, Germany
| | - Payam Sariaslani
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahram Rafie
- Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Vakilian
- Department of Neurology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Masoud Mehrpour
- Iranian Stroke Association, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Saadatnia
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mehdi Farhoudi
- Neurosciences Research Center AND Division of Neurology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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17
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Abbasinia M, Norouzadeh R, Adib-Hajbaghery M, Nasiri MA, Sharifipour E, Koohpaei A, Eskandari N, Aghaie B. Nurses' experiences of providing ethical care to the patients with COVID-19: A phenomenological study. ACTA ACUST UNITED AC 2021; 22:100717. [PMID: 34485658 PMCID: PMC8407951 DOI: 10.1016/j.jemep.2021.100717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/09/2021] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Coronavirus disease (COVID-19) is a newly emerging infectious disease that bringing a heavy workload on nursing staff. OBJECTIVE This study explores the nurses' experiences of providing ethical care for patients with COVID-19. METHODS This qualitative study was carried out based on hermeneutic phenomenology. Unstructured interviews were conducted with 18 Iranian nurses. Data were analyzed based on the hermeneutic approach using the Diekelmann approach. RESULTS Three themes emerged: strong clinical dilemma, flourishing of professional values, and strengthening human and organizational communication. CONCLUSION The findings highlight ethical care and its dimensions for COVID-19 patients. Nurses need support from health managers to provide ethical care in such health crises.
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Affiliation(s)
- Mohammad Abbasinia
- Assistant Professor, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Reza Norouzadeh
- Assistant Professor, Nursing and midwifery faculty, Shahed University, Tehran, Iran
| | - Mohsen Adib-Hajbaghery
- Professor, Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Ehsan Sharifipour
- Assistant Professor, Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Alireza Koohpaei
- Assistant Professor, Occupational health and safety at work department, health faculty, Qom University of Medical Sciences, Qom, Iran
| | - Narges Eskandari
- Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Bahman Aghaie
- Assistant Professor, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
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18
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Aghaali M, Yoosefee S, Hejazi SA, Shuaib A, Rahimi M, Razavinia FS, Radmard F, Sabokbar T, Sharifipour E. A prospective population-based study of stroke in the Central Region of Iran: The Qom Incidence of Stroke Study. Int J Stroke 2021; 17:957-963. [PMID: 34292120 DOI: 10.1177/17474930211037526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Based on the few population-based studies that have been conducted in the Middle East, we determined the incidence of stroke in Qom, one of the central provinces of Iran. METHODS The Qom province includes an estimated at-risk population of about 1 million. During a 12-month period (November 2018-November 2019), all first-ever strokes occurring in the target population were registered. Hospitalized cases were ascertained by discharge codes. Out-of-hospital cases were ascertained by a prospective screening of emergency medical services, emergency departments, ambulances records, primary care clinics, rural and urban public health centers, primary care physician offices, and neurologists' offices. Crude and age-adjusted incidence rates (per 100,000 person-years) were calculated. RESULTS During the study period, 1462 first-ever strokes occurred with a mean age of 68.1 (17-103) years; of these 45.2% were females (661 cases). The crude annual incidence rate per 100,000 at-risk populations was 145.4 (95% confidence interval, 138.1-153.0) for all types of stroke (156.5 for males and 134.3 for females), 26.4 (95% confidence interval, 23.5-29.8) for hemorrhagic stroke, and 114 (95% confidence interval, 105-121) for ischemic stroke. The incidence rate adjusted to the world population was 201.4 (95% confidence interval, 193-210) per 100,000 at-risk populations (adj incidence, 218.5 for males vs 187.4 for females). The total fatality rate during the first 28 days was 19.6%. CONCLUSION This study states that in this region there is a high incidence of stroke, which occurs at a younger age than the global average. There was a high prevalence of underlying stroke risk factors.
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Affiliation(s)
- Mohammad Aghaali
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Sadegh Yoosefee
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Seyed Amir Hejazi
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Ashfaq Shuaib
- Department of Medicine, Stroke Program, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Rahimi
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | | | - Fatemeh Radmard
- Student Research Committee, Qom University of Medical Sciences, Qom, Iran
| | - Tayebeh Sabokbar
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
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19
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Mehrpour M, Zamani B, Shadnoush M, Kermanchi J, Hozhabri S, Aghaali M, Shuaib A, Sharifipour E. "724" The First National Acute Stroke Treatment Plan in Iran. Arch Iran Med 2021; 24:651-652. [PMID: 34488334 DOI: 10.34172/aim.2021.92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/03/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Masoud Mehrpour
- Iranian Stroke Association, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Zamani
- Iranian Stroke Association, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Shadnoush
- Deputy of national transplantation and disease management center, Ministry of Health and Medical Education, Tehran, Iran
| | - Jamshid Kermanchi
- Deputy of national transplantation and disease management center, Ministry of Health and Medical Education, Tehran, Iran
| | - Shiva Hozhabri
- Deputy of national transplantation and disease management center, Ministry of Health and Medical Education, Tehran, Iran
| | - Mohammad Aghaali
- Iranian Stroke Association, Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | | | - Ehsan Sharifipour
- Iranian Stroke Association, Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
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20
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Norouzadeh R, Abbasinia M, Tayebi Z, Sharifipour E, Koohpaei A, Aghaie B, Asgarpour H. Experiences of Patients With COVID-19 Admitted to the Intensive Care Units: A Qualitative Study. J Patient Exp 2021; 8:23743735211007359. [PMID: 34179418 PMCID: PMC8205342 DOI: 10.1177/23743735211007359] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This study aimed to describe the experiences of patients with COVID-19 admitted to the intensive care units (ICU). The data were analyzed by content analysis on 16 ICU patients with COVID-19. Data were collected by semi-structured interviews. Three categories were identified: (a) captured by a challenging incident with subcategories: perceived sudden and challenging death, fear of carelessness in overcrowding, worry about the family, and frustration with stigmatizing; (b) the flourishing of life with subcategories: spiritual-awakening, resilience in the face of life challenges, promoting health behaviors, and striving for recovery; and (c) honoring the blessings with subcategories: understanding the importance of nurses, realizing the value of family, and realizing the value of altruism. COVID-19 survivors experienced both positive and negative experiences. The results of this study could help health care providers identify the needs of ICU patients with COVID-19, including psychological, social, and spiritual support and design care models.
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Affiliation(s)
- Reza Norouzadeh
- Faculty of Nursing and Midwifery, Shahed University, Tehran, Iran
| | - Mohammad Abbasinia
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Zahra Tayebi
- Faculty of Nursing and Midwifery, Alborz University Medical Sciences, Alborz, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Alireza Koohpaei
- Health Faculty, Departments of Occupational Health and Safety at Work, Qom University, Qom, Iran
| | - Bahman Aghaie
- Department of Medical Sciences and Medical-Surgical Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Hossein Asgarpour
- Department of Surgical Nursing, Faculty of Health Sciences, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
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21
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Khani S, Hejazi SA, Yaghoubi M, Sharifipour E. Comparative study of magnesium, sodium valproate, and concurrent magnesium-sodium valproate therapy in the prevention of migraine headaches: a randomized controlled double-blind trial. J Headache Pain 2021; 22:21. [PMID: 33827421 PMCID: PMC8028183 DOI: 10.1186/s10194-021-01234-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023] Open
Abstract
Objective This study aimed to assess the efficacy of concurrent magnesium-sodium valproate therapy and compare it with either magnesium or sodium valproate alone in migraine prophylaxis. Materials and methods This randomized single-center double-blind parallel-group controlled clinical trial study was conducted on migraine patients within the age range of 18–65 years. The subjects with at least four monthly attacks were randomly assigned to group A (n = 82) sodium valproate, group B (n = 70) magnesium with sodium valproate, and group C (n = 70) magnesium. The patients passed a one-month baseline without prophylactic therapy and then received a 3-month treatment. The characteristics of migraine, including frequency, severity, duration of the attacks, and the number of painkillers taken per month, were monthly recorded in each visit. The Migraine Disability Assessment (MIDAS) and Headache Impact Test-6 (HIT-6) scores were recorded at the baseline and after 3 months of treatment in each group. Within- and between-group analyses were performed in this study. Results The obtained results revealed a significant reduction in all migraine characteristics in all groups compared to those reported for the baseline (P < 0.001). Intragroup data analysis indicated that there was no statistically significant difference in headache frequency between groups A and B in the third month (P = 0.525); nevertheless, three other parameters showed a significant reduction in group B, compared to those reported for group A in the third month (P < 0.05). On the other hand, group C could not effectively reduce measured parameters in the patients, compared to groups A and B after 3 months (P < 0.001). Furthermore, the MIDAS and HIT-6 scores significantly diminished in groups A, B, and C compared to those reported at the baseline (P < 0.001), and these changes were more significant in groups A and B than in group C (P < 0.001). Conclusion The obtained results of this study revealed that magnesium could enhance the antimigraine properties of sodium valproate in combination therapy and reduce the required valproate dose for migraine prophylaxis.
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Affiliation(s)
- Samira Khani
- Department of Neurology, Neurosciences Research Center (NSRC), Qom University of Medical Sciences, Shahid-Beheshti hospital, Shahid-Beheshti street, Qom, Iran
| | - Seyed Amir Hejazi
- Department of Neurology, Neurosciences Research Center (NSRC), Qom University of Medical Sciences, Shahid-Beheshti hospital, Shahid-Beheshti street, Qom, Iran
| | - Mehdi Yaghoubi
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Ehsan Sharifipour
- Department of Neurology, Neurosciences Research Center (NSRC), Qom University of Medical Sciences, Shahid-Beheshti hospital, Shahid-Beheshti street, Qom, Iran.
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22
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Nogueira RG, Abdalkader M, Qureshi MM, Frankel MR, Mansour OY, Yamagami H, Qiu Z, Farhoudi M, Siegler JE, Yaghi S, Raz E, Sakai N, Ohara N, Piotin M, Mechtouff L, Eker O, Chalumeau V, Kleinig TJ, Pop R, Liu J, Winters HS, Shang X, Vasquez AR, Blasco J, Arenillas JF, Martinez-Galdamez M, Brehm A, Psychogios MN, Lylyk P, Haussen DC, Al-Bayati AR, Mohammaden MH, Fonseca L, Luís Silva M, Montalverne F, Renieri L, Mangiafico S, Fischer U, Gralla J, Frei D, Chugh C, Mehta BP, Nagel S, Mohlenbruch M, Ortega-Gutierrez S, Farooqui M, Hassan AE, Taylor A, Lapergue B, Consoli A, Campbell BC, Sharma M, Walker M, Van Horn N, Fiehler J, Nguyen HT, Nguyen QT, Watanabe D, Zhang H, Le HV, Nguyen VQ, Shah R, Devlin T, Khandelwal P, Linfante I, Izzath W, Lavados PM, Olavarría VV, Sampaio Silva G, de Carvalho Sousa AV, Kirmani J, Bendszus M, Amano T, Yamamoto R, Doijiri R, Tokuda N, Yamada T, Terasaki T, Yazawa Y, Morris JG, Griffin E, Thornton J, Lavoie P, Matouk C, Hill MD, Demchuk AM, Killer-Oberpfalzer M, Nahab F, Altschul D, Ramos-Pachón A, Pérez de la Ossa N, Kikano R, Boisseau W, Walker G, Cordina SM, Puri A, Luisa Kuhn A, Gandhi D, Ramakrishnan P, Novakovic-White R, Chebl A, Kargiotis O, Czap A, Zha A, Masoud HE, Lopez C, Ozretic D, Al-Mufti F, Zie W, Duan Z, Yuan Z, Huang W, Hao Y, Luo J, Kalousek V, Bourcier R, Guile R, Hetts S, Al-Jehani HM, AlHazzani A, Sadeghi-Hokmabadi E, Teleb M, Payne J, Lee JS, Hong JM, Sohn SI, Hwang YH, Shin DH, Roh HG, Edgell R, Khatri R, Smith A, Malik A, Liebeskind D, Herial N, Jabbour P, Magalhaes P, Ozdemir AO, Aykac O, Uwatoko T, Dembo T, Shimizu H, Sugiura Y, Miyashita F, Fukuda H, Miyake K, Shimbo J, Sugimura Y, Beer-Furlan A, Joshi K, Catanese L, Abud DG, Neto OG, Mehrpour M, Al Hashmi A, Saqqur M, Mostafa A, Fifi JT, Hussain S, John S, Gupta R, Sivan-Hoffmann R, Reznik A, Sani AF, Geyik S, Akıl E, Churojana A, Ghoreishi A, Saadatnia M, Sharifipour E, Ma A, Faulder K, Wu T, Leung L, Malek A, Voetsch B, Wakhloo A, Rivera R, Barrientos Iman DM, Pikula A, Lioutas VA, Thomalla G, Birnbaum L, Machi P, Bernava G, McDermott M, Kleindorfer D, Wong K, Patterson MS, Fiorot JA, Huded V, Mack W, Tenser M, Eskey C, Multani S, Kelly M, Janardhan V, Cornett O, Singh V, Murayama Y, Mokin M, Yang P, Zhang X, Yin C, Han H, Peng Y, Chen W, Crosa R, Frudit ME, Pandian JD, Kulkarni A, Yagita Y, Takenobu Y, Matsumaru Y, Yamada S, Kono R, Kanamaru T, Yamazaki H, Sakaguchi M, Todo K, Yamamoto N, Sonoda K, Yoshida T, Hashimoto H, Nakahara I, Cora E, Volders D, Ducroux C, Shoamanesh A, Ospel J, Kaliaev A, Ahmed S, Rashid U, Rebello LC, Pereira VM, Fahed R, Chen M, Sheth SA, Palaiodimou L, Tsivgoulis G, Chandra R, Koyfman F, Leung T, Khosravani H, Dharmadhikari S, Frisullo G, Calabresi P, Tsiskaridze A, Lobjanidze N, Grigoryan M, Czlonkowska A, de Sousa DA, Demeestere J, Liang C, Sangha N, Lutsep HL, Ayo-Martín Ó, Cruz-Culebras A, Tran AD, Young CY, Cordonnier C, Caparros F, De Lecinana MA, Fuentes B, Yavagal D, Jovin T, Spelle L, Moret J, Khatri P, Zaidat O, Raymond J, Martins S, Nguyen T. Global impact of COVID-19 on stroke care. Int J Stroke 2021; 16:573-584. [PMID: 33459583 PMCID: PMC8010375 DOI: 10.1177/1747493021991652] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
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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Affiliation(s)
- Raul G Nogueira
- Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA
| | - Mohamad Abdalkader
- Radiology, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Muhammed M Qureshi
- Radiology, Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Michael R Frankel
- Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA
| | - Ossama Yassin Mansour
- Neurology Department, Stroke and Neurointervention Division, Alexandria University Hospital, Alexandria University, Egypt
| | - Hiroshi Yamagami
- Stroke Neurology, National Hospital Organization, Osaka National Hospital, Japan
| | - Zhongming Qiu
- Neurology, Xinqiao Hospital of the Army Medical University, Chongqing, China
| | | | - James E Siegler
- Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Shadi Yaghi
- Neurology, Radiology, New York University School of Medicine, New York, USA
| | - Eytan Raz
- Radiology, Neurology, New York University School of Medicine, New York, USA
| | - Nobuyuki Sakai
- Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuyuki Ohara
- Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Michel Piotin
- Fondation Ophtalmologique Adolphe de Rothschild, France
| | | | - Omer Eker
- Neuroradiologie, Hospices Civils de Lyon, France
| | | | | | - Raoul Pop
- Hôpitaux Universitaires de Strasbourg, France
| | | | | | | | | | - Jordi Blasco
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Spain
| | | | | | | | | | - Pedro Lylyk
- Clínica Sagrada Familia, Buenos Aires, Argentina
| | - Diogo C Haussen
- Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA
| | | | | | - Luísa Fonseca
- Stroke, Centro Hospitalar Universitário de São João, Portugal
| | - M Luís Silva
- Neuroradiology, Centro Hospitalar Universitário de São João, Portugal
| | | | | | | | - Urs Fischer
- Neurology, University Hospital Bern, Switzerland
| | - Jan Gralla
- Interventional Neuroradiology, University Hospital Bern, Switzerland
| | | | | | | | - Simon Nagel
- Neurology, University Hospital Heidelberg, Germany
| | | | | | | | - Ameer E Hassan
- Neurosciences, Valley Baptist Medical Center, Harlingen, Texas, USA
| | - Allan Taylor
- Neurosurgery, University of Cape Town, South Africa
| | | | | | | | | | | | - Noel Van Horn
- Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Jens Fiehler
- Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Germany
| | | | | | | | - Hao Zhang
- Affiliated Hangzhou First People's Hospital, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Naoki Tokuda
- Japanese Red Cross Kyoto Daiichi Hospital, Japan
| | | | | | | | | | | | | | | | | | | | | | | | - Fadi Nahab
- Emory University School of Medicine, USA
| | | | | | | | | | | | | | | | - Ajit Puri
- University of Massachusetts Medical Center, USA
| | | | | | | | | | | | | | | | - Alicia Zha
- UTHealth McGovern Medical School, Houston, USA
| | | | | | | | | | - Wenjie Zie
- Xinqiao Hospital of the Army Medical University, China
| | | | - Zhengzhou Yuan
- Affiliated Hospital of Southwest Medical University, China
| | - Wenguo Huang
- Maoming Traditional Chinese Medicine Hospital, China
| | | | - Jun Luo
- Mianyang 404 Hospital, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alice Ma
- Royal North Shore Hospital, Australia
| | | | - Teddy Wu
- Christchurch Hospital, Christchurch , New Zealand
| | | | | | | | - Ajay Wakhloo
- Interventional Neuroradiology, Beth Israel Lahey Health, USA
| | - Rodrigo Rivera
- Neuroradiology, Instituto de Neurocirugia Dr. Asengo, Chile
| | | | | | | | - Gotz Thomalla
- Neurology, Universitätsklinikum Hamburg-Eppendorf, Germany
| | | | | | | | | | | | - Ken Wong
- Royal London Hospital, United Kingdom
| | | | | | | | | | | | - Clifford Eskey
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | | | | | | | | | | | | | | | | | - Congguo Yin
- Affiliated Hangzhou First People's Hospital, China
| | | | - Ya Peng
- First People's Hospital, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kenichi Todo
- Osaka University Graduate School of Medicine, Japan
| | - Nobuaki Yamamoto
- Tokushima University Graduate School of Biomedical Sciences, Japan
| | | | | | | | | | - Elena Cora
- Dalhousie University, Nova Scotia, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Conrad Liang
- Neurointerventional Radiology, Kaiser Permanente, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Thanh Nguyen
- Radiology, Neurology, Boston Medical Center, USA
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Arsang-Jang S, Mohammadbeigi A, Sharifipour E, Koohpaei A, Vahedian M, Mohammadsalehi N, Jafaresmaeili M, Karami M, Mohebi S. Spatiotemporal analysis, hotspot mapping, and clustering of confirmed cases of COVID-19 in the initial phase of the pandemic in Qom province, Iran. J Acute Dis 2021. [DOI: 10.4103/2221-6189.320963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Hejazi SA, Rohampour K, Sharifipour E, Sharifimoghadam S, Paybast S, Ghoreishi A, Hassanzadeh N, Vahedian M. The correlation of serum adiponectin and insulin resistance with the presence and severity of dementia in non-obese Alzheimer's patients. Clin Nutr ESPEN 2020; 40:376-382. [PMID: 33183566 DOI: 10.1016/j.clnesp.2020.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Alteration in the insulin signaling could contribute to the development of Alzheimer's disease (AD) through metabolic or inflammatory processes, adipokines could affect insulin dysregulation. This study aimed to investigate whether there is a correlation between serum adiponectin level alteration and insulin resistance with the presence and severity of AD, compared to normal controls. METHODS This analytical observational study was conducted on 60 non-overweight and non-diabetic participants who were assigned to AD patients (n = 34) and healthy volunteers (n = 26). The diagnosis and severity of dementia were evaluated by the same protocol, and the Mini-Mental Score Exam (MMSE) questionnaire was utilized to collect the data. Moreover, adiponectin concentration, fasting blood sugar, and plasma insulin levels were measured using enzyme-linked immunosorbent assay. Furthermore, the homeostasis model assessment for insulin resistance (HOMA-IR) was utilized in this study. RESULTS The mean ages of the AD patients and control participants were 71.35 and 70.46, respectively. In addition, the mean values of the serum adiponectin level of the participants were 9660 and 12,730 ng/mL in control and AD groups, respectively (P ≤ 0.05). Additionally, the insulin resistance (IR) was 2.90 and 5.10 in the control and AD groups, respectively (P ≤ 0.05). According to the results, there was a significant positive correlation between serum adiponectin level and HOMA-IR in the AD group; however, no significant correlation was observed between serum adiponectin level and MMSE score in this group. The MMSE score of AD patients significantly decreased by 1.2 times with an increase in each score of the IR (P ≤ 0.05). CONCLUSION A significant direct positive correlation was observed between the serum adiponectin level and IR among the AD patients. However, a significant decrease in cognition levels was detected following an increase in IR scores of the AD patients.
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Affiliation(s)
- Seyed Amir Hejazi
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Kambiz Rohampour
- Neuroscience Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran.
| | | | | | - Abdoreza Ghoreishi
- Department of Neurology, Vali-e-Asr Hospital, School of Medicine, University of Medical Sciences, Zanjan, Iran
| | - Navid Hassanzadeh
- Student Research Committee, Qom University of Medical Sciences, Qom, Iran
| | - Mostafa Vahedian
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
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25
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Malekzadeh R, Abedini A, Mohsenpour B, Sharifipour E, Ghasemian R, Javad-Mousavi SA, Khodashahi R, Darban M, Kalantari S, Abdollahi N, Salehi MR, Rezaei Hosseinabadi A, Khorvash F, Valizadeh M, Dastan F, Yousefian S, Hosseini H, Anjidani N, Tabarsi P. Subcutaneous tocilizumab in adults with severe and critical COVID-19: A prospective open-label uncontrolled multicenter trial. Int Immunopharmacol 2020; 89:107102. [PMID: 33075713 PMCID: PMC7553010 DOI: 10.1016/j.intimp.2020.107102] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 12/15/2022]
Abstract
Potential therapeutic approaches in coronavirus disease 2019 (COVID-19) comprise antiviral and immunomodulatory agents; however, no immunomodulator drug has been approved. This multicenter, prospective, open-label, uncontrolled study aimed to assess the use of subcutaneous tocilizumab in adult patients with severe and critical COVID-19. Tocilizumab was added to the standard care of therapy at a dose of 324 mg (<100 kg bodyweight) or 486 mg (≥100 kg bodyweight). The study endpoints were all-cause mortality rate, changes in oxygen-support level, oxygen saturation, body temperature, respiratory rate, and laboratory variables during the study, and drug safety. Of 126 patients enrolled, 86 had severe and 40 had critical disease. Most patients were male (63.49%) and aged below 65 (78.57%). By day 14 of the study, 4.65% (4/86) of severe patients and 50.00% (20/40) of critical patients died. By the end, 6.98% (6/86) of severe patients and 60.00% (24/40) of critical patients died.Outcomes concerning three additional endpoints (oral temperature, oxygen saturation, and respiratory rate)were significantly improved as early as three days after tocilizumab administration in both groups of subjects, more considerably in severe patients. Significant improvement in the required level of oxygenation was reported in severe patients seven days after tocilizumab administration. No tocilizumab-related serious adverse event occurred in this study. Subcutaneous tocilizumab might improve some clinical parameters and reduce the risk of death in COVID-19 patients, particularly if used in the early stages of respiratory failure.
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Affiliation(s)
- Reza Malekzadeh
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behzad Mohsenpour
- Department of Infectious Disease, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Roya Ghasemian
- Department of Infectious Diseases, School of Medicine, Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Ali Javad-Mousavi
- Department of Pulmonology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Rozita Khodashahi
- Department of Infectious Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahboobeh Darban
- Department of Internal Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Saeed Kalantari
- Antimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Abdollahi
- Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Reza Salehi
- Department of Infectious Disease, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farzin Khorvash
- Department of Infectious Disease, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Melika Valizadeh
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Dastan
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Yousefian
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Hosseini
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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26
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Abolghasemi H, Eshghi P, Cheraghali AM, Imani Fooladi AA, Bolouki Moghaddam F, Imanizadeh S, Moeini Maleki M, Ranjkesh M, Rezapour M, Bahramifar A, Einollahi B, Hosseini MJ, Jafari NJ, Nikpouraghdam M, Sadri N, Tazik M, Sali S, Okati S, Askari E, Tabarsi P, Aslani J, Sharifipour E, Jarahzadeh MH, Khodakarim N, Salesi M, Jafari R, Shahverdi S. Clinical efficacy of convalescent plasma for treatment of COVID-19 infections: Results of a multicenter clinical study. Transfus Apher Sci 2020; 59:102875. [PMID: 32694043 PMCID: PMC7362821 DOI: 10.1016/j.transci.2020.102875] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
Since Dec. 2019 the new coronavirus (SARS-CoV-2) has infected millions and claimed life of several hundred thousand worldwide. However, so far no approved vaccine or drug therapy is available for treatment of virus infection. Convalescent plasma has been considered a potential modality for COVID-19 infection. One hundred eighty-nine COVID-19 positive patients including 115 patients in plasma therapy group and 74 patients in control group, registered in the hospitals with confirmed COVID-19 infection, entered this multi-center clinical study. Comparison of outcomes including all-cause mortality, total hospitalization days and patients' need for intubation between the two patient groups shows that total of 98 (98.2 %) of patients who received convalescent plasma were discharged from hospital which is substantially higher compared to 56 (78.7 %) patients in control group. Length of hospitalization days was significantly lower (9.54 days) in convalescent plasma group compared with that of control group (12.88 days). Only 8 patients (7%) in convalescent plasma group required intubation while that was 20 % in control group. This clinical study provides strong evidence to support the efficacy of convalescent plasma therapy in COVID-19 patients and recommends this treatment for management of these patients. Clinical efficacy, immediate availability and potential cost effectiveness could be considered as main advantages of convalescent plasma therapy.
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Affiliation(s)
- Hassan Abolghasemi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Peyman Eshghi
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences and Iran Blood Transfusion Organization, Tehran, Iran
| | - Abdol Majid Cheraghali
- School of Pharmacy and Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Abbas Ali Imani Fooladi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Sina Imanizadeh
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Matin Moeini Maleki
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Ranjkesh
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Rezapour
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Bahramifar
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Hosseini
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Nematollah Joneidi Jafari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohamad Nikpouraghdam
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | | | - Shanaz Sali
- Infectious Disease and Tropical Medicine Research Center, Shahid Behesti University of Medical Sciences, Tehran, Iran
| | - Shamsi Okati
- High Institute for Research and Education in Transfuion Medicine, Tehran, Iran
| | - Elham Askari
- National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jafar Aslani
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center of Qom University of Medical Science, Qom, Iran
| | | | - Nastaran Khodakarim
- Department of Medical Oncology and Hematology, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ramezan Jafari
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Samira Shahverdi
- Department of Radiology, Baqiyatallah University of Medical Sciences, Tehran, Iran
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27
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Sharifipour E, Shams S, Esmkhani M, Khodadadi J, Fotouhi-Ardakani R, Koohpaei A, Doosti Z, Ej Golzari S. Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU. BMC Infect Dis 2020; 20:646. [PMID: 32873235 PMCID: PMC7461753 DOI: 10.1186/s12879-020-05374-z] [Citation(s) in RCA: 199] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
Background COVID-19 is known as a new viral infection. Viral-bacterial co-infections are one of the biggest medical concerns, resulting in increased mortality rates. To date, few studies have investigated bacterial superinfections in COVID-19 patients. Hence, we designed the current study on COVID-19 patients admitted to ICUs. Methods Nineteen patients admitted to our ICUs were enrolled in this study. To detect COVID-19, reverse transcription real-time polymerase chain reaction was performed. Endotracheal aspirate samples were also collected and cultured on different media to support the growth of the bacteria. After incubation, formed colonies on the media were identified using Gram staining and other biochemical tests. Antimicrobial susceptibility testing was carried out based on the CLSI recommendations. Results Of nineteen COVID-19 patients, 11 (58%) patients were male and 8 (42%) were female, with a mean age of ~ 67 years old. The average ICU length of stay was ~ 15 days and at the end of the study, 18 cases (95%) expired and only was 1 case (5%) discharged. In total, all patients were found positive for bacterial infections, including seventeen Acinetobacter baumannii (90%) and two Staphylococcus aureus (10%) strains. There was no difference in the bacteria species detected in any of the sampling points. Seventeen of 17 strains of Acinetobacter baumannii were resistant to the evaluated antibiotics. No metallo-beta-lactamases -producing Acinetobacter baumannii strain was found. One of the Staphylococcus aureus isolates was detected as methicillin-resistant Staphylococcus aureus and isolated from the patient who died, while another Staphylococcus aureus strain was susceptible to tested drugs and identified as methicillin-sensitive Staphylococcus aureus. Conclusions Our findings emphasize the concern of superinfection in COVID-19 patients due to Acinetobacter baumannii and Staphylococcus aureus. Consequently, it is important to pay attention to bacterial co-infections in critical patients positive for COVID-19.
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Affiliation(s)
- Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Saeed Shams
- Cellular and Molecular Research Center, Faculty of Medicine, Pardis Campus, Qom University of Medical Sciences, Qom, Iran.
| | | | - Javad Khodadadi
- Department of Infectious Diseases, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Reza Fotouhi-Ardakani
- Cellular and Molecular Research Center, Faculty of Medicine, Pardis Campus, Qom University of Medical Sciences, Qom, Iran.,Department of Medical Biotechnology, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Alireza Koohpaei
- Occupational health & Safety Department, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - Zahra Doosti
- Cellular and Molecular Research Center, Faculty of Medicine, Pardis Campus, Qom University of Medical Sciences, Qom, Iran
| | - Samad Ej Golzari
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Dortmund, Dortmund, Germany
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28
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Ghadir MR, Ebrazeh A, Khodadadi J, Zamanlu M, Shams S, Nasiri M, Koohpaei A, Abbasinia M, Sharifipour E, Golzari SE. The COVID-19 Outbreak in Iran; The First Patient with a Definite Diagnosis. Arch Iran Med 2020; 23:503-504. [PMID: 32657602 DOI: 10.34172/aim.2020.48] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022]
Abstract
The novel coronavirus, formerly named as 2019 novel coronavirus (2019-nCov) caused a rapidly spreading epidemic of severe acute respiratory syndrome (SARS) in Wuhan, China and thereafter, progressed globally to form a pandemic of coronavirus disease 2019 (COVID-19) in numerous countries; and now confirmed cases are reported from several provinces of Iran. Now various medical centers, clinicians and researchers around the world share their data and experiences about COVID-19 in order to participate in the global attempt of controlling the pandemic. The current report investigates the clinical presentations and paraclinical findings of the first confirmed cases and mortalities in the initiation of the outbreak of COVID-19 in Iran.
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Affiliation(s)
- Mohammad Reza Ghadir
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Ali Ebrazeh
- Department of Public Health, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - Javad Khodadadi
- Department of Infectious Diseases, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Masumeh Zamanlu
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Saeed Shams
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Maryam Nasiri
- Department of Infectious Diseases, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Alireza Koohpaei
- Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran
| | - Mohammad Abbasinia
- Department of Nursing, Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Samad Ej Golzari
- Department of Anesthesiology and Intensive Care Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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29
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Hormati A, Akbari N, Sharifipour E, Hejazi SA, Jafari F, Alemi F, Mohammadbeigi A. Migraine and gastric disorders: Are they associated? J Res Med Sci 2019; 24:60. [PMID: 31523246 PMCID: PMC6669996 DOI: 10.4103/jrms.jrms_464_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/10/2018] [Accepted: 03/25/2019] [Indexed: 12/29/2022]
Abstract
Background: Migraine is a common disorder which affects quality of life. There has been an increasing interest for discovering the association of gastrointestinal (GI) disorders with migraine during past years. This study aims to evaluate the association of Helicobacter pylori contamination, gastroesophageal reflux disease (GERD), gastric ulcer (GU), and duodenal ulcer (DU) with migraine in patients who underwent upper GI endoscopy due to refractory dyspepsia. Materials and Methods: In this observational cross-sectional study, 341 dyspeptic patients who underwent upper GI endoscopy in Shahid Beheshti Hospital, Qom, Iran, included during 2016–2018. A checklist was used for collecting demographics, symptoms, and results from endoscopy and H. pylori testing. Diagnosis of migraine was made according to the International Headache Society criteria in patients who had headache. Data were analyzed using Chi-square and independent samples t-tests in SPSS 16 (SPSS Inc., Chicago, IL, USA) with P < 0.05 as significance level. Results: Among 341 patients, 141 (% 41.3) were male and 200 (58.7%) were female. 149 (43.7%) patients were diagnosed with migraine, from which 48 (32.2%) were male and 101 (67.8%) were female. The observed difference in migraine prevalence among male and female was statistically significant (P = 0.003). 198 (58.06%) patients were H. pylori contaminated, among these 138 (69.7%) suffered from migraine. Among 143 H. pylori-negative patients, there were 11 (7.7%) migraineurs. The difference in the prevalence of migraine among H. pylori positive and negative patients was significant. H. pylori and GERD were associated with migraine with P < 0.001. Patients with DU were more commonly suffering from migraine (P = 0.001). The association in patients with GU was not statistically significant (P = 0.863). Conclusion: Migraine might be associated with GERD, H. pylori infection, and DU, and the treatment of the underlying GI disorder may control headaches.
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Affiliation(s)
- Ahmad Hormati
- Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Qom, Iran.,Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nayyereh Akbari
- Neuroscience Research Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Seyyed Amir Hejazi
- Neuroscience Research Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Fatemeh Jafari
- Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Faezeh Alemi
- Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Abolfaz Mohammadbeigi
- Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Qom, Iran
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30
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Akbari N, Hormati A, Sharifipour E, Hejazi SA, Jafari F, Mousavi-Aghdas SA, Golzari SEJ. Migraine, dyspepsia, and Helicobacter pylori: Zeroing in on the culprit. Iran J Neurol 2019; 18:19-24. [PMID: 31316732 PMCID: PMC6626606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Background: Numerous studies have evaluated the impact of Helicobacter pylori (H. pylori) eradication on the number, severity, and recurrence of migraine attacks. But the association of migraine, H. pylori, and gastrointestinal (GI) presentation is challenging. The aim of the current study was to investigate the correlation between migraine, H. pylori, and peptic ulcers among patients with dyspepsia undergoing upper GI endoscopy. Methods: 305 patients with dyspepsia referring to our endoscopy ward, Shahid Beheshti Hospital affiliated to Qom University of Medical Sciences, Qom, Iran, for upper GI endoscopy filled out the study questionnaire. If a patient was experiencing headaches and the migraine was confirmed by neurologists, he/she was asked to answer the questions related to migraine, which were prepared exactly from Migraine Disability Assessment (MIDAS) questionnaire. The relation between migraine and confirmed H. pylori contamination was investigated using statistical models. Results: Of all the 305 patients, 133 (43.6%) had confirmed episodic migraine headaches (MHs) and 177 patients (58.04%) had positive RUT for confirming H. pylori contamination, of which 123 (69.5%) had confirmed migraine. 52 (17.0%) had duodenal peptic ulcer(s), of which, 49 (94.2%) had a positive rapid urease test (RUT) (P < 0.001). 20 (6.5%) of all patients had the gastric peptic ulcer(s) which did not have a significant relation with H. pylori contamination. There was a significant relationship between the peptic ulcer site and migraine. In total, 177 patients (58.0%) had a positive RUT. History of migraine was significantly positive in those with positive H. Pylori contamination. Notably, multivariable analysis demonstrated a significant relation of H. pylori and migraine at younger ages. Conclusion: The prevalence of H. pylori and migraine in patients with dyspepsia seems to be high. Moreover, there is a meaningful association between migraine, duodenal peptic ulcers, and H. pylori infection, too.
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Affiliation(s)
- Nayereh Akbari
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Ahmad Hormati
- Gastroenterology and Hepatology Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Seyed Amir Hejazi
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Fatemeh Jafari
- Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | | | - Samad EJ Golzari
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran,Road Traffic Injury Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Mohammadian R, Sharifipour E, Taheraghdam A, Mansourizadeh R, Altafi D, Fattahzadeh G, Sariaslani P, Yousefshahi P, Ebrahimzadeh K, Vahedian M, Golzari SEJ. Efficacy of carotid artery stenting on stroke prevention of octogenarians. Clin Neurol Neurosurg 2018; 173:187-193. [PMID: 30165319 DOI: 10.1016/j.clineuro.2018.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/15/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Octogenarians account for a third of ischemic stroke (IS) patients and applying endovascular carotid artery stenting (CAS), as a secondary prevention, in these patients is challenging. The aim of this study was to evaluate peri-procedural and long term clinical and angiographic impact of CAS on octogenarians. PATIENTS AND METHODS In a prospective study, 102 patients aged over 80 years old with symptomatic internal carotid artery (ICA) stenosis presenting by non-disabling IS or transient ischemic attack and having undergone CAS were evaluated prospectively from January 2012 to July 2016. All patients received standard stroke care during the study follow up period. Peri-procedural complication, cerebrovascular accidents, restenosis in target vessel and mortality rate were recorded and the collected data were analyzed to evaluate safety and durability of CAS in octogenarians. RESULTS 48 (47.06%) males and 54 (52.9%) females with the mean age of 83.39 ± 2.53 (range, 80-88) years were followed in a mean period of 24.5 ± 14.1 months (6-50 months). Success rate of CAS was 100%; whereas, the peri-procedural complication rate was 5.8% (only one patient experienced acute ischemic stroke during the procedure). Restenosis and recurrent cerebrovascular accidents were observed in 3.9% and 9.8% of the cases, respectively. Recurrent cerebrovascular accident leading to death was seen in 2.9% of the cases. The median patient event-free survival was 20 months. CONCLUSION Endovascular CAS seems to be a safe and durable method for secondary prevention in ischemic stroke following symptomatic carotid artery stenosis in octogenarians.
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Affiliation(s)
- Reza Mohammadian
- Institute of Neuroradiology University Hospital of Zurich, Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center of Qom University of Medical Sciences, Iran.
| | | | - Reza Mansourizadeh
- Institute of Neuroradiology University Hospital of Zurich, Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Davar Altafi
- Neurologist, Ardebil University of Medical Sciences, Iran
| | | | | | | | | | - Mostafa Vahedian
- Clinical Research and Development Center (CRDC), Qom University of Medical Sciences, Qom, Iran
| | - Samad E J Golzari
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Road Traffic Injury Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Sharifipour E, Aliakbar T, Pourkhanjar P, Heydarzadeh N. Correlations between cytomegalovirus, epstein-barr virus, anti-ganglioside antibodies, electrodiagnostic findings and functional status in guillain-barre syndrome. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sharifipour E, Hejazi S, Najafi Ghodsi F, Hatami H. The role of coping styles in the relationship between personality traits and quality of life of multiple sclerosis patients. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Savadi Oskouie D, Sharifipour E, Sadeghi Bazargani H, Hashemilar M, Nikanfar M, Ghazanfari Amlashi S, Abbaszade Z, Sadeghihokmabadi E, Rikhtegar R, Golzari SEJ. Efficacy of Citalopram on Acute Ischemic Stroke Outcome: A Randomized Clinical Trial. Neurorehabil Neural Repair 2017; 31:638-647. [PMID: 28454498 DOI: 10.1177/1545968317704902] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Ischemic stroke (IS) is one of the main causes of death and disability in the adult population, and recovery from it is a major health concern worldwide. The aim of the present study was to evaluate the effectiveness of citalopram on 3-mounth outcome of nondepressed acute IS patients. METHODS In a randomized, placebo-controlled clinical trial, 144 patients with acute IS were studied for 3 months. In one group, the patients received oral citalopram 20 mg (once daily), and in the other group, they received placebo. All patients received standard care, including physiotherapy. Patients with depression were excluded throughout the study. The primary outcome of the study was set to a 50% reduction in the 3-month National Institutes of Health Stroke Scale compared with the baseline scores (Clinical Trial Registration URL: http://www.irct.ir ; Unique identifier: IRCT201203192150N2). RESULTS The mean age of patients was 66.4 years. Of 144 eligible patients, 15 patients died (4 in the citalopram and 11 in the placebo group), and 21 patients did not complete the study follow-up period (10 in the citalopram and 11 in the placebo group). The primary outcome of the study was achieved in 57 patients (79%) in the citalopram and 39 patients (54%) in the placebo group ( P < .001), with risk ratio and number needed to treat of 2 (CI = 1.2-3) and 4 (CI = 2.5-8.6), respectively. No major adverse events were found in either group. CONCLUSIONS Citalopram is a safe and tolerable medication in patients with acute IS, which could improve the outcome in these patients.
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Affiliation(s)
| | | | | | - Mazyar Hashemilar
- 1 Tabriz University of Medical Sciences, Razi Hospital, Tabriz, Iran
| | - Masoud Nikanfar
- 1 Tabriz University of Medical Sciences, Razi Hospital, Tabriz, Iran
| | | | - Zahra Abbaszade
- 1 Tabriz University of Medical Sciences, Razi Hospital, Tabriz, Iran
| | | | - Reza Rikhtegar
- 1 Tabriz University of Medical Sciences, Razi Hospital, Tabriz, Iran
| | - Samad E J Golzari
- 1 Tabriz University of Medical Sciences, Razi Hospital, Tabriz, Iran
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Sharifipour E, Farnia P, Mozafari M, Irani S, Akbar Velayati A. Deletion of region of difference 181 in Mycobacterium tuberculosis Beijing strains. Int J Mycobacteriol 2016; 5 Suppl 1:S238-S239. [PMID: 28043579 DOI: 10.1016/j.ijmyco.2016.09.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES/BACKGROUND The region of differences (RDs) polymorphisms is a potential molecular epidemiology method to distinguish origins of Mycobacterium tuberculosis. To date, 68 RDs have been identified in M. tuberculosis. This study was designed to determine the frequency of RD deletions in M. tuberculosis strains that were isolated from patients with pulmonary tuberculosis who were referred to the National Research Institute of Tuberculosis and Lung Disease for diagnosis and treatment. Therefore, highly polymorphic regions (RD1, RD150, and RD181) among M. tuberculosis strains isolates were investigated. METHODS A total of 250 M. tuberculosis isolates were identified by conventional and molecular methods. Subsequently, spoligotyping and RD typing (RD1, RD150 and RD181) were performed to genotype these strains. RESULTS The most frequent spoligotype belonged to Haarlem (n=85, 34.0%) followed by CAS (n=54, 21.6%), T1 (n=27, 10.8%), and Beijing (n=28, 11.2%) lineages. Deletion in RD181 was identified only among the Beijing lineage (Fig. 1). CONCLUSION As we found a deletion in RD181 in the Beijing strains only, we propose to use this marker as an identification tool for genotyping of the Beijing strain.
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Affiliation(s)
- Ehsan Sharifipour
- Mycobacteriology Research Centre, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parissa Farnia
- Mycobacteriology Research Centre, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Mozafari
- Mycobacteriology Research Centre, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shiva Irani
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Ali Akbar Velayati
- Mycobacteriology Research Centre, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sadeghi-Hokmabadi E, Farhoudi M, Taheraghdam A, Hashemilar M, Savadi-Osguei D, Rikhtegar R, Mehrvar K, Sharifipour E, Youhanaee P, Mirnour R. Intravenous recombinant tissue plasminogen activator for acute ischemic stroke: a feasibility and safety study. Int J Gen Med 2016; 9:361-367. [PMID: 27822079 PMCID: PMC5087792 DOI: 10.2147/ijgm.s112430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background In developing countries, intravenous thrombolysis (IVT) is available at a limited number of centers. This study aimed to assess the feasibility and safety of IVT at Tabriz Imam Reza Hospital. Methods In a prospective study, over a 55-month period, any patient at the hospital for whom stroke code had been activated was enrolled in the study. Data on demographic characteristics, stroke risk factors, admission blood pressure, blood tests, findings of brain computed tomography (CT) scans, time of symtom onset, time of arrival to the emergency department, time of stroke code activation, time of CT scan examination, and the time of recombinant tissue plasminogen activator administration were recorded. National Institutes of Health Stroke Scale assessments were performed before IVT bolus, at 36 hours, at either 7 days or discharge (which ever one was earlier), and at 3-month follow-up. Brain CT scans were done for all patients before and 24 hours after the treatment. Results Stroke code was activated for 407 patients and IVT was done in 168 patients. The rate of functional independence (modified Rankin Scale [mRS] 0–1) at 3 months was 39.2% (62/158). The mortality rate at day 7 was 6% (10/168). Hemorrhagic transformation was noted in 16 patients (9.5%). Symptomatic intracranial hemorrhage occurred in 5 (3%), all of which were fatal. One case of severe urinary bleeding and one other fatal case of severe angioedema were observed. Conclusion During the first 4–5 years of administration of IVT in the hospital, it was found to be feasible and safe, but to increase the efficacy, poststroke care should be more organized and a stroke center should be established.
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Affiliation(s)
- Elyar Sadeghi-Hokmabadi
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Mehdi Farhoudi
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Aliakbar Taheraghdam
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Mazyar Hashemilar
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Daryous Savadi-Osguei
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Reza Rikhtegar
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Kaveh Mehrvar
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Ehsan Sharifipour
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Parisa Youhanaee
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Reshad Mirnour
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
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Talebi M, Ghertasi M, Taheraghdam A, Andalib S, Sharifipour E. A comparison of risk factors and severity of ischemic stroke in female and male genders in North-West Iran: A cross-sectional study. Iran J Neurol 2014; 13:215-9. [PMID: 25632333 PMCID: PMC4300796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/26/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Gender difference has been reported in stroke risk factors and disease history. The aim of this study was to compare risk factors and the severity of ischemic stroke based upon modified Rankin Scale (mRS) and hospital mortality between two genders. METHODS In a cross-sectional study, 341 patients (44% males and 56% females with a mean age of 68.94 ± 12.74 years) with ischemic stroke, who were hospitalized in the neurology wards of two referral university hospital of North-West Iran (Imam Reza and Razi Hospitals), from the beginning to the end of 2011 were selected and assessed. Gender difference in terms of demographic findings, vascular risk factors, 7(th) day mRS, and hospital mortality (during admission) were evaluated. RESULTS In 2.6% of cases, mRS was found to be less than 2 (favorable) and in 97.4% of cases; mRS was 2-5 (with disability). No significant difference in ischemic stroke severity based on mRS was observed between two genders. There was a significant difference in the rate of hypertension (females = 72.3%, males = 59.3%, P = 0.010), diabetes (females = 28.8%, males = 18.7%, P = 0.030), smoking (females = 6.3%, males = 35.3%, P < 0.001). No significant difference was seen in other risk factors between two genders. There was no significant difference in the mortality rate, which constituted 8.9% and 4.7% in females and males respectively (P = 0.140). CONCLUSION The evidence from the present study suggests that despite the existence of some difference between risk-factors in two genders, there was no difference in terms of ischemic stroke severity and mortality rate between two genders.
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Affiliation(s)
- Mahnaz Talebi
- Department of Neurology, Neurosciences Research Center (NSRC), School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Ghertasi
- Department of Neurology, Neurosciences Research Center (NSRC), School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aliakbar Taheraghdam
- Department of Neurology, Neurosciences Research Center (NSRC), School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sasan Andalib
- Department of Neurology, Neurosciences Research Center (NSRC), School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Sharifipour
- Department of Neurology, Neurosciences Research Center (NSRC), School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Pashapour A, Mohammadian R, Salehpour F, Sharifipour E, Mansourizade R, Mahdavifard A, Salehi M, Mirzaii F, Sariaslani P, Ardalani GF, Altafi D. Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms. A Non-Controlled Trial with Clinical and Angiographic Follow-up. Neuroradiol J 2014; 27:461-70. [PMID: 25196621 DOI: 10.15274/nrj-2014-10079] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 07/10/2014] [Indexed: 11/12/2022] Open
Abstract
Ocular symptoms are regularly observed in patients with cavernous sinus dural arteriovenous fistulas (cDAVF). We aimed to evaluate the long-term efficacy and safety of endovascular approaches in patients with cDAVF presenting with different ocular symptoms. In a prospective study between June 2008 and March 2013, 46 patients with ocular symptoms due to cDAVF who were not eligible for conservative therapy, met the inclusion criteria and underwent endovascular treatment. They underwent a transarterial approach with histoacryl glue injections or transvenous coil embolization, all in one session. They were followed up for a mean period of 17.3 months (range 7 to 30 months) clinically and using angiography. The mean age of patients was 36.8 years (18-60) and 65% of them were male. All patients showed venous drainage into the superior and inferior orbital veins. Access to the cavernous sinus was transvenous in ten patients, transarterial in 26 patients, and mixed in ten patients. Initial symptoms were improved in 97.8% of patients and did not recur during the study follow-up. The procedural complications included: blurred vision, transient sixth nerve palsy and exacerbation of chemoproptosis in two, one and two patients respectively that completely resolved in initial weeks with no recurrence. No patient worsened or developed new symptoms suggestive of a recurrent fistula during the follow-up period. One patient experienced intracranial dissection of the internal carotid artery and ischemic stroke with an unfinished procedure. The relief of early presentation was durable in long-term follow-up and the cured lesions were stable in angiographic controls. Favorable and durable outcomes could be obtained following endovascular approaches for cDAVF presenting with different ocular symptoms.
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Affiliation(s)
- Ali Pashapour
- Neurology Department, Tabriz University of Medical Sciences; Tabriz, Iran - -
| | - Reza Mohammadian
- Neuroscience Research Center, Tabriz University of Medical Sciences; Tabriz, Iran
| | - Firooz Salehpour
- Neurosurgery Department, Tabriz University of Medical Sciences; Tabriz, Iran
| | - Ehsan Sharifipour
- Neuroscience Research Center, Tabriz University of Medical Sciences; Tabriz, Iran
| | | | - Ali Mahdavifard
- Ophthalmology Department, Tabriz University of Medical Sciences; Tabriz, Iran
| | - Mohamadgharib Salehi
- Radiology Department, Kermanshah University of Medical Sciences; Kermanshah, Iran
| | - Farhad Mirzaii
- Neurosurgery Department, Tabriz University of Medical Sciences; Tabriz, Iran
| | - Payam Sariaslani
- Neurology Department, Kermanshah University of Medical Sciences; Kermanshah, Iran
| | | | - Davar Altafi
- Neurology Department, Ardabil University of Medical Sciences; Ardabil, Iran
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Ayromlou H, Soleimanpour H, Farhoudi M, Taheraghdam A, Sadeghi Hokmabadi E, Rajaei Ghafouri R, Najafi Nashali M, Sharifipour E, Mostafaei S, Altafi D. Eligibility assessment for intravenous thrombolytic therapy in acute ischemic stroke patients; evaluating barriers for implementation. Iran Red Crescent Med J 2014; 16:e11284. [PMID: 25031844 PMCID: PMC4082504 DOI: 10.5812/ircmj.11284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 04/29/2013] [Indexed: 11/16/2022]
Abstract
Background: Intravenous thrombolysis is an approved treatment method for patients with acute ischemic stroke (AIS) and is recommended by multiple guidelines. However, it seems that it is less frequently used in the developing countries compared to the developed countries. Objectives: The purpose of this study was to estimate the percentage of patients with AIS, eligible for intravenous thrombolytic therapy, at the main referral center in Northwest Iran and to determine the main barriers for implementation of this method. Patients and Methods: Over one year, 647 patients who were admitted to the emergency department and met the Cincinnati Stroke Scale were enrolled into the study. The center to which patients were admitted, is a tertiary university hospital that has the required infrastructure for thrombolytic therapy in AIS. Factors recorded were neurological examinations and time between onset of symptoms and hospital arrival, hospital arrival and performance of brain computed tomography (CT) scanning, and hospital arrival to complete the investigations. Patients eligible for intravenous thrombolytic therapy were identified according to the American Heart Association (AHA) guidelines. Results: Mean time interval between hospital arrival and completion of brain CT scanning was 91 minutes (range: 20–378 minutes) and mean time from hospital arrival to completion of investigations was 150 minutes (range: 30–540 minutes). A total of 159 (31.3%) patients arrived at hospital within 3 hours of the onset of symptoms (early enough for intravenous thrombolytic therapy). However, 81.7% (130/159) of these patients missed thrombolytic therapy due to delayed performance of brain CT scanning and laboratory tests and 38.3% (61/159) had contraindications. The remaining 16 patients (10% of those who arrived within 3 hours and 3.1% of all cases) were eligible for thrombolytic therapy. Conclusions: The major barriers for thrombolytic therapy for patients with AIS in this setting were delays in the provision of in-hospital services, like initial patient assessment, CT scans or laboratory studies. These results were in contrast with previous reports.
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Affiliation(s)
- Hormoz Ayromlou
- Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Hassan Soleimanpour
- Department of Emergency, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Mehdi Farhoudi
- Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | | | - Elyar Sadeghi Hokmabadi
- Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding Author: Elyar Sadeghi Hokmabadi, Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-4113340730, Fax: +98-4113340730, E-mail:
| | | | | | - Ehsan Sharifipour
- Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Somayeh Mostafaei
- Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Davar Altafi
- Department of Neurology, Tabriz University of Medical Sciences, Tabriz, IR Iran
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Shaafi S, Sharifipour E, Rahmanifar R, Hejazi S, Andalib S, Nikanfar M, Baradarn B, Mehdizadeh R. Interleukin-6, a reliable prognostic factor for ischemic stroke. Iran J Neurol 2014; 13:70-6. [PMID: 25295149 PMCID: PMC4187333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/28/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Interleukin-6 (IL-6) is one of the inflammatory mediators characterized by elevated levels in ischemic stroke (IS) patients. The present study set out to assess the role of IL-6, as a marker for inflammation, in the severity and prognosis of acute IS. METHODS In a cross-sectional descriptive study, 45 patients with acute IS were selected. Patients with their first day of stroke were included in the study. National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) for stroke severity were evaluated on Days 1, 5, 90, and 365. Serum IL-6 level was measured by enzyme-linked immunosorbent assay (ELISA) on days 1 and 5. RESULTS In the present study, 45 patients with a mean age of 77.6 ± 4.9 including 32 (71%) men and 13 (28.9%) women were studied. Death occurred in 2 (4.4%) patients before discharge from the hospital; the others, be that as it may, followed the study until Day 365 with a mortality rate of 6 (13.3%). A positive significant correlation was found between IL-6, and NIHSS and mRS of the patients from the time of admission to the end of the follow-up period (P < 0.001, r = 0.6). Moreover, there was a significant correlation between IL-6 and infarction size in brain magnetic resonance imaging (MRI) scan (P < 0.001, r = 0.7). CONCLUSION The evidence from the present study suggests that IL-6 contributes to determination of severity of ischemic stroke. In addition, IL-6 concentrations affect clinical outcomes in ischemic stroke.
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Affiliation(s)
- Sheyda Shaafi
- Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Sharifipour
- Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rouhollah Rahmanifar
- Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - SeyedShamseddin Hejazi
- Department of Neurology, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Sasan Andalib
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Nikanfar
- Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behzad Baradarn
- Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Robab Mehdizadeh
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Ayromlou H, Soleimanpour H, Farhoudi M, Sadeghi-Hokmabadi E, Rajaei Ghafouri R, Sharifipour E, Mostafaei S, Najafi Nashali M. What are the most important barriers for thrombolytic therapy in ischemic stroke patients? Int J Stroke 2014; 8:E7. [PMID: 23692492 DOI: 10.1111/ijs.12093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Taheraghdam AA, Sharifipour E, Pashapour A, Namdar S, Hatami A, Houshmandzad S, Sadeghihokmabadi E, Tazik M, Rikhtegar R, Mahmoodpoor A. Allopurinol as a preventive contrivance after acute ischemic stroke in patients with a high level of serum uric acid: a randomized, controlled trial. Med Princ Pract 2014; 23:134-9. [PMID: 24296871 PMCID: PMC5586842 DOI: 10.1159/000355621] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 09/16/2013] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To assess the clinical relevance (functional outcome) of a 3-month allopurinol regimen in patients with high serum uric acid (SUA) levels and acute ischemic stroke without considering the changes in SUA levels. MATERIALS AND METHODS In a randomized, double-blind, controlled study, 70 patients (45 females, 25 males) with acute ischemic stroke who had elevated levels of SUA were included. They were divided in two 35-patient groups to investigate the effect of 3 months of an allopurinol (200 mg/day) regimen versus placebo on their functional outcome, which was evaluated using a modified Rankin scale. RESULTS The overall mean age was 68.9 ± 11.33 years (range 27-89). The final favorable functional status (mRS = 0-2) was 23 (65.7%) and 14 (40.0%) in the treated and placebo groups, respectively, which was strongly associated with allopurinol consumption (OR = 4.646, p = 0.014) and age ≤70 years (OR = 0.139, p = 0.005) in patients with ischemic stroke after adjusting for confounders. There was no significant difference in death between allopurinol-treated cases (3; 8.6%) and placebo-treated ones (6; 17.2%; p = 0.278). CONCLUSION Allopurinol treatment was well tolerated and improved the 3-month functional status of patients with acute ischemic stroke who had high levels of SUA without considering the decreasing effect of allopurinol on SUA.
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Affiliation(s)
- Ali Akbar Taheraghdam
- Department of Neurology, Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Sharifipour
- Department of Neurology, Neurosciences Research Center (NSRC), Student Research Committee, Tabriz University of Medical Sciences, Imam Reza Hospital, Tabriz, Iran
- *Ehsan Sharifipour, Neurosciences Research Center (NSRC), Student Research Committee, Tabriz University of Medical Sciences, Imam Reza University Hospital, Gholghasht Street, Tabriz 5166614756 (Iran), E-Mail
| | - Ali Pashapour
- Department of Neurology, Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Abolfazl Hatami
- Department of Neurology, Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samaneh Houshmandzad
- Department of Neurology, Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Reza Rikhtegar
- Department of Neurology, Neurosciences Research Center (NSRC), Student Research Committee, Tabriz University of Medical Sciences, Imam Reza Hospital, Tabriz, Iran
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Pashapour A, Atalu A, Farhoudi M, Taheraghdam AA, Sadeghi Hokmabadi E, Sharifipour E, Najafineshli M. Early and intermediate prognosis of intravenous thrombolytic therapy in acute ischemic stroke subtypes according to the causative classification of stroke system. Pak J Med Sci 2013; 29:181-6. [PMID: 24353536 PMCID: PMC3809211 DOI: 10.12669/pjms.291.2897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 11/21/2012] [Accepted: 11/29/2012] [Indexed: 11/17/2022] Open
Abstract
Objectives: Intravenous thrombolytic therapy has established acceptable results in treating ischemic stroke. However, there is little information on treatment outcome especially in different subtypes. The aim of current study was to evaluate early and intermediate prognosis in intravenous thrombolytic therapy for acute ischemic stroke subtypes. Methodology: Forty eligible patients (57.5% male with mean age of 63.18±13.49 years) with definite ischemic stroke who were admitted to emergency department of Imam Reza University Hospital, in the first 180 minutes after occurrence received recombinant tissue plasminogen activator. All investigation findings were recorded and stroke subtypes were determined according to the Causative Classification of Stroke System. Stroke severity forms including modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores were recorded for all patients in first, seven and 90 days after stroke and disease outcome was evaluated. Results: The etiology of stroke was large artery atherosclerosis in 20%, cardio-aortic embolism in 45%, small artery occlusion in 17.5% and undetermined causes in 17.5%. NIHSS and mRS scores were significantly improved during time (P < 0.001 in both cases). Three months mortality rate was 25%. Among the etiologies, patients with small artery occlusion and then cardio-aortic embolism had lower NIHSS score at arrival (P = 0.04). Caplan-meier analysis showed that age, sex and symptom to needle time could predict disease outcome. Conclusion: Intravenous thrombolytic therapy is accompanied by good early and intermediate outcome in most patients with ischemic stroke. Small artery occlusion subtype had less disease severity and higher improvement.
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Affiliation(s)
- Ali Pashapour
- Ali Pashapour, Associate Professor, Departments of Neurology, Imam Reza Teaching Hospital, School of Medicine,Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abolfazl Atalu
- Abolfazl Atalu, Resident of Neurology, Neurosciences Research Center, Imam Reza Teaching Hospital, School of Medicine,Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Farhoudi
- Mehdi Farhoudi, Associate Professor, Neuroscience Research Center, Imam Reza Teaching Hospital, School of Medicine,Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali-Akbar Taheraghdam
- Ali-Akbar Taheraghdam, Assistant Professor, Departments of Neurology, Resident of Neurology, Neurosciences Research Center, Imam Reza Teaching Hospital, School of Medicine,Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elyar Sadeghi Hokmabadi
- Elyar Sadeghi Hokmabadi, Imam Reza Teaching Hospital, School of Medicine,Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Sharifipour
- Ehsan Sharifipour, Imam Reza Teaching Hospital, School of Medicine,Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Najafineshli
- Mehdi NajafiNeshli, Resident of Neurology, Neurosciences Research Center, Imam Reza Teaching Hospital, School of Medicine,Tabriz University of Medical Sciences, Tabriz, Iran
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Mohammadian R, Sharifipour E, Mansourizadeh R, Sohrabi B, Nayebi AR, Haririan S, Farhoudi M, Charsouei S, Najmi S. Angioplasty and stenting of symptomatic vertebral artery stenosis. Clinical and angiographic follow-up of 206 cases from Northwest Iran. Neuroradiol J 2013; 26:454-63. [PMID: 24007733 DOI: 10.1177/197140091302600410] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 08/18/2013] [Indexed: 01/29/2023] Open
Abstract
Percutaneous transluminal angioplasty (PTA) has recently become a noteworthy treatment option for significant stenosis involving the vertebral artery (VA) in selected patients. We conducted a prospective study to evaluate the efficacy, safety and mid-term follow up results of 206 cases received PTA with or without stent implant to treat their symptomatic atherosclerotic VA stenosis in all segments (V1-V4). In a prospective mono-arm trial from October 2008 to July 2012 in a single center, 239 lesions affecting the intra or extracranial VA (171 in V1, 17 in V2, 14 in V3, 21 in V4 and 16 in combined segments) were treated by PTA with or without stent implant. Non-disabling stroke patients who had failed conservative medical treatment and had angiographic evidence of >50% stenosis in the dominant VA with clinical signs and symptoms of VB stenosis were included in this study. They were mean followed for 13.15±5.24 months after treatment. Overall, 206 patients underwent the procedure. A stent was implemented in 199 patients (96.6%). The periprocedural complication rate was 7.2%. The procedural (technical) success rate was 97.6%. Of the total 239 lesions, 223 were treated with stent implant. Clinical success was achieved in all 206 symptomatic patients after the procedure. Restenosis occurred in 15.9% after a mean 10.8 (6-24) months. Of those, 63.1% and 34.2% had mild and moderate stenosis that was treated medically, whereas one case (2.6%) with severe restenosis underwent balloon angioplasty. No deaths occurred during the follow-up period. The follow-up complication rate was 6.3%. TIA occurred in 4.4%, a minor stroke in 1.4% and a major stroke in one patient. The overall patient event-free survival was 92.4%. These results demonstrate the safety and feasibility of PTA with or without stent implant, with a high technical success rate, a low complication rate, a low restenosis rate and durable clinical success in patients with symptomatic VA stenosis. This approach seems to improve patients' immediate and mid-term clinical results. Randomized controlled trials are necessary to further validate this treatment option.
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Affiliation(s)
- R Mohammadian
- Neuroscience Research Center, Tabriz University of Medical Sciences; Tabriz, Iran - ,
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Oskouei DS, Rikhtegar R, Hashemilar M, Sadeghi-Bazargani H, Sharifi-Bonab M, Sadeghi-Hokmabadi E, Zarrintan S, Sharifipour E. The effect of Ginkgo biloba on functional outcome of patients with acute ischemic stroke: a double-blind, placebo-controlled, randomized clinical trial. J Stroke Cerebrovasc Dis 2013; 22:e557-63. [PMID: 23871729 DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 05/30/2013] [Accepted: 06/08/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute ischemic stroke is a major cerebrovascular disease with potential morbidity and mortality. Despite the availability of thrombolytic therapy in some centers, risk factor modification and rehabilitation therapy are the mainstays of stroke management. There is supporting evidence that Ginkgo biloba may afford neuroprotection and improve the outcomes of patients with acute ischemic stroke. METHODS In a double-blind, placebo-controlled, randomized controlled trial, we assessed the efficacy of G biloba on functional outcome in patients with acute stroke. The National Institutes of Heath Stroke Scale (NIHSS) was used to measure functional outcome. A total of 102 patients with acute ischemic stroke were studied. All patients received either G biloba or placebo tablets for 4 months. This trial was registered to the Iranian Registry of Clinical Trials (www.irct.ir; trial IRCT138804212150N1). RESULTS There were 52 patients who received G biloba and 50 patients who were in the placebo group. Age, sex distribution, previous medical condition, and laboratory data did not have any significant difference between the 2 groups (P>.05). The mean difference of 4-month follow-up NIHSS scores and NIHSS scores at admission was 4.7±2.7 and 4.1±3.0 in the G biloba and placebo groups, respectively (P>.05). The primary outcome-a 50% reduction in the 4-month follow-up NIHSS score compared to the baseline NIHSS score-was reached in 17 patients (58.6%) and 5 patients (18.5%) in the G biloba and placebo groups, respectively (P<.05). The risk ratio and number needed to treat were 3.16 (confidence interval 1.35-7.39) and 2.50 (confidence interval 1.58-5.90), respectively. In addition, multivariate regression adjusted for age and sex revealed a significant NIHSS decline in the G biloba group compared to the placebo group (P<.05). CONCLUSIONS Our data suggest that G biloba may have protective effects in ischemic stroke. Therefore, the administration of G biloba is recommended after acute ischemic stroke.
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Affiliation(s)
- Darioush Savadi Oskouei
- Department of Neurology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran; Neurosciences Research Centre, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Farhoudi M, Najafi-Nesheli M, Hashemilar M, Mahmoodpoor A, Sharifipour E, Baradaran B, Taheraghdam A, Savadi-Oskouei D, Sadeghi-Bazargani H, Sadeghi-Hokmabadi E, Akbari H, Rikhtegar R. Effect of IMOD™ on the inflammatory process after acute ischemic stroke: a randomized clinical trial. ACTA ACUST UNITED AC 2013; 21:26. [PMID: 23514014 PMCID: PMC3620936 DOI: 10.1186/2008-2231-21-26] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 03/10/2013] [Indexed: 12/13/2022]
Abstract
Background and purpose of the study Considering the role of inflammation in acute cerebrovascular accidents, anti-inflammatory treatment has been considered as an option in cerebrovascular diseases. Regarding the properties of Setarud (IMOD™) in immune regulation, the aim of the present study was to evaluate the role of this medication in treating patients with acute ischemic stroke. Methods In this randomized clinical trial, 99 patients with their first ever acute ischemic stroke were divided into two groups of IMOD™ (n = 49) and control (n = 50). The control group underwent routine treatment and the intervention group underwent routine treatment plus daily intermittent infusion of IMOD™ (250mg on the first day and then 375mg into DW5% serum during a 30-minute period for 7 days). The serum levels of inflammatory markers were evaluated on the first day (baseline) and on 4th and 7th days. Data were analyzed and the results were compared. Results and major conclusion 58 males (58.6%) and 41 females (41.4%) with a mean age of 67.00 ± 8.82 years, who had their first ever stroke attack, were enrolled in this trial. Treatment with IMOD™ showed a decreasing trend in IL-6 levels compared to the control group (p = 0.04). In addition, the treatment resulted in the control of increasing serum levels of hsCRP after 7 days compared to the control group (p = 0.02). There was an insignificant decrease in TNF-α and IL-1 levels in the IMOD™ group. Considering the prominent role of inflammation after an ischemic cerebral damage, it appears that treatment with IMOD™ improves the inflammatory profile. Therefore, IMOD™ (Setarud) might be considered as a therapeutic option in the acute ischemic stroke. However, future studies are necessary on its long-term results and clinical efficacy.
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Affiliation(s)
- Mehdi Farhoudi
- Neuroscience Research Center (NSRC), Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
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Talebi M, Nikanfar M, Sorkhabi R, Sharifipour E, Bahrebar M, Kiavar A, Andalib S, Khanli HM. Optic coherence tomography findings in relapsing-remitting multiple sclerosis patients of the northwest of Iran. Iran J Neurol 2013; 12:81-6. [PMID: 24250910 PMCID: PMC3829296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/12/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) is a simple, high-resolution technique to quantify the thickness of retinal nerve fiber layer (RNFL) and macula volume, which provide an indirect measurement of axonal damage in multiple sclerosis (MS). This study aimed to evaluate OCT finding in relapsing-remitting MS patients of the northwest of Iran and compare them with a normal control group. METHODS In a cross-sectional, descriptive, analytic study, 60 patients with MS as case group and 60 patients as controls were studied. Total macular volume (TMV) and retinal nerve fiber layer (RNFL) in perioptic disk area (3.4 millimeter around the disk) and macula was measured using Stratus 3000 in circular form. These findings were compared between the two groups and their relationship with the duration and severity of MS [based on Expanded Disability Status Scale (EDSS)] and history of optic neuritis were evaluated. RESULTS In total, 35 men and 85 women with a mean age of 34.8 years were evaluated. The mean RNFL in MS patients were 231.9 and 233.1 micrometers in right and left eyes; while they were 246.7 and 250.4 micrometers in right and left eyes of healthy subjects, respectively. This difference in thickness of RNFL in total measure and all quadrants around the optic disk and TMV between case and control groups was analytically meaningful (P = 0.001 and P = 0.001 for right and left eyes, respectively). The mean thickness of RNFL in patients with optic neuritis was significantly lower than other patients in right and left eyes (P = 0.042 and P = 0.005). There was a significant correlation between most of OCT findings and the MS disease duration and EDSS. CONCLUSION Findings of the present study in the northwest of Iran buttress the idea that RNFL thickness can be greatly affected by MS. Our results also indicate that this effect is associated with ON and MS duration and severity.
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Affiliation(s)
- Mahnaz Talebi
- Associate Professor, Department of Neurology AND Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Nikanfar
- Associate Professor, Department of Neurology AND Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rana Sorkhabi
- Associate Professor, Department of Ophthalmology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Sharifipour
- Resident, Department of Neurology AND Neurosciences Research Center (NSRC), Student Research Committee, Tabriz University of Medical Sciences, Imam Reza Hospital, Tabriz, Iran
| | - Mansour Bahrebar
- Resident, Department of Neurology AND Neurosciences Research Center (NSRC), Student Research Committee, Tabriz University of Medical Sciences, Imam Reza Hospital, Tabriz, Iran
| | - Ali Kiavar
- Resident, Department of Ophthalmology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sasan Andalib
- PhD Student, Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
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Mohammadian R, Pashapour A, Sharifipour E, Mansourizadeh R, Mohammadian F, Taher Aghdam AA, Mousavi M, Dadras F. A Comparison of Stent Implant versus Medical Treatment for Severe Symptomatic Intracranial Stenosis: A Controlled Clinical Trial. Cerebrovasc Dis Extra 2012; 2:108-20. [PMID: 23599702 PMCID: PMC3567882 DOI: 10.1159/000344004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Atherosclerotic stenosis of the major intracranial arteries is the most common cause of ischemic stroke. There are limited treatments for severe intracranial stenosis, and stent placement versus medical treatment remains controversial. The aim of this study was to compare functional outcomes of these two modalities in patients with severe symptomatic intracranial stenosis. Methods At a single center, between 2008 and 2011, patients with angiographically demonstrated severe (70–90%) symptomatic intracranial atherosclerosis were divided into two groups: group A, which received only medical treatment, and group B, which underwent endovascular stent implant treatment. The severity and location of the stenosis was determined by digital subtraction angiography and the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial criteria in all patients. The exclusion criteria were: specific causes other than atherosclerosis, such as artery dissection, fibromuscular dysplasia, vasculitis, radiation and intracranial hemorrhage, focal neurological deficit that did not correlate to internal carotid artery or middle cerebral artery stenosis. All procedures were done under light anesthesia. Technical success was defined as the reduction of stenosis to <30% with complete enveloping of the lesion after the procedure. Early and late adverse events and functional outcomes were compared between the groups using the modified Rankin Scale (mRS). Results Overall, 63 patients (29 in group A and 34 in group B) were evaluated and followed for a mean period of 15.22 months (range 6–25). The technical success rate was 97% in a total of 34 stents in 34 patients. There was no difference between the early (within 30 days) adverse event rates of the two groups. The median follow-up duration for the stent implant patients was 15 months (range 6–25), and for the medically treated cohort it was 14 months (range 8–25). The re-stenosis rate was 5.8% and the total number of late (>30 days) adverse events, including stroke, myocardial infarction and death, was 1 (2.9%) and 6 (20.7%) in the stent implant and medical groups, respectively (p = 0.042). The stent implant group had significantly better favorable functional outcomes according to the mRS than the medical group (93.9 vs. 63.0%). The cumulative secondary adverse event-free survival was significantly lower in the stent implant group. Conclusion Stent implants can be considered more durable and safe for patients with symptomatic severe stenosis of the internal carotid artery or middle cerebral artery, despite optimal medical therapy. Randomized, multicenter trials are required to confirm these results.
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Affiliation(s)
- Rezao Mohammadian
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Ayromlou H, Tarzamni MK, Daghighi MH, Pezeshki MZ, Yazdchi M, Sadeghi-Hokmabadi E, Sharifipour E, Ghabili K. Diagnostic value of ultrasonography and magnetic resonance imaging in ulnar neuropathy at the elbow. ISRN Neurol 2012; 2012:491892. [PMID: 22888452 PMCID: PMC3409534 DOI: 10.5402/2012/491892] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/30/2012] [Indexed: 11/23/2022]
Abstract
Aim. To evaluate the diagnostic value of ultrasonography and magnetic resonance imaging (MRI) in patients with ulnar neuropathy at the elbow (UNE). Methods. We prospectively performed electrodiagnostic, ultrasonographic, and MRI studies in UNE patients and healthy controls. Three cross-sectional area (CSA) measurements of the ulnar nerve at multiple levels along the arm and maximum CSA(-max) were recorded. Results. The ulnar nerve CSA measurements were different between the UNE severity grades (P < 0.05). CSA-max had the greatest sensitivity (93%) and specificity (68%). Moreover, CSA-max ≥10 mm2 defined the severe UNE cases (sensitivity/specificity: 82%/72%). In MRI, ulnar nerve hyperintensity had the greatest sensitivity (90%) and specificity (80%). Conclusion. Ultrasonography using CSA-max is sensitive and specific in UNE diagnosis and discriminating the severe UNE cases. Furthermore, MRI particularly targeting at increased signal of the ulnar nerve can be a useful diagnostic test of UNE.
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Affiliation(s)
- Hormoz Ayromlou
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz 51666-14756, Iran
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