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Sabayan B, Moghadami M, Assarzadegan F, Komachali SHA, Poorsaadat L, Babaeepour Z, Ebrahimzadeh SA, Hamidi A, Hasheminejad ZS, Mohammadi-Vosough E, Mirkarimi HR, Paybast S, Rahimian N, Safari A, Sepehrnia M, Nematollahi R, Shahripour RB, Batra A, Sorond F, Borhani-Haghighi A. COVID-19 Respiratory Illness and Subsequent Cerebrovascular Events, the Initial Iranian Experience. J Stroke Cerebrovasc Dis 2020; 30:105454. [PMID: 33212340 PMCID: PMC7647448 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/01/2020] [Revised: 10/21/2020] [Accepted: 10/31/2020] [Indexed: 12/15/2022] Open
Abstract
The majority of patients with stroke and COVID-19 had vascular risk factors. Stroke and COVID-19 might be associated with severe disability and death. There might be major disruptions in investiagtions needed for stroke.
Objectives COVID-19 disproportionately affects older adults and individuals with cardiovascular co-morbidities. This report presents fifteen patients who had COVID-19 respiratory illness followed by cerebrovascular events. Materials and Methods A call by the Iranian Neurological Association gathered cases across the country who developed neurological symptoms attributed to hemorrhagic or ischemic stroke after a definite or probable Covid-19 respiratory illness. Definite cases were those with a typical respiratory illness, positive nasopharyngeal Covid-19 PCR test, and chest CT consistent with Covid-19 infection. Probable cases were defined by a typical respiratory illness, history of contacts with a Covid-19 case, and chest CT characteristic for Covid-19 infection. Results Fifteen patients (12 men and 3 women) with an age range of 38 to 93 years old (median: 65 years old) were included. Fourteen patients had a first-ever acute ischemic stroke and one patient had a subarachnoid hemorrhage. Eleven patients (73%) had previous cardiovascular comorbidities. The median time between respiratory symptoms and neurological symptoms was seven days (range 1-16 days). Stroke severity in two patients was mild (NIHSS ≤ 6), in six patients moderate (NIHSS: 7-12), and in seven patients severe (NIHSS ≥13). One patient received intravenous tissue plasminogen activator ( IV-tPA) with improved neurological symptoms. Six out of 15 patients (40%) died. All but one of those who survived had significant disability assessed by a modified ranking scale >2. The majority of patients in this case series had vascular risk factors and their stroke was associated with severe disability and death. Conclusion This report highlights the need for further investigation of the links between Covid-19 and cerebrovascular events.
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Affiliation(s)
- Behnam Sabayan
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mohsen Moghadami
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Assarzadegan
- Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran
| | | | - Leila Poorsaadat
- Department of Neurology, Arak University of Medical Sciences, Arak, Iran
| | | | | | - Ava Hamidi
- Department of Neurology, Modarres Hospital, Kashmar, Iran
| | | | | | | | - Sepideh Paybast
- Department of Neurology, Bou Ali hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Anahid Safari
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mersedeh Sepehrnia
- Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran
| | - Reza Nematollahi
- Medical imaging research center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ayush Batra
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Farzaneh Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Baradaran Rahimi V, Rajabian A, Rajabi H, Mohammadi Vosough E, Mirkarimi HR, Hasanpour M, Iranshahi M, Rakhshandeh H, Askari VR. The effects of hydro-ethanolic extract of Capparis spinosa (C. spinosa) on lipopolysaccharide (LPS)-induced inflammation and cognitive impairment: Evidence from in vivo and in vitro studies. J Ethnopharmacol 2020; 256:112706. [PMID: 32109547 DOI: 10.1016/j.jep.2020.112706] [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] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Capparis spinose (C. spinosa) belonging to Capparaeae, originates from dry areas in the west or central Asia and Mediterranean basin. For thousands of years, C. spinosa has been reported to be used as a therapeutic traditional medicine to relieve various ailments including rheumatism, pain and inflammatory diseases. AIM OF THE STUDY There are several studies mentioning that systemic inflammation results in learning and memory impairments through the activation of microglia. The objective of this study was to investigate the effect of C. spinosa on both in vivo and in vitro models of neuroinflammation and cognitive impairment using lipopolysaccharide (LPS). MATERIALS AND METHODS In vivo: 40 male rats were used in the present study. Cognitive impairment was induced using LPS (1 mg/kg/d; i.p.) for 4 weeks. Treatment with C. spinosa (100 and 300 mg/kg/d; p.o.) was performed 1 h before LPS administration. At the end of the experiment, rats were undergone for behavioral and biochemical analysis. In vitro: Primary microglia isolated from mouse was used in the present study. The cells were pretreated with C. spinosa extract (10-300 μg/ml) and then stimulated with LPS (1 μg/ml). The expression levels of inflammatory and anti-inflammatory cytokines were elucidated using Real-Time PCR and ELISA methods. RESULTS The escape latency in the Morris water maze test in the LPS group was significantly greater than the control group (p < 0.001), while, in extract-treated groups, it was less than the LPS group (p < 0.001). Additionally, we found that the levels of IL-1β, TNF-α, and iNOS/Arg-1 ratio was also significantly lower in extract-treated groups than the LPS group (p < 0.001). The results revealed that C. spinosa extract significantly reduced the levels of TNF-α, iNOS, COX-2, IL-1β, IL-6, NO and PGE2, and the ratios of iNOS/Arg-1 and NO/urea, following the LPS-induced inflammation in microglia (p < 0.001). CONCLUSIONS Our finding provides evidence that C. spinosa has a neuroprotective effect, and might be considered as an effective therapeutic agent for the treatment of neurodegenerative diseases that are accompanied by microglial activation, such as AD.
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Affiliation(s)
- Vafa Baradaran Rahimi
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Arezoo Rajabian
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Hamed Rajabi
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Elahe Mohammadi Vosough
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Neurology, Kashan University of Medical Sciences, Kashan, Iran.
| | - Hamid Reza Mirkarimi
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Neurology, Kashan University of Medical Sciences, Kashan, Iran.
| | - Maede Hasanpour
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mehrdad Iranshahi
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Hassan Rakhshandeh
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Vahid Reza Askari
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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