Serum Iron and Free Hemoglobin Concentrations in Patients with Acute Ischemia Stroke

A number of evidences suggest that during ischemic stroke, serum iron and hemoglobin (Hb) levels are changed. Yet, there are few reports in the literature related to this issue and resolution of this mechanism requires further experiments. The aim of the present study was to investigate the potential role of serum iron and hemoglobin levels as a  biomarker in diagnosis of acute ischemic stroke.  The sample size was  60 ischemic  stroke patients who were admitted to the Rouhhani hospital in Babol, with 60 healthy volunteers selected as control group. Clinical evaluation consisted of complete medical history and physical examination and neuro-imaging's  studies. Sampling strategy was  based on clinical characteristics, including age, gender, and history of diseases. Laboratory measurements were performed in the department of clinical biochemistry. Serum iron and plasma hemoglobin levels were measured by standard kit of iron and hemoglobin ELISA Kit, as of the manufactures' manual. Data were analyzed through statistical software SPSS version 22. The mean level of serum iron and hemoglobin in patients with acute ischemic stroke were higher than those in control group (P<0.05). However, there was no relation between these biomarkers and age and gender of subjects (P>0.05). Our results reinforce the possibility of serum iron and hemoglobin as biomarker in diagnosis of ischemic stroke patients

Examining the frequency of dysphagia and the predictive factors of dysphagia that require attention in patients with Parkinson's disease

Introduction. Due to the prevalence of dysphagia in patients with Parkinson's disease (PD) and its complications such as aspiration pneumonia, which is the main cause of death in these patients, PD-related disability can be prevented by early diagnosis and treatment of dysphagia. Objective. The present study was aimed at investigating the frequency of dysphagia in PD patients. Materials and methods. This cross-sectional study included 150 PD patients visiting a Neurology Clinic. The severity of PD was determined based on the Unified Parkinson Disease Rating Scale (UPDRS) and modified Hoen and Yahr (HYS) Scale. The Munich Dysphagia Test-Parkinson's disease (MDT-PD) questionnaire was used to assess dysphagia. Comparisons were made using generalized Fisher exact, Chi-square, ANOVA, and KruskalWallis tests. Predictive factors were analyzed using logistic regression. Statistical analyses were performed at significance level of 0.05. Results. Out of all 150 patients referred to the Clinic, the prevalence of dysphagia requiring attention was 25.3% (n = 38). The patients of the three groups according to the MDT-PD (no noticeable dysphagia, noticeable oropharyngeal, and dysphagia with aspiration risk) had a significant difference only in terms of the PD duration (p 0.001). In the predicting of dysphagia, the longer PD duration (p = 0.011) and homemaker occupation (p = 0.033) were protective factors, while female gender was a risk factor (p = 0.011). Conclusion. The prevalence of dysphagia requiring attention in the studied patients was 25.3%. It decreased with the longer duration of the disease, and its prevalence was lower in homemaker patients, while the odds of dysphagia was 5.8 times higher in women than in men

Prevalence of headache at the initial stage of stroke and its relation with site of vascular involvement. a clinical study

Background: Stroke is the most common neurologic disease and an important cause of morbidity and mortality. Headache is an initial presenting feature of ischemic stroke and sometimes preceedes the development of stroke and thus, provides an opportunity for offering preventive measures. The aim of the present study was to determine the association of new onset headache with stroke. Methods: A total of 263 consecutive patients with stroke entered the study. Development of headache 24 have prior to admission lasting <3 days was considered the new onset headache. The intensity of headache was graded as mild, moderate and severe. Stroke was classified with respect to the localization of brain damage using magnetic resonance image (MRI). Chi-square test was applied for comparison of proportions.  Results: One hundred thirty-nine males and one hundred twenty-four females with mean age of 76.4±10 (40-89) years were analyzed. Ischemic stroke involving anterior circulation was diagnosed in 210 (79%) patients and vertebrobasilar ischemia in the remaining population. Diabetes, hypertension, hyperlipidemia and coronary artery disease were observed in 36%, 52%, 38% and 42%, respectively. New onset headache was found in 49 (18.9%) patients in who 81.6% was mentioned as new onset. Six out of 9 patients with severe headache had involvement of posterior circulation, whereas in the remaining population, anterior circulation was involved. Conclusion: The findings of this study indicate no association of new onset headache with stroke. There was only a trend for severe headache toward the involvement of vertebrobasilar ischemia

Evaluation of Serum Magnesium, Iron, Copper and Zinc Levels in Ischemic and Hemorrhagic Stroke Patients and Healthy Controls

Introduction: Many studies have shown a relationship between serum level of trace elements and risk of stroke, but the exact mechanism of this relationship is not clear. The purpose of this study was to measure changes of serum magnesium, iron, copper, and zinc levels in ischemic and hemorrhagic stroke patients to evaluate their potential diagnostic utility.Materials and methods: Overall, 53 healthy individuals (30 men, 32 women) and 53 ischemic and hemorrhagic stroke patients (30 men, 23 women) who were admitted to the Rouhani Hospital in Babol (Iran) were enrolled in the study within 24 hours after stroke onset. Diagnosis was made based on medical history and physical examination by a neurologist. After blood sampling, serum copper was assessed by atomic absorption spectrophotometry, and zinc, magnesium and iron levels were assessed by spectrophotometry. Data analysis was performed in SPSS (version 21) using independent sample t-test and chi-square test. Results: Serum concentrations of copper was significantly higher in the patients (58.8 ±14.7 mg/dL) compared with the controls (45.7 ±10.0 mg/dL). Serum concentrations of zinc was significantly higher in the patients (113.2 ±17.3 mg/dL) compared with the controls (95.60 ±12.80 mg/dl). Moreover, serum concentrations of iron was significantly higher in the patients (148.5 ±30.4 mg/dL) compared with the controls (74.22 ±33.3 mg/dL). However, the patients (1.4 ±0.8 mEq/L) had significantly lower level of magnesium level compared to the controls (2.1 ±0.3 mEq/L). Conclusions: Our results suggest that evaluation of serum magnesium, iron, copper and zinc levels in ischemic and hemorrhagic stroke patients may be useful for the prediction and diagnosis of stroke status

Original Article Seyed-Reza Hossini (MD) 2* Associated factors of headache in an unstudied cohort of elderly subjects

Abstract Background: Headache and depression are prevalent among general population. The aim of this study was to determine the associated factors of headache in elderly subjects with emphasis to depression. Methods: All cohort of elderly individuals of the Amirkola Health Study Project were included. Data regarding several clinical and demographic characteristics were provided via fill in quesstionnaire, interview and clinical examination. Presence and duration as well as severity of headache were collected through an interview based on self-reported data. Diagnosis of depression was confirmed according to standard Geriatric Depression Scale (GDS) criteria. In statistical analyses chi-square test with logistic regression analysis was used for association. Results: A total of 832 men and 667 women aged &gt;/= 60 years old were studied. Headache and depression were diagnosed in 42% and 42.4% respectively. In depressed subjects, headache was significantly higher by OR=3.1(95% CI, 2.5-3.83, P=0.001). Proportions of headache increased by severity of depression with a dose-response pattern of relationship from 53.3% in mild depression to 72.6% in severe depression. The magnitude of OR for headache increased from 2.59 (95% CI, 2.03-3.31) in patients with mild depression to 6.04 (95% CI, 3.54-10.3) in patients with severe depression. After adjustment for all covariates, headache was significantly associated with female gender and back pain as well as with depression with a significant dose-response relationship. Conclusion: The findings of this study indicated an independent association between headache and psychological factors in elderly subjects, particularly in women

Analgesic Effect of Duloxetine Compared to Nortryptiline in Patients with painful Neuropathy: A Randomized, Double-Blind, Placebo-Controlled Trial

Background:&#160; Diabetic neuropathic pain (DNP) is a common complication of diabetes and has a profound effect on patients quality of life. Therefore. The purpose of the present study was to compare the analgesic effects of duloxetine and nortryptiline in the management of patients with diabetic neuropathy. Methods: This was a randomized, double-blind, parallel-group, placebo-controlled trial in subjects with a proven diagnosis of DM and suffered from neuropathic pain. Patients were recruited in this study from 20 February 2016 (first patient, first visit) to 22 June 2017 (last patient, last visit), including 5 weeks follow-up. A diagnosis of DNP was based on history, clinical examination, Nerve conduction velocity and Diabetic neuropathy symptom score (more than one point). Results: Both drugs reduced pain when compared with placebo. A significant VAS reduction from 6.4 at baseline to 3.75 at endpoint was observed in the duloxetine group. However, there was no significant difference in the efficacy between nortriptyline and duloxetine based on patientchr('39')s visual analogue scale (VAS) (p&#62;0.05). No clinically significant changes or serious adverse events were found among treatment groups including changes in vital signs, laboratory assessments, physical examination or electrocardiograms. The decrease in the mean pain intensity was significantly greater in the duloxetine and nortriptyline group compared to the placebo group both in the primary analysis and in the by-visit analysis (p&#60;0.003) Conclusions: The present study demonstrates the safety and effectiveness of both duloxetine and nortriptyline in the management of DNP

Serum Homocysteine Level in Parkinson’s Disease and Its Association with Duration, Cardinal Manifestation, and Severity of Disease

Background and Purpose. Due to the high prevalence of Parkinson’s disease (PD) in the elderly, a large financial burden is imposed on the families and health systems of countries in addition to the problems related to the mobility impairment caused by the disease for the patients. Studies on controversial issues in this disease are taken into consideration, and one of these cases is the role of serum homocysteine level in Parkinson’s patients. In this study, the serum level of homocysteine and its association with various variables in relation to this disease was compared with healthy individuals. Materials and Methods. In this study, 100 patients with PD and 100 healthy individuals as control group were investigated. Serum homocysteine level and demographic and clinical data were included in the checklist. Data were analyzed by SPSS version 23. In all tests, the significance level was below 0.05. Results. The mean level of serum homocysteine in case and control groups was 14.93 ± 8.30 and 11.52 ± 2.86 µmol/L, respectively (95% CI: 1.68; 5.14, P<0.001). In total patients, 85 had normal serum homocysteine level, while 15 had high serum homocysteine level. In controls, the homocysteine level was 98 and 2, respectively (P=0.002). In multivariate logistic regression analysis, serum homocysteine level higher than 20 µmol/L was accompanied by 8.64-fold in Parkinson’s disease involvement (95% CI: 1.92; 38.90, P=0.005). Conclusion. Increasing serum homocysteine level elevates the rate to having PD. Serum homocysteine levels did not have any relationship with the duration of the disease, type of cardinal manifestation, and the severity of Parkinson’s disease

Etiology of syncope in hospitalized patients

Background: Syncope is a common clinical problem which can be remarkably debilitating and associated with high health care costs. Syncope is a clinical syndrome with many potential causes. The aim of the study was to determine the etiologies of patients with syncope in the emergency department (ED) of a referral and general university hospital.  Methods: One hundred sixty-five consecutive patients aged more than 18 years old with syncope were admitted to the emergency department of Ayatollah Rouhani Hospital. Initially organized, systematic approach included detailed medical history and structured questionnaires for history taking, physical examination, ECG and cardiac monitoring, cardiology and neurology were done. Advanced diagnostic tests were carried out if the etiology of syncope remained unexplained.  Results: Out of the 165 patients who presented to the ED between February 2012 and February 2013, 124 had definition of syncope. The mean age of male patients was 59.5±19.8, 58. The etiology of syncope was diagnosed in 104 (83%) patients. Neurocardiogenic syncope was found in 36 (29.03%) patients, cardiac arrhythmias in 40 (32.25%) patients, and acute coronary syndrome in 8 (6.45%) patients. There are some infrequent etiologies like intracranial hemorrhage in 5 patients, aortic stenosis in 4 patients, hypertrophic cardiomyopathy and aortic dissection in 3 patients, Brugada and pulmonary embolism in 2 patients and carotid hypersensitivity in one patient.  Conclusion: We found that cardiac arrhythmias and neurocardiogenic type are the frequent causes of syncope. In about one-sixth of the patients, no etiology was found. Approximately one-third of patients had traumatic syncope