The characterization of oxaliplatin-induced peripheral neuropathy using electromyography in gastrointestinal cancer patients

Oxaliplatin-induced peripheral neuropathy (OIPN) is a common dose-dependent chemotherapy complication in gastrointestinal cancer (GIC). This side effect may restrict therapeutic dose elevation of oxaliplatin. Here, OIPN frequency and determinants of neuropathy appearance in oxaliplatin-treated GIC patients. A total of 102 GIC patients who underwent chemotherapy with fluorouracil, folinic acid and oxaliplatin (FOLFOX4) regimen participated in this longitudinal study. Electromyography (EMG) was accomplished for ulnar, radial, sural, peroneal nerves and superficial peroneal nerve (SPN) before, 3, and 6 months after treatment. National Cancer Institute-Common Toxicity Criteria V.3 and clinical version of the Total Neuropathy Score were used for the neuropathy diagnosis at six months after treatment onset. Of all entered patients, twelve people discontinued this study, and five patients passed away. About 85 patients remained three and six months after chemotherapy onset. Approximately 95% of patients three months after chemotherapy demonstrated OIPN manifestations. Finally, data for 81 patients having neuropathy were analyzed. Mean age of patient 64.0±10.9 years. There were about 3.7%, 30.9%, 63% grade III, II, I of neuropathy, respectively. Interestingly, a significant decrease in action potential (AP) amplitude of SPN, sural and radial nerves but not ulnar and peroneal was observed after treatment onset. However, only the ulnar nerve indicated a substantial deceleration of nerve conduction. Age, sex, weight, past medical diseases, smoking and acute neuropathy were not significantly associated with OIPN. The occurrence of OIPN is detectable by electrophysiological changes of SPN, radial, and sural nerves at three and six months after starting chemotherapy with the FOLFOX4 regimen

A Survey about the Temporal Pattern of Stroke Occurrence

Background: Temporal variation of stroke onset is suggested in some studies contained somewhat varieties. It is proposed that some predisposing changes occur in some ascertained times consequently resulted in stroke occurrence in some special times. Objective: To determine the circadian and circaseptan variation of stroke onset. Materials and Methods: This cross sectional study was conducted from March 2012 to February 2013 in an academic hospital in the North of Iran. All patients with acute onset of neurological symptoms were enrolled in the study after being diagnosed as a stroke patient. The diagnosis was made by a neurologist using brain imaging. Age, gender, history of diabetes and hypertension, time and date of stroke onset were recorded for all patients. The data were analysed using Chi-square test in SPSS software version19. Results: A total of eight hundred sixty-nine patients with mean age of 67.5±12.4 years (55.6% women 44.4% men) were admitted during one year study. Eighty-five percent of stroke cases were ischemic in nature and the others were hemorrhagic type. Distribution of cases during a day was not uniform (p < 0.0001). The peak of stroke onset occurred in the mornings (7-9 a.m.) followed by a second peak in the evenings (7-9 p.m.). In addition, the distribution of cases during the week was also not uniform (p < 0.016). Conclusion: Stroke occurrence has a diurnal variation probably resulted from circadian physiologic changes. Although there is a circaseptan variation in the times of stroke record, it seemingly isn’t related to physiologic changes

The Applicability, Concurrent Validity and Internal Consistency Reliability of the Persian Version of the National Institutes of Health Stroke Scale (NIHSS): Evidences for Gender Differences

Background: The National Institutes of Health Stroke Scale (NIHSS) can objectively quantify the severity of stroke. However no information is available about psychometric properties and it’s applicability in the Iranian population. Objectives: The present study purposed by utilization of this instrument for neurological deficits measurement due to stroke, to determine the internal consistency reliability and concurrent validity of NIHSS to separate two groups of men and women patients. Materials and Methods: In a cross-sectional study, 206 ischemic stroke patients were selected and the internal consistency reliability and concurrent validity of NIHSS were assessed. For this purpose, Barthel index that measures the functional disability was used. Data also were analyzed by Independent t-test, Chi-square, Pearson correlation, Fisher's z tests and bivariate regression analysis. Results: Internal consistency for men (α=0.881), women (α=0.913) and total patients (α=0.893) was excellent. Negative correlation was found between NIHSS and Barthel index in both men (r=-0.43, p<0.0001) and women (r=-0.63, p<0.0001) and this relationship estimated to be more significant among women rather than men (p<0.05). In addition, NIHSS scores could significantly predict the Barthel score in both groups (p<0.0001) but the results revealed the more ability of NIHSS in predicting functional disability for women (R2=0.40) rather than men (R2=0.18). Conclusion: Persian version of NIHSS was reliable and valid instrument that can be applicable in both men and women with ischemic stroke; however, it was found that the degree of concurrent validity is better among women than men

A comparative study of the dose-dependent effects of low level and high intensity photobiomodulation (laser) therapy on pain and electrophysiological parameters in patients with carpal tunnel syndrome: a randomized controlled trial

Carpal tunnel syndrome (CTS) is a common peripheral nerve disorder of the wrist. Nonsurgical treatments e.g. laser therapy may cause potential beneficial effects.To compare the dose dependent effects of low level laser therapy (LLLT) and high intensity laser therapy (HILT) on pain and electrophysiology studies in patients with CTS.Double-blind randomized controlled trial.Outpatient physiotherapy clinic.Ninety-eight participants with CTS, aged between 20 to 60 years, were randomly assigned to five groups.All participants undertook four standard exercises, with one group serving as exercise-only controls. Patients were randomly allocated to either high or low fluence LLLT or high or low fluence HILT received over 5 sessions. All patients were assessed by visual analogue scale, median compound muscle action potential (CMAP) and sensory nerve conduction studies before and 3 weeks after the interventions.VAS was significantly lower in all groups after 3 weeks (

Ability of serum C-reactive protein and white blood cell cout in predicting acute schemic stroke. A short -term follow-up study

Background: Stroke is one of the leading causes of mortality and long-term morbidity. The aim of the present study was to determine the ability of baseline serum C-reactive protein (CRP) and white blood cell count (WBC) values in predicting the outcome of acute ischemic stroke (AIS). Methods: This study consisted of patients with first AIS referred to Poursina Hospital, Rasht, Iran. Severity of stroke was determined according to the National Institute of Health (NIH) Stroke Scale at the time of admission. Serum CRP levels and WBC count were measured at the time of admission. All patients were followed-up for 90 days after discharge and the severity of stroke was assessed using modified Rankin Scale. Receiver operating characteristic curve analysis was used for calculating the most appropriate cutoff point of CRP and WBC count for differentiating patients with and without poor outcome at the end of the study period. Results: A total of 53 out of 102 patients (52%) had poor outcome. The most appropriate cutoff value for CRP in differentiating patients with and without poor outcome was 8.5mg/l (sensitivity: 73.1%, specificity: 69.4%) and for WBC the difference did not reach to a significant level. The cutoff points of CRP > 10.5 mg/ml yielded a predictive ability at sensitivity: 75%, specificity: 63.8% whereas predictive ability of WBC for mortality was at a borderline level. Conclusion: These findings indicate that high levels of serum CRP in AIS at the time of admission is associated with poor prognosis. However, this study found no ability for WBC in predicting AIS outcom

Changes in Seizure Frequency and Characteristics During COVID-19 Pandemic: A Hospital-based Study

Background: It was found that the novel coronavirus disease 2019 (COVID-19) pandemic contributed to changes in the epidemiologic and symptomatic pattern of some neurologic disorders. Objectives: The present study investigated the frequency of seizures and their characteristics from February to August 2020 (the peak of the COVID-19 pandemic) compared to the same period the year before. Materials & Methods: This cross-sectional-analytical study was performed on patients with seizures in Poursina hospital in Guilan province, Iran, between February and August 2020 and the same period the year before. Patients with seizures at the beginning or during hospitalization with at least one seizure in the desired period were included in the study. Results: The increase in seizure frequency during the COVID-19 pandemic versus last year was statistically significant (P=0.014). It also observed a significant difference in seizure etiology (P=0.032), types (P<0.005), and history of seizure (P<0.001). The most prevalent causes of seizures and stroke before and during the COVID-19 pandemic are unknown. The convulsive status epilepticus increased during the COVID-19 pandemic period by 4-fold. Before the pandemic, the patients had a higher prevalence of seizure history. Conclusion: The frequency of seizures, their types, and etiology changed during the COVID-19 pandemic, signifying that COVID-19 can influence on hospital burden of the seizure population

Comparing the Effect of Memantine and Placebo on Clinical Outcome of Intracranial Hemorrhage: A Randomized Double Blind Clinical Trial

Background: Intracerebral Hemorrhage (ICH) is a stroke type which resulted in disability. Memantine have been supposed to have the effect on the functional status in patients with ICH. Objectives: Comparing the effect of memantine with placebo on the clinical outcome of ICH. Materials and Methods: This double-blind clinical trial was conducted in an academic hospital in northern Iran on patients with ICH allocated in memantine and placebo group through the random block method. The patients’ neurological status was assessed on admission, the seventh day, upon discharge and ultimately three months after the ICH onset, according to the National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Barthel Index (BI) and Glasgow Coma Scale (GCS). The data analysis was done by using independent t-test, Chi-square and repeated measure tests in SPSS software version 21. Results: A total of 64 patients have been allocated into two equal size groups with no significant differences in terms of age or gender (p>0.05). The mean increase in the BI and the decrease in the mRS were significantly greater in the memantine group compared with the placebo group as measured from admission time until three months following the ICH onset (p=0.001 and p=0.049, respectively). No significant differences were observed between the two groups in mortality rate (p=0.492) and the means and changes of the GCS (p=0.331) and the NIHSS score (p=0.211). Conclusion: Early administration of memantine to ICH patients can result in significant improvement of long-term motor function and functional independence

Non-adherence to Disease-Modifying Treatments in Patients with Multiple Sclerosis

Background: Multiple Sclerosis (MS) is a debilitating disease of the central nervous system. Usually, long-term MS medications are injected intramuscularly or subcutaneously, making them intolerable for many MS patients. Objectives: In the present study, the rate and the causes of non-adherence to MS disease-modifying drugs (DMDs) were assessed in patients with MS. Materials and Methods: Two hundred and three MS patients of Guilan MS Society were interviewed demographic and clinical data of the patients were collected. Results: Among the 203 patients, 73.9% were female. The mean±SD age of the patients was 32.47±9.15. Non-adherence to DMDs was due to side effects (21.7%) and requests of the families (21.7%) or ineffectiveness (17.4%). Significant association was seen between the non-adherence to DMDs and gender (p=0.015) and relapses (p=0.021). Conclusion: The evidence from the present study suggests that there is a high rate of non-adherence to DMDs in MS patients in Guilan