Frequency of stroke patients qualified for recombinant tissue plasminogen activator (r-TPA) injection and limitations in Zahedan 2016

Background: Stroke is one of the common causes of mortality and disability. By introducing r-TPA into the global drug market and its effect on the patients’ prognosis, using this drug is recommended in all patients with ischemic stroke who visited less than 4.5 hours after stroke and do not have contraindications. The aim of this study was to investigate the frequency of stroke patients qualified for recombinant tissue plasminogen activator (r-TPA) and its limtations.Methods: In this descriptive cross-sectional study, 244 patients examined with stroke admitted to the Neurology Department of Zahedan city hospital in 2016. Information form were completed with demographic data, transmission method, referral time, CT scan preparation time, and the response of the patients' trials, and finally the data were inserted in SPSS.16 software and analysed by statistical methods.Results: Out of all patients with ischemic stroke, 28 (11.5%) patients had contraindication to receive drug. Of 216 remain patients, 201 patients (93.1%) had no possibility to receive r-TPA due to the loss of golden time and only 15 patients (6.9%) had possibility to receive drug because of visited 4.5 hours before the beginning of symptoms. Of them, 3 (20%) patients due to delay in CT scan and test results, had no possibility to receive r-TPA. In summary, of all patients with inclusion criteria, only 12 (5.5%) patients could use the r-TPA in this study.Conclusions: The most important barrier to using r-TPA has been the loss of golden time and training to raise awareness of the society can lead to early referral from the onset of stroke symptoms

The Incidence and Characteristics of Stroke in Urban-Dwelling Iranian Women

Background: Population-based data regarding stroke among women are scarce in developing countries. This study was designed to determine whether sex differences exist in stroke incidence, mortality, and recurrence. Methods: The Mashhad Stroke Incidence Study is a population-based cohort study in Iran. For a period of 1 year, all patients with stroke in 3 geographical regions in Mashhad were recruited and then followed up for 5 years. Age- and sex-specific crude incidence rates were standardized to the World Health Organization New World Population. Male-to-female incidence rate ratios were assessed for all age groups and all subtypes of first-ever stroke (FES). Results: The annual crude incidence rate of FES (per 100,000 population) was similar in men (144; 95% confidence interval [CI]: 129-160) and women (133; 95% CI: 119-149). Standardized FES annual incidence rates were 239 (95% CI: 213-267) for men and 225 (95% CI 200-253) for women, both greater than in most western countries. There were no significant differences in stroke recurrence or case-fatality between women and men during early and long-term follow-up. Conclusion: The similar incidence of stroke between men and women highlights the importance of equally prioritizing adequate preventive strategies for both sexes. The greater relative incidence of stroke in women in Mashhad compared with other countries warrants improvement of primary and secondary stroke prevention

TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN PATIENTS WITH CEREBRAL ISCHEMIA

Abstract INTRODUCTION: Transesophageal echocardiography (TEE) is superior to Transthoracic echocardiography (TTE) in detection of atrial septal defects and aneurysm, aortic atheroma, left atrial thrombus and mitral valve abnormalities. TEE is indicated in young adults with cryptogenic ischemic stroke who are suspected of having cardioembolic mechanism despite non-diagnostic TTE. METHODS: A prospective clinical study was conducted in patients with ischemic stroke or TIA who had TTE done in Ghaem hospital, Mashhad during 2006-2007. Ischemic cerebrovascular events were detected by stroke neurologist. TEE was performed with VIPI3/GE device, USA and a 7&nbsp;MHz transesophageal probe by an echocardiologist. Patients who did not have TTE before TEE were excluded. Comparison of TEE to TTE results was performed by the echocardiologist and stroke neurologist in each patient. Influence of TEE on therapeutic decisions in each patient was evaluated. RESULTS: Forty-seven patients (20 females, 27 males) with a mean age of 42.6&plusmn;7.3 years were studied. Cardiac and aortic abnormalities were detected in TEE of 35 cases (35/47; 74%) with ischemic cerebrovascular events. Cardiac abnormalities of 17 cases (36%) were only detectable by TEE. These seventeen cases included 7 patients with PFO, 1 case with ASD, 6 cases with aortic atheroma and 2 patients with clot in the left atrium. Comparing the preventive stroke strategies before and after TEE revealed that it was changed only in two cases (2/47; 4.3%) due to performing TEE. These included one patient with a small high-risk PFO and another case with dehicense of mechanical mitral valve. CONCLUSION: TEE revealed cardiac or aortic abnormalities in one-third of the patients with cerebral ischemia and has not been detected by TEE previously. The influence of TEE in therapeutic decisions of patients with ischemic cerebrovascular events is very low. &nbsp;&nbsp; &nbsp; &nbsp;&nbsp; Keywords: Transesophageal echocardiography, Stroke, Transient Ischemic Attack.</p

Reflex epilepsy: a review

Interesting phenomena of reflex epileptic syndromes are characterized by epileptic seizures each one induced by specific stimulus with a variety of types. Simple triggers, which lead to seizures within seconds, are of sensory type (most commonly visual, most rarely tactile or proprioceptive stimuli). Complex triggers, which are mostly of cognitive type such as praxis, reading, talking, and music, usually induce the epileptic event within minutes. It should differ from what most epileptic patients report as provocative precipitants for seizures (such as emotional stress, fatigue, fever, sleep deprivation, alcohol, and menstrual cycle). The identification of a specific trigger is not only important for patients or their parents to avoid seizures, but also it might help neurologists to choose the most effective antiepileptic drug for each case. In addition, research in this area may possibly reveal some underlying pathophysiology of epileptic phenomena in the brain.In this review, we briefly introduce reported reflex epileptic seizures, their clinical features and management

Frequency of stroke patients qualified for recombinant tissue plasminogen activator (r-TPA) and constraints in Zahedan 2016

Background: Stroke is one of the common causes of mortality and disability. By introducing r-TPA into the global drug market and its effect on the patients’ prognosis, using this drug is recommended in all patients with ischemic stroke who visited less than 4.5 hours after stroke and do not have contraindications. The aim of this study was to investigate the frequency of stroke patients qualified for recombinant tissue plasminogen activator (r-TPA) and its limtations.Methods: In this descriptive cross-sectional study, 244 patients examined with stroke admitted to the Neurology Department of Zahedan city hospital in 2016. Information form were completed with demographic data, transmission method, referral time, CT scan preparation time, and the response of the patients' trials, and finally the data were inserted in SPSS.16 software and analysed by statistical methods.Results: Out of all patients with ischemic stroke, 28 (11.5%) patients had contraindication to receive drug. Of 216 remain patients, 201 patients (93.1%) had no possibility to receive r-TPA due to the loss of golden time and only 15 patients (6.9%) had possibility to receive drug because of visited 4.5 hours before the beginning of symptoms. Of them, 3 (20%) patients due to delay in CT scan and test results, had no possibility to receive r-TPA. In summary, of all patients with inclusion criteria, only 12 (5.5%) patients could use the r-TPA in this study.Conclusions: The most important barrier to using r-TPA has been the loss of golden time and training to raise awareness of the society can lead to early referral from the onset of stroke symptoms

Investigating the Relationship Between the Dysphonia Severity Index and the Speech and Voice Severity of Parkinson Disease Patients

Objectives: This study aims to investigate the relationship between dysphonia severity index (DSI), speech disease and voice severity of Parkinson disease (PD) patients. Methods: This was a cross-sectional study, carried out on 45 randomly selected PD patients with the age range of 50 to 75 years. The Hoehn and Yahr scale (H.Y scale) was employed to measure the severity of PD. To measure the DSI, we required detecting the acoustic features of the voice, such as shimmer (dB), vital capacity (VC), semitone range (STR), and voice onset time (VOT); therefore, the participants were asked to produce the vowel /a/ three times for calculating the variables, i.e., STR, VOT, fundamental frequency (F0), second formant (F2), and shimmer (dB). Their voices were analyzed by the Praat software (version 6.0.23). F0 and F2 were utilized to calculate the STR. The VOT was assessed by analyzing the spectrograph of the syllable /pa/. The Kruskal-Wallis test was used to understand the correlation between DSI scores and the stage of PD (Y.H scale); the P value of less than 0.05 was considered significant. Results: A significant relationship was detected between severe DSI and the stage of PD. Meanwhile, the DSI score was statistically significant compared to the scores of the other four groups (P<0.05). Discussion: There was a significant relationship between the severity of voice changes in PD patients by DSI and the stage of their disease. Further studies in this field are needed considering that such information may be of cardinal importance for voice professionals to take early interventions, appropriate to the stage of PD

An Open Study of Botulinum-A Toxin Treatment of Idiopathic Trigeminal Neuralgia

Introduction: Trigeminal Neuralgia (TN) is a unilateral, recurrent, sharp facial pain disorder that is limited to the distribution of divisions of the trigeminal nerve. The aim of this study was to evaluate the efficacy of Botulinum neurotoxin type A (BTX-A) for alleviating the frequency and severity of TN pain. Materials and Methods: This trial was performed as a before and after study. We treated 31 patients (15 male and 16 female) with mean age of 52 year old that their diagnosis was made at least 4.5 years before. We injected BTX-A in various parts of face and particularly in the origin of mandibular and maxillary branches of trigeminal nerve. Injection volume was determined by the necessity and pain intensity measured with visual analog scale up to 100U. Patients were evaluated before and after the injection and were followed after week, and each month, for a three months period. Other related variables were recorded such as: toxin complications, pain status variations by brushing, chewing, cold weather and patient’s satisfaction with their therapy. Results: showed that after injection, pain intensity and frequency decreased after tooth brushing, chewing and cold weather (

The Comparative Study of ECG Findings in the Patients Suffered from Subarachnoid Hemorrhage and Control Group in Northeastern Iran

Introduction: Subarachnoid Hemorrhage (SAH) which accounts for (5% to 10%) of cerebrovascular accidents is an important cause of mortality and disability. It can be complicated by many neurological and medical conditions including cardiovascular complications. During the course of SAH morphologic Electrocardiography (ECG) changes, arrhythmias, myocardial injury and elevation of cardiac enzymes, subendocardial hemorrhage and necrosis may be observed. Materials and Methods:102 SAH patients, without any history of Ischemic heart Disease (IHD), admitted in Ghaem Hospital were studied. Their clinical and radiological parameters were evaluated. Three serial ECGs were performed within the first 72 hours for each patient and the ECG findings were analyzed. The control group consisted of 102 elective patients of Ghaem hospital without any expected heart disease. Results: ECG changes were observed in 60.8% of SAH patients with average age of (53.4±14.2) years and in (2.9%) of control group. The ECG findings were as follows: chamber abnormalities (6.9%), conduction abnormalities (7.8%), repolarization abnormalities (49%), rhythm abnormalities (22.5%) and pathologic Q wave (6.9%). According to this study, ECG changes are related to subarachnoid hemorrhage (

Long-term disability after stroke in Iran: Evidence from the Mashhad Stroke Incidence Study

Background: Accurate information about disability rate after stroke remains largely unclear in many countries. Population-based studies are necessary to estimate the rate and determinants of disability after stroke. Methods: Patients were recruited from the Mashhad Stroke Incidence Study and followed for five years after their index event. Disability was measured using the modified Rankin scale and functional dependency was measured using the Barthel index. Results: Among 684 patients registered in this study, 624 were first-ever strokes. In total, 69.0% (n = 409) of patients either died or remained disabled at five-year follow-up. Among the first-ever stroke survivors, 18.5% (n = 69) at one year and 15.9% (n = 31) at five years required major assistance in their daily activities. Patients with a history of stroke (before the study period) compared with first-ever strokes were more likely to be disabled at one year (modified Rankin scale\u3e2 in 40.0% vs. 19.1%; P \u3c 0.001). Advanced age, severity of stroke at the time of admission, diabetes mellitus, and educational level (\u3c12 years) were independently associated with greater disability and functional dependency. Conclusion: We found that significant disability and functional dependency after stroke in Northeast Iran were largely attributable to the effects of stroke severity and prior dependency

Socioeconomic Status and Long-Term Stroke Mortality, Recurrence and Disability in Iran: The Mashhad Stroke Incidence Study

Background: Little is known about the association between socioeconomic status and long-term stroke outcomes, particularly in low- and middle-income countries. Methods: Patients were recruited from the Mashhad Stroke Incidence Study in Iran. We identified different socioeconomic variables including the level of education, occupation, household size, and family income. Residential location according to patient\u27s neighbourhood was classified into less privileged area (LPA), middle privileged area and high privileged area (HPA). Using Cox regression, competing risk analysis and logistic regression models, we determined the association between socioeconomic status and 1- and 5-year stroke outcomes. Generalized linear model was used for adjusting associated variables for stroke severity. Results: Six hundred twenty-four patients with first-ever stroke were recruited in this study. Unemployment prior to stroke was associated with an increased risk of 1- and 5-year post-stroke mortality (1 year: adjusted hazard ratio [aHR] 3.3; 95% CI 1.6-7.06: p = 0.001; 5 years: aHR 2.1; 95% CI 1.2-3.6: p = 0.007). The 5-year mortality rate was higher in less educated patients (\u3c12 years) as compared to those with at least 12 years of schooling (aHR 1.84; 95% CI 1.05-3.23: p = 0.03). Patients living in LPA compared to those living in HPAs experienced a more severe stroke at admission (aB 3.84; 95% CI 0.97-6.71, p = 0.009) and disabling stroke at 1 year follow-up (OR 6.1; 95% CI 1.3-28.4; p = 0.02). Conclusion: A comprehensive stroke strategy should also address socioeconomic disadvantages