Intracranial Blood Flow Velocity in Patients with β-Thalassemia Intermedia Using Transcranial Doppler Sonography: A Case-Control Study

Introduction. Patients with β-thalassemia intermedia have a higher incidence of thromboembolic events compared to the general population. Previous studies have shown that patients with sickle cell disease, who are also prone to ischemic events, have higher intracranial arterial blood flow velocities measured by transcranial Doppler sonography (TCD). The aim of this study is to evaluate intracranial arterial flow velocities in patients with β-thalassemia intermedia and compare the results with those found in healthy subjects. Methods. Sixty-four patients with β-thalassemia intermedia and 30 healthy subjects underwent transcranial Doppler sonography. Results. Significantly higher flow velocities were found in intracranial arteries of patients compared to controls (P = 0.001). Previously splenectomized patients with thrombocytosis showed higher flow velocities than nonsplenectomized patients without thrombosis. Conclusion. The increased flow velocities in patients with β-thalassemia intermedia may point to a higher risk of ischemic events. Preventive measures such as blood transfusion or antiplatelet treatment may be beneficial in these patients

The Role of Disease Perception, Religious Coping Strategies, and Cognitive Regulation of Emotion in Predicting Adaptation to the Disease in People with Multiple Sclerosis (MS)

Introduction: Multiple sclerosis is one of the most common chronic disorders of the central nervous system, which causes many psychological problems in patients. Therefore, this research aimed to investigate the role of disease perception, religious coping strategies, and cognitive emotion regulation in predicting adaptation to the disease in people with multiple sclerosis (MS).Methods: The current research had a descriptive and correlational design. The statistical population included all people with multiple sclerosis in Shiraz. For this purpose, 113 people were selected by convenience sampling method. The research tools included questionnaires of adaptation to the disease, perception of the disease, religious coping, and cognitive emotion regulation strategies. To analyze the data, multiple linear regression was used with SPSS software, version 20.Results: The results of the regression analysis showed that among the components of illness perception, the components of the outcome, emotional response, and the nature of the disease are negative predictors, and personal control is a positive predictor, and among the components of religious coping, negative religious coping is a negative predictor, and Benevolent coping is a positive predictor and also among the components of cognitive emotion regulation, positive reappraisal, refocusing on planning and perspective-taking, were  positive predictors and rumination, and catastrophizing were significant negative predictors of adaptation to the disease in people affected by  multiple sclerosis.Conclusion: According to the obtained results, it can be claimed that psychological variables play an important role in adapting to the disease in people with multiple sclerosis

Caring for Patients with Alzheimer’s Disease in Nursing Homes: A Qualitative Content Analysis

Introduction: Gradual and inevitable deterioration of mind and self causes wide ranges of somatic, emotional, and financial needs in patients with Alzheimer’s disease. Nurses have a main role in preparing a suitable environment and care for patients. The aim of this research was to understand caring experience and perspective of staff in nursing homes. Method: In a qualitative study, 10 female and three male caregivers in Iranian nursing homes were selected based on purposeful sampling. The subjects were interviewed and data was analyzed using content analysis method. After data immersion, interview texts were transcribed verbatim and initial codes were extracted. These initial codes were re-evaluated and categorized. Results: Nearly 850 initial codes were extracted and categorized as three main themes of aspects, bases, and characteristics of care. In addition, 17 sub-themes were identified. Conclusion: Caring for patients’ with Alzheimer’s disease consists of physical routines. Other aspects of care receive limited attention and are provided unprofessionally, based on common sense and personal experience. Employing and continuous education of trained staff in assessment and caring of patients with Alzheimer’s disease can improve the environment of nursing homes, the quality of the provided care, and patients’ quality of life.. Keywords: Alzheimer’s disease, Care, Nursing home, Qualitative research, Experienc

Outcome of decompressive craniectomy in comparison to nonsurgical treatment in patients with malignant MCA infarction

Background: Malignant cerebral infarction is a well-recognized disease, comprising 10-15% of all cases with cerebral infarction and causing herniation and death in 80% of cases. In this study, we compare the effects of decompressive craniectomy versus conventional medical treatment on mortality rate and functional and neurological outcome in patients with malignant MCA infarction. Methods: We performed a prospective case-control study on 60 patients younger than 80years of age suffering malignant MCA cerebral infarction. The case group underwent decompressive craniectomy in addition to routine aggressive medical care; while the control group received routine medical treatment. Patient outcome was assessed using Glasgow outcome scale and modified Rankin scale within three months of follow-up. The data were analyzed by SPSS version 16.0 software using Chi Square, One-way ANOVA and Mann-Whitney tests. Results: There were 27 male and 33 female patients with a mean age of 60.6 years (SD = 12.3). Glasgow outcome scale score averaged 2.93 in the surgical versus 1.53 in the medical group; this difference was significant (p = 0.001). Outcome in modified Rankin scale was also significantly lower in the surgical (3.27) versus medical (5.27) group (p <0.001). Surgery could decrease the mortality rate about 47%. Conclusion: In this study, decompressive craniectomy could decrease mortality rate, and improve neurological and functional outcome, and decrease long-term disability in patients with malignant MCA infarction.Peer reviewe

The Hospitalization Rate of Cerebral Venous Sinus Thrombosis before and during COVID-19 Pandemic Era: A Single-Center Retrospective Cohort Study

Objectives: There are several reports of the association between SARS-CoV-2 infection (COVID-19) and cerebral venous sinus thrombosis (CVST). In this study, we aimed to compare the hospitalization rate of CVST before and during the COVID-19 pandemic (before vaccination program). Materials and methods: In this retrospective cohort study, the hospitalization rate of adult CVST patients in Namazi hospital, a tertiary referral center in the south of Iran, was compared in two periods of time. We defined March 2018 to March 2019 as the pre-COVID-19 period and March 2020 to March 2021 as the COVID-19 period. Results: 50 and 77 adult CVST patients were hospitalized in the pre-COVID-19 and COVID-19 periods, respectively. The crude CVST hospitalization rate increased from 14.33 in the pre-COVID-19 period to 21.7 per million in the COVID-19 era (P = 0.021). However, after age and sex adjustment, the incremental trend in hospitalization rate was not significant (95% CrI: -2.2, 5.14). Patients \u3e 50-year-old were more often hospitalized in the COVID-19 period (P = 0.042). SARS-CoV-2 PCR test was done in 49.3% out of all COVID-19 period patients, which were positive in 6.5%. Modified Rankin Scale (mRS) score ≥3 at three-month follow-up was associated with age (P = 0.015) and malignancy (P = 0.014) in pre-COVID period; and was associated with age (P = 0.025), altered mental status on admission time (P\u3c0.001), malignancy (P = 0.041) and COVID-19 infection (P = 0.008) in COVID-19 period. Conclusion: Since there was a more dismal outcome in COVID-19 associated CVST, a high index of suspicion for CVST among COVID-19 positive is recommended

Three atypical manifestations of granulomatosis with polyangiitis: lateral medullary syndrome, anterior cheek mass and melting scleritis of eye

Granulomatosis with polyangiitis (GPA, formerly Wegener granulomatosis) is a vasculitis with various organ involvement. There have been a few cases of CNS stroke and rare cases of lateral medullary infarction (LMI) as a manifestation of GPA. Also there have been reports of sinuses, nose and laryngeal masses mistakenly referred as carcinomas and subsequently GPA was diagnosed in their pathological reports. Another severe fulminant manifestation can be necrotizing scleritis leading to perforation of sclera. Therefore, here we present some rare and fulminant manifestations of GPA in 3 separate cases for further emphasis of the unusual manifestations of GPA that should always be kept in mind

Detecting and managing drug-related problems in the neurology ward of a tertiary care teaching hospital in Iran: A clinical pharmacist's intervention

Objective: Nowadays, the role of clinical pharmacists has become more prominent by more clinical pharmacists joining the health-care teams. This study was aimed to assess the role of a clinical pharmacist specialist in detecting and managing drug-related problems (DRPs) in the neurology ward of a tertiary care teaching hospital in Iran. Methods: This is a prospective cross-sectional study conducted on 123 hospitalized patients admitted to the neurology ward of a teaching hospital. The clinical pharmacist visited the patients and filled out the designed pharmacotherapy sheet for each patient. Then, the general pharmacist checked the patients' files and pharmacotherapy sheets and categorized DRPs using modified method of “The Pharmaceutical Care Network Europe classification, Version 5.01.” Findings: A total of 168 errors were found and 346 interventions were done by the clinical pharmacist during the study period. The most common form of errors in our study was “drug choice problems” (57.76%). The acceptance rate of interventions was 41.91% among physicians. Conclusion: The large number of interventions reported in several studies, as well as this study, revealed that clinical pharmacy services could contribute to a rationalization of drug therapy and may eventually lead to more medication safety