Evaluating the Effect of Novel Ways of Teaching Symptoms and Treatment of Acute Stroke on Thrombolytic Therapy

Background and Objective: Given that a small percentage of people with ischemic stroke are treated with recombinant tissue plasminogen activator (rtPA) in Iran, it is necessary to use appropriate educational methods that, in addition to raising the awareness of patients about stroke, lead them to refer health centres early. The purpose of this study was to evaluate the effect of new methods of training warning signs of acute stroke on thrombolytic therapy.Method: This was a community-based empirical intervention study in Ahvaz, Iran, in 2018. Initially, educational content was provided, including warning signs of a stroke, its risk factors, and the need for prompt referral to a well-equipped treatment centre for thrombolytic therapy. This content was used to prepare brochures, pamphlets, posters, and training sessions for health care personnel. Before starting, immediately, and three months after the training course, a questionnaire was used to assess staff knowledge of stroke symptoms and the need for rapid patient referral for FAST-based thrombolytic therapy. Also, the timely referral of patients with suspected stroke to hospital, as well as their thrombolytic therapy during the six months after the intervention and the similar six months in the previous year were compared.Results: The level of knowledge was significantly increased at the end of training (P<0.0001). Although this average was reduced three months after completion of training, the difference was not significant (P = 0.42). Based on the results, the number of stroke patients referred to hospital in golden time (less than 4.5 hours) from the beginning of training to 6 months after the end of the course (n = 54) was increased compared to the same period last year (n=38). The number of thrombolytic patients from the beginning of the training course to 6 months after the course (n=38) increased compared to the same period of the previous year (n=21).Conclusion: Based on the results, the implementation of educational programs was reported to be effective in raising public awareness of stroke symptoms and the need for prompt hospital referral for appropriate and timely treatment

Investigating the Effect and Immunity of Tissue Plasminogen Activator in the Treatment of Acute Ischemic Stroke

Background and Objective: Although current evidence has demonstrated the efficacy and immunity of Alteplase, further studies are needed to evaluate its functioning in the therapeutic system. This study aims to assess the effect and immunity of tissue plasminogen activator (tPA) in the treatment of acute ischemic stroke (AIS).Methods: This study was conducted as a retrospective observational study on patients with AIS referred to Ahvaz Golestan Hospital in 2017-2018. By using the hospital database, demographic information, the cause of lack of thrombolytic therapy, the onset of symptoms and admission were extracted. The National Institutes of Health Stroke Scale (NIHSS) at the time of referral, 24 hours after treatment, and at the time of discharge, the modified Rankin Scale (mRS) scores at discharge time and 3 months after discharge, complications and mortality at the time of admission and 3 months after discharge were recorded.Results: The mean of the event to needle (hrs) was significantly lower in the tPA group (P <0.0001), and delay in visiting time and loss of golden time were of the main reasons for not receiving tPA in the control group. The mean difference and the decrease in NIHSS score 24 hours after admission and discharge in the tPA group was significantly higher (P <0.0001). At the time of discharge, the mean score of mRS in the two groups was not significantly different. Three months after treatment, the mean score of mRS in the tPA group was significantly lower than that in the control group (P <0.05). The percentage of patients with bleeding complications was higher in the tPA group (7.27%) than that in the control group (4.89%). The percentage of deaths during the hospital stay in the tPA group (3.64%) was higher than that in the control group (1.63%).Conclusion: Patients with AIS under intravenous thrombolytic therapy with tPA showed improvement in functional measurements and neurological outcomes compared with the control group. Lack of significant difference in the rate of complications and mortality between the two groups indicated the safety and high efficacy of thrombolytic therapy in patients with AIS

Comparison of Efficacy and Complication of Alteplase Injection in Acute Ischemic Stroke

Background and Aim: Alteplase is a thrombolytic drug that is produced by recombinant DNA technology. Tissue plasminogen activator enzyme which converts plasminogen to the active form of plasmin is also produced by the same technology; it causes fibrinolysis and clot dissolution. This study aimed to compare the efficacy and complications of Alteplase injection in patients with acute ischemic stroke (AIS( during the first 3 hours and  3-4.5 hours after the onset of symptoms. Methods: In this study, patients with AIS who were referred to Golestan Hospital of Ahvaz city during 2018-2019 were selected. Information was collected by a checklist. Results: The results showed that the mean Modified Rankin Scale (mRS) for 3 months and 6 months (p-value: 0.91 for 3 months and p-value: 0.80 for 6 months) and National Institutes of Health Stroke Scale (NIHSS) (p-value: 0.21) were not significantly different between both groups; statistically, no significant relationship was observed between them. The incidence of complications after treatment was almost similar, in both groups. Conclusion: Finally, it was concluded that complications and efficacy of rt-PA (Alteplase) injection were not statistically different, between the two groups under study. *Corresponding Author: Gholamreza Shamsaei; Email: [email protected]; [email protected] Please cite this article as: Amirazodi E, Shamsaei G, Rafie S, Kashipazha D, Hesam S. Comparison of Efficacy and Complication of Alteplase Injection in Acute Ischemic Stroke. Arch Med Lab Sci. 2021;7:1-6 (e4). https://doi.org/10.22037/amls.v7.3350

The Effect of Uric Acid as a Predisposing Factor on Polyneuropathy in Patients with Type 2 Diabetes Mellitus

Background: Since serum uric acid is a controllable and modifiable factor in diabetic patients, identifying the risk factors and accelerating the incidence of neuropathy in these patients plays an important role, and can reduce its level, and the patient's disability, as well as additional therapeutic costs for the patient and the health system in the country. Method: In this retrospective cohort study conducted at the Golestan Hospital in 2015-2017, the study population was 100 type 2 diabetic patients based on NCS of 54 patients with polyneuropathy. First, the demographic data on clinical examinations, lab tests, and uric acid levels in these patients were recorded on a checklist. Then, in 2017, patients were reassessed for clinical investigations and lab tests, and all data entered on the previous checklist. Finally, all the data were analyzed using the SPSS v23. Results: The mean age of patients with polyneuropathy was 51.77 years, and there was a significant relationship between age, BMI and duration of diabetes with neuropathy, but there was no significant difference in gender, smoking and hypertension. The mean serum level of uric acid in the two years ago was 3.85 mg/dl, and at the time of the study, it was 4.18 ±1.55 mg/dl. There was no significant difference in serum levels of this substance after two years of follow up in patients with polyneuropathy (P=0.139). The incidence of polyneuropathy was reported by NCS findings of 54%. In other words, 54% of diabetic patients developed diabetic polyneuropathy for two years. Conclusion: Polyneuropathy is a common complication in diabetic patients, and the serum levels of uric acid over time cannot have a significant effect on the incidence of this disorder

The role of microRNAs in neurobiology and pathophysiology of the hippocampus

MicroRNAs (miRNAs) are short non-coding and well-conserved RNAs that are linked to many aspects of development and disorders. MicroRNAs control the expression of genes related to different biological processes and play a prominent role in the harmonious expression of many genes. During neural development of the central nervous system, miRNAs are regulated in time and space. In the mature brain, the dynamic expression of miRNAs continues, highlighting their functional importance in neurons. The hippocampus, as one of the crucial brain structures, is a key component of major functional connections in brain. Gene expression abnormalities in the hippocampus lead to disturbance in neurogenesis, neural maturation and synaptic formation. These disturbances are at the root of several neurological disorders and behavioral deficits, including Alzheimer’s disease, epilepsy and schizophrenia. There is strong evidence that abnormalities in miRNAs are contributed in neurodegenerative mechanisms in the hippocampus through imbalanced activity of ion channels, neuronal excitability, synaptic plasticity and neuronal apoptosis. Some miRNAs affect oxidative stress, inflammation, neural differentiation, migration and neurogenesis in the hippocampus. Furthermore, major signaling cascades in neurodegeneration, such as NF-Kβ signaling, PI3/Akt signaling and Notch pathway, are closely modulated by miRNAs. These observations, suggest that microRNAs are significant regulators in the complicated network of gene regulation in the hippocampus. In the current review, we focus on the miRNA functional role in the progression of normal development and neurogenesis of the hippocampus. We also consider how miRNAs in the hippocampus are crucial for gene expression mechanisms in pathophysiological pathways

Molecular identification of Enterocytozoon bieneusi and Encephalitozoon spp. in immunodeficient patients in Ahvaz, Southwest of Iran

Microsporidia are often considered as an opportunistic infection in patients with impaired immune systems such as transplant recipients and patients with acquired immune deficiency syndrome (AIDS). Due to the increasing prevalence of parasitic infections and immunodeficiency diseases; the aim of the study is to evaluate molecular identification of Enterocytozoon bieneusi and Encephalitozoon spp. in immunodeficient patients in Ahvaz, southwest of Iran. At first, 310 stool samples were collected from patients with immunodeficiency. The specimens were stained by modified trichrome (weber) and were examined microscopically. The extracted DNA samples were evaluated by multiplex/nested PCR method. The products of multiplex/nested PCR were explored by RFLP method using the restriction enzyme of Mnl1. Of 310, 93 samples were suspected positive for microsporidia by the staining. Also, of 310, 88 samples were positive by the multiplex/nested-PCR test that 62 samples were positive for E. bieneusi as well as 26 were detected as Encephalitozoon species that including 3 E. cuniculi, 19 E. intestinalis and 4 E. hellem. Of 62 E. bieneusi, 45, 16 and 1 were detected as genotype D, M and WL11, respectively. Also, Of 3 E. cuniculi, 1 and 2 cases were identified as genotype I and II, respectively. All E. hellem samples were included genotype 1A. Our findings revealed a relatively high prevalence of microsporidia species in immunodeficient patients. The highest risk of this infection is at individuals with impaired immune systems that it can be life-threatening in people with immune system dysfunction. It is essential that the high-risk people should be receiving the information about the risk of direct contact with infected individuals and animal

The Efficacy and Safety of Intrathecal Autologous Bone Marrow-Derived Mesenchymal Stromal Cells in Amyotrophic Lateral Sclerosis: A Pilot Study

Purpose: Amyotrophic lateral sclerosis (ALS) is an uncommon and aggressive neurodegenerative disorder that influences the lower and upper motor neurons. There are low eligible drugs for ALS treatment; in this regard, supplemental and replacement treatments are essential. There are relative studies in the field of mesenchymal stromal cells (MSCs) therapy in ALS, but the different methods, differently used medium, and difference in follow-up periods affect the outcome treatment. Methods: The current survey is a single-center, phase I clinical trial to evaluating the efficacy and safety of autologous bone marrow (BM)-derived MSCs through intrathecal administration in ALS patients. MNCs were isolated from BM specimens and cultured. The clinical outcome was evaluated based Revised Amyotrophic Lateral Sclerosis Functional Rating (ALSFRS-R) Scale. Results: Each patient received 15±3×106 cells through subarachnoid space. No adverse events (AEs) were detected. Just one patient experienced a mild headache after injection. Following injection, no new intradural cerebrospinal pathology transplant-related was observed. None of the patients’ pathologic disruptions following transplantation were detected by magnetic resonance imaging (MRI). The additional analyses have shown the average rate of ALSFRS-R score and forced vital capacity (FVC) reduction have decreased during 10 months following MSCs transplantation versus the pretreatment period, from -5.4±2.3 to -2±3.08 ALSFRS-R points/period (P=0.014) and -12.6±5.22% to -4.8±14.72%/period (P<0.001), respectively. Conclusion: These results have shown that autologous MSCs transplantation reduces the disease’s progression and has favorable safety. Trial Registration: This study performed as a phase I clinical trial (code IRCT20200828048551N1)

The Effect of In-Hospital Intervention to Reduce Door to Needle Time in Patients Receiving Tissue Plasminogen Activator

Background and Objective: Attempts have been made to confirm the diagnosis of stroke at the earliest stage and to prevent the development of neurological deficits. Tissue plasminogen activator (tPA) plays a logical role in the treatment of acute stroke by converting plasminogen to plasmin, and recent studies have shown that the drug can be injected up to four and a half hours after the onset of symptoms. The present study aimed to evaluate the effect of an in-hospital intervention to reduce door to needle (DTN) time in acute stroke patients. Methods: This epidemiological case-control study was performed on patients with acute ischemic stroke from September to March 2016 (n= 25) (group A) who were treated with tPA according to stroke guidelines. Their basic specifications, DTN and Door to Computed Tomography scan (DTC) time were recorded. Then, from April to August 2017, an intra-hospital recipe for tPA injection was provided by investigating the obstacles and causes of intra-hospital delays. Subsequently, stroke patients receiving tPA from September to March 2017 (n= 23) (group B) were examined, and their DTN and DTC were compared with patients in the first group. Results: The mean DTN and DTC in group A were 67.27 ±28.83 and 30.40 ±10.59 minutes, and in group B, were 45 ±25.98 and 22.17 ±8.50, minutes, respectively, which made a significant difference between the two groups (P=0.005, P=0.006, respectively). The percentage of patients with DTN less than 60 minutes increased from 52% in group A to 95.6% in group B. The percentage of patients with DTC less than 25 minutes decreased from 32% to 69.56% (P&lt;0.001). The percentage of patients with symptomatic cerebral haemorrhage increased from 12% to 8.7% (P&lt;0.001). The percentage of patients with independent ambulatory (mRS: 0-2) at three months after discharge increased from 48% to 56.5% (P=0.003). The mortality rate also decreased from 24% to 13.4% (P&lt;0.001). Conclusion: By resolving the causes of intra-hospital delays and using a proper team program, the mean DTN and DTC of patients receiving tPA were reduced. This decrease in DTN time was accompanied by reduced complications in the form of reduced symptomatic cerebral haemorrhage and mortality and improved prognosis

Botulism Outbreak in a Family after Ingestion of Locally Produced Cheese

Botulism is one of the most important foodborne diseases and is caused by Clostridium botulinum toxin. The main manifestations are flaccid muscle paralysis and cranial nerve palsies. Botulism is an essential health problem because of its high mortality. The diagnosis of botulism, especially in sporadic cases, is a medical challenge and a high clinical suspicion is necessary for early recognition. So, every physician should be familiar with its signs and symptoms for early detection and treatment. We describe a family with dysphasia and acute paralysis after the ingestion of locally made cheese. The clinical presentations of the 1st patient were similar to myasthenic crisis and she, therefore, received plasma exchange. After the appearance of similar symptoms in the other family members, they were treated with polyvalent botulinum antitoxin and diagnosis was confirmed by toxicology and detection of serotype A botulinum toxin in cheese and stool samples. Uncommon clinical presentations and unusual sources of botulinum toxin should be kept in mind because of the importance of early diagnosis and treatment