Serum Uric Acid as a Potential Concomitant with Carotid Atherosclerosis

Background: Common carotid intima-media thickness (CC-IMT) measured by ultrasonography as a non-invasive method is nowadays known as a marker for early atherosclerosis. Objectives: Survey the relationship between serum uric acid and carotid intima-media thickness considering hypertension. Materials and Methods: This study was designed as a comparative cross-sectional study in northern Iran in 2013–2014. The samples for uric acid level were taken from 90 patients. Data were collected through questionnaires and a non-invasive ultrasound technique was used to measure IMT. The analysis of data was done by one-way ANOVA and Tukey post hoc tests and logistic regression model using SPSS software version 21. The significance level was set as 0.05. Results: Patients in the 3 groups were the same age and gender. The measured carotid intima-media thickness was significantly different among the groups (p=0.004). Using multivariate logistic regression and entering all variables, The intima-media thickness of the carotid in the group with hypertensive and hyperuricemia was significantly higher than that of the other research groups (p<0.05). Conclusion: An association was found between serum uric acid level and increased thickness of carotid intima-media and hyperuricemia can be considered as a risk factor for atherosclerosis

Analysis of Cerebrospinal Fluid in Diagnosis of Bacterial Meningitis; Using Nuclear Magnetic Resonance Spectroscopy: A Systematic Review

Background: Analysis of biofluids provides a unique window into the biochemical status of a living organism since the composition of a given biofluid will be modulated according to the level of function of the cells that are intimately concerned with its manufacture and secretion. One of the most successful approaches to biofluid analysis has been the application of NMR spectroscopy. Objectives: The aim of this study was the survey of the role of Nuclear Magnetic Resonance (NMR) Spectroscopy in differential diagnosis of septic bacterial meningitis. Methods: Using the search strategy from three databases (MEDLINE/PMC, Web of Science, Scopus), list of references of selected articles and gray literature, without time and language limitation, articles up to March 2017 were entered into this review. In this review, 219 articles were acquired at the primary search. Study selection and quality assessment processes were done based on Cochrane library guidelines. After assessing the quality and inclusion and exclusion criteria, 4 articles were selected and entered into the data synthesis. Results: The results of 4 studies demonstrated relative elevation of lactate value and extracellular acidosis in bacterial meningitis not in aseptic meningitis. Moreover in most of them, decreasing its level by treatment was evident. Conclusion: Metabolomic analysis with NMR spectroscopy of cerebrospinal fluid can become a powerful helping in differentiation of septic meningitis from aseptic meningitis

Serum C-Reactive Protein Level as a Biomarker for Differentiation of Ischemic from Hemorrhagic Stroke

Cerebrovascular accidents rank first in the frequency and importance among all neurological disease. Although a number of studies had shown increased level of the high sensitive C-reactive protein (hs-CRP) in patients with ischemic stroke, the association of increased hs-CRP with various type of stroke especially the assessment hs-CRP level in ischemic and hemorrhagic stroke have not been investigated. In the present study, we assessed the concentration of hs-CRP in patients with documented ischemic and hemorrhagic stroke in the first 24 hours of the onset of symptoms. Thirty-two patients with Ischemic and hemorrhagic stroke were evaluated at neurology department of Poursina Hospital. The presence of baseline vascular risk factors, including hypertension, diabetes mellitus, hypercholesterolemia, obesity, and smoking, was determined. The blood samples were then collected and routine hematology and biochemistry tests were done. hs-CRP levels were determined using a highly sensitive immunonephelometric method. In this cross sectional study, the age of patient varied from 45-85 years (Mean 70.9  9.4). Serum level of hs-CRP in Ischemic patients were 18.92  11.28 and in hemorrhagic group was 2.65  1.7. This relationship was statistically significant (P<0.0001). It might be concluded that hs-CRP might be considered as a usefully adjunct method for the initial diagnosis of the type of stroke

Diagnosis of Meningitis Caused by Pathogenic Microorganisms Using Magnetic Resonance Imaging: A Systematic Review

Introduction: Bacterial meningitis is an acute infectious inflammation of the protective membranes covering the brain. Its early diagnosis is vital because of its high morbidity and mortality. It is mostly diagnosed by a gold standard diagnostic tool i.e. Cerebrospinal Fluid (CSF) analysis. However, it is sometimes difficult and or impossible to do this procedure and an alternative diagnostic tool is needed. Contrast enhanced magnetic resonance imaging can detect the pus or other changes in subarachnoid space. But our optimal aim is to use an imaging method without using contrast to be useable and available in more specific condition. Methods: This study aimed to survey the role of non-contrast Magnetic Resonance Imaging (MRI) in the diagnosis of the bacterial meningitis. MEDLINE/PubMed Central, Web of Science and Scopus were searched without time period and language limitation until March 2017. We found 6410 papers in our initial search. After assessing the content of the papers based on Cochrane library guidelines and inclusion/exclusion criteria, 6 relevant studies were included in the systematic review. All of included studies were observational studies. Results: MRI studies demonstrated that Fluid Attenuation Inversion Recovery (FLAIR) and Diffusion-Weighted Image (DWI) MR imaging among all MRI modalities can detect some abnormalities compatible with bacterial meningitis. FLAIR and DWI-MR imaging are potentially useful to diagnose bacterial meningitis and can be used in emergent condition in which bacterial meningitis is highly suspicious and the other diagnostic tools are not available or feasible

The Findings of Transcranial Doppler Ultrasonography in Patients with Ischemic Stroke

Background: Stroke is a multifactorial disorder, the most common cause being arterial occlusion. Transcranial Doppler Ultrasonography (TCD) is a common non-invasive method available for assessment the arterial blood flow of the brain. Objective: Assessment the hemodynamic parameters of cerebral arteries, using TCD device in patients suffering ischemic stroke. Materials and Methods: This descriptive cross-sectional study was conducted on patients with ischemic stroke in 2014 in Iran after being approved by ethics committee of Researches and Technology Vice-chancellorship of Guilan University of Medical Sciences. After obtaining informed consent, all patients underwent TCD. Demographic details and TCD findings were recorded. Data were analysed in SPSS software 21 using independent t-test, Chi-square, and Fisher's exact tests. The descriptive results were presented as mean ± SD and frequency. Results: A total of 102 patients (69 men and 33 women) with ischemic stroke and mean age of 63.72 ± 12.64 years participated in this study. Among 49.02% of patients at least one hemodynamic abnormality was diagnosed. Small Vessel Disease (SVD), extracranial stenosis (ECS) and intracranial stenosis (ICS) were found in 29.41%, 20.59% and 11.76% of patients respectively. Abnormal Pulsatility Index (PI), Peak Systolic Velocity (PSV) and Mean Blood Flow Velocity (Vm) were reported in 32.25%, 20.59% and 9.8% of them respectively. A significant relationship was found between PSV parameter and also presence of ECS and gender (p = 0.047). Moreover, SVD and abnormal PI were found significantly related to age (p = 0.002). Conclusion: TCD results showed almost half of the patients with ischemic stroke were found to have at least one hemodynamic abnormality

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

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