Effects of Alpha Lipoic Acid Supplementation on Serum Levels of Oxidative Stress, Inflammatory Markers and Clinical Prognosis among Acute Ischemic Stroke Patients: A Randomized, Double Blind, TNS Trial.

Purpose: Stroke is one of the most common conditions causing death. There have been few studies examining the effects of alpha lipoic acid (ALA) on stroke patients. In this regard, the present randomized controlled clinical trial was conducted to examine the effects of ALA supplementation on serum albumin, and inflammatory and oxidative stress markers in stroke patients. Methods: The present paralleled randomized controlled clinical trial involved 42 stroke patients who were over 40 years and under enteral feeding. The participants were randomly assigned into two groups and finally 40 patients completed the study. Patients in alpha lipoic acid group (n=19) took 1200 mg ALA supplement daily along with their meal, and participants in control group (n=21) underwent the routine hospital diet for 3 weeks. Fasting blood samples were obtained and albumin, oxidative stress, and inflammatory indices were assessed at baseline, as well as at the end of the trial. Results: After 3 weeks, treatment of patients with ALA led to a significant decrease in tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) levels (P=0.01) compared to baseline. But serum levels of albumin, total antioxidant capacity (TAC), malondialdehyde (MDA), highsensitivity C-reactive protein (hs-CRP), IL-6 and TNF-α did not change significantly vs. control group (P>0.05). Conclusion: ALA did not significantly change the serum levels of albumin and inflammatory as well as antioxidant capacity indices in stroke patients compared with the control group. More clinical trials with large sample sizes and long duration are needed to clarify the effects of ALA on these patients.

Effect of Whey Protein Supplementation on Inflammatory and Antioxidant Markers, and Clinical Prognosis in Acute Ischemic Stroke (TNS Trial): A Randomized, Double Blind, Controlled, Clinical Trial.

Purpose: Malnutrition is extensively prevalent amongst critically ill patients afflicted by ischemic stroke (IS). This study purpose was to evaluate the protein whey effect on inflammatory and antioxidant markers and functional prognosis in acute IS patients. Methods: out of 42 patients with acute IS who were referred to Imam Reza Educational Hospital, Tabriz, Iran, 40 patients participated in the study. Twenty-one patients as control group received the hospital routine formula, and 19 patients as intervention group received 20 g/daily of whey protein through oral gavage. Inflammation and oxidative stress indicators (e.g., albumin, malondialdehyde (MDA), total antioxidant capacity (TAC), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and high sensitivity C reactive protein (hs-CRP)and clinical variables included in were evaluated using National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during admission and also 3 weeks after intervention. Results: Whey protein supplementation significantly decreased the NIHSS and mRS scores, TNF-α, IL-6, and hs-CRP by passing 3 weeks from intervention (P<0.05). However, whey formula had no significant effect on other markers including albumin, and MDA. The hs-CRP (P = 0.02) reduction was significantly higher in whey protein group in comparison with control group. Conclusion: Whey protein supplementation reduced inflammation markers in those patients with IS. However, these changes should be studied in larger-scale trials.

Interleukin-6, a reliable prognostic factor for ischemic stroke.

BACKGROUND: Interleukin-6 (IL-6) is one of the inflammatory mediators characterized by elevated levels in ischemic stroke (IS) patients. The present study set out to assess the role of IL-6, as a marker for inflammation, in the severity and prognosis of acute IS. METHODS: In a cross-sectional descriptive study, 45 patients with acute IS were selected. Patients with their first day of stroke were included in the study. National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) for stroke severity were evaluated on Days 1, 5, 90, and 365. Serum IL-6 level was measured by enzyme-linked immunosorbent assay (ELISA) on days 1 and 5. RESULTS: In the present study, 45 patients with a mean age of 77.6 ± 4.9 including 32 (71%) men and 13 (28.9%) women were studied. Death occurred in 2 (4.4%) patients before discharge from the hospital; the others, be that as it may, followed the study until Day 365 with a mortality rate of 6 (13.3%). A positive significant correlation was found between IL-6, and NIHSS and mRS of the patients from the time of admission to the end of the follow-up period (P < 0.001, r = 0.6). Moreover, there was a significant correlation between IL-6 and infarction size in brain magnetic resonance imaging (MRI) scan (P < 0.001, r = 0.7). CONCLUSION: The evidence from the present study suggests that IL-6 contributes to determination of severity of ischemic stroke. In addition, IL-6 concentrations affect clinical outcomes in ischemic stroke.

Ketogenic Diet Provides Neuroprotective Effects against Ischemic Stroke Neuronal Damages.

Ischemic stroke is a leading cause of death and disability in the world. Many mechanisms contribute in cell death in ischemic stroke. Ketogenic diet which has been successfully used in the drug-resistant epilepsy has been shown to be effective in many other neurologic disorders. The mechanisms underlying of its effects are not well studied, but it seems that its neuroprotective ability is mediated at least through alleviation of excitotoxicity, oxidative stress and apoptosis events. On the basis of these mechanisms, it is postulated that ketogenic diet could provide benefits to treatment of cerebral ischemic injuries.

Evaluating role of leukocytosis and high sedimentation rate as prognostic factors in acute ischemic cerebral strokes.

Leukocytosis and increased Erythrocyte Sedimentation Rate (ESR) during the early phases of acute ischemic stroke has been proposed to be related with poor prognosis. The aim of this study was to evaluate these two parameters in patients with ischemic stroke. In this descriptive analytical study, 150 patients with confirmed ischemic stroke were taken under study for a period of 13 month. The White Blood Cell (WBC) count and ESR were determined on admitting and after 3 days. Any history of Diabetes Mellitus (DM), Hypertension (HTN), Heart Disease (HD), Hyperlipidemia (HLP), smoking, CT scan findings, level of consciousness and the condition of patient on admission and discharge (according to Rankin's scale) were assessed. In this study, 150 patients were enrolled, in which 75 were males and 75 were females, with the mean age of 67.3 +/- 8.2 years. Leukocytosis on day one was significantly more prevalent in patients passed away during hospitalization or discharged in not-so-well condition. High WBC and ESR levels, altered consciousness, diffused lesions in CT scan and imperfect neurological condition on day one, as well as positive history of DM and HTN were significantly related with higher in-hospital death rate and/or poor condition at discharge. Raised WBC count and ESR just after an ischemic stroke attack might be related with a poor prognosis and necessitate immediate and meticulous monitoring and therapies.

Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease.

BACKGROUND: Generalized screening for carotid artery stenosis with carotid duplex ultrasonography in patients with peripheral arterial disease is controversial. OBJECTIVES: The aim of the present study was to determine the prevalence of significant internal carotid artery (ICA) stenosis in a group of Iranian patients with peripheral arterial disease. METHODS: We prospectively screened 120 patients with a known diagnosis of peripheral vascular disease for carotid artery stenosis. Based on the angiographic assessment of abdominal aorta and arteries of the lower extremities, patients with stenosis greater than 70% in the lower extremity arteries were included. A group of healthy individuals aged ≥ 50 years was recruited as a control. Risk factors for atherosclerosis including smoking, diabetes mellitus, hyperlipidemia, ischemic heart disease, and cerebrovascular disease were recorded. Common carotid arteries (CCAs) and the origins of the internal and external arteries were scanned with B-mode ultrasonography. Significant ICA stenosis, > 70% ICA stenosis but less than near occlusion of the ICA, was diagnosed when the ICA/CCA peak systolic velocity ratio was ≥ 3.5. RESULTS: Ninety-five patients, with a mean age of 58.52 ± 11.04 years, were studied. Twenty-five patients had a history of smoking, six patients had a history of coronary artery disease, six patients had hypertension, and ten patients had diabetes mellitus. Significant ICA stenosis was present in four patients (4.2%) with peripheral arterial disease in one healthy individual (1%) of the control group (P > 0.05). In terms of the risk factors for atherosclerosis, no statistically significant relationship was found between individual atherosclerotic risk factors and significant ICA stenosis (P > 0.05). CONCLUSION: The prevalence of significant ICA stenosis in Iranian patients with peripheral arterial disease is low. In addition, there is no relationship between individual atherosclerotic risk factors and significant ICA stenosis.

Anti-oxidative effect of lipoic Acid in spinal cord ischemia/reperfusion.

OBJECTIVE: Lipoic acid (LA) is an effective anti-oxidant agent that can scavenge free radicals in biological systems. The aim of this research was to study the probable protective effect of LA in spinal ischemic/reperfusion (I/R) injury. MATERIALS AND METHODS: Thirty male Wistar rats, weighing 230-285 g, were assigned randomly into 3 groups (10 animals in each group): sham spinal I/R, and spinal I/R + LA. The spinal I/R + LA rats received LA 100 mg/kg subcutaneously 3 days prior to ischemia induction and 3 days after. The induction of ischemia lasted for 30 min. RESULTS: At 72 h postoperatively, the neurological status was worse in the I/R group than the sham group (p < 0.05). The neurological status of animals in the LA-treated group appeared better than the I/R group (p < 0.05). In the I/R group, tissue glutathione peroxidase (GPx) and super oxide dismutase (SOD) activity were significantly less compared to the control group (p < 0.05). In the LA-treated group, tissue GPx and SOD levels were higher compared to the I/R group (p < 0.05). CONCLUSIONS: LA pretreatment reduced neurologic injury in the rats, most probably by maintaining the oxidant/anti-oxidant ion balance during spinal cord ischemia. Reperfusion may have contributed to the protective effects seen in the LA pretreatment.