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1.
J Res Med Sci ; 28: 10, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36974106

RESUMO

Background: Some studies showed the cerebrovascular manifestation in patients with recently pandemic coronavirus 2 named the coronavirus disease 2019 (COVID-19). However, there are rare reports about stroke subtypes in these patients. Here, we reported the stroke subtype in patients with laboratory-confirmed diagnosis of COVID-19 and treated at our hospitals, which are located in Isfahan, Iran. Materials and Methods: This is a retrospective, observational case series. Data were collected from March 01, 2020, to May 20, 2020, at three designated special care centers for COVID-19 of Isfahan University of Medical Sciences. The study included 1188 consecutive hospitalized patients with laboratory-confirmed diagnosis of COVID-19. Results: Of 1188 COVID-19 patients, 7 (0.5%) patients developed stroke. Five (0.4%) had ischemic arterial stroke, 1 (0.08%) hemorrhagic stroke and 1(0.08 %) cerebral venous and sinus thrombosis. Sixty percent of ischemic stroke were cardioembolic stroke (CE) and the rest 2 (40%) were embolic stroke of undetermined source. Three male patients (40%) had stroke as a presenting and admitted symptom of COVID-19. Four patients (57%) had severe COVID-19. Conclusion: Stroke was an uncommon manifestation in COVID-19 patients. CE was a common subtype of stroke in COVID-19 patients in our centers.

2.
BMC Neurol ; 22(1): 227, 2022 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-35729625

RESUMO

OBJECTIVES: Ischemic stroke is the most common presentation of cervical artery dissection (CAD). Information regarding CAD-induced stroke is scarce, especially in the Middle East. Here we investigated the incidence of CAD-induced stroke, its characteristics, and the clinical course in central Iran. METHODS: This is an observational study conducted in the city of Isfahan, Iran. We recruited patients with ischemic stroke during 2017-2019. We analyzed characteristics of the CAD-induced stroke patients with regards to the involved vessel (internal carotid artery dissection (ICAD) or vertebral artery dissection (VAD)). We assessed functional outcome (modified Rankin Scale [mRS]) and recanalization status after 1 year of follow-up. RESULTS: Among 3630 ischemic stroke patients, 51(1.4%) had CAD-induced stroke (mean age: 41.8 ± 12.6; 40.4% female; 28 and 19 ICAD and VAD cases, respectively). The crude incidence rate of CAD-induced stroke was 1.20/100,000/year (0.66/100,000/year and 0.45/100,000/year for strokes due to ICAD and VAD, respectively). mRS ≤ 2 was present in 63.8% of the patients after 1 year of follow-up. History of exercise during the last days before stroke occurrence was associated with a better follow-up mRS (ß = -3.1, p-value: 0.037). Administration of anticoagulant or double-antiplatelets was related neither to mRS nor recanalization results. Trauma (27.7%), smoking (21.3%), and headache disorders/migraine (21.3%) were the most common reported factors. CONCLUSION: We found a crude incidence rate of 1.20/100,000/year for CAD-induced stroke. Trauma, smoking, and headache disorders were the most common reported factors among our patients. CAD-induced stroke had a favorable long-term prognosis regardless of the type of the involved vessel or the used medication.


Assuntos
Dissecação da Artéria Carótida Interna , Transtornos Cerebrovasculares , AVC Isquêmico , Transtornos de Enxaqueca , Acidente Vascular Cerebral , Dissecação da Artéria Vertebral , Adulto , Artérias , Dissecação da Artéria Carótida Interna/complicações , Dissecação da Artéria Carótida Interna/epidemiologia , Transtornos Cerebrovasculares/complicações , Feminino , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/complicações , Prognóstico , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/epidemiologia
3.
Nutr Neurosci ; 25(11): 2239-2246, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34311680

RESUMO

BACKGROUND & AIM: No study explores the association of dietary phytochemical index (DPI) with stroke. This study was undertaken to obtain the required insight in this regard in Iranian adults. METHODS: This hospital-based case-control study was carried out on 195 stroke patients (diagnosed based on clinical and brained CT findings) and 195 control subjects with no history of cerebrovascular diseases or neurologic disorders). Data collection on dietary intakes was done using a 168-item validated FFQ. DPI was calculated using the McCarty equation. Logistic regression model in different models was used to evaluate the association between DPI and stroke. RESULTS: Mean age of study participants was 64.8 years, and 53.4% of them were male. Individuals in the highest tertile of DPI were younger (63 ± 11 vs. 67.4 ± 13 y, P = 0.01) and less likely to be physically active (2804 ± 5714 vs. 4772 ± 11912 M, P = 0.03). After adjustment for potential confounders, no significant relationship was observed between DPI and stroke risk (OR: 0.76; 95% CI: 0.39-1.49). However, when we considered the effect of dietary intakes, subjects in the top tertile of DPI were 61% less likely to have a stroke than those in the bottom tertile (OR: 0.39; 95% CI: 0.16-0.95). When BMI was controlled, the association between DPI and stroke became strengthened (OR: 0.32; 95% CI: 0.12-0.86). CONCLUSION: We found evidence indicating a significant inverse association between DPI and odds of stroke in adults. Further prospective studies are warranted to confirm this association.


Assuntos
Dieta , Acidente Vascular Cerebral , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Estudos de Casos e Controles , Irã (Geográfico)/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Compostos Fitoquímicos
4.
Nutr Neurosci ; 25(9): 1956-1961, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33926371

RESUMO

OBJECTIVES: Although some components of MIND diet were associated with stroke, no information is available on the association between adherence to the MIND diet and odds of stroke. This study was conducted to investigate the association between adherence to the MIND diet and odds of stroke among Iranian adults. METHODS: This case-control study was done on 193 hospitalized stroke cases and 195 hospital-based controls in Al-Zahra hospital, Isfahan, Iran. Dietary intakes of study participants were assessed using a validated 168-item food frequency questionnaire (FFQ). The MIND diet score was computed based on participants' dietary intakes obtained from FFQ. Stroke was confirmed by a trained neurologist using standard imaging methods. RESULTS: After controlling for age, sex, energy intake, physical activity, smoking, hypertension, diabetes, dyslipidemia, and heart disease, there was no significant association between adherence to the MIND diet and stroke (OR: 0.54; 95% CI: 0.26, 1.12). However, after further adjustment for BMI, we found that those with the greatest adherence to the MIND diet were less likely to have stroke compared with those with the lowest adherence; such that greater adherence to the MIND diet was associated with a 59% reduced odds of stroke (OR: 0.41; 95% CI: 0.18-0.94). CONCLUSION: In conclusion, we found that adherence to the MIND diet was inversely associated with odds of stroke in a case-control study. Further studies are required to confirm these findings.


Assuntos
Hipertensão , Acidente Vascular Cerebral , Adulto , Estudos de Casos e Controles , Dieta , Humanos , Irã (Geográfico)/epidemiologia , Acidente Vascular Cerebral/epidemiologia
5.
Neurol Sci ; 43(1): 549-557, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33945036

RESUMO

AIM: There is a paucity of evidence and consensus on exactly how to carry out the detoxification process. To examine the effect of a greater occipital nerve block (GONB) in the detoxification process, we conducted an open-label, parallel, randomized, controlled clinical trial. MATERIALS AND METHODS: In order to conduct this study, 54 medication-overuse headache (MOH) patients were recruited and allocated randomly to group A (n = 27) or B (n = 27). In both groups, patients underwent detoxification processes without any acute migraine medication or analgesics. During the run-in period, all patients in both groups received the same education, managed by a neurologist and nutritionist. All patients were offered maximally 300 mL of promethazine syrup (5 mg/5 mL) to be taken 10 mg every 8 h during the first 10 days of the study. A 2-mL syringe containing 1 mL of lidocaine 2% and 1 mL of triamcinolone 40 mg/mL was prepared for each patient of group A for conducting GONB. Characteristics of headache attacks, including headache severity, frequency, and duration, were assessed at baseline and after 3 months of intervention. RESULTS: Twenty-six patients in group A (96.3%) and twenty-three in group B (85.2%) completed detoxification, and were thus cured of MOH (P = 0.351). The present study revealed that GONB with local anesthetic and triamcinolone significantly improved the characteristics of headache, including frequency (- 13.66 in group A and - 7.55 in group B), duration (- 7.92 in group A and - 5.88 in group B), and severity (- 3.44 in group A vs. - 1.33 in group B) in group A compared to control (all P value < 0.05). CONCLUSIONS: Although both detoxification programs were effective, detoxification with GONB resulted in better outcomes. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (registration number; IRCT20150906023922N2).


Assuntos
Transtornos da Cefaleia Secundários , Bloqueio Nervoso , Anestésicos Locais , Cefaleia/induzido quimicamente , Cefaleia/tratamento farmacológico , Transtornos da Cefaleia Secundários/tratamento farmacológico , Humanos , Irã (Geográfico) , Resultado do Tratamento , Triancinolona
6.
J Res Med Sci ; 27: 31, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35548177

RESUMO

Background: Neurological manifestations of coronavirus disease 2019 (COVID-19) have been highlighted. COVID-19 potentially increases the risk of thromboembolism. We aimed to compare patients with COVID-19 with and without new-onset acute ischemic stroke (AIS). Materials and Methods: In this single-center retrospective case-control study, demographics, clinical characteristics, laboratory findings, and clinical outcomes were compared between 51 patients with both COVID-19 and AIS (group A) and 160 patients with COVID-19 and without AIS (group B). Results: Patients in group A were significantly older, more likely to present with critical COVID-19 (P = 0.004), had higher rates of admission in the intensive care unit (P < 0.001), more duration of hospitalization (P < 0.001), and higher in-hospital mortality (P < 0.001). At the time of hospitalization, O2 saturation (P = 0.011), PH (P = 0.04), and HCO3 (P = 0.005) were lower in group A. White blood cell count (P = 0.002), neutrophil count (P < 0.001), neutrophil-lymphocyte ratio (P = 0.001), D-Dimer (P < 0.001), blood urea nitrogen (BUN) (P < 0.001), and BUN/Cr ratio (P < 0.001) were significantly higher in patients with AIS. Conclusion: Stroke in COVID-19 is multifactorial. In addition to conventional risk factors of ischemic stroke (age and cardiovascular risk factors), we found that patients with more severe COVID-19 are more prone to ischemic stroke. Furthermore, leukocyte count, neutrophil count, neutrophil-lymphocyte ratio, D-Dimer, BUN, and BUN/Cr ratio were higher in patients with AIS following COVID-19 infection.

7.
J Res Med Sci ; 27: 82, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36685031

RESUMO

Background: Survival and prognostic factors following stroke occurrence differ between world regions. Studies investigating stroke features in the Middle-east region are scarce. We aimed to investigate 1-year survival and related prognostic factors of stroke patients in Central Iran. Materials and Methods: It is an observational analytical study conducted on patients registered in the Persian Registry of Cardiovascular Disease-Stroke (PROVE-Stroke) database. Records of 1703 patients admitted during 2015-2016 with the primary diagnosis of stroke in all hospitals of Isfahan, Iran were reviewed. Information regarding sociodemographic characteristics, clinical presentations, medications, and comorbidities were recorded. The living status of patients after 1 year from stroke was considered as 1-year survival. Results: Among 1345 patients with the final diagnosis of stroke, 970 (72.1%) were alive at the 1 year follow-up and the mean survival time based on Kaplan-Meier procedure was estimated 277.33 days. The hemorrhagic and ischemic types of stroke were reported in 201 (15.0%) and 1141 (84.8%) patients, respectively. Age (hazard ratio [HR] = 1.07, 95% confidence interval [CI] = 1.05-1.09), diabetes (HR = 1.49, 95% CI = 1.07-2.06), history of stroke or transient ischemic attack (HR = 1.81, 95% CI = 1.30-2.52), history of warfarin usage (HR = 1.73, 95% CI = 1.11-2.71), hospital complications of hemorrhage (HR = 3.89, 95% CI = 2.07-7.31), sepsis (HR = 1.78, 95% CI = 1.18-2.68), and hydrocephalus (HR = 3.43, 95% CI = 1.34-8.79), and modified Rankin Scale (mRS) ≥3 at the time of hospital dicharge (HR = 1.98, 95% CI = 1.27-3.07), were predictors of 1-year survival. Conclusion: Predictors of 1-year survival can be categorized into unchangeable ones, such as age, diabetes, previous stroke, and mRS. The changeable factors, such as hospital complications of infection and hemorrhage, guide physicians to pay greater attention to reduce the risk of mortality following stroke.

8.
Int J Vitam Nutr Res ; 91(1-2): 48-55, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31259666

RESUMO

Background: Stroke is a major global health problem that contributes to a significant burden of morbidity and mortality. The association of several foods and nutrients with stroke has been well-established. However, the effect of the whole diet on stroke is poorly understood. In this work, we aimed to examine the association between the quality of whole diet, as measured using Alternate Healthy Eating Index-2010 (AHEI-2010), and risk of stroke in Iranian adults. Methods: In this hospital-based case-control study, 193 stroke patients (diagnosed based on clinical and brain CT findings) and 193 controls with no history of cerebrovascular diseases or neurologic disorders were included. The participants' dietary intakes were examined using a validated 168-item semi-quantitative food frequency questionnaire. AHEI-2010 was constructed based on earlier studies. Participants were classified according to tertiles of AHEI-2010 scores and multivariate logistic regression was used to evaluate the association between whole diet quality and risk of stroke. Results: Individuals with greater adherence to AHEI-2010 had a higher intake of fruits, vegetables, nuts and legumes, whole grains and carbohydrate, and a lower intake of trans-fatty acids, sugar-sweetened beverages, total energy and fat (P < 0.05). After adjusting for potential confounders, adherence to AHEI-2010 was not significantly associated with a reduced risk of stroke (OR: 0.92; 95% CI: 0.56-1.51). Conclusion: We found that adherence to AHEI-2010 was not associated with risk of stroke in Iranian adults. Further prospective studies are warranted to validate this finding and clarify the relationship between whole diet and stroke.


Assuntos
Dieta Saudável , Acidente Vascular Cerebral , Adulto , Estudos de Casos e Controles , Dieta , Humanos , Irã (Geográfico)/epidemiologia , Estudos Prospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
9.
J Stroke Cerebrovasc Dis ; 30(6): 105670, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33751991

RESUMO

BACKGROUND: Considering the high burden of stroke in developing countries, it is important for the community to have adequate information and awareness of this disease. In this study, the baseline knowledge of an Iranian population towards stroke has been evaluated. METHOD: This study was conducted in a governmental hospital in Isfahan, Iran. The participants were selected from the companions of non-cardio-vascular hospitalized patients. A self-administered questionnaire was designed for gathering information RESULTS: A total of 630 questionnaires were analysed. Hypertension and stress were the most frequently identified risk factors (recognised by 83.7% and 75.8% respectively), while pregnancy, oral contraceptives, and anti-coagulants were the least (recognised by 3.5%, 14.2% and 15.8% respectively). Knowledge of other important risk factors such as cardiac diseases was also relatively low (39.4%). Sudden visual difficulties and irrelevant speech were the least identified warning signs of stroke (45.3% and 34.6% respectively), however, knowledge towards all other warning signs was moderately good (each identified by 60-70%). Importantly only 44.2% of respondents were aware that stroke treatment should be started within the first 3 hours. Participants tended to have moderately good insight of most stroke complications and rehabilitation (60-70%). Urban residence, high level of education and knowing someone with a history of stroke were significant predictors of a higher level of stroke awareness. CONCLUSION: The findings of this study indicate that there is a need to improve general knowledge of cardiac and hypercoagulable related risk factors. Furthermore, understanding of the importance of time critical stroke management and the ineffectiveness of traditional medicine needs to be raised in the general community.


Assuntos
Conscientização , Países em Desenvolvimento , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde , Acidente Vascular Cerebral , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Educação de Pacientes como Assunto , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Inquéritos e Questionários , Tempo para o Tratamento , Adulto Jovem
10.
Nutr Neurosci ; 23(6): 465-470, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31354094

RESUMO

Objective: This study was conducted to investigate the association between dietary TAC and odds of stroke among Iranian adults.Methods: This case-control study was done on 195 hospitalized stroke cases and 195 hospital-based controls in Al-Zahra hospital, Isfahan, Iran. Dietary TAC was estimated using the ferric-reducing antioxidant power (FRAP) international databases. Stroke was confirmed by a trained neurologist using standard imaging methods.Results: Mean dietary TAC was not significantly different comparing cases and controls (10.2 ± 6.0 vs. 10.4 ± 4.8, P = 0.61). However, after adjustment for potential confounders including dietary intakes of fiber and omega-3 fatty acids, we found an almost significant inverse association between dietary TAC and odds of stroke; such that each unit increase in dietary TAC was associated with 29% reduced odds of stroke (OR: 0.71; 95% CI: 0.50-1.01, P = 0.06). When we examined the association across tertiles of dietary TAC, we found that after controlling for potential confounders, those in the top tertile of dietary TAC were 51% less likely to have a stroke than those in the bottom tertile (0.49; 0.23-1.00).Discussion: We found an almost significant inverse association between dietary TAC and odds of stroke.


Assuntos
Antioxidantes/administração & dosagem , Dieta/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances
11.
Home Health Care Serv Q ; 39(3): 154-167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32401625

RESUMO

The present study aimed to determine the effect of education based on the BASNEF model on the physical activity and improvement of motor activity in patients with stroke. This randomized control trial study was conducted on 40 patients with acute ischemic stroke admitted to a teaching hospital in Isfahan, Iran from August 2017 to September 2018. The patients were randomly divided into intervention and control groups. The intervention included personal education and a manual CD of physical activity for the intervention group. After education, the mean scores of the BASNEF model's constructs in the intervention group were significantly higher than those of the control group (P < .001). Furthermore, the motor ability of the intervention group in upper and lower extremities was significantly higher than that of the control group (p < .001). Interventions based on educational models can increase the motivation of patients with stroke in performing recommended physical activity.


Assuntos
Exercício Físico/psicologia , Serviços de Assistência Domiciliar/normas , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral/normas , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde/métodos , Estudos Prospectivos , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/tendências
12.
J Stroke Cerebrovasc Dis ; 28(10): 104247, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31350167

RESUMO

BACKGROUND/OBJECTIVE: Most of the studies and registries related to cerebral venous thrombosis (CVT) are reported from European countries and the United States. The objective of the present study is to identify risk factors, presentation, and outcome of CVT in Asian patients. METHODS: Asian CVT registry is a prospective multinational observational study that included patients (aged > 16 years) with symptomatic CVT. RESULTS: Eight hundred and twelve patients (59% women) from 20 centers in 9 Asian countries were included. Mean age of the patients was 31 years. Motor weakness in limbs was present in 325 (40%) patients. One hundred and eighty (22.1%) patients had a normal Glasgow coma scale (GCS) at presentation, and another 529 patients (65%) had GCS between 11 and 14. The rest (103; 13%) had a GCS of less than 10 at presentation. Permanent risk factors were present in 264 (33%) patients, transient in 342 (42%) patients, both in 43 (5%) patients and no risk factors were found in 163 (20%) patients. Anemia was present in 51%, use of oral contraceptive pills (OCP) was present in 12% women and a hypercoaguable state was present in more than 40% of those tested. One hundred and forty-three cases (18%) were in women who were either pregnant (18; 2%) or in the puerperium (up to 6 weeks postpartum; N = 125; 15%). A total of 86 (10.5%) patients were diagnosed with infection in any part of the body. The most common MRI finding was local brain edema or ischemia (53.3%) followed by hemorrhage (26.7%). Twenty-seven patients (3.3%) died during hospital stay. The mRS score at discharge was available for 661 (81%) patients. Of these, 577 (87.3%) had good functional outcome at discharge. Motor weakness at presentation, GCS of 9 or less and mental status disorder were the strongest independent predictors of mortality at last follow-up among patients with CVT. CONCLUSIONS: Important differences were identified as compared to western data including younger age, high frequency of anemia, low use of OCP, and high frequency of hypercoaguable states. Functional outcome at discharge was good.


Assuntos
Trombose Intracraniana/epidemiologia , Trombose Venosa/epidemiologia , Adolescente , Adulto , Fatores Etários , Anemia/epidemiologia , Ásia/epidemiologia , Anticoncepcionais Orais Hormonais/efeitos adversos , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/mortalidade , Trombose Intracraniana/terapia , Masculino , Gravidez , Estudos Prospectivos , Recuperação de Função Fisiológica , Sistema de Registros , Fatores de Risco , Trombofilia/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/mortalidade , Trombose Venosa/terapia , Adulto Jovem
13.
Eur Neurol ; 79(1-2): 82-85, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29275418

RESUMO

BACKGROUND: The effect of opium addiction (OA) on cerebrovascular disease is controversial. The aim of this study was to clarify this relationship in Iranian patients with ischemic stroke. METHODS: In a case-control study, 672 patients with ischemic stroke and 293 controls without a previous history of cerebrovascular or cardiovascular diseases were compared. OA as well as other risk factors such as diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, tobacco smoking (TS) were compared between the 2 groups. RESULTS: OA percentage, TS, TS amount (pack/year), HTN and DM history were significantly higher in the case group compared to controls (p < 0.05). After regression analysis between risk factors, a significant difference remained between 2 groups with regards to HTN (OR 4.21, 95% CI 3.05-5.81, p < 0.001), TS (OR 2.33, 95% CI 1.51-3.59, p < 0.001), and OA (OR 2.36, 95% CI 1.16-4.85, p = 0.018). CONCLUSION: Our study showed OA is a risk factor for stroke. However, a follow-up study with a larger cohort is required to confirm the results.


Assuntos
Dependência de Ópio/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Seguimentos , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
14.
J Res Med Sci ; 22: 19, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28458710

RESUMO

BACKGROUND: According to previous publications, in patients with acute ischemic cerebral infarction, thrombolytic therapy using intravenous tissue plasminogen activator (IV-tPA) necessitates precise documentation of symptoms' onset. The aim of this study was to identify major barriers related to the IV-tPA injection in such patients. MATERIALS AND METHODS: Between the year 2014-2015, patients with definitive diagnosis of acute cerebral infarction (n = 180) who attended the neurology ward located at the Isfahan Alzahra Hospital were studied. To investigate barriers related to door to IV-tPA needle time, personal reasons, and criteria for inclusion or exclusion of patients, three questionnaire forms were designed based on the Food and Drug Administration-approved indications or contraindications. RESULTS: The mean age of males versus females was 60 versus 77.5 years (ranged 23-93 vs. 29-70 years), respectively. Out of total population, only 10.7% transferred to hospital in <4.5 h after the onset of symptoms. Regarding to eligibility for IV-tPA, 68.9% of total population have had criteria for such treatment. Concerning to both items such as transferring to hospital in <4.5 h after the onset of symptoms and eligibility for IV-tPA, only 6.6% of total population met the criteria for such management. There was ignorance or inattention to symptoms in 75% of population studied. There was a mean of 195.92 ± 6.65 min (182.8-209.04 min) for door to IV-tPA needle time. CONCLUSION: Despite the international guidelines for IV-tPA injection within 3-4.5 h of ischemic stroke symptoms' onset, the results of this study revealed that falling time due to ignorance of symptoms, literacy, and living alone might need further attention. As a result, to decrease death and disability, educational programs related to the symptoms' onset by consultant neurologist in Isfahan/Iran seem to be advantageous.

15.
J Res Med Sci ; 21: 47, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27904593

RESUMO

BACKGROUND: The role of endothelial progenitor cells (EPCs) in the maintenance of vascularization following ischemic brain after experimental stroke has been established. Accordingly, in this study, we evaluated the role of circulating EPCs in transient ischemic attack (TIA) patients for future cerebrovascular (CV) events. MATERIALS AND METHODS: The level of circulating EPCs (staining markers: CD34, CD309) were determined using flow cytometry at 24 h after TIA in thirty consecutive patients. The EPCs level was also evaluated once in thirty healthy volunteers. Over a period of 12 months, all patients were evaluated by an experienced neurologist for recurrent TIA, stroke or death induced by CV disorders. RESULTS: Circulating EPCs increased in patients group following the first attack of TIA when compared with controls. By analysis of covariance, cardiovascular event history, hyperlipidemia, and statin therapy remained significant independent predictors of EPCs. The mean (standard deviation) duration of follow-up was 10.5 (3.1) months (range, 2-12 months). During follow-up, a total of three patients died due to CV accident and four patients experienced again recurrent TIA. By analyzing data with Cox regression, EPC did not predict the future CV events in TIA patients. CONCLUSION: Increased incidence of future CV events did not occur in those patients with elevated EPCs in the first attack of TIA. The significant predicting factors of EPCs were cardiovascular event history, hyperlipidemia, and statin therapy.

16.
J Am Coll Nutr ; 34(5): 408-15, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25826615

RESUMO

BACKGROUND: Despite the growing body of evidence from Western societies on the association between dietary patterns and stroke, limited data are available in this regard from developing countries. OBJECTIVE: This study was conducted to examine the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and risk of stroke among the Iranian population. METHODS: This hospital-based case-control study included 194 stroke patients and 194 controls and was conducted at the Alzahra University Hospital, Isfahan, Iran. The cases were stroke patients who were hospitalized in the neurology ward of the Alzahra University Hospital. Controls were randomly selected from among hospitalized patients in the orthopedic or surgical wards of this center. A validated food frequency questionnaire (FFQ) was used to assess the patients' usual dietary intake. We constructed the DASH diet score based on food and nutrients emphasized or minimized in the DASH diet. RESULTS: The prevalence of stroke among those in the top quartile of the DASH diet score was 40%, which was 15% lower than among those in the bottom quartile; this difference was marginally significant (p = 0.10). After controlling for age, sex, and total energy intake, adherence to the DASH diet was inversely associated with the risk of stroke (OR: 0.52; 95% CI: 0.28; 0.98). These associations remained significant even after additionally controlling for physical activity, smoking, hypertension, and diabetes, such that individuals in the highest quartile of the DASH diet score had a 58% lower risk of stroke than those in the lowest category (OR: 0.48; 95% CI: 0.24, 0.96). However, after further adjustment for body mass index (BMI), the association disappeared (OR: 0.62; 95% CI: 0.29, 1.31), indicating an obesity-dependent association. CONCLUSION: We found an inverse relationship between the DASH-style diet and prevalence of stroke. Prospective studies are needed to confirm this association.


Assuntos
Dieta , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Casos e Controles , Ingestão de Energia , Feminino , Humanos , Hipertensão/dietoterapia , Irã (Geográfico)/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Análise Multivariada , Avaliação Nutricional , Cooperação do Paciente , Prevalência , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
17.
J Am Coll Nutr ; 34(1): 32-41, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25565395

RESUMO

BACKGROUND: Although several studies have linked dietary patterns to the risk of stroke in Western countries, we are aware of no report in Middle Eastern populations with regard to this association. OBJECTIVE: The aim of this study was to examine the association between major dietary patterns and risk of stroke among a group of Iranian population. METHODS: In a hospital-based case-control study, 195 stroke patients, hospitalized in Alzahra University Hospital in 2008, were selected as cases and 195 control subjects from patients hospitalized in orthopedic or surgical wards with no history of cerebrovascular diseases or neurologic disorders were recruited. Usual dietary intakes of participants were assessed by means of a validated 168-item semiquantitative food frequency questionnaire. To identify major dietary patterns, principal component analysis was used and each participant received a factor score for each identified pattern. RESULTS: We identified 3 major dietary patterns: high carbohydrate-low fat dietary pattern, sweet-fatty dietary pattern, and traditional dietary pattern. Those in the highest quartile of traditional dietary pattern were 4.48 times more likely to have stroke compared to those in the lowest quartile. After adjustment for confounders, the association was attenuated. A significant association between high carbohydrate-low fat dietary pattern and stroke was also observed after controlling for potential confounding factors (odds ratio = 2.19, 95% confidence interval, 1.08-4.44). Consumption in the sweet-fatty food pattern was not associated with the risk of stroke either in crude or in adjusted models. CONCLUSION: Major dietary patterns identified by principal components analysis are significantly associated with stroke in a Middle Eastern population.


Assuntos
Inquéritos sobre Dietas/estatística & dados numéricos , Dieta/efeitos adversos , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Doces , Estudos de Casos e Controles , Carboidratos da Dieta/administração & dosagem , Carboidratos da Dieta/efeitos adversos , Gorduras na Dieta/administração & dosagem , Gorduras na Dieta/efeitos adversos , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Razão de Chances , Análise de Componente Principal , Fatores de Risco
18.
Public Health Nutr ; 18(6): 1084-90, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24924876

RESUMO

OBJECTIVE: We aimed to examine the association between red meat consumption and stroke in a group of Iranian adults. DESIGN: A hospital-based case-control study. SETTING: The study included stroke patients and hospital-based controls. Usual dietary intakes of participants were assessed by means of a validated 168-item semi-quantitative FFQ. Total red meat consumption was calculated by summing up the consumption of red, processed and visceral meats. SUBJECTS: One hundred and ninety-five cases were stroke patients hospitalized in the neurology ward and 195 controls were recruited from patients hospitalized in other wards with no history of cerebrovascular diseases or neurological disorders. RESULTS: Participants with stroke were older, more likely to be male and less likely to be obese. Individuals in the highest tertile of red meat intake were 119 % more likely to have stroke (OR=2·19; 95% CI 1·33, 3·60) compared with those in the lowest tertile. After controlling for age, sex and total energy intake, the association between red meat consumption and stroke was strengthened (OR=2·72; 95% CI 1·53, 4·83). This association remained significant even after further controlling for physical activity and smoking as well as dietary intakes. Additional adjustments for BMI, diabetes, hypertension and hyperlipidaemia did not influence the association significantly (OR=2·51; 95 % CI 1·19, 5·09). CONCLUSIONS: Consumption of red meat was associated with greater odds of having stroke in a group of Iranian adults.


Assuntos
Fenômenos Fisiológicos da Nutrição do Idoso , Produtos da Carne/efeitos adversos , Carne/efeitos adversos , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Animais , Estudos de Casos e Controles , Bovinos , Feminino , Coração , Humanos , Irã (Geográfico)/epidemiologia , Rim , Fígado , Masculino , Pessoa de Meia-Idade , Músculo Esquelético , Prevalência , Estudos Prospectivos , Fatores de Risco , Carneiro Doméstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia
19.
J Res Med Sci ; 20(6): 554-62, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26600830

RESUMO

BACKGROUND: Factor V G1691A (FV Leiden), FII GA20210, and methylenetetrahydrofolate reductase (MTHFR) C677T mutations are the most common genetic risk factors for thromboembolism in the Western countries. However, there is rare data in Iran about cerebral venous and sinus thrombosis (CVST) patients. The aim of this study was to evaluate the frequency of common genetic thrombophilic factors in CVST patients. MATERIALS AND METHODS: Forty consequently CVST patients from two University Hospital in Isfahan University of Medical Sciences aged more than 15 years from January 2009 to January 2011 were recruited. In parallel, 51 healthy subjects with the same age and race from similar population selected as controls. FV Leiden, FII GA20210, MTHFR C677T, and FV Cambridge gene mutations by polymerase chain reaction technique were evaluated in case and control groups. RESULTS: FV Leiden, FII GA20210, and FV Cambridge gene mutations had very low prevalence in both case (5%, 2%, 0%) and control (2.5%, 0%, 0%) and were not found any significant difference between groups. MTHFR C677T mutations was in 22 (55%) of patients in case group and 18 (35.5%) of control group (P = 0.09). CONCLUSION: This study showed that the prevalence of FV Leiden, FII GA20210, and FV Cambridge were low. Laboratory investigations of these mutations as a routine test for all patients with CVST may not be cost benefit.

20.
J Stroke Cerebrovasc Dis ; 23(4): 675-80, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23834851

RESUMO

BACKGROUND: Combined oral contraceptives (COCs) are considered for their thrombogenicity and the risk of premature atherosclerosis and the stroke caused by them. The aim of this study was to evaluate the relationship between chronic use of low-dose COCs (ethinyl estradiol 30 mcg + levonorgestrel 150 mcg) and endothelial dysfunction and intima-media thickness. METHODS: In a cross-sectional study, in 2011-2012, 60 healthy premenopausal women (30 cases of COC consumers and 30 controls as nonconsumers), aged between 25 and 45 years, participated in this study. They were current users for at least a 3-year period. Brachial artery flow-mediated dilatation (FMD) and common carotid artery intima-media thickness (CCA-IMT) were measured for the patients. RESULTS: The mean duration of COC consumption was 54.03 ± 27.27 months in the case group. There was a significant FMD% difference between 2 groups of cases and controls: 11 ± 3.53 versus 15.80 ± 9.22 (P = .01). In addition, a significant mean CCA-IMT thickness difference was detected: .53 ± .07 versus .44 ± .08 (P = .00). However, after multiple regression analysis and adjusting for body mass index (BMI), in COC users, no significant association between COC consumption duration and FMD% and mean CCA-IMT was observed. CONCLUSIONS: Prolonged used of low-dose COCs may cause changes in both endothelial function (measured by FMD%) and endothelial structure (measured by CCA-IMT). There was a nonsignificant inverse relationship between the duration of COC ingestion and FMD% and a nonsignificant positive relationship with CCA-IMT. Our results are in favor of early atherosclerotic changes in prolonged users of COCs.


Assuntos
Artéria Braquial/fisiopatologia , Artérias Carótidas/fisiopatologia , Espessura Intima-Media Carotídea , Anticoncepcionais Orais Combinados/efeitos adversos , Endotélio Vascular/fisiopatologia , Adulto , Aterosclerose/induzido quimicamente , Aterosclerose/patologia , Pressão Sanguínea/efeitos dos fármacos , Artéria Braquial/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Combinação de Medicamentos , Endotélio Vascular/diagnóstico por imagem , Etinilestradiol/efeitos adversos , Feminino , Humanos , Levanogestrel/efeitos adversos , Adulto Jovem
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