Quality of in-hospital care in traumatic spinal column and cord injuries (TSC/SCI) in I.R Iran.

PURPOSE: This study aimed to implement the Quality of Care (QoC) Assessment Tool from the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to map the current state of in-hospital QoC of individuals with Traumatic Spinal Column and Cord Injuries (TSCCI). METHODS: The QoC Assessment Tool, developed from a scoping review of the literature, was implemented in NSCIR-IR. We collected the required data from two primary sources. Questions regarding health system structures and care processes were completed by the registrar nurse reviewing the hospital records. Questions regarding patient outcomes were gathered through patient interviews. RESULTS: We registered 2812 patients with TSCCI over six years from eight referral hospitals in NSCIR-IR. The median length of stay in the general hospital and intensive care unit was four and five days, respectively. During hospitalization 4.2% of patients developed pressure ulcers, 83.5% of patients reported satisfactory pain control and none had symptomatic urinary tract infections. 100%, 80%, and 90% of SCI registration centers had 24/7 access to CT scans, MRI scans, and operating rooms, respectively. Only 18.8% of patients who needed surgery underwent a surgical operation in the first 24 h after admission. In-hospital mortality rate for patients with SCI was 19.3%. CONCLUSION: Our study showed that the current in-hospital care of our patients with TSCCI is acceptable in terms of pain control, structure and length of stay and poor regarding in-hospital mortality rate and timeliness. We must continue to work on lowering rates of pressure sores, as well as delays in decompression surgery and fatalities.

Nitric oxide pathway presumably does not contribute to antianxiety and memory retrieval effects of losartan.

Nitric oxide (NO) and angiotensin (AT) receptors have demonstrated well-established interactions in various physiological phenomena. AT1 receptors can play a part in stress-induced activation of the hypothalamic-pituitary-adrenal axis; also, angiotensinergic neurotransmission plays a pivotal role in stress-evoked physiological responses. On the basis of the stress-modulating characteristics of NO, AT1, and AT2 receptors, the present study evaluated the roles of NO and AT1 receptors in the attenuation of stress-induced anxiety-like behaviors after administration of losartan, an AT1 antagonist. Male Wistar rats were exposed to the communication stress box, using a novel method to induce physical or emotional stress, and losartan (10 mg/kg), losartan+L-NG-nitroargininemethyl ester (L-NAME), L-NAME (1, 10, and 100 mg/kg), and normal saline-treated groups were compared. Losartan had reduced behavioral changes induced by both types of stressor and enhanced memory retrieval. Anxiety-like behaviors were significantly attenuated by administration of losartan, to a greater extent in the emotional rather than physical stress group. None of the injected dosages of L-NAME reversed the antianxiety and memory retrieval effects of losartan. Our results indicate that losartan probably improves memory retrieval and lessens anxiety-like behaviors through mechanisms other than the NO pathway.

Predicting mortality, hospital length of stay and need for surgery in pediatric trauma patients.

PURPOSE: Pediatric trauma is one of the major health problems around the world which threats the life of children. The survival of injured children depends upon appropriate care, accurate triage and effective emergent surgery. The objective of this study was to determine the predictive values of injury severity score (ISS), new injury severity score (NISS) and revised trauma score (RTS) on children's mortality, hospitalization and need for surgery. METHODS: In this study, records of trauma patients under 15 years old transported from a trauma scene to emergency department of Poursina hospital from 2010 to 2011 were included. Statistical analysis was applied to determine the ISS, NISS and RTS ability in predicting the outcomes of interest. RESULTS: There were 588 records in hospital registry system. The mean age of the patients was (7.3 ± 3.8) years, and 62.1% (n = 365) of patients were male. RTS was the more ability score to predict mortality with an area under curve (AUC) of 0.99 (95% CI, 0.99-1). In the hospital length of stay (LOS), ISS was best predictor for both the hospital LOS with AUC of 0.72 (95% CI, 0.67-0.76) and need for surgical surgery with AUC of 0.94 (95% CI, 0.90-0.98). CONCLUSION: RTS as a physiological scoring system has a higher predicting AUC value in predicting mortality. The anatomic scoring systems of ISS and NISS have good performance in predicting of hospital LOS and need for surgery outcomes.

Turn Around, Don't Drown: A Systematic Review of Risk Factors for Motor Vehicle-Related Drowning in Floods and its Preventive Strategies.

OBJECTIVE: Exposure to flood, one of the most widespread disasters caused by natural hazards, increases the risk of drowning. Driving through flooded waterways is a cause of death due to flood-related drowning, especially in flood-prone areas. This study aimed at identifying the risk factors for motor vehicle-related drowning in floods and its prevention strategies. METHODS: International and national databases (WOS, PubMed, Scopus, Google Scholar, Magiran, and SID) were searched in the time span from 2000 to 2022. The studies investigating the risk factors relevant to land motor vehicle-related drowning in floods and its prevention strategies were included and analyzed using thematic content analysis. RESULTS: In 14 eligible studies, risk factors for land motor vehicle-related drowning in floods were identified and categorized in 3 subthemes: driver (3 categories: socio-demographic characteristics, knowledge and attitude, and beliefs); technology (1 category: land motor vehicles); and environment (2 categories: physical and socio-economic environment). Physical and structural measures (1 category: road safety improvement) and nonstructural measures (4 categories: research and education and raising awareness, risk management, promoting social-cognitive beliefs, and reconstruction and improvement of legal infrastructure) were proposed as drowning prevention strategies. CONCLUSIONS: The knowledge, attitude, and belief of the driver; the vehicle; and the environment were the most important risk factors of driving through flooded waterways. These factors should be considered when designing programs and physical and structural strategies for future interventions to curb this dangerous and potentially fatal driving behavior.

Practical immunomodulatory landscape of glioblastoma multiforme (GBM) therapy.

Glioblastoma multiforme (GBM) is the most common harmful high-grade brain tumor with high mortality and low survival rate. Importantly, besides routine diagnostic and therapeutic methods, modern and useful practical techniques are urgently needed for this serious malignancy. Correspondingly, the translational medicine focusing on genetic and epigenetic profiles of glioblastoma, as well as the immune framework and brain microenvironment, based on these challenging findings, indicates that key clinical interventions include immunotherapy, such as immunoassay, oncolytic viral therapy, and chimeric antigen receptor T (CAR T) cell therapy, which are of great importance in both diagnosis and therapy. Relatively, vaccine therapy reflects the untapped confidence to enhance GBM outcomes. Ongoing advances in immunotherapy, which utilizes different methods to regenerate or modify the resistant body for cancer therapy, have revealed serious results with many different problems and difficulties for patients. Safe checkpoint inhibitors, adoptive cellular treatment, cellular and peptide antibodies, and other innovations give researchers an endless cluster of instruments to plan profoundly in personalized medicine and the potential for combination techniques. In this way, antibodies that block immune checkpoints, particularly those that target the program death 1 (PD-1)/PD-1 (PD-L1) ligand pathway, have improved prognosis in a wide range of diseases. However, its use in combination with chemotherapy, radiation therapy, or monotherapy is ineffective in treating GBM. The purpose of this review is to provide an up-to-date overview of the translational elements concentrating on the immunotherapeutic field of GBM alongside describing the molecular mechanism involved in GBM and related signaling pathways, presenting both historical perspectives and future directions underlying basic and clinical practice.

The effects of the combination therapy of chemotherapy drugs on the fluctuations of genes involved in the TLR signaling pathway in glioblastoma multiforme therapy.

One of the most lethal and aggressive types of malignancies with a high mortality rate and poor response to treatment is glioblastoma multiforme (GBM). This means that modernizing the medications used in chemotherapy, in addition to medicines licensed for use in other illnesses and chosen using a rationale process, can be beneficial in treating this illness. Meaningly, drug combination therapy with chemical or herbal originations or implanting a drug wafer in tumors to control angiogenesis is of great importance. Importantly, the primary therapeutic hurdles in GBM are the development of angiogenesis and the blood-brain barrier (BBB), which keeps medications from getting to the tumor. This malignancy can be controlled if the drug's passage through the BBB and the VEGF (vascular endothelial growth factor), which promotes angiogenesis, are inhibited. In this way, the effect of combination therapy on the genes of different main signaling pathways like TLRs may be indicated as an impressive therapeutic strategy for treating GBM. This article aims to discuss the effects of chemotherapeutic drugs on the expression of various genes and associated translational factors involved in the TLR signaling pathway.

Trinitroglycerin-loaded chitosan nanogels accelerate angiogenesis in wound healing process.

Trinitroglycerin (TNG) with remarkable angiogenic, antibacterial, and antioxidative activity is a promising candidate to govern wound healing capacity. However, its clinical administration is limited due to associated complications and NO short half-life. In the current study, TNG-loaded chitosan nanogels (TNG-Ngs) were examined in-vitro and in-vivo to gain insight into their clinical application. We prepared TNG-Ngs and characterized their physiochemical properties. The potential of TNG-Ngs was assessed using biocompatibility, scratch assay, and a full-thickness skin wounds model, followed by histopathological and immunohistochemistry examinations. TNG-Ngs particle size 96 ± 18 and definite size distribution histogram. The loading capacity (LC) and encapsulation efficiency (EE) of prepared TNG-Ngs were 70.2 % and 2.1 %, respectively. The TNG-Ngs samples showed enhanced migration of HUVECs with no apparent cytotoxicity. The topical use of TNG-Ngs200 on the wounds revealed a complete wound closure ratio, skin component formation, less scar width, remarkable granulation tissue, promoted collagen deposition, and enhanced the relative mean density of α-SMA and CD31. TNG-Ngs accelerated wound healing by promoting collagen deposition and angiogenic activity, as well as reducing inflammation. The findings indicated that TNG-Ngs is expected to be well vascularized in the wound area and to be more effective in topical therapy.

Trinitroglycerin-loaded chitosan nanogels: Shedding light on cytotoxicity, antioxidativity, and antibacterial activities.

AIM AND BACKGROUND: Trinitroglycerin (TNG) is a remarkable NO-releasing agent. Here, we synthesized TNG based on chitosan Nanogels (Ngs) for ameliorating complications associated with high-dose TNG administration. METHOD: TNG-Ngs fabricated through ionic-gelation technique. Fourier-transformed infrared (FT-IR), zeta-potential, dynamic light scattering (DLS), and electron microscopy techniques evaluated the physicochemical properties of TNG-Ngs. MTT was used to assess the biocompatibility of TNG-Ngs, as the antioxidative properties were determined via lactate dehydrogenase (LDH), reactive oxygen species (ROS), and lipid peroxide (LPO) assays. The antibacterial activity was evaluated against Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), Methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococci (VRE). RESULTS: Physicochemical characterization reveals that TNG-Ngs with size diameter (96.2 ± 29 nm), polydispersity index (PDI, 0.732), and negative zeta potential (-1.1 mv) were fabricated. The encapsulation efficacy (EE) and loading capacity (LC) were obtained at 71.1 % and 2.3 %, respectively, with no considerable effect on particle size and morphology. The cytotoxicity assay demonstrated that HepG2 cells exposed to TNG-Ngs showed relative cell viability (RCV) of >80 % for 70 µg/ml compared to the TNG-free drug at the same concentration (P < 0.05). TNG-Ngs showed significant differences with the TNG-free drug for LDH, LPO, and ROS formation at the same concentration (P < 0.001). The antibacterial activity of the TNG-Ngs against S. aureus, E. coli, VRE, and MRSA was higher than the TNG-free drug and Ngs (P < 0.05). CONCLUSION: TNG-Ngs with enhanced antibacterial and antioxidative activity and no obvious cytotoxicity might be afforded as novel nanoformulation for promoting NO-dependent diseases.

Human umbilical cord-derived mesenchymal stem cells-harvested mitochondrial transplantation improved motor function in TBI models through rescuing neuronal cells from apoptosis and alleviating astrogliosis and microglia activation.

Each year, traumatic brain injury (TBI) causes a high rate of mortality throughout the world and those who survive have lasting disabilities. Given that the brain is a particularly dynamic organ with a high energy consumption rate, the inefficiency of current TBI treatment options highlights the necessity of repairing damaged brain tissue at the cellular and molecular levels, which according to research is aggravated due to ATP deficiency and reactive oxygen species surplus. Taking into account that mitochondria contribute to generating energy and controlling cellular stress, mitochondrial transplantation as a new treatment approach has lately reduced complications in a number of diseases by supplying healthy and functional mitochondria to the damaged tissue. For this reason, in this study, we used this technique to transplant human umbilical cord-derived mesenchymal stem cells (hUC-MSCs)-derived mitochondria as a suitable source for mitochondrial isolation into rat models of TBI to examine its therapeutic benefit and the results showed that the successful mitochondrial internalisation in the neuronal cells significantly reduced the number of brain cells undergoing apoptosis, alleviated astrogliosis and microglia activation, retained normal brain morphology and cytoarchitecture, and improved sensorimotor functions in a rat model of TBI. These data indicate that human umbilical cord-derived mesenchymal stem cells-isolated mitochondrial transplantation improves motor function in a rat model of TBI via rescuing neuronal cells from apoptosis and alleviating astrogliosis and microglia activation, maybe as a result of restoring the lost mitochondrial content.

Burden in caregivers of spinal cord injury patients: a systematic review and meta-analysis.

BACKGROUND: Caregivers of individuals with spinal cord injury encounter high levels of physical, psychosocial, and financial burden by providing lifelong assistance. In the present study, we aimed to assess the overall burden score of caregivers in spinal cord injury by pooling different standard scores together as a review. METHOD: Search on databases of PubMed/Medline, Web of Science and Scopus was conducted using PRISMA guidelines. Studies that assessed the burden of care using the caregiver burden inventories of CBI (caregiver burden inventory), CBS (caregiver burden scale), CG (caregiver), CSI (Caregiver Strain Index), and short- and long-form Zarit questionnaires were included in our study. The results were analyzed using the meta-analysis method and a random effect pooled estimator. All analyses were performed using STATA SE software version 14. RESULT: A total of 23 articles out of 399 retrieved studies were added to this review study. The overall score of caregiver burden in individuals with SCI was calculated 48.68 (95% CI 42.574-54.788). The I2 heterogeneity was 11.7%, suggesting a low level of heterogeneity among the included studies. There was no systematic difference between various questionnaires added to meta-analysis (P = 0.526). In addition, the caregiver burden did not differ in less and highly developed countries (P = 0.405). CONCLUSION: Since SCI places a considerable burden on caregivers, scoring the burden of care can help policymakers plan for essential interventions and allocate more facilities for these patients and their caregivers.

Determinants of long-term health-related quality of life in adult patients with mild traumatic brain injury.

PURPOSE: Mild traumatic brain injury (mTBI) usually leads to the appearance of post-concussion symptoms (PCS) which may resolve after a short time. In this study, the mental and physical aspects of quality of life (QoL) were evaluated 6 months after mTBI, and the association of demographic and injury-related factors, post-injury primary executive function and PCS types with the long-term QoL status was investigated. METHODS: 123 eligible mTBI patients of initial sampling participated in follow-up phase of this longitudinal study. The demographic, clinical, and para-clinical data of patients were recorded. Paraclinical data comprised brain lesion volume, type and location determined by CT scan. The executive function and primary PCS were examined during the discharge using the verbal fluency task and a checklist, respectively. QoL was measured via SF-36 questionnaire. The collected data were entered into SPSS 22, and analyzed using appropriate statistical tests. RESULTS: Youngers aged between 18 and 35 years and women had a lower QoL score than others. Primary somatic and cognitive PCS together were associated with poor QoL. There was no significant difference in QoL and executive function scores between the normal and abnormal brain CT groups. However, among people with abnormal CT, those having multifocal lesions including at least an intracranial hemorrhage type such as intra parenchymal hemorrhage or extra-axial bleeding together with other intracranial lesions or skull fracture demonstrated less QoL score in SF-36. A significant correlation was discovered between the scores of the executive function and QoL in mental dimensions of SF-36. CONCLUSIONS: This study emphasizes on the clinical significance of early executive function and PCS examination in mTBI population, as well as optimal management of the victims regardless of the initial brain CT findings, especially in high-risk populations.

Cannabidiol enhanced the development of sensitization to the expression of methamphetamine-induced conditioned place preference in male rats.

Cannabis and ecstasy are illicit substances, and currently, there are no approved treatments for methamphetamine (METH) use disorder. Some studies have proposed that cannabidiol (CBD) decreases the motivation for METH seeking, but reports indicate that the therapeutic benefits are only for heroin. Here, we studied the interaction between CBD and METH during the sensitization phase on the rewarding effect of METH, using the conditioned place preference (CPP) paradigm to measure possible alterations in sensitivity. Our data showed that i. p. injection of METH created METH-induced CPP at two of the highest applied doses (1 and 2 mg/kg), and injection of METH during the sensitization period caused an establishment of METH-induced CPP at lower doses (0.25 and 0.5 mg/kg). Data also revealed that i. c.v. administration of CBD during the sensitization phase, shifted the establishment of METH-induced CPP toward a lower dose (0.5 mg/kg). Concurrent administration of CBD (10 µg/5 µl, i. c.v.) and METH (0.25 mg/kg, i. p.) during sensitization phase established METH-induced CPP with sub-threshold doses of METH (0.125, 0.25, and 0.5 mg/kg). Our results suggest the involvement of CBD and prior exposure to METH in creating sensitization to METH CPP.

Prevalence of Cervical Myofascial Pain Syndrome and its Correlation with the Severity of Pain and Disability in Patients with Chronic Non-specific Neck Pain.

BACKGROUND: Nonspecific chronic neck pain is increasing according to work-related gestures and modern lifestyle. Myofascial pain syndrome is a common problem and may be a primary disease. This study was designed to evaluate the prevalence of cervical myofascial pain syndrome in patients with chronic non-specific neck pain with normal MRI. We also examined the correlation between patients' age as well as pain severity and duration. METHODS: Patients with neck pain radiating to their upper extremity were examined despite normal MRI findings. We evaluated 10 different muscles based on myofascial pain syndrome criteria and also recorded pain intensity and functional ability using visual analogue scale and neck disability index, respectively. A physical therapist with at least 10 years of clinical experience with myofascial pain syndrome performed all physical examinations. RESULTS: A total of 126 patients (69 females and 57 males) participated in this study, out of whom, 14 patients (11.1%) had no muscular involvement, while 112 cases (88.9%) revealed at least one trigger point. The infraspinatus and scalene muscles were the most commonly involved muscles accounting for 38.9% and 34.9% of all the involvements, respectively. The severity of pain was significantly associated with the disability of the patients (r=0.64, P<0.001). However, the correlation between pain and the number of trigger points was not significant (r=-0.19, P=0.31). Finally, the least significantly correlated variables were disability and the number of trigger points (r=-0.17, P=0.05). Patient's age was significantly correlated neither with the number of trigger points (r=-0.04, P=0.62), nor the pain duration (r=0.07, P=0.39). CONCLUSION: Myofascial pain syndrome is a common disorder in patients with nonspecific chronic neck pain, despite normal MRI findings. Although, pain is not correlated with the number of trigger points in these patients, we demonstrated a small correlation between patients' disability and the latter variable.

Lobectomy in traumatic brain injury patients with intracerebral hemorrhage and delayed contusion.

BACKGROUND: TBI, standing for Traumatic Brain Injury, is a leading cause of death worldwide; nonetheless, data on its management has hitherto been sparse. In view of the fact that brain lobectomy is a contentious issue in the management of TBI, we set out the current study to assess the mortality rate and outcomes of TBI with delayed contusion or Intracerebral Hemorrhage (ICH) undergoing lobectomy. METHODS: We evaluated 135 TBI patients with delayed contusion or ICH undergoing brain lobectomy from 2001 to 2013. Withal, the mortality and Glasgow Outcome Scale (GOS) and Glasgow Comma Scale (GCS) rates were assessed in these patients and the association in between was sought. RESULTS: The TBI patients undergoing brain lobectomy (77% male versus 23 % female) had a mean age of 43.4±20.3 years and experienced a survival rate of 62.2% (71% in females versus 60% in males). Favorable GOS was observed in 53% of male patients, compared with 27% in the females. Age was demonstrated to significantly affect the mortality rate (p=0.0001). Initial GCS score was associated with GOS as 79.1% of the survived patients with a GCS of higher than 9 on admission were discharged with favorable GOS. CONCLUSIONS: The evidence from the present study indicates that lobectomy can be an acceptable surgical procedure in management of TBI patients with delayed contusion or ICH.

The relationship between weight indices and injuries and mortalities caused by the motor vehicle accidents: a systematic review and meta-analysis.

BACKGROUND: The relationship between weight indices and injuries and mortality in motor vehicle accidents is unknown. Systematic review studies addressing the collection and analysis of the relationship in investigations are very limited. The purpose of this systematic review is to determine the relationship between BMI, obesity and overweight with mortality and injuries and their severity and vulnerable organs after the motor vehicle accident. METHODS: The databases (MEDLINE/PUBMED, EMBASE, Web of Science, etc) were searched for relevant abstracts using certain keywords. Of all the articles, similar ones were removed considering different filters. The collected data were entered into the STATA SE v 13.1. The heterogeneity of the data was analyzed using i2 statistics. In addition, the estimates of the study were done based on the age group (children and adults) and the impact of obesity on different regions of the body. RESULTS: A direct relationship was observed between the overall BMI and the degrees of injuries (CI=0.503-1.139), and mortality due to motor vehicle accident (CI=1.267-1.471). A positive relationship was found between obesity and AIS+2 (CI=0.653-1.426), and AIS+3 (CI=1.184-1.741), and ISS (CI=1.086-1.589). Also, a negative relationship between overweight and injuries rates, and a direct relationship between overweight and mortality (CI=0.979-1.167), and injuries with index of AIS+2 (CI=1.178-0.768) and AIS+3 (CI=0.48-2.186) were found. CONCLUSIONS: The prediction of injury, mortality and severity of injuries in the motor vehicle accident by the variable of obesity and overweight determines the need to design prevention programs for this vulnerable group at all levels.

A comparative study of the dose-dependent effects of low level and high intensity photobiomodulation (laser) therapy on pain and electrophysiological parameters in patients with carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common peripheral nerve disorder of the wrist. Nonsurgical treatments e.g. laser therapy may cause potential beneficial effects. AIM: To compare the dose dependent effects of low level laser therapy (LLLT) and high intensity laser therapy (HILT) on pain and electrophysiology studies in patients with CTS. DESIGN: Double-blind randomized controlled trial. SETTING: Outpatient physiotherapy clinic. POPULATION: Ninety-eight participants with CTS, aged between 20 to 60 years, were randomly assigned to five groups. METHODS: All participants undertook four standard exercises, with one group serving as exercise-only controls. Patients were randomly allocated to either high or low fluence LLLT or high or low fluence HILT received over 5 sessions. All patients were assessed by visual analogue scale, median compound muscle action potential (CMAP) and sensory nerve conduction studies before and 3 weeks after the interventions. RESULTS: VAS was significantly lower in all groups after 3 weeks (P<0.05). CMAP latency decreased in all groups. The interaction of group and time (5×2) was significant for pain (P<0.001), the latency of CMAP (P=0.001) and CMAP amplitude (P=0.02). The interaction of group and time was not significant for the CMAP conduction velocity, sensory nerve latency and amplitude (P>0.05). CONCLUSIONS: HILT with a power of 1.6 W and low fluence of 8 J/cm2 was superior in reduction of pain and improvement of the median motor nerve electrophysiological studies compared to LLLT and exercise-only control groups. CLINICAL REHABILITATION IMPACT: LLLT and HILT in conjunction with exercise program are effective in reducing pain and improving median motor nerve conduction studies of the patients with CTS. It seems that high power and low fluence laser therapy is better than LLLT and exercise interventions to treat these patients.

Cerebral hemodynamic abnormalities of patients with ischemic stroke who are opium addicted: A study by transcranial doppler ultrasonography.

Background: Ischemic stroke as the major cause of mortality and morbidity worldwide has different risk factors. One of its modifiable risk factors is opium addiction whose role is not clear yet. This study aimed at assessing the hemodynamic parameters in ischemic stroke patients addicted to opium using transcranial Doppler (TCD) ultrasonography and comparing them with non-addicted patients. Methods: This comparative cross-sectional study was conducted in an academic hospital in the north of Iran in 2016. All the patients diagnosed as ischemic stroke underwent cerebrovascular ultrasound in the first 4 days of symptoms onset. Frequency of hemodynamic abnormalities confirmed by pulsatility index (PI) and mean flow velocity (MFV) were determined and compared between the two groups. The data were analyzed by chi-square test, t-test, and multiple logistic regression models using SPSS software. Results: A total of 353 patients with ischemic stroke (92 addicted and 261 non-addicted patients) were enrolled in the study. Univariate analysis indicated that the PI and MFV differences were statistically significant between two groups of addicted and non-addicted patients (P = 0.0001). By multivariate logistic regression model, the age [odds ratio (OR) = 1.143], diabetes mellitus (DM) (OR = 3.875), hypertension (HTN) (OR = 2.557), and opium usage (OR = 9.615) had influence on PI and only opium usage (OR = 3.246) had influence on MFV. Conclusion: Opium usage affects the cerebral hemodynamic parameters and increases the chance of having abnormal PI as ten-fold and abnormal MFV as three-fold.

Spontaneous Cervical Epidural Hematoma with Stroke Manifestations.

Spontaneous cervical epidural hematoma (SCEH), which is a rare disease, is manifested as by a sudden quadriplegia or paraplegia and other neurological deficits. SCEH can compress the spinal cord resulting in its clinical manifestations. The reported etiological risk factors are anticoagulants, coagulopathies, vascular malformations, infections, and herniated discs. Here, we report a 77-year-old woman with a presenting chief complaint of left hemiparesis and a history of hypertension. The medical drugs in use were aspirin and antihypertensives. The initiating presentations were hemiparesis, in favor of ischemic stroke, so the patient admitted to neurology ward and received anticoagulant therapy with the initial diagnosis of stroke. Although clinical manifestations and examinations are important in these patients due to mimicking stroke picture, imaging evaluation is paramount for a definite diagnosis, which in our case showed a SCEH, who was suspected to have an ischemic stroke during the initial assessment because its initial demonstration mimicked ischemic stroke. This patient underwent laminectomy after 3 days and showed a clinical recovery the day after. Her muscle strength improved gradually, and neurological symptoms were diminished after physiotherapy.

Effectiveness of an educational program on decreasing burns and injuries in Persian festival of fire: A burden of diseases approach.

Chaharshanbeh souri is a historical Persian firework festival which has several health and financial damages for Iranians near celebration of New Year. In this study we tried to find effectiveness of Chaharshanbeh souri educational campaign on decreasing burden of injuries due to fireworks of this day. In this before-after study, an educational campaign was done for 2017 focusing on children and students. Data of a registry which was designed for gathering information of injuries and mortalities of this festival was used to show effectiveness of the program. Disability adjusted life years was calculated and compared before and after intervention. The results of this study showed that mean age of injuries was increased from 27.75 to 32.65 years and DALY decreased significantly after the intervention (P=0.0460) showing that the intervention was effective. Educational programs might be effective to decrease burden of injuries related to Chaharshanbeh souri festival.

Rolipram optimizes therapeutic effect of bevacizumab by enhancing proapoptotic, antiproliferative signals in a glioblastoma heterotopic model.

The unstable response to bevacizumab is a big dilemma in the antiangiogenic therapy of high-grade glioma that appears to be linked to an increase in the post-treatment intratumor levels of hypoxia-inducible factor 1 α (HIF1α) and active AKT. Particularly, a selective phosphodiesterase IV (PDE4) inhibitor, rolipram is capable of inhibiting HIF1α and AKT in cancer cells. Here, the effect of bevacizumab alone and in presence of rolipram on therapeutic efficacy, intratumor hypoxia levels, angiogenesis, apoptosis and proliferation mechanisms were evaluated. BALB/c mice bearing C6 glioma were received bevacizumab and rolipram either alone or combined for 30 days (n = 11/group). At the last day of treatments, apoptosis, proliferation and microvessel density, in xenografts (3/group) were detected by TUNEL staining, Ki67 and CD31 markers, respectively. Relative expression of target proteins was measured using western blotting. Bevacizumab initially hindered the tumor progression but its antitumor effect was weakened later despite the vascular regression and apoptosis induction. Unpredictably, bevacizumab-treated tumors exhibited the highest cell proliferation coupled with PDE4A, HIF1α and AKT upregulation and p53 downregulation and reversed by co-treatment with rolipram. Unlike a similar antivascular pattern to bevacizumab, rolipram consistently led to a more tumor growth suppression and proapoptotic effect versus bevacizumab. Co-treatment maximally hampered the tumor progression and elongated survival along with the major vascular regression, hypoxia, apoptosis induction, p53 and caspase activities. In conclusion, superior and persistent therapeutic efficacy of co-treatment provides a new insight into antiangiogenic therapy of malignant gliomas, suggesting to be a potential substitute in selected patients.