Epidemiology of Stroke 2 Years Before and During COVID-19 Pandemic in Kerman (south of Iran): a Hospital-Based Study.

INTRODUCTION: Stroke is the second leading cause of death worldwide. Recent studies have shown that the COVID-19 pandemic has been associated with a higher frequency of stroke. This study aimed to investigate the epidemiologic aspects of stroke two years before and during the COVID-19 pandemic in Kerman. METHOD: This cross-sectional study was conducted in Kerman. The participants included all patients with a confirmed diagnosis of stroke. COVID-19 confirmation was based on a positive PCR test. The data was analyzed with SPSS.V24 software. RESULTS: In this study, 4152 patients with stroke were evaluated. The frequency of stroke before and during the COVID-19 pandemic was the same. The total number of stroke patients with COVID-19 was 298 (8.16%). The frequency of ischemic stroke patients before the COVID-19 pandemic was 1751 and during the pandemic was 1770. Before and after the pandemic, the mean age of ischemic stroke patients was 67.42±14.14 and 64.49±14.46 respectively, which showed a statistically significant difference (P>0.001). Our findings showed a significant difference between the NIHSS of ischemic stroke before and after the pandemic (P<0.001). The mortality rate of stroke patients was 111 before COVID-19 and 115 patients in the first two years of COVID-19. Except for the mortality rate (P<0.001), there was no significant difference in other demographic variables between ischemic stroke patients with and without COVID-19. CONCLUSION: The patients with ischemic stroke during the COVID-19 pandemic were younger and had more neurological deficits than the ischemic stroke patients before the pandemic. COVID-19 was associated with higher mortality in patients with ischemic stroke.

Frequency of Asymptomatic Intracranial and Extracranial Arterial Stenosis in a Group of Healthy General Papulation in Kerman (South of Iran).

INTRODUCTION: This study aimed to investigate the frequency of asymptomatic intracranial and extracranial artery stenosis in healthy volunteers in Kerman, Iran, in 2019 using Doppler ultrasound imaging. METHOD: This cross-sectional study was conducted on healthy volunteers in Kerman in 2019 following a public elicitation. After the general examination, 138 healthy volunteers who had no history of any disease and were not treated with any medication underwent cerebrovascular evaluation with Doppler ultrasound. Demographic information, history of addiction, and sonographic findings were recorded in a checklist and then analyzed using SPSS 22. RESULTS: Stenosis was found in 14.4% of volunteers. The mean age of participants was 45.8±10.12 years, and 74 (54%) of them were male. In volunteers with stenosis, a significant correlation was found between age (P = 0.03) and addiction (P = 0.04) with the involved artery. There was also a significant correlation between addiction and intracranial and extracranial artery stenosis (P = 0.04). Logistic regression analysis showed a significant relationship between being female, addiction, and age with stenosis, as well as between addiction and intracranial artery stenosis (P <0.05). CONCLUSION: The majority of healthy residents of Kerman have asymptomatic cerebrovascular stenosis, and this is more prevalent in the elderly, addicts, and women.

Early and mid-term outcomes of carotid angioplasty and stent placement in 579 patients.

BACKGROUND AND PURPOSE: Carotid angioplasty and stenting (CAS) could be considered for preventing stroke in patients with carotid artery stenosis. This study aimed to determine the incidence and the risk factors of the early and mid-term complications associated with CAS. METHODS: This is a retrospective cohort study conducted at Shiraz University of Medical Sciences from March 2011 to March 2019. Patients at high risk and standard risk for carotid endarterectomy were included. The primary composite outcome was defined as stroke, myocardial infarction (MI), and death in the first 30 days after CAS. All-cause mortality, vascular mortality, and stroke were investigated during mid-term follow-up. RESULTS: A total of 579 patients (618 CAS) were recruited (mean age: 71.52 years). Overall, 394 (68.40%), 211 (36.63%), 179 (31.07%), and 96 (16.72%) patients had hypertension, dyslipidemia, diabetes mellitus, or were cigarette smokers, respectively. Primary composite outcomes were observed in 2.59% of patients (1.55% stroke, 0.69% MI, and 1.72% death). Atrial fibrillation was a predictor of primary composite outcome in multivariate logistic regression (p = .048). The presence of total occlusion in the contralateral carotid artery was significantly associated with the risk of stroke in univariate logistic regression (p = .041). The patients were followed for a period ranging from 1 to 83 months. The overall survival rate for all-cause mortality was 93.48% at 1 year, 77.24% at 5 years, and 52.92% at 8 years. All-cause mortality was significantly higher among patients with symptomatic carotid stenosis (p = .014). CONCLUSION: CAS provides acceptable short-term and mid-term outcomes in a unique population of high- and standard-surgical-risk, symptomatic and asymptomatic, octogenarian, and nonoctogenarian patients.

Comparison of Brain Magnetic Resonance Imaging Lesions in Opium Addict and Non-addict Patients with Thrombotic Stroke: A Case-Control Study.

BACKGROUND: There is no consensus on the effect of opium on stroke yet. Some studies show the negative effects of opium on ischemic strokes. Here, we attempt to compare the volume of lesions in opium addict and non-addict patients with thrombotic stroke. METHODS: This case-control study was conducted on patients with thrombotic stroke at Shafa Hospital in Kerman, Iran. The diagnosis was confirmed by clinical examinations, imaging, and laboratory tests. The volume of lesions was calculated by magnetic resonance imaging (MRI), and the data were analyzed by descriptive statistics, Mann-Whitney U test, Chi-square test, and linear regression analysis. FINDINGS: A total of 60 patients were studied, 30 of whom were opium addicts and the rest were non-addicts. The mean volume of the lesion was 46.008350 ± 7.488990 (in the addict group) and 31.023335 ± 1.441570 (in the non-addict group), indicating a significant difference between the two groups (P = 0.005). Regression analysis results showed a significant relationship between the volume of stroke with opium addiction (P = 0.017), ischemic heart diseases (IHDs) (P = 0.006), hyperlipidemia (HLP) (P = 0.016), age (P = 0.035), and smoking (P = 0.044). CONCLUSION: The results of this study showed a higher volume of lesion in opium-addict patients compared to that in non-addicts as an indicator of stroke severity.

The association between incidence and mortality of brain cancer and human development index (HDI): an ecological study.

BACKGROUND: Brain cancer is a rare and deadly malignancy with a low survival rate. The present study aims to evaluate the epidemiology of brain cancer and its relationship with the human development index (HDI) worldwide. METHODS: This is an ecological study. The data on cancer incidence and cancer mortality was extracted from the World Bank for Cancer in 2018 (GLOBOCAN 2018). The incidence, mortality rate, and brain cancer distribution maps were drawn for different countries. We used correlation and regression tests to examine the association of incidence and mortality rates of brain cancer with HDI. The statistical analysis was carried out by Stata-14 and a significance level of 0.05 was considered. RESULTS: According to the results of Global Cancer Registry in 2018, there were 18,078,957 registered cases of cancer in both sexes, of which 29,681 were related to brain cancer. The highest incidence (102,260 cases, 34.4%) and mortality (77,815 cases, 32.3%) belonged to very high HDI regions. Results showed that incidence (r = 0.690, P < 0.0001) and mortality rates (r = 0.629, P < 0.001) of brain cancer are significantly correlated with HDI. We also observed a positive correlation between brain cancer incidence and Gross National Income (GNI) (r = 0.346, P < 0.001), Mean Years of Schooling (MYS) (r = 0.64, P < 0.001), TABLE (LEB) (r = 0.66, P < 0.001) and Expected Years of Schooling (EYS) (r = 0.667, P < 0.001). Results also revealed that mortality rate was significantly correlated with GNI (r = 0.28, P < 0.01), MYS (r = 0.591, P < 0.01), LEB (r = 0.624, P < 0.01), and EYS (r = 0.605, P < 0.01). CONCLUSION: The results of the study showed that the incidence and mortality of brain cancer in countries with higher HDI levels is higher than countries with lower HDI levels, so attention to risk factors and action to reduce it in countries with higher HDI levels in controlling this cancer in this Countries are effective.

Classifying patients with lumbar disc herniation and exploring the most effective risk factors for this disease.

Objectives: To classify patients suffering from low back pain (LBP) into two different groups - patients with lumbar disc herniation (LDH) and patients without this disease based on simple questions and without magnetic resonance imaging (MRI) procedure - and to diagnose the most effective risk factors of LDH. Methods: Four hundred patients aged over 18 years suffering from LBP for over 6 months were randomized into two groups in this cross-sectional study. The data were gathered at Besat clinic, in Kerman, southeast of Iran. Twelve dichotomous questions from the main LDH risk factors were asked. Three statistical classification methods - K-nearest neighbors (KNN), support vector machine (SVM), and logistic regression (LR) - were performed. LR was used in order to diagnose the most important risk factors of LDH. Results: SVM method was more efficient among the small sample sizes, while KNN method showed the best classification relative to other methods when the sample size increased. LR model had the least efficiency of all. The drug use increased the chance of LDH more than 7 times (OR=7.249), and the chance of having LDH among people who had associated illness was 4.847 times more compared with people who did not have. Using hookah increased the chance of having LDH more than twice (OR=2.401), and the chance of smokers for LDH was near four times higher than nonsmokers (OR=3.877). Conclusion: The statistical classification methods had acceptable precisions for diagnosis of LDH patients. It is suggested that neurologists become more familiar with these methods and use them before MRI prescription to decrease the unnecessary burden on health services. Addiction to drugs, cigarettes, and hookah is the main factor in the creation of a lumbar disc herniation.

Cerebrovascular Reactivity and Carotid Intima-Media Thickness in Opium Dependents: A Case-Control Study.

BACKGROUND: There is still no consensus among researchers on the impact of opium dependency on cerebrovascular stenosis. Some studies suggest that opium may be a risk factor for ischemic stroke. This study compared carotid intima-media thickness (CIMT) and cerebrovascular reactivity between opium-dependent and healthy people. METHODS: This case-control study was done among opium addicts at Shafa hospital in Kerman, Iran, in year 2018. People with systemic disease or who took any medicine were excluded from our study. The control group were selected from healthy non-addicted volunteers. The control group was matched in age and sex with the case group. Cerebrovascular reactivity of middle cranial artery and intima-media thickness of carotid artery were measured for all in both groups. The results were analyzed using chi-square, independent samples t, and logistic regression tests. FINDINGS: 47 opium addicts and 47 healthy people entered this study. 88% of them were men and 12% were women. 68.1% of the case group and 31.9% of the control group were cigarette smokers; this difference was statistically significant. Comparison of cerebrovascular reactivity and CIMT between the two groups was statistically significant (P < 0.001). This relationship remained significant for the CIMT after removing confounding factors (P = 0.018). CONCLUSION: Overall, our findings show that opium dependency affects the carotid intima-media thickness as an indicator of cerebral atherosclerosis.

Cost-effectiveness analysis of tissue plasminogen activator in acute ischemic stroke in Iran.

AIMS: Tissue plasminogen activator (tPA) is used to treat acute ischemic stroke up to 4.5 h after symptom onset. Its cost-effectiveness in developing countries is not specified yet. This study aimed to study cost-effectiveness of tPA in Iran. METHODS: This is a cost-effectiveness analysis from the perspective of the third party payer to compare IV tPA with no tPA of ischemic stroke. A Markov model with a lifetime horizon was used to analyze the costs and outcomes. Cost data were extracted from the 94 patients admitted in two hospitals in Iran. All costs were calculated based on US dollars in 2016. Quality-adjusted life years (QALY) were extracted from previously published literature. Cost-effectiveness was determined by calculating ICER by TreeAge Pro 2011 software. RESULTS: Lifetime costs of no tPA strategy were higher than tPA ($10,718 in the no tPA group compared with $8,796 in the tPA group). The tPA arm gained 0.20 QALY compared with no tPA. ICER was $8,471 per QALY. ICER value suggests that tPA is cost-effective compared with no tPA. LIMITATIONS: The limitations of the present study are the reliance on calculated QALY value of other countries and difficulty in accessing patients treated with tPA. CONCLUSIONS: The balance of hospitalization and rehabilitation costs and QALYs support the conclusion that treatment with intravenous tPA in the 4.5-h time window is cost-effective from the perspectives of the third party payer and inclusion of tPA in the insurance benefit package being reasonable.

Deficiency in Mental Rotation of Upper and Lower-Limbs in Patients With Multiple Sclerosis and Its Relation With Cognitive Functions.

Mental rotation is a cognitive motor process which was impaired in different neurologic disorders. We investigated whether there were deficits in response pattern, reaction time and response accuracy rate of mental rotation in multiple sclerosis (MS) patients compared to healthy subjects and whether cognitive dysfunctions in MS patients were correlated with mental rotation deficits. Moreover, we showed whether there was a difference between upper and lower-limbs mental rotation in MS patients. Thirty-five MS patients and 25 healthy subjects performed hand mental rotation (HMR) and foot mental rotation (FMR) tasks. Visual information processing speed, spatial learning and memory ability, and visuospatial processing were assessed by Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), and Judgment of Line Orientation Test (JLO) respectively in MS patients. Reaction time for both hand and foot stimuli increased, and response accuracy rate for hand stimuli decreased in MS patients compared to healthy subjects, but response pattern of mental rotation in MS patients persisted. Similar to healthy subjects, MS patients performed upper-limbs mental rotation more easily than a lower-limbs mental rotation with more speed and response accuracy rate. Reaction time and response accuracy rate were correlated with the mentioned cognitive functions. MS patients made use of the correct response pattern for problem solving of increasing orientation from upright stimuli. Reaction time and response accuracy rate altered in these patients and this alteration might occur along with impairment in motor planning. Subjects' better responding to hand stimuli was due to more familiarity with hand stimuli. The correlation of mental rotation ability with cognitive functions indicates the possible role of cognitive functions in mental rotation.

Effects of Intermittent Theta Burst Stimulation on Manual Dexterity and Motor Imagery in Patients with Multiple Sclerosis: A Quasi-Experimental Controlled Study.

BACKGROUND: Intermittent theta burst stimulation (iTBS) is a repetitive transcranial magnetic stimulation (rTMS) protocol that influences cortical excitability and motor function recovery. OBJECTIVES: This study aimed to investigate the effects of iTBS on manual dexterity and hand motor imagery in multiple sclerosis (MS) patients. METHODS: Thirty-six MS patients were non-randomly assigned into sham (control) or iTBS groups. Then, iTBS was delivered to the primary motor cortex for ten days over two consecutive weeks. The patients' manual dexterity was assessed using the nine-hole peg test (9HPT) and the Box and Block Test (BBT), while the hand motor imagery was assessed with the hand mental rotation task (HMRT). RESULTS: iTBS group showed a reduction in the time required to complete the 9HPT (mean difference = -3.05, P = 0.002), and an increase in the number of blocks transferred in one minute in the BBT (mean difference = 8.9, P = 0.001) when compared to the control group. Furthermore, there was no significant difference between the two groups in terms of the reaction time (P = 0.761) and response accuracy rate (P = 0.482) in the HMRT. CONCLUSIONS: When iTBS was applied over the primary motor cortex, it significantly improved manual dexterity, but had no significant effect on the hand motor imagery ability in MS patients.

Prognostic value of hemoglobin A1c in nondiabetic and diabetic patients with acute ischemic stroke.

Background: Diabetes is a well-known risk factor for acute ischemic stroke (AIS). Some recent studies point to hemoglobin A1c (HbA1c) may have prognostic value in nondiabetic and diabetic patients with ischemic stroke (IS). The aim of this study was to evaluate the prognostic value of HbA1c on mortality and morbidity in AIS patients with and without diabetic. Methods: In this prospective observational study, 150 diabetic and nondiabetic patients with AIS were evaluated for serum HbA1c level, hypertension (HTN), hyperlipidemia, and smoking in the first 24 hours of admission to determine their value to predict mortality and mortality at 30 and 90 days. Morbidity was estimated by the National Institutes of Health Stroke Scale (NIHSS) and follow-up visits were scheduled 30 and 90 days after admission. Results were analyzed with independent t-test and logistic regression analysis. Results: In this study, 73 patients (48.7%) were female and the rest were men. At 30 days, the diabetic patients had a significantly higher mortality, but no significant difference was found between diabetics and morbidity. No significant statistical differences were seen between HbA1c and 30 and 90 days with mortality and morbidity among diabetic patients. Furthermore, no significant statistical difference was seen between HbA1c and 30 and 90 days morbidity and between HbA1c and 30 days mortality in nondiabetic patients. However, in nondiabetic patients, on multiple logistic regression analysis, a significant correlation was seen between 90 days month mortality and HbA1c (P = 0.002). Conclusion: HbA1c can be as a predictive biomarker in nondiabetic patients with AIS.

Acute ischemic non-embolic stroke and serum level of uric acid.

BACKGROUND: Impact of high level of uric acid on stroke is still controversial. We conducted this study to investigate the relationship between acute ischemic non-embolic stroke and serum levels of uric acid. METHODS: This was a case-control study on patients with acute ischemic non-embolic stroke in Rafsanjan, Iran. The control group consisted of normal persons who were similar to the case group in terms of age and gender. Serum level of uric acid in the first 24 hours of admission was measured with photometry method. RESULTS: In a total of 130 patients (59 mens), hyperuricemia was seen in 13.0% of subjects in the control group and 10.7% of subjects in the case group. Nine patients in case group and 7 patients in control group with hyperuricemia were women. No significant relationship was found between acute ischemic non-embolic stroke and serum level of uric acid. CONCLUSION: There was no relationship between uric acid and acute ischemic non-embolic stroke.

Comparison of cerebral blood flow pattern by transcranial Doppler in patients with diffuse and focal causes of brain death.

BACKGROUND: This study aims to assess the cerebral vessels flow in brain death patients with different causes, including focal and diffuse lesions and comparison of flows according to the underlying causes. MATERIALS AND METHODS: Two groups of 15 brain-dead patients one with focal and the other with diffuse brain lesions were compared according to their cerebral blood flow pattern 48 h passed brain death certification. RESULTS: Bilateral absence of flow in middle cerebral artery (MCA) was found in 54.5% of brain-dead patients with diffuse lesion and 50.33% of those with focal lesions. Systolic spike pattern in MCA flow was found in 46.2% of patients with focal lesion and 16.65% of patients with diffuse lesion. Diastole-systole separation pattern in MCA was seen in 16.65% of patients with the diffuse lesions. This pattern in MCA was not seen in patients with the focal lesion group. In carotid arteries, we did not find the absence of flow in any cases. Thirty percent of all patients in both groups had a normal flow pattern (36.6% of patients with focal lesions and 23.3% of patients with diffuse lesion). Patients with focal lesion had 33.3% systolic spike pattern flow and had 23.35% diastole-systole separation flow pattern. In intra-cranial vessels, systolic spike pattern was more common among patients with focal lesions than patients with diffuse lesion, however, this difference was not statistically significant (46.2% of patients with focal lesion and 16.65% of patients with diffuse lesion) (P value = 0.244-0.09). Diastole-systole separation flow was more common in patients with diffuse lesions than those with the focal lesions although this could not reach the significant level as the previous pattern (20% of patients with diffuse lesion versus no case in patients with focal lesion) (P value = 0.181). CONCLUSION: Absence of flow was the most common brain flow pattern in the focal and diffuse group lesions. There was no difference in flow pattern between the focal and diffuse brain lesions groups in brain-dead patients.

Heart rate variability and QT dispersion study in brain death patients and comatose patients with normal brainstem function.

OBJECTIVE: To compare heart rate variability (HRV) and QT dispersion in comatose patients with normal brainstem function and with brain death. STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: The Intensive Care Unit of Ali-Ebn-Abitaleleb Hopital, Rafsanjan Medical University from September 2007 to June 2009. METHODOLOGY: Fourteen brain death patients with clinical signs of imminent brain death and 15 comatose patients were examined by neurologist in intensive care unit. HRV, RR interval and QT dispersion on ECG were assessed for 24 hours in both groups. Independent t-test and chi-square test were used for statistical analysis to determine significance which was set at p < 0.05. RESULTS: According to Holter findings, mean of standard deviation of RR-interval in the comatose and brain death groups was 48.33 and 35 respectively (p = 0.045). Mean of covariance coefficient of RR-interval was 0.065 in the comatose group and 0.043 in the brain deaths (p = 0.006). QT dispersion was not significant difference in two groups. CONCLUSION: HRV and RR-interval analysis appeared as an early finding for the diagnosis of brainstem death in comparison to comatose patients with normal brainstem function. QT dispersion had not significant in this regard.

Post-stroke depression and hospital admission. A need for nursing care partition according to the clinical condition.

OBJECTIVES: To investigate the prevalence of post stroke depression and its association with hospital admission conditions. METHODS: In this case-control study, 120 patients with ischemic cerebral stroke from Aliebne-Abitaleb Hospital, Rafsanjan, Iran, during 2004-2006 were evaluated. Sixty patients were hospitalized near very ill patients (including patients with delirium, decreased consciousness, stupor, coma, sphincteric disorders, ingestion disorder with nasogastric tube insertion, and deceased patients) (cases), and 60 were admitted not adjacent to ill patients (controls). All patients were matched for stroke risk factors and location and size of lesion, and all were admitted to hospital for at least one week. Depression was assessed on admission and after one week according to the Beck inventory questionnaire. The results were analyzed using Fisher's exact test. RESULTS: The mean age of the patients was 63 +/- 4 years, and 65% were female. The depression rate in all patients adjacent to ill patients significantly increased by the seventh day of admission compared with the control group (p<0.001). On analysis according gender, this increase was significant only in women (p<0.001). CONCLUSION: Hospitalization of stroke patients without considering separation according to clinical condition, increases the depression rate in these patients.

Assessment of cerebrovascular reactivity during major depression and after remission of disease.

BACKGROUND: There are a growing number of studies suggesting that depression may increase the risk of stroke. Impaired autoregulation of vascular tone may contribute to a higher risk of developing cerebrovascular diseases. Cerebrovascular reactivity (CVR) reflects the compensatory dilatory capacity of cerebral arterioles to a dilatory stimulus and is an important mechanism that ensures constant cerebral blood flow. There is a hypothesis that CVR is reduced in major depression, which would explain the association between depression and stroke. OBJECTIVES: The aim of this study was to investigate the effect of depression on CVR in cerebral vessels by comparing CVR during the depression phase with that during remission. MATERIAL AND METHODS: Using the apnea test, we assessed CVR in 16 patients with unipolar depression during disease and after remission of disease by calculating the increase in cerebral blood flow velocity after breath-holding (the apnea test). Blood flow velocities were measured by transcranial Doppler ultrasound (TCD). RESULTS: CVR was significantly reduced in the depression phase in comparison to that in the remission phase. However, this change was not seen in all the patients. CONCLUSION: CVR was reduced in most of the depressed patients. The decreased CVR, as indicated by the changes in peak systolic velocity (PSV) and mean flow velocity (MFV) of the middle cerebral artery, in depressed patients was more marked on the right side, which could point to a vascular basis for some kinds of depression. We recommend that other studies, with larger samples, be done; future studies should assess whether the changes in the CVR varies with the severity and type of depression.

Outcome of head trauma.

OBJECTIVE: To investigate the outcome of head trauma and its related factors in Iranian children. METHODS: In a nonrandomized cross-sectional study 380 patients younger than 18-yr-old admitted to the surgery ward of Ali-E-Bne-Abitaleb Hospital, Rafsanjan due to head trauma were included. In all of them, skull X-ray and brain CT scan were performed under the supervision of the neurologist and neurosurgeon according to special indications. Patients were followed till discharge from the hospital or death. At the time of discharge, the patients were evaluated by pediatrician. Demographic information and imaging findings were statistically analyzed using SPSS software. RESULTS: Male to female ratio was 3:1 Most cases were in the age range of 7-12 year. Seventy two percent and 11% of patients' admission was due to motor accidents and falling, respectively. Eighty two percent of patients were discharged with complete recovery; also 12% of skull-radiographs and 17% of brain CT scans were abnormal. CONCLUSION: Head trauma had more prevalence and mortality in male than female. Also in the present study, motor accidents as an etiology of head trauma was more frequent than the western countries, which demands special precautions to decrease this problem.

Post stroke depression among Iranian patients.

OBJECTIVE: To assess the incidence of depression and its contributing factors after an episode of stroke. METHODS: This prospective study was performed on 200 consecutive patients with acute ischemic stroke admitted to Aliebne-Abitaleb Hospital in Rafsanjan, Iran, from September 2006 to September 2007. The diagnosis of acute ischemic stroke was made by a neurologist and confirmed by MRI. Frequency of depression, according to DSM-IV criteria, as well as demographic data and some contributing factors were registered and analyzed by chi squared test and the logistic regression method. RESULTS: The mean age of patients was 61.15+/-8.66 years. Thirty-two percent of patients suffered depression. The frequency of depression was significantly higher in women (40.9%) than men (21.1%) (p=0.004). There was no significant relation between depression and age, location of lesion, and risk factors for stroke. Hypertension (34%), diabetes (15%), smoking (14%), and hyperlipidemia (14%) were the most common risk factors. CONCLUSION: Generally, our results show that post stroke depression is prevalent in our society, and this is more prominent among women. Early diagnosis and treatment can help to improve quality of life of these patients.

Efficiency of citicoline in increasing muscular strength of patients with nontraumatic cerebral hemorrhage: a double-blind randomized clinical trial.

BACKGROUND: Brain infarction cerebrovascular accident is the most common neurologic disease throughout the world. Currently, there is no proven therapeutic effect for drugs other than thrombolytic ones in treatment of the acute phase of cerebrovascular accident. Some recent studies indicate that neuroprotective compounds such as citicoline can be of benefit in the acute phase of cerebrovascular accidents, including the bleeding form. This study was carried out to assess the efficiency of citicoline in increasing muscular strength of patients with nontraumatic cerebral hemorrhage. MATERIALS AND METHODS: This was a double-blind randomized clinical trial on 32 patients with hemorrhagic nontraumatic supratentorial cerebral infarction, who were divided into two groups of 16, the first of which was treated with citicoline (250 mg intravenously twice a day) for 14 days. The second group was given placebo and their muscular strength was measured through physical examination before treatment and then 3 months later. The groups were matched in terms of age, sex, and amount of bleeding. The muscular strength of the two groups was compared using Mann-Whitney nonparametric test. RESULTS: Half of the patients were male and the mean of muscular strength in both groups before intervention was 2.5 (0-4.5) and after intervention was 4 in the group receiving citicoline and 3.12 and in the group receiving placebo, which indicates a meaningful difference (P = .019). CONCLUSION: The findings of this study showed that muscular strength in patients with cerebral hemorrhage receiving citicoline increased and indicated that citicoline may be efficient in treatment of patients with cerebral hemorrhage.

Prognostic value of electrocardiography and electroencephalography in patients with ischemic stroke.

PURPOSE: Stroke is the most common disease among neurological disorders, often resulting in handicap, complications and mortality. Recent studies revealed that electrocardiography (ECG) and electroencephalography (EEG) were noninvasive but effective methods to assess the prognosis of stroke patients. The purpose of this study is to evaluate the use of EEG and ECG for the prognosis of ischemic stroke. METHODS: Thirty five patients with supratentorial ischemic stroke and muscle weakness were included in the study carried out at the Ali-EbneAbitaleb Hospital, Rafsanjan, Iran. At admission, muscle power was recorded for every patient. EEG and ECG were performed on patients within 12 hours of admission. The muscle power was re-evaluated for all study cases at 3 months. The data were analyzed using SPSS software; Mann-Whitney and Kruskal-Wallis tests. RESULTS: Opium addiction (45.7%), hypertension (40%), and smoking (28.6%) were the most common risk factors. ECG change was seen in 71.4% of patients (ST-T change: 51.4%, QT: 22.9%). No significant correlation was seen between ECG and muscle power changes at three months among stroke patients. 57.1% of patients had mild to severe abnormality in EEG and a significant correlation was seen between EEG and muscle power changes at three months (P= 0.01). CONCLUSION: This study showed that EEG abnormality was positively correlated with poor prognosis in our patients with ischemic stroke. This study did not show any significance for ECG, which may be due to a small patient number, and further study is needed.