Mediatory role of the serum mineral level and discharge disability of stroke survivors.

Background: Possible association between minerals contributing and mortality related to stroke were seen, but prospective data on the relation of vitamin D, magnesium and calcium serum levels with stroke were inconsistent. Consideration about the potential health effects of minerals and nutrients, the current study was conducted. Methods: This analytical cross-sectional study was conducted on 216 stroke survivors who were referred to the Ayatollah Rouhani Hospital of Babol, Iran. Demographic characteristics, clinical variables, and serum mineral levels were completed in the checklist. Admit score and discharge scale of these patients were determined according to the National Institute of Health Stroke Scale. A path model was constructed to explore the interrelationship between variables and to verify the relationship between variables and disability discharges. Results: Of 216 stroke patients, 185 (85.6%) cases were ischemic. The discharge status of 29 (12.9%) cases were severe or expired. The patients with moderate and severe admit scores, hemorrhagic stroke type, diabetes mellitus, hypertension and live in the village significantly had a poor discharge disability scale (all of p<0.05). Of all direct paths, Mg (ß=-2.85), and among indirect paths, calcium(ß=-3.59) had the highest effect on the discharge scale. Only mg had affected the discharge scale through direct and indirect (ß=-2.45) paths and had the greatest reverse effect on the discharge scale (ß=-5.30; totally). Conclusion: Hypomagnesemia and hypocalcemia play a mediatory role in poor outcomes. Especially, hypomagnesemia was the direct parameter for poor outcomes. The independent role of each mineral in this issue is difficult to define and suggested for future study.

Trigeminal neuralgia: IncobotulinumtoxinA (Xeomin), can it decrease the pharmacological intervention? (A case series).

Background: Trigeminal neuralgia is one of the most disabling facial pain syndromes. In recent years' new therapeutic strategy, incobotulinumtoxin A has emerged. The aim of the current study was to determine the time and duration of pain in 3 cases with pharmacological treatment and incobotulinumtoxin A. Case presentation: In three patients with different onsets, trigeminal neuralgia was diagnosed. Pain severity was assessed by the visual analogue scale. Patient demographics and clinical data were filled in a checklist. They were females with age ranging from 39 to 49 years. Two patients had normal MRI and one patient had no any recent MRI. One center and specialist injection Xeomin 50 units for one time. Despite long time oral treatment, their symptoms had no significant improvement, but after incobotulinumtoxin A injection, pain frequency, severity and duration decreased in patients. Conclusion: Result showed that the frequency, severity and duration of pain attacks was efficiently decreased by incobotulinumtoxin A with low side-effects. Its complication and side-effect should be considered in the future.

Epilepsy and associated factors in elderly people of Amirkola, North of Iran (The Amirkola Health and Ageing Project).

Background: Knowledge about the associated factors with epilepsy in the elderly in Iran is limited. Therefore, this study aimed to determine the prevalence of epilepsy and associated factors in Amirkola elderly patients. Methods: This cross-sectional study is a part of a comprehensive and cohort research of "The Amirkola Health and Ageing Project". The Mini-mental State Examination was used for cognitive impairment, Geriatric Depression Scale for psychiatric diseases and the Physical Activity Scale for Elderly questionnaire for physical activity. Results: The prevalence of epilepsy was 35 from 1482 participants (24/1000). The significant association between Parkinson's Disease (OR=6.25, 95%CI=1.35-28.4, P=0.001), falls (OR= 3.81, 95%CI=1.62-8.97, P=0.001), depression (P=0.001), hyperphosphatemia (P=0.039) and hypokalemia (P= 0.031) concluded with epilepsy. Past history of stroke (6 % versus 2%, OR= 2.8, 95%CI, 0.97-8.27, P=0.07), increased serum level of triglyceride (OR= 1.96, 95%CI= 0.99-3.88, P=0.06) and low-density lipoprotein (LDL) (P=0. 45) were seen in epileptic patients vs. non-epileptic patients. Conclusion: Parkinson's disease, frequency of falls and depression were the associated factors in epileptic patients and a correlation between past history of stroke, increased serum level of triglyceride and LDL with epilepsy were seen. Associated factors required screening, diagnosis and treatment.

Iranian Smell Diagnostic Test in Covid-19 Disease; Report of Covid-19 Center of North of Iran.

Background: SARS-CoV-2 is a pandemic coronavirus that causes the COVID-19 syndrome. In the pandemic of COVID-19 many patients were affected to new onset olfactory dysfunction. Since there is a dearth of research studies regarding the standard smell test, the present study was conducted to fill this gap. Methods: The present retrospective cohort study was conducted on 250 clients with or without diagnosis of Covid-19 disease who referred to Covid-19 centers of North of Iran. Two groups were matched for age and sex. Data were collected by examination, demographic and clinical information questionnaire and Iranian smell diagnostic test. The binary logistic regression to estimate the odds ratio value in SPSS version 23.0 was used. Results: One-hundred cases (42.2%) had hyposmia and 20 cases (8.4%) were found to have anosmia. Type of covid-19 sign and symptom were statistically significant with olfactory dysfunction (41 cases, 31.8%), fever (28 cases, 21.7%), weakness and dyspnea (15 cases, 11.6%), (p=0.0001). The urban residency equal OR=6.42 (3.04-13.53) to rural residency for olfactory dysfunction (p=0.0001). Covid-19 patients' OR=61.25 (27.36-137.11) chance to be affected by the olfactory dysfunction in compare to control group (p=0.0001). Also, with increasing age, chance of olfactory dysfunction changed from OR=0.61(1.16-0.13) to OR=1.89 (0.82-4.33). Furthermore, female chance OR=1.21 (0.72-2.03) and employee patients was OR=2.29 (1.30-4.04) to olfactory dysfunction. Conclusion: Alf of the patients were affected by olfactory dysfunction. Furthermore, Covid-19 patients, urban residency, lower age, female and employee were the prognostic factors for olfactory dysfunction. The standard olfactory tests such as IR-SIT is suggested for screening and detecting the clients probably affected by covid-19 especially in younger ages.

Caspian Nursing Process: Impactions on New-Onset Constipations in Admission, Discharge, and Follow-up of Acute Stroke Patients.

Background: Structural planning is essential for the management of constipation in stroke patients. The current study aims to determine the impact of a care plan on the frequency of new-onset constipation following stroke. Materials and Methods. Materials and Methods: This clinical trial was conducted on 132 stroke patients (two groups of 66) in three phases (pre-intervention, during discharge, 1 month after discharge). Clients were randomly assigned to blocks based on gender, type of stroke, and age. The care plan according to the nursing process was conducted. Data collection tools included a demographic-clinical information questionnaire, Rome IV criteria (diagnosis of constipation), and Bristol scale (consistency of stool). Data were analyzed using the Chi-square, McNemar, Wilcoxon, Analysis of Variance (ANOVA), and a general estimated model. Results: The prevalence of new-onset constipation following stroke in the control group decreased from 66 (100%) at admission to 39 (67.20%) at discharge and in the intervention group from 66 cases (100%) to 18 cases (34%) (p = 0.001), but it was not significant at follow-up (p = 0.16). The trend of frequency of constipation from admission to follow-up was generally significant in the intervention group (p = 0.03) vs the control group (p = 0.21). The difference in the mean number of cases of constipation was statistically significant (2.89) 2.10) control group vs 1.58 (1.65) intervention group, p < 0.001). Conclusions: A significant impact of the care plan was observed from admission to discharge, but further follow-up was required with more client-side collaboration. Therefore, the present care plan is recommended in the hospital and home care.

Different Stroke Scales; Which Scale or Scales Should Be Used?

BACKGROUND: There has been a considerable development in the clinometric of stroke. But researchers are concerned that some scales are too generic, inherently and the insight may not be provided. The current study was conducted to determine which scale or scales should be used in stroke survivors. METHODS: We selected 67 studies which were published between January 2010 and December 2018 from Up to date, CINAHL, ProQuest, Scopus, PubMed, Embase, Medline, Elsevier and Web of Science with MeSH terms. Inclusion criteria were: clinical trials, prospective studies, retrospective cohort studies, or cross-sectional studies; original research in adult human stroke survivors. We excluded the following articles: non-adult population; highly selected studies or treatment studies without incidence data; commentaries, single case reports, review article, editorials and non-English articles or articles without full text available. RESULTS: Face Arm Speech Test and Cincinnati Pre-Hospital Stroke Scale scales because it was easy to learn and rapidly administer the recommended dose to use in pre-hospital, but there are not gold standard in stroke diagnosis in Pre-Hospital. National Institutes of Health Stroke Scale valuable in the acute stage for middle cerebral artery, not chronic or long term post stroke outcome. The Barthel Index scores for approximately three weeks could predict activities of daily living disabilities in 6 months. CONCLUSION: Every scale has an advantage and a disadvantage and we were not able to introduce the gold standard for each item, but some special scales were used more in the studies, preferred for comparing with other studies to match the research results.

Empowerment of Nurses: A Key to Stroke Patients' Satisfactions.

BACKGROUND: Stroke is a major cause of disability around the world. Different studies have shown the inadequate knowledge and skills of nurses to educate and manage stroke patients. Therefore, stroke patients are facing many challenges in their lifetime. In this study, we investigated the effects of nursing empowerment on stroke patients' satisfaction. MATERIALS AND METHODS: This cross-sectional study is the fifth stage (evaluation phase) of action research study that was conducted on 29 stroke patients from Alzahra hospital, Isfahan, Iran, during 2013-2014. Workshops, pamphlets, and booklets were used for nursing empowerment. The stroke patients have been trained by empowered nurses. The data gathering tool that was the researcher-made survey questionnaire included the characteristics of patients, participants' satisfaction with self-care training and nurses' performances. T-test was used for the analysis of the obtained data. RESULTS: Twenty-seven (93.10%) cases mentioned that "they would try to follow all the received trainings". Twenty-three (73.10%) cases were satisfied with self-care training. Majority of patients, 25 (85%) participants were satisfied with the training performances by the empowered nurses and 24 (82.80%) cases were highly satisfied with the nurses' training method. CONCLUSIONS: Most patients were satisfied with the self-care training held by the nurses. Based on the obtained data by questionnaires, the nurses' performance and their training methods were directly associated with a high satisfaction level in stroke patients. Therefore, improving the skills and knowledge of nurses could be a potential approach for increasing the satisfaction levels among stroke patients.

Increased Zinc Serum Level: New Clues in Babol Stroke Patients, Northern Iran.

BACKGROUND: Stroke is the second leading cause of death worldwide. The role of zinc as a new predictor of stroke was considered. METHODS: This prospective study was conducted in Ayatollah Rouhani Hospital within a year on 100 stroke and 100 control patients. FINDINGS: The difference in zinc serum level in two groups was significant (deficiency: 3 (3%) in patients versus 20 (20%) in control group, normal: 25 (25%) versus 54 (54%), and increased level: 72 (72%) versus 26 (26%); p < 0.001). Difference in zinc serum levels was statistically significant with ischemic heart disease (deficiency: 0 cases (0%), normal: 8 cases (24%), increased level: 24 cases (75%), p = 0.003). Increases in zinc serum level were significantly correlated with the frequency of hemorrhagic and ischemic patients (deficiency: 3 (3.3%) hemorrhagic versus 0 (0%) ischemic; normal: 19 (21%) versus 6 (60%), increased level: 68 (75.6%) versus 4 (40%); p = 0.025). Regression logistics showed that ischemic heart disease (p < 0.001; OR = 28.29, %95 CI: 5.53; 144.87), hyperlipidemia (p < 0.001; OR = 0.26, %95 CI: 0.12; 0.56), and zinc serum level (p < 0.001, OR = 15.53, %95 CI: 4.03; 59.83) each had a significant role. CONCLUSIONS: Babol stroke patients are prone to increased zinc serum level as a new parameter. Ischemic heart disease, increased levels of zinc, and hyperlipidemia were found to be probable predictor factors for stroke in Babol.

Sex difference in types and distribution of risk factors in ischemic and hemorrhagic stroke.

Background Stroke is the second leading cause of death worldwide and is associated with several risk factors with variable risk factor distribution by population. We report the types and frequency of the associated factors of stroke in north Iran. Methods Consecutive patients with stroke were recruited from 2014 to 2015. The two groups of ischemic and hemorrhagic stroke were compared with respect to age, sex, the prevalence, and distribution of the risk factors. Results Among 230 patients (84.3% ischemic stroke) with mean age of 61.2 years, hypertension (73%), diabetes mellitus (53%), cardiovascular disease (51%), and dyslipidemia (47%) were the most frequent risk factors. Hypertension was significantly more prevalent in males compared with females (88% vs. 60%, OR = 4.91, 95% CI: 2.48-9.71). Hypertension, smoking, and opioid consumption were associated with hemorrhagic stroke. Dyslipidemia was significantly higher in ischemic stroke (OR = 2.65, 95% CI: 1.21-5.8). Overall, 84.3% of stroke occurred in patients aged >50 years (92.8% of women vs. 74.5% of the men, OR = 4.43, 95% CI: 1.93-10.16, p = 0.001). Conclusion Stroke was more prevalent in females; hypertension was more prevalent in males. In the age group less than 50 years old, stroke is more prevalent in men.