Oral and dental health status in patients with chronic headache.

INTRODUCTION: Headache is an illness with high prevalence and adverse effects on quality of life. As oral or dental problems such as pain can trigger or aggravate it, we aimed to investigate and compare oral and dental health status in patients affected with chronic headaches and healthy individuals. METHODS: The present case-control study included 60 patients with chronic headaches (case) and 60 healthy individuals (control) in Rasht, Iran. The demographic characteristics and clinical examinations, including decayed/missing/filled teeth (DMF-T) and community periodontal index of treatment needs (CPITN) indices, as well as bruxism, frequency of tooth brushing and flossing, and maxillary and mandibular tooth wear were recorded in a checklist. Data analysis was performed using the IBM SPSS version 28 at a significance level of 0.05. RESULTS: The case group consisted of 25 men (41.7%) and 35 women (58.3%) with an average age of 32.55 ± 6.62 years, while the control group had 27 men (45%) and 33 women (55%) with an average age of 30.95 ± 6.33 years. The study groups were not significantly different in bruxism, frequency of tooth brushing and flossing, DMFT, CPTIN, and maxillary and mandibular tooth wear. CONCLUSION: It seems that chronic headaches do not significantly affect the oral and dental health of the sufferers. Moreover, it appears that these patients are well aware of the role of oral and dental hygiene in triggering or aggravating the episodes of headaches.

¬Transcranial direct current stimulation improves sleep quality in patients with insomnia after traumatic brain injury.

INTRODUCTION: Insomnia is a serious problem after traumatic brain injury (TBI) and partially improves via sleeping pills. We investigated the efficacy of transcranial direct current stimulation (tDCS) with a focus on the role of age and gender. MATERIALS AND METHODS: In a randomized double-blind clinical trial, 60 eligible TBI-induced insomnia patients were assigned to real and sham tDCS groups and were treated for three weeks. Sham but not real tDCS took sleeping pills for the first three weeks of the study and then used the placebo until the end of the study. The placebo was used by the real-tDCS group throughout the study. Sleep quality and insomnia severity were respectively evaluated by Pittsburg Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) at three time points. RESULTS: Real tDCS group reported lower mean ISI and PSQI scores at 3 weeks post treatment onset and maintained this decline for six weeks post treatment onset (P < 0.001). In younger participants and those identified as men, the treatment-induced attenuation of the mean PSQI score was reported higher and more lasting in real than sham tDCS groups. CONCLUSION: Gender and age-specific tDCS protocols may be warranted to optimize the therapeutic effect of tDCS.

The association of 25 (OH) D3 serum level with ischemic cerebrovascular accident risk, severity and outcome in Iranian population.

OBJECTIVES: The role of combined presence of vitamin D deficiency and other risk factors of stroke in ischemic cerebrovascular accident (CVA) development in Iranian adults has been unclear, so far. The association of vitamin D status at admission with ischemic CVA severity and outcome in this community is not yet well elucidated. This study aimed to clarify these ambiguities. METHODS: In a cross-sectional study 104 hospitalized ischemic CVA patients and 104 healthy controls participated. The serum level of 25 (OH) D3 and baseline biochemical parameters were measured in ischemic patients within the first 24 h of admission, as well as healthy controls. The severity of CVA and clinical outcome were assessed using National Institutes Health Stroke Scale and Modified Rankin Scale, respectively. Data were analyzed using the Chi-square test, independent t-test, and multiple logistic regression. RESULTS: There was a significant difference between patients and controls regarding the presence of vitamin D3 deficiency, hypertension, smoking, and baseline level of LDL and FBS. Vitamin D3 deficiency boosted the risk of ischemic in males and those having family history of CVA. A low serum level of 25 (OH) D3 was associated with more severity and poor outcome of CVA. The CVA severity, vitamin D3 deficiency, and hypertension were predictors of poor outcome. CONCLUSIONS: The study highlights the increased risk of ischemia in Iranians by cooccurrence of vitamin D3 deficiency and other risk factors of CVA. Clinical significance of vitamin D3 deficiency control may be suggested in those at risk of CVA and functional poor outcomes.

Relationship between self-compassion and psychological well-being with the mediating role of resilience in people with multiple sclerosis.

Purpose: Paying attention to the factors affecting the psychological well-being of people with multiple sclerosis (PwMS) is of particular importance, hence the present study investigated the relationship between self-compassion and psychological well-being with the mediating role of resilience. Methods: This cross-sectional study was performed using an online survey in a sample of 410 PwMS registered with the Guilan MS Society (GMSS) of Iran. The study was conducted in 2021. A demographic questionnaire, Ryff 's Psychological Well-Being Scales (PWB), the Connor-Davidson Resilience Scale (CD-RISC), and the Self Compassion Scale Short Form (SCS-SF) were used to collect data. Data analysis was performed using structural equation modeling. Results: The model and data were sensibly in agreement. Moreover, bootstrap results showed that all direct path coefficients were significant (t ≥ 1.96). The direct effects of self-compassion and resilience on psychological well-being were significant, with standardized coefficients of 0.69 and 0.21. In addition resilience, with a coefficient of 0.73, was associated with psychological well-being. Furthermore, the indirect effect of self-compassion on psychological well-being with the mediating role of resilience was also confirmed (p ≤ 0.05). Conclusions: In particular, a higher self-compassion score predicts greater resilience, which is correlated with greater psychological well-being. These findings underscore the need to target the psychological well-being of PwMS through resilience to help them cope with living with chronic conditions.

Animal Kernicterus Models: Progress and Challenges.

Kernicterus is a leading cause of neonatal death throughout the world, especially in low-middle-income countries. It is developed by an unconjugated hyperbilirubinemia in the blood and brain tissue, triggering pathological processes that spawn neurotoxicity and neurodegeneration. However, the biological mechanism (s) of bilirubin-induced neurotoxicity and Kernicterus development remain to be well elucidated. Likewise, a practical therapeutic approach for human Kernicterus has yet to be found. Undoubtedly, animal models of Kernicterus can be helpful in the identification of underlying biological processes of hyperbilirubinemia evolution to Kernicterus, as well as the evaluation of various treatments efficacy in preclinical studies. More importantly, establishing an animal model that can mimic the Kernicterus and its behavioral, neuro-histological, and hematological manifestations is a severe priority in preclinical studies. So far, several Kernicterus animal models have been established that could partially mimic one or more clinical and paraclinical signs of human Kernicterus. The present study aimed to review all methods modeling Kernicterus with a focus on their potentials and shortcomings and subsequently provide the optimal methods for an ideal Kernicterus animal model.

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.

Colorectal cancer risk factors in north-eastern Iran: A retrospective cross-sectional study based on geographical information systems, spatial autocorrelation and regression analysis.

Colorectal cancer (CRC) is the second most common cancer among females and the third most common malignancy in males in the world. No single risk factor has been identified, but there are many interrelated factors that together cause the disease. This retrospective, cross-sectional study aimed to identify potential spatial factors contributing to its geographical distribution. Data concerning 1,089 individuals with CRC from the Khorasan-Razavi Province in Iran, located in the North-East of the country, were obtained from the national CRC registry. Local Moran's I statistic was performed to identify clustered areas of CRC occurrence and ordinary least squared regression was calculated to predict frequency of the disease based on a set of variables, such as diet, body mass index (BMI) and the proportion of the population ≥50 years of age. Some dissimilarities related to the geography in the province and also some neighbourhood-related similarities and dissimilarities of CRC occurrence in the city of Mashhad were found. A significant regression equation was found (F (4,137)=38.304, P<.000) with an adjusted R2 of 0.6141. The predicted CRC frequency was -58.3581 with the coefficients for average BMI=+1.594878; fibre intake=-0.610335; consumption of red meat +0.078970; and ≥50-year age group =+0.000744. All associations were statistically significant, except the consumption of red meat one. The study results illuminate the potential underlying risk factors in areas where the CRC risk is comparatively high and how the CRC risk factors may play a role in CRC geographic disparity. Further research is required to explain the patterns observed. We conclude that people should include more fibre in their daily diet and decline their BMI to decrease risk of CRC.

Cardiovascular Disease Risk Factors Profile in Individuals With Diabetes Compared With Non-Diabetic Subjects in North-East of Iran.

BACKGROUND: Diabetes mellitus is assumed to be a strong risk factor for cardiovascular diseases (CVD) and is frequently associated with other CVD risk factors. OBJECTIVES: The aims of this study were to assess the prevalence of different patterns of dyslipidemia in individuals with diabetes compared with non-diabetic subjects and evaluate other accompanied CVD risk factors between the two groups. PATIENTS AND METHODS: This was an analytical cross-sectional study on 230 participants, aged 28 - 66 years old, who were referred to different urban health centers of Khorasan Razavi province (north-east of Iran). Data from the participants were collected during their first visit by primary care physicians. Statistical package for social science (version 11.5) was used to analyze the data. The chi-square or Fisher's exact, student's t or the Mann-Whitney U and correlation tests were used in the analysis. RESULTS: The age and gender of the participants were not different between the two groups (P = 0.1 and P = 0.4, respectively). The most common patterns of dyslipidemia in both groups were isolated dyslipidemia followed by combined dyslipidemia. Prevalence of dyslipidemia as a whole (one, two or three lipid profile abnormalities) in patients with diabetes and non-diabetic participants was 89.3% and 82.6%, respectively and the difference between the two groups was not statistically significant (P = 0.1). Subjects with diabetes had higher systolic blood pressure (P < 0.001), higher diastolic blood pressure (P = 0.002) and higher body mass index (P = 0.09) compared to non-diabetics. Moreover, they were more likely to have higher levels of total cholesterol (P = 0.01), triglycerides (P = 0.001) and low density lipoprotein cholesterol (P = 0.009) and lower levels of high density lipoprotein cholesterol (P = 0.2). CONCLUSIONS: Cardiovascular diseases risk factors are more common in patients with diabetes; however, non-diabetic individuals also had a high prevalence of risk factors in our region, predisposing them to diabetes. Therefore, further attention by the medical community is necessary to choose effective strategies for a more a aggressive approach to prevent and manage these risk factors.

Ability of serum C-reactive protein and white blood cell cout in predicting acute schemic stroke. A short -term follow-up study.

BACKGROUND: Stroke is one of the leading causes of mortality and long-term morbidity. The aim of the present study was to determine the ability of baseline serum C-reactive protein (CRP) and white blood cell count (WBC) values in predicting the outcome of acute ischemic stroke (AIS). METHODS: This study consisted of patients with first AIS referred to Poursina Hospital, Rasht, Iran. Severity of stroke was determined according to the National Institute of Health (NIH) Stroke Scale at the time of admission. Serum CRP levels and WBC count were measured at the time of admission. All patients were followed-up for 90 days after discharge and the severity of stroke was assessed using modified Rankin Scale. Receiver operating characteristic curve analysis was used for calculating the most appropriate cutoff point of CRP and WBC count for differentiating patients with and without poor outcome at the end of the study period. RESULTS: A total of 53 out of 102 patients (52%) had poor outcome. The most appropriate cutoff value for CRP in differentiating patients with and without poor outcome was 8.5mg/l (sensitivity: 73.1%, specificity: 69.4%) and for WBC the difference did not reach to a significant level. The cutoff points of CRP > 10.5 mg/ml yielded a predictive ability at sensitivity: 75%, specificity: 63.8% whereas predictive ability of WBC for mortality was at a borderline level. CONCLUSION: These findings indicate that high levels of serum CRP in AIS at the time of admission is associated with poor prognosis. However, this study found no ability for WBC in predicting AIS outcome.

applicability, concurrent validity and internal consistency reliability of the Persian version of the national institutes of health stroke scale [NIHSS]: evidences for gender differences

Background: The National Institutes of Health Stroke Scale [NIHSS] can objectively quantify the severity of stroke. However no information is available about psychometric properties and it's applicability in the Iranian population

Objectives: The present study purposed by utilization of this instrument for neurological deficits measurement due to stroke, to determine the internal consistency reliability and concurrent validity of NIHSS to separate two groups of men and women patients

Materials and Methods: In a cross-sectional study, 206 ischemic stroke patients were selected and the internal consistency reliability and concurrent validity of NIHSS were assessed. For this purpose, Barthel index that measures the functional disability was used. Data also were analyzed by Independent t-test, Chi-square, Pearson correlation, Fisher's z tests and bivariate regression analysis

Results: Internal consistency for men [alpha=0.881], women [alpha=0.913] and total patients [alpha=0.893] was excellent. Negative correlation was found between NIHSS and Barthel index in both men [r=-0.43, p<0.0001] and women [r=-0.63, p<0.0001] and this relationship estimated to be more significant among women rather than men [p<0.05]. In addition, NIHSS scores could significantly predict the Barthel score in both groups [p<0.0001] but the results revealed the more ability of NIHSS in predicting functional disability for women [R[2]=0.40] rather than men [R[2]=0.18]

Conclusion: Persian version of NIHSS was reliable and valid instrument that can be applicable in both men and women with ischemic stroke; however, it was found that the degree of concurrent validity is better among women than men

survey about the temporal pattern of stroke occurrence

Background: Temporal variation of stroke onset is suggested in some studies contained somewhat varieties. It is proposed that some predisposing changes occur in some ascertained times consequently resulted in stroke occurrence in some special times

Objective: To determine the circadian and circaseptan variation of stroke onset

Materials and Methods: This cross sectional study was conducted from March 2012 to February 2013 in an academic hospital in the North of Iran. All patients with acute onset of neurological symptoms were enrolled in the study after being diagnosed as a stroke patient. The diagnosis was made by a neurologist using brain imaging. Age, gender, history of diabetes and hypertension, time and date of stroke onset were recorded for all patients. The data were analysed using Chi-square test in SPSS software version 19

Results: A total of eight hundred sixty-nine patients with mean age of 67.5il2.4 years [55.6% women 44.4% men] were admitted during one year study. Eighty-five percent of stroke cases were ischemic in nature and the others were hemorrhagic type. Distribution of cases during a day was not uniform [p < 0.0001]

The peak of stroke onset occurred in the mornings [7-9 a.m.] followed by a second peak in the evenings [7-9 p.m.]

In addition, the distribution of cases during the week was also not uniform [p < 0.016]

Conclusion: Stroke occurrence has a diurnal variation probably resulted from circadian physiologic changes. Although there is a circaseptan variation in the times of stroke record, it seemingly isn't related to physiologic changes

Comparing the effect of memantine and placebo on clinical outcome of intracranial hemorrhage: a randomized double blind clinical trial

Background: Intracerebral Hemorrhage [ICH] is a stroke type which resulted in disability. Memantine have been supposed to have the effect on the functional status in patients with ICH

Objectives: Comparing the effect of memantine with placebo on the clinical outcome of ICH

Materials and Methods: This double-blind clinical trial was conducted in an academic hospital in northern Iran on patients with ICH allocated in memantine and placebo group through the random block method

The patients' neurological status was assessed on admission, the seventh day, upon discharg and ultimately three months after the ICH onset, according to the Nationa Institute of Health Stroke Scale [NIHSS], modified Rankin Scale [mRS] Barthel Index [BI] and Glasgow Coma Scale [GCS]

The data analysis was done by using independent t-test, Chi-square and repeated measure tests SPSS software version 21

Results: A total of 64 patients have been allocated into two equal size group! with no significant differences in terms of age or gender [p>0.05]

The meal increase in the BI and the decrease in the mRS were significantly greater in tW memantine group compared with the placebo group as measured fron admission time until three months following the ICH onset [p=0.001 anc p=0.049, respectively]

No significant differences were observed between the two groups in mortality rate [p=QA92] and the means and changes of the GCS [p=0.331] and the NfflSS score [p=0.211]

Conclusion: Early administration of memantine to ICH patients can result ii significant improvement of long-term motor function and functional independence