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Background Malnutrition as a result of insufficient intake or uptake of nutrition leads to increasing rate of chronic diseases such as stroke. Stroke is one of the most common causes of death in western countries and its increasing trend has attracted lots of attention. In this regard, it seems logical to focus on modifiable risk factors such as nutrition, in order to reduce the resulting complications. Accordingly, this study aimed at evaluating nutrition status of stroke patients to estimate its relationship with clinical outcomes of stroke. Methods In the present cross-sectional study, 349 patients were recruited. Nutrition assessment was performed using Patient-Generated Subjective Global Assessment (PG-SGA). In addition, National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and biochemical tests were performed. Results Our findings elucidated a significant positive correlation of mRS with PG-SGA and consciousness score, as well as a negative correlation with BMI, calf circumference, mid-arm circumference, and triceps skinfold at admission time (P ≤ 0.002). Moreover, a direct correlation was found between mRS and PG-SGA and consciousness score at discharge time (P ≤ 0.001). In contrast, an inverse correlation was established between mRS and mid-arm circumference (P = 0.02). Furthermore, univariate analysis indicated significant associations between mRS ≥ 3 and age (OR: 1.02; 95%CI: 1.00–1.04), PG-SGA (OR: 1.08; 95%CI: 1.03–1.13), NIHSS (OR: 1.04; 95%CI: 1.02–1.07), dysphagia (OR: 1.69; 95%CI: 1.03–2.77), consciousness (OR: 1.48; 95%CI: 1.07–2.04), and mid-arm circumference (OR: 0.95; 95%CI: 0.90–1.00). In addition, these associations remained significant in multivariate analysis for PG-SGA (OR: 1.07; 95%CI: 1.00–1.13) and NIHSS (OR: 1.04; 95%CI: 1.01–1.07). Conclusion This study revealed a positive correlation between mRS and consciousness status and PG-SGA score, as well as a negative one between mRS and MAC at discharge time.

Systematic HIV program evaluation requires looking at all steps of the HIV cascade of care, from diagnosis to treatment outcomes. Our study was carried out to assess the treatment cascade of people living with HIV (PLWH) in Iran in 2019. We used data from the HIV Case Registry System of Iran through December 2019. We estimated the number of PLWH in 2019 by using Spectrum, and then the proportion of them being diagnosed, linked to care, received antiretroviral treatment and suppressed viral load. We estimated that there are 59,314 (UI: 32,685-125,636) PLWH in Iran, of whom 22,054 people (37% of PLWH) were diagnosed. At the end of 2019, of whom, 14,685 (25% of PLWH) people received antiretroviral therapy. Also, of whom 6338 (11% of PLWH) people had viral load suppression by 2019. Our results showed that about one-third of total PLWH were diagnosed, while this defect is somewhat less in children than adults. To reach the 90.90.90 targets Iran needs to developed the current national HIV care guidelines, which recommend best strategies to scale up the case finding and linkage to care among undiagnosed people specifically those who infected by sexual contact in general and key populations as well.

Objective: A new national clinical guideline for the management of tuberculosis and HIV in Iranian prisons was released in 2011. The aim of this study was to compare HIV indicators in the case and control prisons after implementation of the new guideline. Methods: This report examines outcomes observed during the pilot phase of its implementation at a case prison from October 2013 to June 2014 compared to a control prison that had not yet implemented the guideline. The case prison included incarcerated individuals in the Great Tehran Prison. A prison in Alborz province was considered as a control group. Pearson’s Chi-squared, two-sample t-test, paired t-test and Kruskal-Wallis were used for the analysis. Results: The intervention significantly increased the total number of inmates tested for HIV and of diagnoses of HIV-positive inmates in the case prison compared to the control prison (P Conclusion: We recommend the implementation of this guideline in all Iranian prisons.

Background: Antiretroviral medications have improved the survival and life quality of people living with HIV and turned HIV into a chronic controllable disease. However, the success of HIV treatment depends on many factors; patient adherence is one the most important indicators. In this study, we explored the potential barriers to an effective adherence antiretroviral therapy (ART) among the HIV-positive prisoners of Ghezel-Hesar prison, Iran. Methods: To explore and identify the barriers toward ART adherence, a focus group discussion was held with six prisoners eligible for ART but rejected to be treated or did not retain on ART. The prisoners were recruited through purposive sampling method. All the words, behaviors and even body languages were precisely recorded and analyzed to reach the final results. Results: The most reported obstacles toward ART adherence were the lack of trust in the effectiveness of medications and drug complications. Other reasons were inadequate nutrition, lack of amenities, social stigma, lack of economic and psychological support, misbehavior of prison staff and inadequate methadone prescription for those with opium addiction. Conclusion: Due to the results and the fact that adequate Methadone prescription for opium addiction, improving life quality and receiving emotional and medical support from staff could improve adherence to HIV medication in prisoners,comprehensive education of prisoners about their health condition along with staff education may improve the life condition of HIV infected prisoners and may cause dramatic improvement in ART adherence and prisoners health.

Background: People with chronic illnesses, such as HIV infection, face many barriers in the way of adherence to the treatment. In this study, the researchers attempted to investigate the barriers and facilitators of adherence to antiretroviral therapy (ART) among patients with HIV.Methods: Focus group discussion (FGD) was conducted with the primary objectives of investigating the barriers to ART adherence. Nine participants with HIV infection were recruited through a purposive sampling method at Great Tehran Prison.Results: In terms of the influencing factors of non-adherence; the drug side effects, especially with Efavirenz, Methadone and opioids effects resolution due to interaction with antiretroviral drugs, forgetfulness, fear of hangover due to the missed or delayed Methadone use, inappropriate nutrition and lack of access to food supplements and poverty were noted by majority of participants. In addition, there were some less, but still important factors of non-adherence among the patients, which were mentioned in the manuscript of the article.Conclusion: The medications side effects, inappropriate methadone prescription, stigma, lack of family support, and unfavorable prison conditions were found to be the potential barriers of adherence to HIV medication, whilst a strong and realistic patient-physician relationship, psychosocial and family support, and knowledge regarding the level of CD4 were amongst the possible facilitators for adherence to HIV medication in HIV-positive prisoners.

PurposeThe aim of present study was to integrate vital noncommunicable diseases (coronary artery disease, hypertension, diabetes mellitus and mental health disorders) into Prison-Based Active Health Services Provision (PAHSP).Design/methodology/approachOn Jan 1, 2018, there were 230,000 prisoners in Iran. Timely and systematic detection and diagnosis of chronic health conditions among this population are imperative. The collaboration between healthcare providers in prison and members of the multidisciplinary team of the healthcare community outside prison initiated an active health service provision approach for HIV and tuberculosis (TB). Guidelines for the control of HIV and TB in prison were piloted, and the finalized version was named “Prison-based Active Health Services Provision” (PAHSP), which has been scaled up in 16 of 260 Iranian prisons.FindingThe PAHSP approach emphasizes the importance of early identification of key symptoms and risk factors. This approach provides an opportunity for improved prevention and treatment, enabling prisoners identified at risk or those who have been diagnosed with a target disease to be followed up and receive the appropriate health care.Originality/valueInitiatives such as screening for chronic health conditions coupled with treatment will reduce the burden of chronic illness among prisoners and the broader community, thereby saving on healthcare costs and lives.

PurposeThe aim of this study was to compare the defined indicators of tuberculosis (TB) control program in the intervention and control prisons, after implementation of the national clinical protocol for TB and HIV management in Iranian prisons, suggesting active health service provision in all steps of service provision.Design/methodology/approachThis was quasi-experimental study conducted among inmates of two prisons in Iran. Great Tehran prison was purposively chosen as the intervention prison and Karaj prison was purposively chosen as control prison as well. Intervention and control prisons were compared in terms of the TB indicators within three periods (before intervention, during implementation and follow-up period) from October 2013 to June 2014.FindingsNumber of inmates with TB symptoms who underwent TB workup was four times more in intervention prison compared to control prison (9.3 vs 2.5 cases out of 1,000 inmates per month in the case prison compared to the control prison). Such difference was also significant in the intervention prison, comparing before and during the intervention period. The patient finding in case prison increased significantly after the intervention (223.6 vs 81.8 cases out of 100,000 inmates per year). The number of TB cases who received HIV testing increased from 50 to 100%.Originality/valueActive health service provision has significantly improved indicators in the intervention prison. The authors recommend implementation of this guideline in all prisons of Iran. Integration of other diseases with high burden among prisoners is also recommended in the active health services provision.

Purpose: Stroke is one of the most common conditions causing death. There have been few studies examining the effects of alpha lipoic acid (ALA) on stroke patients. In this regard, the present randomized controlled clinical trial was conducted to examine the effects of ALA supplementation on serum albumin, and inflammatory and oxidative stress markers in stroke patients. Methods: The present paralleled randomized controlled clinical trial involved 42 stroke patients who were over 40 years and under enteral feeding. The participants were randomly assigned into two groups and finally 40 patients completed the study. Patients in alpha lipoic acid group (n=19) took 1200 mg ALA supplement daily along with their meal, and participants in control group (n=21) underwent the routine hospital diet for 3 weeks. Fasting blood samples were obtained and albumin, oxidative stress, and inflammatory indices were assessed at baseline, as well as at the end of the trial. Results: After 3 weeks, treatment of patients with ALA led to a significant decrease in tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) levels (P=0.01) compared to baseline. But serum levels of albumin, total antioxidant capacity (TAC), malondialdehyde (MDA), highsensitivity C-reactive protein (hs-CRP), IL-6 and TNF-α did not change significantly vs. control group (P>0.05). Conclusion: ALA did not significantly change the serum levels of albumin and inflammatory as well as antioxidant capacity indices in stroke patients compared with the control group. More clinical trials with large sample sizes and long duration are needed to clarify the effects of ALA on these patients.

PurposeAlthough the pathogenesis of stroke is not yet completely elucidated, factors such as oxidative stress and inflammation have been shown to play an important role in this regard. The purpose of this paper is to investigate the effects of whey protein plus lipoic acid on the inflammatory and oxidative stress markers and the prognosis in acute ischemic stroke (AIS) patients.Design/methodology/approachA double-blind, randomized controlled clinical trial was conducted among 42 patients with the first episode of AIS at the Imam Reza Hospital of the Tabriz University of Medical Sciences. The blind research staff randomly assigned patients to two groups of receiving usual hospital gavage (control group) and 1,200 mg of lipoic acid plus 20 g of whey protein in addition to usual hospital gavage (intervention group) for midday meal. Levels of albumin, Interleukin-6 (IL-6), tumor necrosis factor (TNF-α), high-sensitivity C-reactive protein (hs-CRP) and clinical outcomes including severity of neurologic damage according to National Institutes of Health Stroke Scale (NIHSS) and functional state based on modified Rankin Scale (mRS) were evaluated initially and three weeks later.FindingsThere were no significant differences in demographic and baseline characteristics between the two groups (p> 0.05). After three weeks, hs-CRP (pp= 0.02) and TNF-α(p= 0.01) levels significantly reduced in the intervention group, but no significant changes were observed in cases of albumin, malondialdehyde (MDA) and total antioxidant capacity (TAC) in this group (p> 0.05). Instead, only IL-6 decreased significantly in the control group (pp > 0.05). While there was significant betterment in clinical prognosis parameters within groups, no significant changes were found between groups.Originality/valueThe investigation implied that whey protein plus lipoic acid supplementation has no significant effects on inflammatory and oxidative stress markers compared to the control group of AIS patients. More studies in this field are needed to approve the result.

Purpose: Malnutrition is extensively prevalent amongst critically ill patients afflicted by ischemic stroke (IS). This study purpose was to evaluate the protein whey effect on inflammatory and antioxidant markers and functional prognosis in acute IS patients. Methods: out of 42 patients with acute IS who were referred to Imam Reza Educational Hospital, Tabriz, Iran, 40 patients participated in the study. Twenty-one patients as control group received the hospital routine formula, and 19 patients as intervention group received 20 g/daily of whey protein through oral gavage. Inflammation and oxidative stress indicators (e.g., albumin, malondialdehyde (MDA), total antioxidant capacity (TAC), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and high sensitivity C reactive protein (hs-CRP)and clinical variables included in were evaluated using National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during admission and also 3 weeks after intervention. Results: Whey protein supplementation significantly decreased the NIHSS and mRS scores, TNF-α, IL-6, and hs-CRP by passing 3 weeks from intervention (P

Purpose Multimorbidity (MM) (presence of more than one chronic condition within a same patient) imposes a heavy burden on patients and health care systems. In contrast to high-income countries, the epidemiology of this phenomenon is unclear in low- and middle-income countries, particularly among Iranian population. Methods This was a retrospective cohort study using Iranian Health Insurance Organization claims database. A framework was developed for identifying a set of 18 chronic conditions from the pharmacy claims data in Iran. All 2013 outpatient utilizers (aged 18 years or older) were included. Data were analyzed according to number of chronic conditions, gender, and age. The association between MM and utilizations of health services was examined for 2013 to 2016. Results In total, 481 733 people were included. Cardiovascular diseases (including hypertension) (19.1%), depression/anxiety/sleep disorders (13.7%), and acid-related disorders (10.3%) were the three most prevalent conditions. MM was present in 21.1%. Although prevalence of MM is higher in older age groups and was present in 40% of individuals aged 65 and older, the absolute number of multimorbid patients was higher in those younger than 65 years (66 271 vs 35 386). MM was more prevalent among women (22.1%) compared with men (19.5). After multivariate adjustment for age group and sex, each additional chronic condition was associated with an increase of 2.23 physician visits, 2.86 drugs dispensed, 2.32 laboratory tests, and 1.6 medical imaging. Conclusions Our findings challenge the current single-disease-based assumption implicit in Iranian health care system. To take account of MM, complementary strategies should be designed and implement in health care system.

Objectives: After being a solid method of measuring consciousness for decades,the Glasgow Coma Scale (GCS) was offered to bereplaced with a better option: The Full Outline of Unresponsiveness (FOUR) score, which several studies later confirmed to besuperior due to its independence from verbal response and ability to consider brain stem reflexes. In this study, we decided to comparethe two scales in the prognosis of stroke, which has never been conducted before.Patients and Methods: We conducted both methods on 150 stroke patients during admission to the emergency service and assessedthem during a 3-month follow-up after discharge.Results: The type of stroke was 80% ischemic and 20% hemorrhagic. 55.3% survived after a 3-month follow-up. The FOUR score hada significant converse relation with hospitalization, a relation with the GCS lacked. The FOUR score also had a stronger correlationwith the outcome of stroke than the GCS. Additionally, the receiver operating characteristic (ROC) curve showed greater sensitivityand specificity in the FOUR score in the prognoses of stroke patients.Conclusion: We recommend using the FOUR score as the first priority.

Aims To assess the prevalence of and factors related to complementary and integrative medicine (CIM) use among multiple sclerosis (MS) patients, using a translated and adapted version of a standard international questionnaire. Methods International complementary and alternative medicine questionnaire (I-CAM-Q) was used. A cross-sectional study was done to assess the prevalence of and factors associated with CIM use among MS patients in Southern Iran. Patients who were randomly selected from MS registry center, were interviewed via phone calls. Results Three hundred patients were enrolled in the study; 69% of them were female. Their mean age was 36.6±8.53 years and the mean duration of the disease was 5.6 ± 4.22 years. In all, 99.3% (95% CI) of the patients had used at least one type of CIM. Herbal medicines and dietary supplements were the most commonly used CIM type (97.3%; 95% CI). Praying was the most common modality among all CIM subgroups (81.3%; 95% CI). Long term illness (MS) was selected as the main reason for the last use of all CIM types. Having non-tertiary education and having sequel due to MS were related to visiting a CIM provider (adjusted odds ratio (AOR) = 2.32, 95% confidence interval (CI) = 1.22–4.43), (AOR = 2.67, 95% CI = 1.47–4.83) respectively. Being female was related to the use of self-help practices (AOR = 3.41, 95% CI = 1.5–7.72). Conclusion There is a high prevalence of CIM use among MS patients. Therefore, patient- physician communication about CIM use should be emphasized.

BackgroundThere is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19.MethodsThis multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation. Using Bayesian multiple regression and after adjusting for variables with significant value in univariable analysis, we reported the posterior adjusted odds ratio (OR, with 95% Credible Intervals [CrI]) of the main outcomes.ResultsA total of 545 stroke patients, including 101 patients with COVID-19 were evaluated. Patients with COVID-19 had a more severe stroke at admission. In the study cohort, 85 (15.9%) patients had a hemorrhagic transformation, and 72 (13.1%) died in the hospital. After adjustment for confounding variables, discharge mRS score ≥2 (OR: 0.73, 95% CrI: 0.16, 3.05), in-hospital mortality (OR: 2.06, 95% CrI: 0.76, 5.53), and hemorrhagic transformation (OR: 1.514, 95% CrI: 0.66, 3.31) were similar in COVID-19 and non COVID-19 patients. High-sensitivity C reactive protein level was a predictor of hemorrhagic transformation in all cases (OR:1.01, 95%CI: 1.0026, 1.018), including those with COVID-19 (OR:1.024, 95%CI:1.002, 1.054).ConclusionIV-tPA treatment in patients with acute ischemic stroke and COVID-19 was not associated with an increased risk of disability, mortality, and hemorrhagic transformation compared to those without COVID-19. IV-tPA should continue to be considered as the standard of care in patients with hyper acute stroke and COVID-19.

© 2021 American Academy of Neurology, Objective: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

Background The development of any disturbance in the Circle of Willis (COW) can change the hemodynamics of blood flow and result in damage to the vascular system. Clinical methods such as TCD for diagnosing an aneurysm or growth factors and rupture can measure blood velocity. Several factors influence the accuracy of TCD that can lead to wrong evaluations and affect the treatment planning. Objective In this study, the conformity between CFD and TCD was accomplished for investigating the accuracy of the clinical method (TCD) in different vessels of the Circle of Willis. Methods The realistic three-dimensional models have been produced from angiography images. Considering fluid-structure interaction, a domain of the blood flow and vessel wall has been simulated by the ANSYS.CFX software. The velocity in the cerebral arteries has been calculated and compared with the velocity acquired from TCD. Results According to the findings, there were significant differences between the results obtained from computational fluid dynamics and Doppler test in different vessels of the Circle of Willis. In some areas, differences close to 80 cm/s were also reported. Conclusion According to the results, there are possibilities of errors in carrying out a Doppler test in some arteries and can lead to wrong estimates and ultimately incorrect decisions.

Background and purpose Optic neuritis (ON) is a common clinical manifestation of Multiple Sclerosis (MS), which is associated with reduced visual acuity, blurred vision, blindness and retro-bulbar pain. In several studies, specific relations between optic nerve diameter and hemodynamics of the eye bulb arteries with ON have been reported. However, no consensus has been reached in this regard. We aim at determining the alterations in optic nerve diameter and eye bulb arteries hemodynamics in ON in MS patients. Methods This case-control study includes 40 patients, who at least had experienced one phase of ON, in one of their eyes. To measure hemodynamics of arteries in the affected eyes, a color Doppler imaging was performed and end diastolic velocity (EDV), peak systolic velocity (PSV), peripheral resistance indices i.e. resistance index (RI) and pulsatile index (PI) were measured in posterior ciliary artery (PCA) and ophthalmic artery (OA). Also, optic nerve diameter was measured using sonography. Non-affected eyes of these patients were considered as control group. Results There were no significant differences in EDV, PSV, RI and PI in PCA and OA. The mean optic nerve diameter in the affected eyes was 4.73 mm, whereas, it was 4.31 mm in unaffected eyes, which was significantly different (P = .02). Conclusion These results indicate that there is a significant relation between eye involvement and increased optic nerve diameter in MS patients with chronic ON. While, there were no significant relations in EDV, PSV, RI and PI in PCA and OA comparing two groups.

Background: Photothrombotic (PT) stroke model is a reliable, reproducible, noninvasive and accessible method to induce ischemic stroke in the target site using excitation of photosensitive agents such as Rose Bengal (RB) dye after light illumination. Methods: The thirty animals were assigned into three groups of Laser irradiation, RB, and Laser irradiation+RB. We assessed ischemic stroke outcomes through multiple cellular and behavioral approaches. Laser irradiation+ RB promoted pale ischemic changes after 7 days. Microscopic staining revealed neural tissue degeneration and demarcated necrotic site and neuronal injury plus prominent astrogliosis in the periphery of irradiated sites. We performed (BrdU/NeuN) staining to examine the neurogenesis on day 28. The volume of the lesion site was calculated using unbiased stereological study and Cavalier’s principle. To assess the efficiency of ischemic stroke, modified neurological severity score (mNSS) and cylinder tests were done on days 1, 7, 14, and 28. Results: BrdU+/NeuN+ staining showed a significant increase in the number of proliferating cells in the Laser irradiation+ RB group compared to the other groups (pConclusion: Our study revealed that the PT although increased the cell proliferating in the periphery of the lesion site, but due to an undesirable microenvironment, the neurogenesis decreased concomitantly with the functional and infarct size alleviation.

Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAM, Background: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. Aims: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March–31 May 2020) compared with two control three-month periods (immediately preceding and one year prior). Methods: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. Results: The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, −19.7 to −18.7), 11.5% (95%CI, −12.6 to −10.6), and 12.7% (95%CI, −13.6 to −11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (−20.5%) had greater declines in mechanical thrombectomy volumes than mid- (−10.1%) and low-volume (−8.7%) centers (p < 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. Conclusion: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes

Background and Purpose: Stroke is reported as a consequence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in several reports. However, data are sparse regarding the details of these patients in a multinational and large scale. Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke, intracranial hemorrhage, and cerebral venous or sinus thrombosis among SARS-CoV-2–infected patients. We further investigated the risk of large vessel occlusion, stroke severity as measured by the National Institutes of Health Stroke Scale, and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with acute ischemic stroke. In addition, we explored the neuroimaging findings, features of patients who were asymptomatic for SARS-CoV-2 infection at stroke onset, and the impact of geographic regions and countries’ health expenditure on outcomes. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least 1 eligible stroke patient. Of 432 patients included, 323 (74.8%) had acute ischemic stroke, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis. A total of 183 (42.4%) patients were women, 104 (24.1%) patients were P =0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; P Conclusions: We observed a considerably higher rate of large vessel occlusions, a much lower rate of small vessel occlusion and lacunar infarction, and a considerable number of young stroke when compared with the population studies before the pandemic. The rate of mechanical thrombectomy was significantly lower in countries with lower health expenditures.

Objectives In the present study, we sought to investigate the association between red cell distribution width (RDW) and stroke severity and outcome in patients who underwent anti-thrombolytic therapy with tissue plasminogen activator (tPA). Results In this prospective study, 282 stroke patients who underwent tPA injection were included. The categorization of RDW to 13% values revealed insignificant difference in stroke severity score, accounting for the mean 36-h NIHSS of 8.19 ± 8.2 in normal RDW values and 9.94 ± 8.28in higher RDW group (p = 0.64). In seventh day, NIHSS was 6.46 ± 7.28 in normal RDW group and was 8.52 ± 8.35 in increased RDW group (p = 0.058). Neither the 36-h, nor the seventh day and 3-month mRS demonstrated significant difference between those with normal and higher RDW values.

Background: Multiple sclerosis (MS), a disease of the central nervous system (CNS), is associated with damage to the myelin sheath of neurons. It is demonstrated that vitamin D deficiency plays an important role in the development of the disease. Binding of vitamin D to its specific nuclear receptors is a way to exert its function. Objective: Possible correlation between vitamin D receptor (VDR) gene and MS was evaluated in Azeri population of Iran. Method: Different genotypes of the Bsml site were determined by using the PCR-RFLP method in 148 MS patients and 220 non-relative healthy controls. Results: In MS patients, genotype bb was significantly higher than the healthy controls (p Conclusions: In conclusion, genotype BB and sufficient exposure to sunlight before the age of 15 were the protective factors against MS. Although, excessive consumption of red meat and inappropriate dieting behaviors were predisposing factors to MS disease.

Parkinson’s disease (PD) is the second most common neurodegenerative disorder and is characterized by a spectrum of clinicopathologic signs and a complex etiology. PD results from the degeneration of dopaminergic (DAergic) neurons in the substantia nigra. Current therapies for PD are only able to alleviate symptoms without stopping disease progression. In addition, the available therapeutic strategies do not have long-lasting effects. Furthermore, these therapies cause different ranges of adverse side effects. There is great interest in neurotrophic factors (NTFs) due to their ability to promote the survival of different neural cells. These factors are divided into four families: neurotrophins, neurokines, the glial cell line-derived NTF family of ligands, and the newly recognized cerebral DA NTF/mesencephalic astrocyte-derived NTF family. The protective and therapeutic effects of these factors on DAergic neurons make them suitable for the prevention of progressive cell loss in PD. Based on the above premise, we focus on the protective effects of NTFs, especially CDNF and MANF, on nigrostriatal DAergic neurons in PD.

Reza Deljavan,1 Mehdi Farhoudi,1 Homayoun Sadeghi-Bazargani2 1Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Objective: The aim of this study was to determine the in-hospital survival of patients referred to the 2 stroke centers in North-West of Iran during a full seasonal year from April 2015. Methods: All the consecutive patients with stroke admitted to the 2 main stroke centers at Tabriz (Imam Reza University Hospital and Razi University Hospital) were recruited in this study. Stroke patients from both ischemic and hemorrhagic subtypes were selected based on the registry data and International Classification of Diseases, 10th edition. At admission, details of examination including vital signs, neurologic and systemic examination, Modified Rankin Scale, and Glasgow Coma Scale were recorded. Baseline hematological and biochemical parameter assessments as well as computerized tomographic scanning were conducted. Cox regression was used to investigate and detect potential predictors of in-hospital survival. Results: A total of 1,990 patients with stroke were studied. Males comprised 52.1% (1,036) of the subjects. The mean age of the patients was 65.8 years. Three hundred and fifty-seven (17.9%) patients had hemorrhagic stroke vs 1,633 (82.1%) with ischemic stroke. In-hospital case-fatality proportion was 12.5% (95% CI: 11.1–14). Based on modified Rankin Scale score at admission, 1,377 of 1,990 patients (69.2%) had a poor outcome (modified Rankin Scale score ≥3) at the admission time. The regression analysis showed that at least 7 variables could independently predict hospital survival of patients with stroke including age ≥65 years, higher admission modified Rankin Scale score, lower admission Glasgow Coma Scale score, hemorrhagic stroke nature, diabetes, having valvular heart disease, and having aspiration pneumonia. Conclusion: The case-fatality of stroke in the present study setting is high and needs to be appropriately addressed through prevention or management of some of these factors such as diabetes, pneumonia, and valvular heart diseases. Keywords: stroke, mortality, hemorrhagic stroke, ischemic stroke, prognostic models

Background Circle of Willis (COW) is a network of cerebral artery which continually supplies the brain with blood. Any disturbance in this supply will result in trauma or even death. One of these damages is known as brain Aneurysm. Clinical methods for diagnosing aneurysm can only measure blood velocity; while, in order to understand the causes of these occurrences it is necessary to have information about the amount of pressure and wall shear stress, which is possible through computational models. Objective In this study purpose is achieving exact information of hemodynamic blood flow in COW with an aneurysm and investigation of effective factors on growth and rupture of aneurysm. Methods Here, realistic three-dimensional models have been produced from angiography images. Considering fluid-structure interaction have been simulated by the ANSYS.CFX software. Results Hemodynamic Studying of the COW and intra-aneurysm showed that the WSS and wall tension in the neck of aneurysms for case A are 129.5 Pa, and 12.2 kPa and for case B they are 53.3 Pa and 56.2 kPa, and more than their fundus, thus neck of aneurysm is prone to rupture. Conclusion This study showed that the distribution of parameters was dependent on the geometry of the COW, and maximum values are seen in areas prone to aneurysm formation.

Aim: To evaluate the feasibility of the revised “Clinical Guideline for HIV and TB” in the Great Tehran Prison during October 2013 to June 2014. Methods: The guideline includes all aspects of HIV/TB diagnosis based on active case finding (ACF), treatment and care services. Before the implementation, a fo-cus group discussion was conducted, and attended by experts on jail diseases. The objective was to identify defects and limitations of the guideline after the discussion, the guideline was revised. The Great Tehran Prison contains three separate units; all prisoners are taken first to “reception and identification unit (quarantine)” and then send to two housing units according to their legal status. An HIV ACF strategy was employed in the quarantine, and two units through a vol-untary provider-initiated HIV testing. Three staffs of the triangular clinic trained the prisoners about common routes of HIV transmission and the symptoms of TB in the units. In the quarantine, all prisoners were examined for all HIV-risk factors, HIV testing and symptoms of TB. In unit one, healthcare staff continued the ACF process, while in unit two, the trained prisoners were assigned as the healthcare communica-tors to proceed with caution the strategy. At this caring process, when the test result was positive, then the process of care, treatment and follow ups was initiated. More-over, the use of directly observed therapy (DOTs) for antiretroviral therapy (ART) and TB was applied to the sick prisoners. There was also a follow-up caring for re-leased prisoner to refer them to care and treatment services outside the prison. Results: The guideline was implemented in the prison successfully. Conclusion: Regarding feasibility of the guideline, the investigators of this study suggest that the guideline should be implemented in other prisons across the country.

Aim: To reduce in-hospital intervals by developing a prehospital notification (PHN) protocol which directly notifies a neurologist to prepare for possible treatment. Methods: A 24/7 connection was established between emergency medical services dispatch and the on-call neurologist. A database of all patients with in-hospital stroke code activation was developed, door-to-computed tomography (CT) time and door-to-needle time was recorded from January 2013 to December 2016. The statistical results were considered significant at p < 0.05. Result: PHN resulted in a significant reduction in door-to-CT time (median 14 vs 20; p < 0.001). Among patients who were treated with intravenous thrombolysis, door-to-needle time was significantly shorter in patients with PHN compared with non-PHN group (median 42 vs 70; p < 0.001). Conclusion: PHN effectively reduced door-to-CT and door-to-needle times. © 2018 2018 Reshad Mirnour.

Background: Multiple sclerosis (MS) is a neurologic disorder with a considerable global burden. During the last decades, some pharmaceutical treatments have been approved for patients with MS. Dimethyl fumarate (DMF) is one of these drugs which has been reported to have early promising results in recent studies, but the efficacy of this drug in patients with MS is still being studied in different parts of the world. In the present study, we evaluated the effectiveness of DMF therapy on reducing relapses, lesions, and disability in Iranian patients with MS.Methods: The present single-arm before-after study was approved by the Ethics Committee of Mashhad University of Medical Sciences, Mashhad, Iran [Iranian Registry of Clinical Trial (IRCT) code: IRCT20190121042439N1]. Every patient who was diagnosed with relapsing MS was considered eligible to enroll in the present clinical trial. Before receiving DMF therapy, the baseline liver function tests and complete blood count were obtained from all individuals. Also, a baseline brain magnetic resonance imaging (MRI) was obtained and Expanded Disability Status Scale (EDSS) was documented from all patients. After receiving 240 mg DMF twice daily for 12 months, the laboratory and imaging measurements as well as EDSS were repeated. Furthermore, the total number of relapses within the study period was recorded. Satisfaction with DMF treatment was determined by answering a yes-no question.Results: A total number of 50 patients enrolled in the study and most of them were female (80%). There was a significant decrease in EDSS score and gadolinium (GD)-enhancing lesions after the study period (P < 0.001 for each). Moreover, the attacks significantly dropped after the study period (P < 0.001) and 86% of patients were satisfied with their treatment.Conclusion: The findings of this study showed that 240 mg DMF administered twice daily can effectively reduce disability and provide satisfaction within the first year of therapy in patients with MS.

Background: Bell’s palsy is the most common cause of peripheral facial palsy. The etiology and treatment of Bell’s palsy are still controversial. Previous studies emphasize the role of herpes simplex and herpes zoster viruses in this ailment. The role of Interleukin-10 (IL-10) in Bell’s palsy is yet unknown, and few studies have shed light on the matter. This study intended to assess the prognostic value of IL-10 and its relation to the intensity of electrodiagnostic abnormalities and evaluate its potential use as a factor for judging the need for medical or surgical interventions.Materials and Methods: 30 patients in the acute phase of Bell’s palsy participated in this study. Peripheral blood samples were obtained for IL-10 assessment within the first 72 hours (before commencing treatment), and a nerve conduction study (NCS) was performed six days after symptom onset.Results: There was no significant correlation between IL-10 serum levels and the severity of nerve conduction pathology in Orbicularis oculi and Orbicularis oris muscles. Also, IL-10 serum levels did not show any meaningful relationships with participants’ age, gender, or symptoms.Conclusion: The IL-10 serum levels are not relevant to the pathology of Bell’s palsy, and the assessment of IL-10 serum levels cannot be used as an alternative to NCS for evaluating the severity of acute Bell’s palsy.

Summary Aim: Atherosclerotic lesions in the carotid arteries lead to a broad range of cerebrovascular disorders such as vascular dementia and ischaemic stroke. Recent studies have verified the beneficial role of atorvastatin (AV) in atherosclerosis. Despite a large body of studies, the mechanisms underlying this effect have not been completely explained. In this study, several experiments were performed on atherosclerotic rat models to investigate the anti-inflammatory and anti-apoptotic effect of AV in the carotid artery. Methods: In this experimental study, 40 male Wistar rats (250 ± 25 g) were randomly divided into four groups: rats on a normal diet (ND; n = 10); a high-cholesterol diet (HD; n = 10); a high-cholesterol diet plus AV (HD + AV; n = 10); and the AV control group (AV; n = 10). Cleavage of caspase-3 protein, expression of B-cell lymphoma 2 (Bcl-2) as well as phosphorylation of p38 mitogen-activated protein kinase (MAPK) were determined by immunoblotting assay in the carotid artery homogenate. Plasma atherogenic indices, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured by colorimetric assay at the end of the experiment. Plasma levels of oxidised LDL (oxLDL) were measured by sandwich enzyme-linked immunosorbent assay (ELISA). Results: After eight weeks of feeding with a high-cholesterol diet, an elevated level of oxLDL was observed in the plasma in the HD group compared with the ND group [214.42 ± 17.46 vs 69.13 ± 9.92 mg/dl (5.55 ± 0.45 vs 1.78 ± 0.26 mmol/l); p < 0.01]. AV administration significantly reduced oxLDL levels in the HD + AV compared to the HD group [126.52 ± 9.46 vs 214.42 ± 17.46 mg/dl (3.28 ± 0.25 vs 5.55 ± 0.45 mmol/l); p < 0.01]. Results also showed that compared with the HC group, the HC + AV group had lower levels of p38 phosphorylation (p < 0.05) and higher levels of Bcl-2 expression (p < 0.05). Lower levels of cleaved caspase-3 were observed in the HC + AV group in comparison with the HC group (p < 0.05). Conclusions: The resultant data suggest that the anti-apoptotic effect of AV could be partially mediated by the pro-inflammatory protein p38 MAPK and the anti-apoptotic protein Bcl-2 in the rat carotid artery. Atorvastatin can therefore be considered a target drug in the prevention or development of atherosclerotic events.

Studies have shown an increase in the incidence of MS in Iran. The aim of our study was to evaluate the relationship between environmental exposure and MS in Iran. This case-control study was conducted on 660 MS patients and 421 controls. Many environmental factors are compared between the two groups. Our findings demonstrated that prematurity ([OR = 4.99 (95% CI 1.34–18.68), P = 0.017]), history of measles and mumps ([OR = 1.60 (95% CI 1.05–2.45), P = 0.029; OR = 1.85 (95% CI 1.22–2.78), P = 0.003, respectively]), breast feeding [OR = 2.90 (95% CI 1.49–5.65), P = 0.002], head trauma in childhood ([OR = 8.21 (95% CI 1.56–43.06), P = 0.013]), vaccination in adulthood ([OR = 4.57 (95% CI 1.14–18.41), P = 0.032, respectively]), migraine ([OR = 3.50 (95% CI 1.61–7.59), P = 0.002]), family history of MS, IBD, migraine, and collagen vascular diseases ([OR = 2.73 (95% CI 1.56–4.78), P

Background Elevated D-dimer levels are a marker of both thrombin formation and fibrinolysis. Currently D-dimer measurement is routinely used for ruling out venous thromboembolism and diagnosis/monitoring of disseminated intravascular coagulation. Recent emerging data suggest that D-dimer may become an important biomarker in ischemic stroke as well as in cardiovascular diseases. Aims To outline the clinical utility of D-dimer in work-up and management of ischemic stroke. Summary D-dimer measurement is most useful in stroke with active cancer as it can confirm etiologic diagnosis, predict recurrent stroke risk, and aid treatment decision in cancer-associated stroke. In cryptogenic stroke, high D-dimer levels can also provide clues for the cause of stroke as occult cancer and undetected cardiac embolic source as occult atrial fibrillation and may be helpful in treatment decision making of secondary stroke prevention. Serial D-dimer measurements should be further studied to monitor antithrombotic therapy effectiveness in both cardiogenic and cryptogenic etiologies. Conclusion Accumulating data suggests the utility of D-dimer test in the management of ischemic stroke, although the evidence is still limited. Future studies would clarify the role of D-dimer measurement in ischemic stroke.

Background: Today, the medical world faces an increase in the incidence of chronic diseases. Medication adherence is an essential component of the effective treatment of such diseases and failure to it, especially in the elderly, has a negative impact on health. Objectives: The current study aimed at determining the level of medication adherence in the elderly with chronic diseases referring to academic medical centers in Ardabil, Iran. Methods: In the current cross sectional study, 222 elderly patients with chronic diseases (i e, musculoskeletal, diabetes, cardiovascular and renal conditions) referring to the clinics of Imam Khomeini, Fatemi, and Alavi hospitals in Ardabil in 2018 were selected by convenience sampling method. Data were collected using a questionnaire including demographic characteristics and the Morisky medication adherence scale (MMAS). The data were analyzed using descriptive statistics and multivariate logistic regression analysis with SPSS version 16. Results: The mean age of the elderly was 68.25 ± 7.65 years; 187 (84%) subjects had unsatisfactory medication adherence (score 6). The probability of satisfactory adherence to medication was higher in the elderly with higher level of education, but other variables such as age, gender, occupational status, income level, network of life, place of residence, marital status, and type of chronic disease had no significant effect on medication adherence. Conclusions: The high level of medication non-adherence in the elderly with chronic diseases is a matter of concern and it seems necessary to perform studies on the barriers to medication adherence in the elderly and solve them.

Objective: Cerebral vascular events are the second leading cause of mortality worldwide and is increasing in developing countries. Epidemiological studies are important to improve outcomes and preventive and supportive strategies. This research was aimed to study epidemiology of stroke in Tabriz, Iran. Materials and Methods :This cross-sectional, analytic population-based study was performed from May 2009 to April 2010. Information about probable stroke events was obtained from 5000 randomly selected people. In a door-to-door process, questionnaires were completed by a trained team. Any probable stroke case was referred to a stroke expert for further evaluation. After diagnosing stroke cases, 214 healthy people were assembled for a control group to compare stroke related risk factors. Results :Out of 5000 studied people, 34(0.68%) stroke patients, with a mean age of 68.7 years (range: 38-85), were detected. Nineteen (56%) patients were male, 31 (91%) were ischemic, and 3 (9%) had hemorrhagic stroke. Six first-ever strokes occurred in the 1 year study period. Identified risk factors included hypertension in 25 (74%), hyperlipidemia in 11 (32%), diabetes mellitus in 9 (27%), smoking in 10 (29%) and coronary artery disease in 6 (18%). Conclusion : This report showed a high incidence rate of stroke of about 120 per 100,000 people and a remarkably high prevalence of hypertension. It speaks to the need to make special health system strategies to raise awareness for primary and secondary prevention of stroke.

Background Hemiplegic Shoulder Pain (HSP) is among common complications occurring after stroke leading to disability. This study was conducted to compare the effects of electrical Interferential Current stimulation (IFC) and Electrical Acupuncture (EAC) on pain intensity, range of motion, and functional ability in patients with HSP and also comparing the two modalities regarding improvement of above indices. Methods In this randomized clinical trial, 46 patients with HSP caused by ischemic stroke were recruited and assigned into 2 groups. Conventional exercise trainings were applied for both groups. Group A received additional IFC with medium frequency of 4000 HZ, and Group B received additional EAC two times a week for a total of 10 sessions. Pain severity, daily function, and shoulder Range of Motion (ROM) were evaluated using Visual Analogue Scale (VAS), Shoulder Pain and Disability Index (SPADI), and goniometry, respectively before and 5 weeks after the treatment. Results Both groups showed relative improvement in pain severity, SPADI score, and its subscales, and also active and passive shoulder ROM after the treatment. However, IFC group compared to EAC group had higher mean changes of active ROM in abduction (28.00 ± 3.81 vs. 12.25 ± 2.39) and functional subscale of SPADI (11.45 ± 1.88 vs. 5.80 ± 1.66) after the treatment. On the contrary, EAC group showed higher percentage of VAS changes (46.14 ± 6.88 vs. 34.28 ± 5.52), indicating better pain improvement compared to IFC group. Other parameters did not show significant difference between two groups. Conclusion Both IFC and EAC caused short term improvement in functional state, increased motion, and decreased pain in patients with HSP. Although pain control was more evident in acupuncture group, IFC resulted in better effects on function and active ROM of abduction, and seems to have higher efficacy. Trial registration This clinical trial was registered in the Iranian Registry of Clinical Trials at 2016-07-16 with a registry number of IRCT201602153217N10.

Stroke is the second leading cause of death and the most common cause of adult disabilities among elderlies. It involves a complex series of mechanisms among which, excitotoxicity is of great importance. Also, miRNAs appear to play role in post-stroke excitotoxicity, and changes in their transcriptome occur right after cerebral ischemia. Recent data indicate that specific miRNAs such as miRNA-223, miRNA-181, miRNA-125a, miRNA-125b, miRNA-1000, miRNA-132 and miRNA-124a regulate glutamate neurotransmission and excitotoxicity during stroke. However, limitations such as poor in vivo stability, side effects and inappropriate biodistribution in miRNA-based therapies still exist and should be overcome before clinical application. Thence, investigation of the effect of application of these miRNAs after the onset of ischemia is a pivotal step for manipulating these miRNAs in clinical use. Given this, present review concentrates on miRNAs roles in post-ischemic stroke excitotoxicity.

The aim of this study was to conduct a systematic review of literature to retrieve all randomized controlled trials that evaluated the efficacy of tamoxifen on manic mood episodes and meta-analyze their quantitative results.Four electronic databases were systematically searched from their inception to March 2014: PubMed, Cochrane Library (Cochrane Central Register of Controlled Trials), Scopus, and PsychINFO. Pooled difference in means of changes in mania scores and pooled odds ratio of treatment response (for tamoxifen monotherapy) were calculated as the main effect size. A random effects model was used to pool the data across studies. Quantitative syntheses were expressed by forest plots.Five randomized controlled trials (3 adjunct trials and 2 monotherapy trials) were included. Regarding adjunct tamoxifen, the standardized difference in mean of mania score changes in tamoxifen arm as compared with control arm was 0.669 (95% confidence interval [CI], 0.15-1.189; P = 0.012). Regarding monotherapy, the pooled difference in means of mania score changes in the tamoxifen arm as compared with the placebo arm was 22.09 (95% CI, 20.98-23.192; P0.000000001). Pooled odds ratio of response to treatment was 15.36 (95% CI, 2.99-78.73; P = 0.001) in the tamoxifen group as compared with the placebo group.Tamoxifen can be considered an effective treatment for manic bipolar patients. Making a conclusion regarding the efficacy and safety for longer periods warrants further studies with a larger sample size and longer follow-up duration.

Alzheimer is a progressive neurological disease that results in irreversible loss of neurons and includes about two thirds of all cases of dementia. Toxoplasma gondii may be an important infectious agent involved in neurodegenerative diseases. The aim of this study was to investigate the correlation between Toxoplasma as an etiologic agent in the progress of Alzheimer's disease. This case control study was conducted on 75 Alzheimer's patients and 75 healthy volunteers. Blood samples were obtained and anti-Toxoplasma IgG and IgM tests were done by using ELISA technique. DNA was extracted from buffy coat and then GRA6 gene and SAG2 loci were amplified by PCR and nested PCR, respectively. Chi-square, Fisher's test, and binary logistic regression were used for data analysis. A percentage of 61.3 % of Alzheimer's patients and 62.6 % of healthy volunteers were positive for anti-Toxoplasma IgG but all participants were negative for anti-Toxoplasma IgM. There were no significant differences between Alzheimer's patients with their controls in terms of anti-Toxoplasma IgG antibody (P = 0.5). Due to lack of positive IgM sample, results of the molecular methods were negative by GRA6 and SAG2 fragments amplification. This result shows that, infection with T. gondii cannot be considered as a risk factor for etiology and developing Alzheimer's disease.

Background: Animal model of multiple sclerosis is a demyelinating and inflammatory disorder of central nervous system and eye. Histological evaluation in eyes in experimental autoimmune encephalomyelitis (EAE) models demonstrated evidence of retinal atrophy and inflammation in late stage of disease. Deciphering the relationships between the retinal atrophy and proliferation on retinal layers may help us in understanding the factors that drive atrophy and proliferation in multiple sclerosis. Original Research Article

The present study was performed to assess nutritional status and its relationship with clinical outcomes in elderly stroke patients.In this cross-sectional study, 253 stroke patients were studied. Mini Nutritional Assessment (MNA) was used to assign patients to three groups: malnourished, at risk of malnutrition, and well nourished. Northwestern Dysphagia Patient Check Sheet was administered to all patients. Anthropometric measures, including body mass index (BMI), calf circumferences (CC), mid-arm circumferences (MAC), and triceps skinfold thickness were brought out. In addition, National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and biochemical tests were performed.Of 253 patients, 34.4% were malnourished, 42.3% were at risk of malnutrition, and 23.3% were well nourished. The malnourished patients had significantly lower BMI, CC, and MAC (p 0.05). The levels of albumin and high-sensitivity C-reactive protein were significantly different among the groups (p 0.001). The admission and 3-month follow-up mRS scores, as well as dysphagia, were significantly higher in the malnourished patients and those at risk of malnutrition (p 0.001). In addition, mRS scores at admission and 3-month follow-up scores, as well as the length of hospital stay (LOS), were significantly correlated with MNA score, dysphagia, BMI, CC, MAC, albumin, and high-sensitivity C-reactive protein (p 0.05). Significant unadjusted associations were observed among MNA scores, BMI, CC, MAC, dysphagia scores, NIHSS scores, length of hospital stay (LOS), albumin, hs-C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR) with a poor outcome. With a multivariate logistic regression analysis, NIHSS scores and MNA scores remained significantly associated with the poor outcome in patients with ischemic stroke.The findings of the present study underline the importance of nutritional status in elderly stroke patients.

Cognitive dysfunction is the most common nonphysical impairment in the stroke survivors. This impairment has a negative impact on patients' quality of life affects their daily living activities. Both pharmacological and nonpharmacological interventions are employed to improve cognitive impairment. Recently, nonpharmacological interventions have attracted great attention. Cognitive rehabilitation is considered as a therapeutic strategy to improve and maintain cognitive skills in patients with stroke. Enriched environment (EE), as a cognitive rehabilitation strategy, has been shown to facilitate physical, cognitive, as well as social abilities. Moreover, EE has been shown to increase endogenous growth factors. Growth factors have pivotal role in neurogenesis, synaptogenesis, as well as brain remodeling through neuron development, differentiation, and survival. In addition, administration of exogenous growth factors prevents cognitive dysfunction. Here, we review preclinical and clinical evidence of cognitive rehabilitation and role of growth factors in treating poststroke cognitive impairment.

Background Tuberculosis [TB] is one of the most important infectious diseases among prisoners. TB Screening plays an important role in prevention among prisoners and their visitors, also better caring of the patients. Active case finding is one of screening methods that is relatively an easy one to find TB suspected prisoners. Therefore, we aimed to assess the prevalence of TB in male prisoners in Tehran, Iran. Methods This study was conducted among male prisoners in Great Tehran Prison to screen and diagnose TB patients from October 2013 to May 2014. We used active case finding [ACF] as a screening method to find TB suspected prisoners in which healthcare staff explained TB symptoms for prisoners and individuals with those symptoms referred to the clinic for further work up (sputum sample tests). Results In total of 6900 prisoners, 448 (6.5%) prisoners were TB suspected by ACF and only nine patients were diagnosed with tuberculosis, indicating the prevalence of 0.13%. Conclusion The relatively low TB prevalence within prisoners besides considering likely common symptoms in ACF may result in many false positive cases during screening (6.5% vs. 0.13%). But, ACF is more fast, easy and affordable method to find TB suspected prisoners. Also, during this active method, prisoners are trained about TB symptoms so, it has a more prolonged effect towards screening goals.

Background: People with chronic illnesses such as HIV infection face many health status outcomes in the correctional settings. The current study aimed at investigating multiple determinants of HIV medication adherence among patients with HIV. Methods: Focus group discussion (FGD) was conducted on inmates of Ghezel-hesar Prison in Karaj, Alborz province, Iran, to investigate the barriers and facilitators of adherence to antiretroviral therapy (ART) in January 2015. The purposive sampling method was employed to recruit seven male prisoners with HIV infection. Results: Participants reported illegal drug use, poor education in HIV treatment, side-effects of antiretroviral drugs, treatment interruption, drug interferences, fear of hangover, poor diet, poor socioeconomic background, hopelessness, depression, not believing in the treatment, rejection and lack of social support, stigma, compulsory rest in the yard, lack of tendency toward visiting psychiatrists, lack of familial support, forgetfulness, and not receiving complementary drugs as the barriers to adherence to ART. In addition, the facilitators were physician-patient good relationship, physician’s compassion, counseling services for the patients, education of patients regarding HIV treatment necessities, peer education, informing patients about their CD4 levels, education of correctional staff to show courtesy in the treatment of patients, timely methadone therapy, and improved diet. Conclusions: Providing welfare programs and education of inmates with HIV infection regarding the adherence to ART may play a prominent role in the treatment of such patients. Training correctional staff regarding the significance of HIV treatment and adherence to ART can also be effective in the treatment of prisoners with HIV infection.

Objectives: We conducted this study to compare the tuberculosis (TB) incidence in an Iranian prison with the society in Iran. Methods: In this present study, we investigated the incidence of TB among prisoners versus the society by an age range of 23 to 49 years. We used an active case finding (ACF) strategy as a screening method to find TB suspected prisoners in the Great Tehran Prison from October 2013 to May 2014. Results: In the total of 5865 prisoners, only nine patients were diagnosed with TB while 2263 out of 4503516 individuals of the society had TB in this period of time. Statistical analyses showed that out of 100,000 people there were 153.5 patients detected in the prison and 5.02 patients in the society. Therefore, the incidence of TB in the prison was significantly more than the society (P < 0.0001). The ratio of TB incidence in the prison to the society was 30.6 (95% CI: 16 - 58). Conclusions: The incidence of TB in prisons is significantly more than society. Thus, TB management needs providing preventive measures such as intensifying case findings in prisons.