[ study of quality of life in aphasic stroke patients in university medical centers of Hamedan]

As clinical improvement of patients surviving stroke is frequently incomplete and is followed by residual neurologic deficit, evaluation of the consequent function of these patients in three respects i.e; physical, social and emotional, which are considered as quality of life is useful in decision making for health care providers. Since few studies have been carried out in this regard, the aim of the present study was to obtain the average life quality score in four levels in aphasic stroke patients and comparing it with the quality of life score of the healthy population which is 5. This study was a descriptive-cross sectional research carried out on 105 aphasic stroke patients referring to medical centers in Hamadan, Iran. Their diagnoses were confirmed by clinical and radiological findings. These patients were eligible for the study and had survived the stroke for at least six months. Sampling was non randomized and goal-oriented. Dependent variables included psychological, communicational, energy and physical status of the patients measured quantitatively. Data were gathered using the SAQOL-39 questionnaire. In this study the female population [58.1%] was greater than the male. The greater number of the aphasic patients [42%] was between 71 to 85 years old and the smallest number [6.7%] was between 39 to 50 years old. The greatest average score of life quality in the studied patients was related to the psychological state [2.17], while the smallest was related to the energy state [1.49]. Average score of the life quality in the total population of the studied patients was calculated to be [1.88]. The findings of the present study can lead to special supportive measures with the aim of improving life quality in aphasic stroke patients. We suggest that life quality of the patient after stroke should be compared to his/her own quality of life before stroke. Because there is no special service for care providers of stroke patients, an international program should be planned so that by reducing stress, they could have a better relation with the patients

[Prevalence of bladder and sexual dysfunctions in patients with multiple sclerosis]

Multiple Sclerosis is the most common disabilitating neurological disease. More than 80% of MS patients show symptoms of lower urinary system impairment. Although rarely life threatening, these complications can affect the quality of life. The aim of this study was to find the frequency of bladder and sexual impairments among MS patients. All patients with diagnosis of MS with no previous history of bladder or sexual dysfunctions, referred to Farshchian hospital in Hamadan during 2006, were included. Information regarding the demographic characteristics and urinary/sexual problems were collected using a questionnaire. The data were analyzed by SPSS ver.10. Out of 103 individuals, 85 [82.5%] and 18 [17.5%] were males and females, respectively. 76.6% of cases were found to have at least one sign of urinary problem. Also, it was revealed that 43.8% of individuals had at least one symptom of sexual dysfunction. A minimum of one sonography on urinary system to control the possible problems was performed in 14.6% of patients. Additionally, 7.8% of patients had experienced at least one period of urinary infection. Considering the high frequency of bladder and sexual dysfunctions in patient with MS, it is recommended that in addition to clinical examinations, the routine urinary test, urinary tract sonography, and urology and gynecology consultations to be performed for patients with MS. Appropriate and symptomatic treatment should also be considered for motor /bladder function/ fatiguabilityand depression to improve the quality of life and reduce the burden of disease

[Comparing the efficacy of avonex, rebif and betaferon in motor disability [expanded disability status scale] and relapsing rate of multiple sclerosis patients]

Multiple sclerosis [MS] is an autoimmune inflammatory demyelinating disease of the central nervous system [CNS] that is a leading cause of disability in young adults. The aim of the present study was to compare the relative efficacies of Avonex, Rebif and Betaferon in EDSS and relapsing rate in MS patients. 126 patients with multiple sclerosis were randomly allocated to the three treatment groups. The first group received Avonex [47.6%], the second group received Rebif [28.5%], and the third group received Betaferon [23.8%]. For all patients, first and final EDSS and relapsing rate was assessed. The mean age of patients was 31.1 +/- 8.6 years and 80.2% of patients were female. Differences between mean of first and final EDSS were statistically significant in three groups [p<0.05]. The mean of EDSS score changes in Avonex, Betaferon and Rebif groups were 1.38 [31.2%], 1.30 [24.3%] and 1.45 [30.7%] [NS]. In Avonex and Betaferon groups, the difference between attack of MS disease before and after treatment was significant [p<0.05], however, the difference in Rebif group was not significant [NS]. The mean decrease relapse of MS disease in Avonex, Betaferon and Rebif groups were 0.69 [40.1%], 0.60 [42.8%] and 1.25 [62.5%] [NS]. Treatment with these three drugs has significantly reduced EDSS score, however, relapsing rate was significantly decreased in Rebif group

[ dexamethasone effect on the motor function of the patients with stroke, a double-blind clinical trails]

Background: steroids therapy remains controversial for the patients with stroke, but some physicians administrate it yet, in such a patient. For this reason, in a double-blind clinical trail, we evaluated the dexamethasone effects on the motor function of the patients with stroke

Materials and methods: in a double-blind clinical trail, and in contrast to placebo, eighty patients presented with hemiplagia and with the impression of stroke enrolled in two groups that received dexamethasone and placebo. In the first admission day, the patients evaluated for risk factors, muscle force, level of consciousness, sphincter and speech disorders. Muscle forces reevaluated for five days later. All the data extracted with a checklist and compared by descriptive statistics and x2, t test, Mann-Whitney, Friedman and repeated measure ANOVA tests

Results: four patients excluded from the study for death. The age mean was 67.93+/-8.84 and 39 and 37 were male and female respectively. Except for sex and smoking, there was no difference in two groups. The muscle forces improved significantly in the patients in each groups [P value=0.000], but we didn't find any difference between them [P value=0.59]. Also we didn't see any steroid complication

Conclusion: this study failed to demonstrate any benefit of dexamethasone in improving the motor function of stroke patients

[Relationship between ADPKD and post renal transplant diabetes mellitus]

Autosomal-dominant polycystic kidney disease [ADPKD], a common hereditary disease, is characterized by the progressive development and enlargement of multiple cysts in both kidneys, and typically resulting in end stage renal disease [ESRD] by the fifth decade of life. Post-transplant diabetes mellitus [PTDM], a common complication after transplantation with an incidence rate of 2.5-20%, is associated with poor graft and patient survival. In few studies, PTDM has been more frequent in ADPKD transplanted patients. In the present study, we investigated whether there is any association between PTDM and ADPKD in our patients. In this prospective study, 140 non-diabetic and nonsmoker successfully transplanted patients [27 ADPKD and 113 non ADPKD patients] were enrolled during three years. Both groups were matched for age, sex, body mass index [BMI], duration of renal replacement therapy before transplantation and also immunosuppressive protocols after transplant. Post-transplant diabetes mellitus was defined as Clinical Practice Guidelines advocated by Canadian Diabetes Association. All patients were followed for 12 months. PTDM occurred in 11.1% of ADPKD patients and in 13.1% of control group which was statistically insignificant [P > 0.05]. The development of PTDM in ADPKD group was not related to sex, age, and hypertension, duration of renal replacement therapy before transplantation, BMI and serum creatinine levels [P > 0.05]. Post-transplant diabetes mellitus appears not to be associated with autosomal-dominant polycystic kidney disease as an etiology of end stage renal disease