The study of intermediate-term survival of the patients with cerebral venous sinus thrombosis

@#Objective: This study aimed to investigate the intermediate survival of patients with cerebral venous sinus thrombosis (CVST). Methods: This is a retrospective study recruiting patients with a definite diagnosis of CVST who were referred to teaching hospitals of “Shiraz University of Medical Sciences” from 2007 to 2017. Follow-up phone calls were conducted in March 2019 till June 2019. All-cause mortality, mortality due to CVST, and CVST recurrence were investigated. Results: Of the total of 301 patients, 213 (70.8%) were female. Patients’ age ranged from 1 to 95 year with a mean of 39.9 year. Intermediate follow-up (mean 46.9, 95%CI: 43.6-50.2 months) was done. Intermediate term mortality was 12.3%, mostly from CVST, and largely occurred within the first month. Age was a significant risk factor for survival (HR=1.056, 95%CI:1.037-1.075). The difference was not statistically significant in males in comparison to females (HR=1.3, 95%CI:0.67-2.60, P=0.41). Patients with recurrent CVST hada higher risk of mortality (HR=9.14, 95%CI:4.70-17.89, P<0.001). There was statistically higher risk of mortality in patients with deep vein thrombosis (DVT) (HR=8.97, 95%CI: 4.32-18.61, P<0.001). Although the risk of death for patients using oral contraceptives (OCPs) was 16% higher, this was not statistically significant (HR=1.16, 95%CI: 0.52-2.55, P= 0.21). Conclusions: Intermediate-term mortality was 12.3%, and associated with older age, recurrent CVST and DVT. The reasons for these findings need further investigation.

Neuroprotectives in acute ischemic stroke, hope or hype?

Stroke is a significant public health burden which absolutely requires more effective therapies. The approved treatment options for stroke including tissue plasminogen activators, antiplatelet agents and anticoagulants mainly bear antithrombotic effects. Meanwhile, evolving investigational approaches such as collateral therapeutics and neuroprotective agents has thus far been attempted with equivocal effects on stroke outcome. The basic structural and ultrastructural changes following acute ischemic stroke should be well-considered when trying to target oxidative stress and cell death pathways using neuroprotective agents. Clearly, the positive results of preclinical studies on neuroprotectives and collateral therapeutics in stroke do not necessarily translate to the true clinical benefits of these agents. As such, several large advance-phased trials have already failed to prove so. On the other hand, controversial results in clinical setting should not discourage further research endeavors on the same. Besides, the concurrent use of flow augmentation and neuroprotectives may serve further clinical benefits. Based on the available evidence, it appears that optimization of preclinical studies and further well-designed prospective clinical trials let neuroprotection possibly find its position in stroke management. The present paper discusses key preclinical and clinical studies on neuroprotectives towards improved outcome in acute ischemic stroke

The McDonald criteria for dissemination in space in the differential diagnosis of multiple sclerosis and neuro-Behcet’s disease

Background: Neuro-Behcet’s disease (NBD) is similar to multiple sclerosis (MS) in multiple aspects. This study was conducted to investigate the sensitivity, specificity, accuracy, positive and negative predictive values for the 2005 revised McDonald MRI criteria for the diagnosis of MS and NBD. Methods: This study enrolled 28 consecutive patients with a diagnosis of NBD and 48 patients with a diagnosis of clinically definite MS, who were referred to the Nemazee Hospital, Shiraz University of Medical Sciences, between March 2009 and March 2010. Brain and spinal cord magnetic resonance imaging (MRI) were obtained. Two Radiologists, blinded to clinical diagnosis, reviewed the MRI. We investigated the sensitivity, specificity, accuracy, and positive and negative predictive values of the 2005 revision of the McDonald criteria for dissemination in space for the diagnosis of MS and NBD. Results: There were a total of 10 men and 38 women with a mean age of 32.76±7.5 years, with a diagnosis of MS, and 18 men and 10 women with a mean age of 26.8±5.9 years with a diagnosis of parenchymal NBD. The interobserver agreement for the diagnosis of MS using the 2005 revision of the McDonald criteria for dissemination in space with the use of the Cohen kappa scores was 0.82. The sensitivity, specificity, accuracy, and positive and negative predictive values were 80%, 61%, 71.5%, 77% and 64%, respectively. Conclusion: The accuracy and specificity of the McDonald criteria for dissemination in space for the differentiation of MS and NBD are not optimal.

Incidence of potential drug-drug interaction and related factors in hospitalized neurological patients in two iranian teaching hospitals

Reciprocal drug interactions are among the most common causes of adverse drug reactions. We investigated the incidence and related risk factors associated with mutual drug interactions in relation to prescriptions written in the neurology wards of two major teaching hospitals in Shiraz, southern Iran. Data was collected from hand-written prescriptions on a daily basis. Mutual drug interactions were identified using Lexi-Comp 2012 version 1.9.1. Type D and X drug interactions were considered as potential drug-drug interactions. The potential risk factors associated with drug-drug interactions included the patient's age and gender, number of medications and orders, length of hospitalization and the type of neurological disorder. To determine potential drug-drug interactions, relevant interventions were suggested to the physicians or nurses and the outcome of the interventions were documented. The study comprised 589 patients, of which 53% were males and 47% females, with a mean age of 56.65 +/- 18.19 SD years. A total of 4942 drug orders and 3784 medications were prescribed among which 4539 drug-drug interactions were detected, including 4118 type C, 403 type D, and 18 type X. Using a logistic regression model, the number of medications, length of hospitalization and non-vascular type of the neurological disorder were found to be significantly associated with potential drug-drug interactions. From the total interventions, 74.24% were accepted by physicians and nurses. Potentially hazardous reciprocal drug interactions are common among patients in neurology wards. Clinical pharmacists can play a critical role in the prevention of drug-drug interactions in hospitalized patients

short introduction to a 19th century Persian book on Pulsology: Naiier Azam

Islamic Golden Age, 9-12 century AD, was the period through which Persian scientists and physicians were most influential in improving medical sciences including cardiovascular knowledge. Although post-Islamic Golden Age witnessed a number of great Persian scholars moving cardiovascular concepts forward, they failed to become as well known as their predecessors. One of these scholars was Hakim Mohammad Azam Khan belonging to the 19th century. He authored many books on medical sciences. He wrote all the books in Persian. Some of his most famous works are Eksir Azam [The Greatest Elixir; a comprehensive medical encyclopedia]; Romouz Azam [The Greatest Secrets; a general book on medicine] and Qarabadin Azam [Pharmacopeia]. In addition, he had a valuable treatise on pulsology, named Naiier Azam. Naiier Azam, one of the important works on cardiology in Persian medicine, which includes three parts: one introduction and two teaching chapters [Taelim]

Hospital mortality associated with stroke in southern Iran

Background: Unlike the western hemisphere, information about stroke epidemiology in southern Iran is scarce. The aim of this study was to determine the main epidemiological characteristics of patients with stroke and its mortality rate in southern Iran

Methods: A retrospective, single-center, hospital-based longitudinal study was performed at Nemazee Hospital in Shiraz, Southern Iran. Patients with a diagnosis of hemorrhagic and ischemic strokes were identified based on the International Classification of Diseases, 9th and 10th editions, for the period between 2001 and 2010. Demographics including age, sex, area of residence, socioeconomic status, length of hospital stay, and discharge destinations were analyzed in association with mortality

Results: 16351 patients with a mean age of 63.4 years [95% CI: 63.1, 63.6] were included in this analysis. Men were slightly predominant [53.6% vs. 46.4%]. Forty-seven percent of the total sample was older than 65,17% were younger than 45, and 2.6% were children younger than 18. The mean hospital stay was 6.3 days [95% CI: 6.2, 6.4]. Among all types of strokes, the overall hospital mortality was 20.5%. Multiple logistic regression revealed significantly higher in-hospital mortality in women and children [P<0.001] but not in patients with low socioeconomic status or from rural areas. During the study period, the mortality proportions increased from 17.8% to 22.2%

Conclusion: In comparison to western countries, a larger proportion of our patients were young adults and the mortality rate was higher

Breast cancer metastasis to pituitary infandibulum

Metastasis from breast cancer to other parts of the body is very common, but the spread of the tumor to pituitary gland, especially to infandibulum, is a rare presentation. At the time of pituitary metastasis, a majority of the patients have clinical and radiological evidence of the disease. It seems that the posterior area of the gland is the most common site of metastasis, probably due to highly rich blood supply through the hypophyseal artery. The present report introduces a case of a 55-years-old woman presented with diabetes insipidus resulting from metastasis of the tumor to pituitary infandibulum, which is a rare site for metastasis, without significant complaint resulting from metastasis to other part of the body, or other primary diseases. Further evaluation revealed that in spite of previous reports, which metastasis usually happens in end stage of cancer, the patients had primary breast cancer. In subsequent evaluations of the case, hypofunction of adenohypophysis was also detected

Cerebral venous-sinus thrombosis: a case series analysis

Cerebral venous-sinus thrombosis is an uncommon form but important cause of stroke, especially in young-aged women. We performed a retrospective descriptive-analytical study in which 124 patients with cerebral venous-sinus thrombosis, who referred to Nemazee Hospital, Shiraz University of Medical Sciences from January 2000 to March 2008, were included, and their demographic, etiologic, radiological and prognostic characteristics were evaluated. The patients' mean age was 34.01 +/- 10.25. Eighty seven [70.16%] were women and 37 [29.83%] were men. The most frequent clinical manifestations were headache, papilledema and seizures. Fifty seven [65.5%] women took oral contraceptive pills. Twenty of 57 women [35.08%] took the pill longer than one month to be able to fast in Ramadan or perform the Hajj ceremonies. In the mean time they developed cerebral venous-sinus thrombosis. Superior sagital sinus, with or without lateral sinuses, was the most involved area [70.96%]. High mortality and morbidity rates [14.51%] and 35.48%, respectively] were found in patients. Poor prognostic factors at the time of admission were stupor and coma [P=0.001] and evidence of hemorrhage in primary CT scan [P=0.005]. Taking oral contraceptive pills was a main factor associated with cerebral venous-sinus thrombosis. Clinical manifestations, prognostic factors, common involved sinuses and image findings of this study were similar to those of other studies. Health care policy makers should design a plan to warn susceptible women of the risk of cerebral venous-sinus thrombosis, and to educate them the ways to prevent it

Validity and reliability of the Persian epilepsy quality of life questionnaire

To translate and test the reliability and validity of the 31-item epilepsy quality of life questionnaire [QOLIE-31] in Iranian epileptic patients. In order to standardize the questionnaire, using a standard "forward-backward" translation, cognitive debriefing, and cultural adaptation procedure, the English version of the QOLIE-31 was translated to Persian [the Iranian official language]. The subjects were Epileptic patients, over 18 years old, referred to the Motaharri Clinic, Shiraz, Southern Iran from March 2007 to March 2008. The reliability and internal consistency of the questionnaire were assessed by Cronbach's alpha coefficient. Validity was assessed using convergent and disconvergent validity through Spearman's correlation. Two hundred and eleven epileptic patients [88 females [41.7%], 123 males [58.3%]], with a mean +/- SD age of 28.7 +/- 11.6 years were enrolled in the study. Reliability analysis showed a satisfactory result [Cronbach's alpha =0.890]. Internal consistency was satisfactory for both demographic and patients' clinical characteristics [alpha >/= 0.70]. The scaling success rates were 100% for convergent validity of each scale. Disconvergent validity for all 7 scales was good. The Persian version of the QOLIE-31 questionnaire has good structural characteristics, is a reliable and valid instrument, and can be used for measuring the effect of epilepsy on the quality of life

Knowledge and attitude towards stroke risk factors, warning symptoms and treatment in an iranian population

To assess the baseline knowledge regarding stroke risk factors, symptoms, treatment and information resources in an Iranian urban population. A community-based face-to-face interview survey was conducted in the Shiraz urban area in Iran. A total of 385 potential participants between the ages of 15 and 83 years were randomly selected from people referred to Motahari Clinic, Shiraz University of Medical Sciences, Shiraz. All the participants answered the 63 questions about different aspects of stroke. SPSS software version 15 was used to analyze the data. The 385 participants completed the face-to-face interview. The most common risk factors for stroke identified by respondents were hypertension [342; 88.8%] and smoking [338; 87.8%]. The most common warning signs of stroke were abdominal pain [370; 96.1%] and chest pain [338; 88.7%]. This study shows that the knowledge of and attitude towards stroke risk factors in the general population of Shiraz are adequate. By using the public media and school education, it is possible to promote the level of the population's knowledge of and attitude towards stroke

Knowledge and attitudes of Iranian patients with regard to lumbar puncture

To investigate the knowledge and attitudes of patients towards lumbar puncture [LP], its complications, and indications. In a questionnaire survey; patients who were referred to the general neurology outpatient clinic at Nemazee Hospital in Shiraz, Iran, from January 2007 to January 2008 were invited to complete a questionnaire consisting of items of demographic and socioeconomic variables, experiences with LP and complications, and knowledge of and attitudes regarding LP. A total of 410 patients were recruited [58%] women, mean age 33.2 +/- 2.7 years]. Poor knowledge of LP was highly prevalent [92.6%], and negative attitudes toward LP were also common [63%] among our patients. Skepticism regarding LP was directly related to lack of information [p=0.00007]. Lower socioeconomic status, lower educational level, and residence in rural areas were associated with being less well informed about LP, but interestingly those who had experience with LP before were better informed and had more positive attitudes. It is possible to overcome reluctance to undergo LP through education of its indications, contraindications, and complications

Neurological manifestations of Behcet's disease

To determine the prevalence, clinical manifestations, and laboratory features of Neuro-Behcets disease. This prospective study was carried out in the Behcets Research Clinic in Shiraz [south-west Iran] and included the patients referred from 1990-1999. The patients' clinical records, images, CSF analyses, and electrodiagnostic studies were reviewed. Eighteen [15 males and 3 females] out of 690 Behcet s patients [2.6%, 95% CI = 1.4-3.8%] were found to have neurological involvement. The mean +/- standard deviation age of these patients was 34.7 +/- 8.6 years. All fulfilled the criteria of the International Study Group of Behcet s Disease. Central nervous system involvement was more common than peripheral nervous system manifestations. Headache, weakness, tingling, and numbness were the most common symptoms. Hyperreflexia, upward plantar reflex, and somatosensory findings were the most frequent signs. Hemispheral and brainstem stroke-like syndromes and cerebral venous thrombosis were the major neurologic presentations. There were also cases of myelitic, pure meningoencephalitic, amyotrophic lateral sclerosis-like, multiple sclerosis-like, and Guillain Barre syndromes. Neuro-Behcets disease must be considered in the differential diagnosis of stroke in young adults, chronic meningitis, intracranial hypertension, multiple sclerosis, myelopathies, and peripheral neuropathies