The effect of bacterial composition shifts in the oral microbiota on Alzheimer's disease.

Alzheimer's disease (AD), a neurological disorder, despite significant advances in medical science, has not yet been definitively cured, and the exact causes of the disease remain unclear. Due to the importance of AD in the clinic, large expenses are spent annually to deal with this neurological disorder, and neurologists warn of an alarm to increase this disease in the elderly people in the near future. It has been believed that microbiota dysbiosis lead to Alzheimer's as a multi-step disease. In this regard, the presence of footprints of perturbations in the oral microbiome and the predominance of pathogenic bacteria and their effect on the nervous system especially AD is a very interesting topic that has been considered by researchers in the last decade. Some studies have looked at the mechanisms by which oral microbiota cause AD. However, many aspects of this interaction are still unclear as to how oral microbiota composition can contribute to this disease. Understanding this interaction requires extensive collaboration by interdisciplinary researchers to explore all aspects of the issue. So, in this review has attempted to give the mechanisms of shift of oral microbiota in AD in order to reveals the link between microbiota composition and this disease with the help of researchers from different fields.

Association of perturbation of oral bacterial with incident of Alzheimer's disease: A pilot study.

OBJECTIVE: This case-control study was designed to compare the composition of the predominant oral bacterial microbiome in Alzheimer's disease (AD) and control group. SUBJECT: A total of 30 adult participants (15 AD and 15 healthy individuals) were entered in this study. The composition of oral bacterial microbiome was examined by quantitative real-time polymerase chain reaction (qPCR) using bacterial 16S rDNA gene. The levels of systemic inflammatory cytokines in both groups were assessed using enzyme-linked immunosorbent assays (ELISA). RESULTS: The loads of Porphyromonas gingivalis, Fusobacterium nucleatum, and Prevotella intermedia were significantly more abundant in the AD compared to the control group (p < 0.05). Although Aggregatibacter actinomycetemcomitans and Streptococcus mutans were relatively frequent in the AD group, no significance difference was observed in their copy number between two groups. Although the concentrations of IL-1, IL-6, and TNF-α were higher in the AD group, there was a significant difference in their levels between the two groups (p < 0.05). Finally, there was a significant relationship between increased number of pathogenic bacteria in oral microbiome and higher concentration of cytokines in patient's blood. CONCLUSION: Our knowledge of oral microbiome and its exact association with AD is rather limited; our study showed a significant association between changes in oral microbiome bacteria, increased inflammatory cytokines, and AD.

Psychometric Properties of the Persian Version of Dizziness Handicap Inventory.

INTRODUCTION: The present study was designed to investigate the psychometric properties of the Persian version of the Dizziness Handicap Inventory (P-DHI). In addition, this research was targeted toward assessing the association of P-DHI with Medical Outcome Study 36-Item Short Form Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS). The current study also involved a comparison of the scores of patients and healthy participants and implementation of a factor analysis. MATERIALS AND METHODS: This cross-sectional study was conducted on 113 patients with dizziness and 30 healthy individuals referring to tertiary centers for otolaryngology and neurology, affiliated to Guilan University of Medical Sciences, Rasht, Iran. The mean age of the patients was 44.5±13.6 years. All patients re-completed the P-DHI after 2 weeks. Internal consistency and reproducibility of the inventory were evaluated using the Cronbach's alpha coefficient, Bland-Altman limits of agreement, and intraclass correlation coefficients. In addition, the relationships of the P-DHI with SF-36 and HADS were evaluated using the Spearman correlation coefficient. An exploratory factor analysis was also run to determine the factor structure of the questionnaire. RESULTS: The Cronbach's alpha coefficient of P-DHI scale was obtained as 0.86. In addition, the functional, physical, and emotional subscales of this instrument had the Cronbach's alpha coefficients of 0.76, 0.52, and 0.80, respectively. The limits of agreement were 16 points for the total scale, and the range of intraclass correlation coefficients was 0.90-0.96. The P-DHI showed a fair correlation with vertigo severity which assesses functional disability subscale. This scale also demonstrated a moderate correlation with SF-36 and HADS. Factor analysis revealed a 2-factor solution which was different from the factor structure of the original DHI. CONCLUSION: As the findings indicated, the P-DHI had good psychometric properties; therefore, it could serve as a useful tool for measuring disability in patients with dizziness and unsteadiness.

The Onset and Frequency of Spasticity After First Ever Stroke.

BACKGROUND: Spasticity is one of the most important causes of disability after stroke. In spite of high incidence of spasticity, little is known about the relationship between the occurrence and the development of spasticity. This study aimed to determine risk-factors of post stroke spasticity. METHODS: This was an observational study of 149 persons with first ever stroke. The following parameters were assessed: Stroke severity, Spasticity, Disability and Joint contracture. RESULTS: Prevalence of spasticity was between 17-25% during the first 3 months after stroke. The onset of spasticity was 13.79% and 4.16% at 1 and 3 months after stroke respectively. The prevalence of spasticity in the upper extremity was significantly more than lower extremity at 1 month. Spasticity was significantly more severe in the upper extremity than lower extremity. In patients with hemorrhagic stroke Odds ratios of spasticity was 2.5 times more than persons with ischemic stroke (P = 0.0210. The Odds ratios of severe spasticity at 1 and 3 months were 1.66 and 1.75 times more than the first week (P = 0.024, P = 0.042 respectively). CONCLUSIONS: Post stroke spasticity is more common in persons with hemorrhagic stroke, severe paresis and lower functional abilities. The most incidence of spasticity happens in the first month after stroke.

Assessing clogging of laminated hydrophobic membrane during fecal sludge drying.

A new sanitation technology has been proposed in which a laminated hydrophobic membrane contains and enhances drying of fecal sludge in a toilet, with particular focus on application to urban regions of low-income countries. The proposed technology uses a laminated hydrophobic membrane liner as an integral component of container-based sanitation systems. The focus of this study is to quantitatively evaluate the laminate's clogging after repeated use, which will affect replacement interval and might limit the laminate's application in container-based toilets. The membrane of the laminated hydrophobic membrane used in this process is hydrophobic and only allows vapor transport. Drying of water vapor using the laminated hydrophobic membrane occurs due to moderate temperature or humidity gradients, while other constituents such as aqueous dissolved solutes of fecal sludge are retained. Controlled laboratory experiments evaluated repeated use of a laminated hydrophobic membrane for fecal sludge drying, with mild brushing/rinsing of the laminate between each application. Drying occurred at a constant rate as long as the fecal sludge moisture content exceeded 11.6 (g/g), below which water activity <1. Over five drying cycles, at a significance level of α = 0.05 the dimensionless drying rate in the constant-rate period was not reduced. While scanning electron microscopy and energy dispersive X-ray analyses of used laminated hydrophobic membrane showed deposition of fecal sludge on the inner fabric of the laminate, particulate accumulation was never sufficient to alter the fecal sludge drying rate. Experiments with only water indicated that the fecal sludge increased the effective diffusion length through the laminate by 10-30%. These data demonstrate that clogging of the laminated hydrophobic membrane is minor over five cycles of fecal sludge drying with mild rinsing between cycles, indicating that use of the laminate may be feasible in many field applications.

Awareness toward stroke in a population-based sample of Iranian adults.

Background: Stroke is the leading cause of death and functional disability. While there have been major advances regarding the management of stroke, a significant proportion of people are still unaware of stroke-related symptoms and risk factors. This study was performed to assess the awareness of stroke's warning signs and risk factors among a sample of Iranian population. Methods: A total of 649 participants were randomly selected using systematic randomization from the list of telephone numbers obtained from the telephone directory. Demographic characteristics were recorded. Participants were asked to answer questions regarding the awareness about stroke, its warning signs and risk factors. Results: Patients' mean age was 32.0 ± 12.2 years old, and 56.4% were women. Hypertension and history of stroke were major risk factors, and loss of consciousness, vertigo and ataxia were major warning signs of stroke correctly identified by respondents. Multiple linear regressions showed that age (ß = 0.277, P < 0.001), academic level of education (ß = 6.41, P = 0.01), housewifery (ß = 8.9, P < 0.001), jobs related to medical care (ß = 13.17, P = 0.016) and previous information about stroke (ß = 18.71, P < 0.001) were significant predictors of the overall awareness about stroke. Conclusion: The awareness of people about stroke, its risk factors and warning signs were good in this study. The awareness toward stroke can be associated with factors such as age, academic level of education, job and previous information about stroke. Further studies are recommended to program public multimedia and health education in academies and colleges.

Surgical outcome of foot drop caused by common peroneal nerve injuries; is the glass half full or half empty?

BACKGROUND: Foot drop is a gait abnormality with various etiologies. The Common Peroneal Nerve (CPN) is one of the most frequently injured peripheral nerves. CPN deficit leads to foot drop. Most CPN injuries recover spontaneously; nonetheless, some require nerve surgery. The present study set out to assess the surgical outcomes of foot drop following CPN injuries. METHOD: Surgical outcomes were reviewed in 36 subjects with foot drop caused by CPN injuries, undergoing surgical nerve exploration. The CPN injuries were confirmed by physical examination, Magnetic Resonance Imaging (MRI) and electrodiagnostic findings. RESULTS: Subsequent to surgery, a significant improvement was seen in the motor recovery of the subjects. Interestingly, no significant difference in the recovery was found between neurolysis and nerve repair (direct repair and nerve grafting). There was no significant association between the age and the functional recovery. Gender was not associated with the functional recovery. No significant difference was seen in the recovery between thigh-level and knee-level CPN divisions. CONCLUSIONS: The findings from the present study suggest that nerve surgery can yield beneficial results in the recovery of foot drop following CPN injuries. In addition, the surgical outcome of neurolysis in the treatment of CPN injuries can be similar to that of the nerve repair (direct repair or nerve grafting). This may show the value of nerve repair, which was comparable to neurolysis in the treatment of CPN injuries.

Iron overload is associated with perihematoma edema growth following intracerebral hemorrhage that may contribute to in-hospital mortality and long-term functional outcome.

Iron overload may contribute to brain damage that involves delayed brain atrophy, edema, and neuronal cell death as well as unfavorable outcome following ischemic stroke and intracerebral hemorrhage (ICH). This prospective study was performed to determine the association of serum ferritin level, an iron storage protein, with perihematoma edema (PHE) growth as well as in-hospital mortality and long-term clinical outcome of patients with ICH. Data was collected from patients with ICH from February 2011 to April 2012. Demographic and clinical data were recorded and serum ferritin was measured on admission. Brain CT scan was performed on admission and 72 hours later. Volume of hematoma and PHE was calculated using ABC/2 formula. Functional outcome was assessed using modified Rankin Scale. A total of 63 patients were included in this study, of those 11 (17.5%) patients died during the first 72 hours of admission. There was a significant correlation between PHE growth during first 72 hours of hospitalization and serum ferritin (P<0.001) as well as history of diabetes mellitus (P<0.001). PHE growth during the first 72-hours of hospitalization and baseline hematoma volume were both predictors of in-hospital mortality and poor outcome (P=0.026 and P=0.035, respectively). These results indicate the role of iron overload in the development of PHE following ICH. However, it seems that serum ferritin level is not directly associated with in-hospital mortality and long-term functional outcome.

The relationship between the serum levels of ferritin and the radiological brain injury indices in patients with spontaneous intracerebral hemorrhage.

OBJECTIVES: Preclinical studies show that iron plays a key role in mediating neuronal injury. This study was performed in order to identify the relationship between the serum level of ferritin and severity of the brain injury which occur after an Intracerebral hemorrhage (ICH). MATERIALS AND METHODS: This was a cross sectional descriptive - analytic study, which was conducted on those patients who had suffered from an ICH and had attended Poursina Hospital. The Serum levels of ferritin were measured at admittance. A Cranial CT scan was performed at admission and also 72 hr afterward. Hematoma and edema surrounding the hematoma volumes were also measured at entrance and 72 hr afterward. Data analysis was carried out by a descriptive - analytic statistics approach and calculated later on by the Spss-20 software. RESULTS: In this investigation, 63 patients were studied, from which 34 (54%) were male and 29 (46%) female. The average age of the patients was 69.7± 11.9 (Min 43 and Max 94 years old). A significant relationship was observed between the level of ferritin and the edema volume surrounding the hematoma at first and next 72 hr after the patients were admitted. CONCLUSION: These results delineated the effective role of iron on the edema volume elevation. More studies are essentially urged to ascertain the clinical evaluation of the curing effect of iron chelators in those patients who suffer from ICH.

Predicting in-hospital mortality in Iranian patients with spontaneous intracerebral hemorrhage.

BACKGROUND: Intracerebral hemorrhage (ICH) is the most fatal subtype of stroke. Despite limited effective therapy, there is no accepted clinical grading scale to predict in-hospital mortality, especially in developing nations. The purpose of this study was to assess the predictors of in-hospital mortality among a sample of Iranian patients with spontaneous ICH for use at the time of the first evaluation. METHODS: This prospective study was carried from January 2010 to the end of January 2011. Demographic, clinical, and laboratory data of ICH patients were collected. Hematoma volume and perihematoma edema (PHE) were measured on brain computed tomography scan using ABC/2 formula. Logistic regression analysis was performed to determine independent variables contributing to in-hospital mortality. RESULTS: Of a total 167 consecutive ICH patients, 98 patients met inclusion criteria. Mean ± standard deviation age of patients was 70.16 ± 12.52. After multivariate analysis, five variables remained as independent predictors of in-hospital mortality included: age [odds ratio (OR) = 1.12, 95% confidence interval (CI) = 1.03-1.23, P = 0.009], diabetes mellitus (OR = 10.86, 95% CI = 1.08-109.24, P = 0.009), National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.41, 95% CI = 1.08-1.68, P ≤ 0.001), as well as volume of hematoma (OR = 1.1, 95% CI = 1.03-1.17, P = 0.003), and PHE (OR = 0.75, 95% CI = 0.60-0.93, P = 0.010). CONCLUSION: Our results indicate that older age, diabetes mellitus, higher NIHSS, as well as larger volume of hematoma, and smaller PHE on admission are important predictors of in-hospital mortality in our ICH patients.

Prevalence and predictors of depression in Iranian patients with multiple sclerosis: a population-based study.

Depression is a frequent symptom in multiple sclerosis (MS) which has a negative impact on quality of life and cognitive status. The purpose of this study was to determine the prevalence and associated factors of depression, and status of antidepressant use in Iranian MS patients. One-hundred and sixty patients with definite MS were included. Demographic and clinical characteristics were recorded. Fatigue and depression were evaluated using the fatigue severity scale and Beck depression inventory-II. Cognitive performance and disability were examined by mini-mental status examination and expanded disability status scale. Multiple logistic regressions were used to determine the associated factors of depression and antidepressant use. The prevalence of depression and severe depression was 59.4 and 18.1 %, respectively. However, only 21.1 % of patients were on antidepressant treatment, while the prevalence of unrecognized/untreated depression was found to be as high as 44.1 %. Multivariable analysis showed that fatigue (P < 0.0001, OR = 5.98, 95 % CI = 2.9-12.3) and older age (P = 0.027, OR = 2.24, 95 % CI = 1.09-4.6) were associated with depression in MS patient. A significant association was found between fatigue and antidepressant use (P = 0.001, OR = 6.81, 95 % CI = 2.26-20.48). Our findings demonstrate that depression is significantly associated with fatigue and older age, regardless of other factors. Moreover, despite the high prevalence of depression in MS, most patients do not receive adequate treatment.

Epidemiology and clinical characteristics of chronic daily headache in a clinic-based cohort of Iranian population.

Although CDH is a major health care problem encountered in headache clinics, our knowledge about the epidemiological features of CDH is limited in developing countries. The objective of this study was to survey the frequency and clinical features of chronic daily headache (CDH) and its subtypes among Iranian population presenting to a referral tertiary Headache clinic in a University Hospital. This cross-sectional survey was carried out between September 2011 and March 2012. Data of patients with CDH including their age, sex, educational level, and marital status were recorded using structured face-to-face interview. Subtypes of the CDH were determined by history, physical examination and appropriated laboratory or imaging findings. A total number of 177 cases (32.71%) fulfilled the CDH criteria. The frequency of CDH was higher in 40-49 age groups (n = 54) and among women with a female to male ratio of 2.12/1. Chronic migraine was the most common subtype of CDH in 75 cases (44.4%). Chronic tension-type headache and secondary causes were second and third frequent subtypes of CDH in 27.8 and 20.1% of cases, respectively. Cervicogenic headaches (10.7%) and medication overuse headache (4.1%) were the most common causes of secondary headaches. The present study confirmed previous findings which showed a high prevalence of CDH and chronic migraine in clinic setting, with preponderance for women. In addition, we found the highest prevalence of cervicogenic headaches among secondary causes of CDH.

Is serum vitamin D levels associated with disability in patients with newly diagnosed multiple sclerosis?

BACKGROUND: Although the precise etiology of multiple sclerosis (MS) is unknown, it seems that both genetic and environmental factors are important. Recent studies suggest that low serum vitamin D levels are important environmental factor in MS. The aim of this study was to compare the serum levels of vitamin D between MS patients and healthy subjects, and to determine its association with disability in MS patients. METHODS: In this cross-sectional study, a total of 52 patients with MS were randomly recruited and matched for age and sex with 52 healthy subjects. Demographic characteristics and serum vitamin D levels for both groups, as well as duration of disease Expanded Disability Status Scale (EDSS) for MS patients were evaluated. Statistical analysis was performed by independent samples t-test and multiple linear regression analysis. RESULTS: The mean serum vitamin D levels were 26.5 ± 16.3 ng/ml in MS patients vs. 37.1 ±19.7 in healthy subjects (P = 0.003). A linear regression analysis showed no significant association between vitamin D levels and EDSS score of patients with MS (P = 0.345), after adjusting for the covariates. CONCLUSION: Our findings did not suggest a protective association for serum vitamin D levels against disability in MS patients.

A randomized open-label study of sodium valproate vs sumatriptan and metoclopramide for prolonged migraine headache.

OBJECTIVE: The objective of this study is to compare the efficacy and tolerability of intravenous valproic acid (iVPA) with intramuscular metoclopramide + subcutaneous (SQ) sumatriptan for prolonged acute migraine. BACKGROUND: Intravenous valproic acid has been explored as a possible treatment of acute migraine. Sumatriptan and newer generation triptans are also effective for migraine. However, iVPA has not yet been compared with triptans in head-to-head studies. METHODS: Patients presenting with moderate to severe intensity migraine without aura were randomized to receive either 400 mg of iVPA or 10 mg intramuscular metoclopramide + 6 mg SQ sumatriptan (30 patients in each study arm). The severity of headache and other associated symptoms such as photophobia and phonophobia were assessed at baseline and after 20 minutes and 1, 2, 4, and 24 hours. The primary end point was to compare the efficacy of the 2 study treatments in relieving headache from moderate-severe to none-mild and of other associated symptoms within a period of 24 hours. RESULTS: Pain relief from severe or moderate to mild or none was obtained in 53.3% of subjects in the iVPA arm and 23.3% in the metoclopramide + sumatriptan arm at 1 hour following treatment (P = .033), whereas 60% and 30% reported pain relief at 2 hour (P = .037). There was no other significant difference in alleviation of associated migraine symptoms between the 2 arms. No serious adverse effects were noted. CONCLUSION: Treatment with iVPA was more effective than metoclopramide + SQ sumatriptan during the first 2 hours in patients with a prolonged migraine.