Atrial Septal Abnormalities and Cryptogenic Stroke: A Cross-Sectional Study.

BACKGROUND: Cryptogenic stroke, whose underlying pathology is unknown, accounts for 30-40% of all ischemic strokes. Studies have mentioned the association between atrial septal abnormalities and cryptogenic stroke, but there are still disparities in the results among different studies. OBJECTIVE: We aimed to clarify the prevalence of atrial septal abnormalities in patients with cryptogenic stroke. METHODS: We conducted a cross-sectional study on 91 patients with cryptogenic stroke/transient ischemic attack from March 2021 to March 2022. We evaluated the demographic data of the patients and also the existence of neurologic attacks. Furthermore, echocardiography was performed to determine the type of atrial septal abnormality. RESULTS: Out of 91 patients with cryptogenic stroke/transient ischemic attack, 16 patients (17.5%) had patent foramen ovale, 1 man (1.1%) had atrial septal aneurysm, and 1 woman (1.1%) had an atrial septal defect. Patients with patent foramen ovale were significantly younger than those without. The size of patent foramen ovale in patients with cryptogenic stroke was larger than those with transient ischemic attack, but this difference was not significant. Also, the size of the patent foramen ovale (length and width) was not significantly related to any of the demographic variables (p-value = 0.544, 0.604). CONCLUSION: Based on our results, the prevalence of atrial septal abnormalities was relatively high. Considering these issues and the importance of preventing neurological accidents in patients, especially young people, it is recommended to always consider atrial septal disorders and, if diagnosed, to carry out the necessary treatment in this field.

Viola tricolor Hydroalcoholic Extract Improves Behavioral Deficiencies in Rats Exposed to Chronic Immobilization Stress

Abstract This study aims to investigate the effect of Viola tricolor extract on hippocampal neuronal death, interleukin (IL) -6 and IL-10 expression, spatial memory, anxiety, and depression in rats exposed to chronic immobilization stress. Rats were divided into groups Control, Viola300, Viola600, Stress, Stress-Viola300, and Stress-Viola600. Animals were placed in a restrainer (6 h / 21 days) to stress exposure. V. tricolor hydro-alcoholic extract was also administrated at doses of 300 and 600 mg/kg by gavage. The extract caused immobilized animals to spend more time in the target quadrant in the Morris water maze test. It also increased the percentage of entries into the open arm and the percentage of time spent in the open arm of the elevated plus-maze in immobilized rats. Treatment with the V. tricolor extract significantly reduced the immobility time of stressed rats in the forced swimming test. Furthermore, it significantly reduced neuronal death and expression of IL-6 in the hippocampus of immobilized animals but could not prevent the decrease of IL-10 expression. We concluded that V. tricolor protects rats from stress-induced behavioral damages, at least in part, by suppressing neuronal death and decreasing IL-6 expression.

Factors associated with intimacy and sexuality among young women with multiple sclerosis.

BACKGROUND: Patients with multiple sclerosis (MS) especially those with younger age experience an alteration in physiological and emotional lifestyle that can affect intimacy and sexuality. The aim of this study was to determine demographic and disease related determinants of intimacy and sexuality in young women with MS. METHODS: This was a cross sectional study carried out in Tehran, Iran. A convenience sample of young women aged ≤35 years old with MS attending to outpatient clinics in a teaching hospital affiliated to Tehran University of Medical Sciences was entered into the study. The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) was used to evaluate how the disease influences sexual function and satisfaction in these patients. Multivariable analysis using hierarchical method was performed to identify variables that are associated with intimacy and sexuality. RESULTS: In total 117 young women with confirmed diagnosis of MS were included in the study. Participants mean was 25.7 (SD = 8.07) years. A multivariable hierarchical regression analysis was performed using demographic variables entered in step one, relevant neurological variables in step two, and psychological variables in step three. Furthermore, we loaded antidepressant use in the last step. Overall, the seven variables accounted for 39% of total variance observed for the MSISQ score (P < 0.001). At step one the demographic variables accounted for 13% of the variance in the MSISQ score (P < 0.001). At step two the inclusion of relevant neurological variables increased the R2 significantly and explained 27% of variance for the MSISQ (P < 0.001). However in the third step the inclusion of psychological factors increased R2 significantly (adjusted R2 increased to 0.39, P < 0.001). CONCLUSIONS: The findings indicated that psychological, disease-related and demographic factors (education and employment status) contributed to intimacy and sexuality in young women with multiple sclerosis. Appropriate interventions, especially psychological interventions, appear to be essential immediately following a definite MS diagnosis in young women.

Tricuspid valve geometry in patients with functional tricuspid regurgitation: A three-dimensional echocardiographic study.

INTRODUCTION: Tricuspid valve (TV) has a complex anatomy causing some difficulties in echocardiographic evaluation. In this study, we sought to assess the geometry of TV in patients with functional tricuspid regurgitation (TR) by the implementation of 2- and 3-dimennsional (2D and 3D) echocardiography. METHODS: In a case-control study, the geometrical features of TV were evaluated in forty patients with functional TR using echocardiographic examinations, and those data compared with twenty-five age- and sex-matched healthy individuals. RESULTS: The mean age of patients was 50 ± 12 years, and 75% were female. All echocardiographic features of TV geometry were significantly greater in TR compared to control group. The 3D evaluation of TV annulus showed that the annulus shape was more circular in the TR compared to the control group. When compared patients with moderate and severe TR, there was a significant difference between groups regarding the size of the TV septolateral annulus diameter (3.5 ± 0.4 vs 3.9 ± 0.7 cm; P = .048), and the angle between mitral valve and TV annuluses (12.5 ± 4.3 vs 17 ± 9º; P = .048). Tenting areas measured by 2D echocardiography and obtained by TomTec software were significantly greater in severe TR compared to moderate TR group. The diameter of TV by 2D echocardiography was significantly higher in atrial fibrillation than that in sinus rhythm group among patients with TR. CONCLUSIONS: The implementation of 3D echocardiography is useful in the determination of TV geometry in patients with functional TR. The accurate evaluation of anatomical features of TV might provide valuable tools in the evaluation of patients with functional TR.

Effects of Stabilization Exercises Focusing on Pelvic Floor Muscles on Low Back Pain and Urinary Incontinence in Women.

OBJECTIVE: To investigate the effects of stabilization exercises focusing on pelvic floor muscles on both low back pain (LBP) and urinary incontinence (UI) in women suffering from chronic nonspecific LBP. METHODS: In a randomized clinical trial, 60 women, ranging from 45 to 60 years old, with chronic nonspecific LBP and stress UI were recruited. They were randomly assigned to the control group (n = 30) that received routine physiotherapy modalities and regular exercises, or the training group (n = 30) that received routine physiotherapy modalities and stabilization exercises focusing on pelvic floor muscle (12 weeks). Clinical characteristics of the study subjects including UI intensity and quality of life assessed by International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire, functional disability assessed by Oswestry disability index scores, pain intensity, pelvic floor muscle strength and endurance, and transverses abdominis muscle strength were measured before and after treatment. RESULTS: Functional disability and pain intensity were significantly decreased in control (P < .05) and training groups (P < .05), with no significant difference between the groups after treatment. However, UI intensity was smaller for the training group (P < .05). Pelvic floor muscle strength and endurance, and transverses abdominis muscle strength were statistically increased in the training group compared with those in the control group (P < .05). CONCLUSION: Stabilization exercises focusing on pelvic floor muscle improves stress UI as well as LBP in women with chronic nonspecific LBP.

Prevalence and risk factors for depression in women with multiple sclerosis: a study from Iran.

BACKGROUND: Multiple sclerosis is increasingly becoming a major health problem among women worldwide. The aim of the present study was to estimate prevalence of depression in women with multiple sclerosis and also to identify risk factors contributing to its development. METHODS: This was a cross-sectional study of depression in a sample of 226 women with multiple sclerosis. The sample was recruited from an outpatient clinic in Tehran, Iran. Depression was assessed using the Beck Depression Inventory-II (BDI-II). Univariate and multiple logistic regression analyses were performed to examine the association between depression and independent variables. RESULTS: Overall, 91 women (40.2 %) had moderate to severe depression. The mean age of participants was 35.7 years (SD = 8.07). The results obtained from multiple logistic regression analysis showed that the disease course (OR for relapsing-remitting MS = 2.36, % 95 CI = 1.14-5.53, P = 0.46), the expanded disability status scale (OR for score of 5-8 = 4.88, % 95 CI = 2.51-11.06, P < 0.001) and employment status (OR for housewife = 4.75, % 95 CI = 1.55-14.58, P = 0.006) were significant contributing factors to depression in patients with multiple sclerosis. CONCLUSIONS: The findings suggest that depression in patients with multiple sclerosis is multi-factorial and very much dependent to physical and social conditions of patients. The recognition of such conditions might help clinicians to manage patients more effectively.

The multiple sclerosis intimacy and sexuality questionnaire-19: reliability, validity, and factor structure of the Persian version.

INTRODUCTION: The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) was designed to assess the perceived influence of multiple sclerosis (MS) symptoms on sexual activity and satisfaction. AIMS: This study aimed to translate and validate the MSISQ-19 in women with MS in Iran. METHODS: The translation of the original questionnaire was carried out in accordance with a standard forward-backward procedure. Then, a sample of 226 married women with MS completed the questionnaire. Reliability was estimated using Cronbach's alpha coefficient. Concurrent validity was assessed by comparison with the Female Sexual Function Index (FSFI), the Expanded Disability Status Scale (EDSS), and the Beck Depression Inventory-II (BDI-II). The factor structure of the questionnaire was extracted by performing exploratory factor analyses. All patients underwent a full neurologic examination. MAIN OUTCOME MEASURES: MSISQ-19 score was the main outcome measure. RESULTS: The mean age of participants was 35.77 years (SD = 8.07), with mean disease duration of 1.84 years (SD = 0.79). Cronbach's alpha coefficient was 0.90 for total MSISQ-19 score, with values of 0.85, 0.90, and 0.78 for the subscales assessing primary, secondary, and tertiary sexual dysfunction, respectively. The principal component analysis indicated a three-factor solution, similar to that found in the original validation study, that explained 63.0% of the total variance for women with MS. Scores on the MSISQ-19 and its subscales correlated with scores on the FSFI, EDSS, and BDI-II (all P < 0.01). CONCLUSION: In general, the findings suggest that the MSISQ-19 is a reliable and valid measure of sexual function among Iranian women with MS. However, further studies are needed to establish psychometric properties for male MS patients in Iran.

Determinants of sexual dysfunction in women with multiple sclerosis.

BACKGROUND: The aim of present study was to determine disease-related and psychological risk factors for sexual dysfunction in women with multiple sclerosis (MS). METHODS: This was a clinical-based study conducted from September 2009 to June 2010 in Tehran, Iran. A consecutive sample of female patients with MS was recruited from an outpatient clinic. The Female Sexual Function Index (FSFI) was used to evaluate sexual function. In addition neurological impairment was measured using the Kurtzke Expanded Disability Status Scale (EDSS), and depression was assessed using the Beck Depression Inventory-II (BDI-II). Univariate and multiple logistic regression analyses were performed in order to examine the association between sexual dysfunction and independent variables. RESULTS: In all, 226 women participated in the study. Of these, 125 women (55.3%) met the criteria for sexual dysfunction. The mean age of participants was 35.7 years (SD = 8.07). The results obtained from multiple logistic regression analysis indicated that the disease duration (OR for the disease duration of equal or greater than 9 years = 3.13, %95 CI = 1.29-7.57, P = 0.01), the disease course (OR for secondary progressive MS = 3.96, %95 CI = 1.55-10.10, P = 0.004) and the BDI score (OR = 1.11, %95 CI = 1.07-1.16, P < 0.001) were significant factors contributing to sexual dysfunction in these patients. CONCLUSIONS: The findings from this study indicated that the duration and severity of the disease in addition to depression were the most significant factors that contributed to sexual dysfunction in women with multiple sclerosis. The burden of disease and sexual dysfunction suggests the need for further attention to this patient population.

Role of serotonergic system on modulation of depressogenic-like effects of silymarine.

In the present study, we have investigated the effects of silymarine on depression and the possible role of serotonergic system in these effects. The rats were anesthetized intraperitoneally with ketamine hydrochloride and placed in a Stoelting stereotaxic instrument. A stainless steel guide cannula (22-gauge) was implanted in the third ventricular region. The third ventricular region was infused by means of an internal cannula (27-gauge), terminated 1 mm below the tip of the guide cannula. Forced swimming test was used for evaluating the depression. The results obtained from this study showed that oral administration of silymarin (35, 70, 140 and 280 mg/rat) for two weeks increased the immobility time in forced swimming test, indicating an increase in depression level of the treated rats. Intra-third-ventricle (Intra-TV) infusion of 5HT1A receptor agonist 8-OH-DPAT (25 and 10 ng/rat) decreased the immobility time indicating an anti-depression effect, while injection of 5HT1A receptor antagonist NAN190 (0.25, 0.5 and 1 µg/rat) had no significant effect on immobility time. An effective dose of 8-OH-DPAT (10 ng/rat) co-administered with silymarin (140 and 280 mg/rat) decreased the depressogenic effects of silymarin. These results showed that the depressogenic effects of silymarin may be modulated via 5HT1A receptor of serotonin.