Three-dimensional in vitro cell culture leads to a marked upregulation of cell function in human hepatocyte cell lines--an important tool for the development of a bioartificial liver machine

Upregulating hepatocyte function in proliferating human liver cell lines could provide cells for a bio-artificial liver. Ideally, a means of mimicking the biological extracellular matrix with a relatively inert, bio-compatible matrix is required. Alginate encapsulation of primary hepatocytes is biocompatible. This study aimed to characterize cells grown in a 3D configuration in alginate. A human-derived liver cell line encapsulated in 1% alginate was assessed for synthetic and detoxification functions. Secreted proteins measured (e.g., albumin, fibrinogen, alpha-1-antitrypsin etc.) were increased in alginate compared with monolayers. Cytochrome P450 1A1 activity increased three- to fourfold, whilst urea synthesis, undetectable in monolayer cultures, was synthesized by cells in alginate at levels approaching in vivo production. TEM revealed good ultrastructure reminiscent of normal hepatocytes. Alginate promotes 3D colonies of proliferating cells with upregulated liver functions. Rapid recovery of function of cryopreserved cells (< 18 h) provides added advantages for this system to support the biological component of an artificial liver for patients with fulminant hepatic failure.

Effect of a traditional syrup from Citrus medica L. fruit juice on migraine headache: A randomized double blind placebo controlled clinical trial

ETHNOPHARMACOLOGICAL RELEVANCE

In Persian ethnomedicine several herbal remedies and functional foods have been used to treat migraine headache which are mostly summarized in Qarabadin-e-kabir (Aghili-Shirazi MH, 1773). One of them is Citron syrup (Sharbat-e-Balang) containing edible Citrus medica L. fruit juice and sugar. The present study was designed to assess the efficacy and safety of Citron syrup on patients with migraine headache.

MATERIALS AND METHODS

Citron syrup was prepared as described in Qarabadin-e-kabir. In this double blind randomized placebo-controlled clinical trial, ninety patients with migraine headache were allocated to three parallel groups (Citron syrup, propranolol or placebo). Patients received 15ml of Citron syrup, placebo syrup or 20mg of propranolol tablet three times daily after a meal for 4 weeks. Primary outcomes were obtained from three measures: the frequency (per month), mean duration (hour) and mean intensity (visual analogue scale "VAS" 0-10 score) of headache attacks evaluated prior to and following 4 weeks of the intervention.

RESULTS

Citron syrup was superior to placebo in reduction of headache attacks intensity (P<0.01) and duration (p<0.0001) and as effective as propranolol in patients with migraine headache (P>0.05). However, unlike propranolol, Citron syrup could not significantly reduce the frequency of attacks compared to placebo. No indication of any serious side effects from Citron syrup was observed.

CONCLUSION

According to obtained results, Citron syrup as a traditional Persian remedy can be suggested as an effective treatment for decreasing pain intensity and duration of attacks in migraine headache and the effectiveness is comparable to propranolol. However, the syrup did not show significant effect on frequency of attacks.

The Adverse Health Effects of Shift Work in Relation to Risk of Illness/Disease: A Review

Biological rhythm of sleeping is a natural disparity in an organism corresponding to and in reply to cyclic environmental changes, such as daylight hours and hours of darkness or elevated and low down flow. There is some evidence, based upon epidemiological studies as well as studies upon smaller groups of subjects, that individuals who work during the night and sleep during the daytime show cognitive impairment at work, have poorer and fragmented daytime sleep, and have increased risks of developing a wide range of social, psychological, physiological and medical impairments and disorders. Circadian rhythms are one of the most important effective factors on the physiological and physical performances of humans and disturbing this normal rhythm leads to different groups of diseases. The majority of investigations in biological rhythm demeanor vary noticeably in regards to the exact type of disease, population and protocols of sampling over the other outcomes or issues. We conducted a systematic review of [Science Direct, Pubmed, Scopus] to identify influence of different kinds of diseases among shift workers in response to abnormal rhythm of sleeping. The results of this review indicate that abnormal patterns of sleeping can lead to immunological issues, hypertension, metabolic syndrome, insomnia, cardiovascular disease, obesity and depression. It is vital for subsequent investigations to find a way to reduce negative effects (such as decreased amount of works’ time and altered diet) without side effects to help them.

The Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation on Functional Indices of Affected Upper Limb in Patients with Subacute Stroke

Background:

Repetitive transcranial magnetic stimulation (rTMS) is a novel technique that may improve recovery in patients with stoke, but the role of rTMS as an applied and practical treatment modality for stroke rehabilitation has not been established yet.

Objective:

This study was conducted to determine the effects of a rehabilitation program (RP) in conjunction with rTMS on functional indices of the paretic upper limb in the subacute phase of stroke.

Material and Methods:

In this experimental study, twenty patients in the subacute phase of stroke were randomly assigned into two groups: The high frequency rTMS (HF-rTMS) in conjunction with RP (experimental group), and the RP group (control group). The experimental group received 10 sessions of 20 Hz rTMS on the affected primary motor cortex and the other group received 10 sessions of RP. In experimental group, RP for the paretic hand was conducted following rTMS session. Box and block test (BBT), Fugl-Meyer Motor Assessment for upper limb (FMA-UL), grip strength and pinch strength were used to assess motor function before the first session and after the last session of treatment.

Results:

Significant improvement in BBT, FMA-UL, grip strength and pinch strength was observed in both groups. Improvement of BBT and grip strength was significantly greater in the experimental group rather than the control group (p<0.05). FMA-UL score and the pinch strength were greater in the experimental group, although the differences were not statistically significant.

Conclusion:

HF-rTMS in conjunction with RP is effective to improve the function of upper limb. It seems HF-rTMS is a novel feasible and safe technique for hemiparesis patients in the subacute phase of stroke.

Prevalence Rate of Musculoskeletal Discomforts Based on Severity Level Among Office Workers

There are a variety of body aches that fall under the umbrella term of Musculoskeletal Discomforts (MSDs). These can be distinguished based on the level of pain suffered by the patient, ranging from mild and sporadic to serious, constant and fatal. It has been suggested that a link exists between MSDs and risk factors involving one’s occupational conditions and physicality. Examining the prevalence rate of musculoskeletal discomforts based on the severity among office workers was the main objective of this study. In order to achieve this objective, we had, in February 2015, selected from a population of 20 000 Malaysian office workers, 753 subjects within the age range of 20-50 years who have had a minimum of a year’s working experience. For this study, a form of structured questionnaire, known as the Cornell questionnaire, has been evaluated and put to use. Under the watch of the researchers, the subjects were instructed to complete the questionnaire in the morning before they begin their respective jobs. Based on their responses, the Cornell questionnaire has revealed that at least one case of severe pain in the neck, shoulder or lower back, respectively, is suffered by 69.7% of the subjects. In the case of neck-related aches, 15% low pain, whereas 51% involved mild pain and 33.9% were cases of severe pain. That being said, 19.3% low pain in the lower back, while 50.7% suffered from mild pain and 30% had severe pain in the same region. Percentages of 34.9% for high severity, 45.4% for mild severity and 19.7% for low severity were simultaneously reported in the shoulder section. In a nutshell, the study has revealed that, in comparison with body aches in the arms, knees, upper back, forearms, wrists, hands, hips and thighs, the subjects are more vulnerable to body aches in the neck, shoulders and lower back.

Optimization of time for neural stem cells transplantation for brain stroke in rats

BACKGROUND

Despite encouraging data in terms of neurological outcome, stem cell based therapy for ischemic stroke in experimental models and human patients is still hampered by multiple as yet un-optimized variables, i.e., time of intervention, that significantly influence the prognosis. The aim of the present study was to delineate the optimum time for neural stem cells (NSCs) transplantation after ischemic stroke.

METHODS

The NSCs were isolated from 14 days embryo rat ganglion eminence and were cultured in NSA medium (neurobasal medium, 2% B27, 1% N2, bFGF 10 ng/mL, EGF 20 ng/mL and 1% pen/strep). The cells were characterized for tri-lineage differentiation by immunocytochemistry for tubulin-III, Olig2 and GFAP expression for neurons, oligodendrocytes and astrocyte respectively. The NSCs at passage 3 were injected intraventricularly in a rodent model of middle-cerebral artery occlusion (MCAO) on stipulated time points of 1 & 12 h, and 1, 3, 5 and 7 days after ischemic stroke. The animals were euthanized on day 28 after their respective treatment.

RESULTS

dUTP nick end labeling (TUNEL) assay and Caspase assay showed significantly reduced number of apoptotic cells on day 3 treated animals as compared to the other treatment groups of animals. The neurological outcome showed that the group which received NSCs 3 days after brain ischemia had the best neurological performance.

CONCLUSIONS

The optimum time for NSCs transplantation was day 3 after ischemic stroke in terms of attenuation of ischemic zone expansion and better preserved neurological performance.

Test-retest reliability and responsiveness of isokinetic dynamometry to assess wrist flexor muscle spasticity in subacute post-stroke hemiparesis

INTRODUCTION

To overcome the limitations of clinical scales, objective measurement methods are becoming prominent in spasticity assessment. The aim of this study was to assess the test-retest reliability and responsiveness of isokinetic dynamometry to evaluate wrist flexor spasticity in patients with subacute stroke.

METHODS

Twenty six patients with hemiparetic stroke (13 men, 13 women, mean age 51.38 ± 12.64 years) volunteered to take part in this study. Resistive torque in the wrist flexor muscles was measured twice, 1 day apart, with an isokinetic dynamometer. Wrist extension was tested at four speeds (5, 60, 120 and 180°/s). Torque response at the lowest speed (5°/s) was attributed to the non-neural component of the wrist flexor muscles, and was subtracted from the torque response at the higher speeds to calculate reflex torque (spasticity). The reliability of reflex torque measurements at 60, 120 and 180°/s was evaluated with the intraclass correlation coefficient (ICC_2,1) and standard error of measurement (SEM and SEM%), which reflect reproducibility and measurement error, respectively. Responsiveness was calculated as the smallest real difference (SRD and SRD%).

RESULTS

Reproducibility was excellent at different movement speeds (ICC_{2, 1} 0.76-0.85). SEM% ranged from 11% to 21%, and SRD% ranged from 30% to 58%. ICC values increased, and SEM% and SRD% decreased, as test speed increased.

CONCLUSION

Our results support the reliability and responsiveness of isokinetic dynamometry to quantify spasticity in wrist flexor muscles in patients with subacute stroke. Reliability and responsiveness increased as the speed of wrist movement increased.

Unilateral Strength Training of the Less Affected Hand Improves Cortical Excitability and Clinical Outcomes in Patients With Subacute Stroke: A Randomized Controlled Trial

OBJECTIVES

To investigate whether unilateral strength training helps improve cortical excitability and clinical outcomes after stroke.

DESIGN

Randomized controlled trial.

SETTING

Rehabilitation sciences research center.

PARTICIPANTS

Patients with subacute stroke (N=26) were randomly assigned to a control group (n=13) or the experimental group (n=13).

INTERVENTIONS

Participants in both groups received conventional physiotherapy. The experimental group also received unilateral strength training of the less affected wrist extensors. Interventions were applied for 4 weeks (12 sessions, 3 d/wk).

MAIN OUTCOME MEASURES

Cortical excitability in both the ipsilesional hemisphere (ipsiH) and contralesional hemisphere (contraH) was assessed by measuring resting motor threshold (RMT), active motor threshold (AMT), motor evoked potential (MEP), and cortical silent period (CSP) at baseline and after the 4-week intervention period. Clinical outcomes were obtained by evaluating wrist extension strength in both the more affected and less affected hands, upper extremity motor function, activities of daily living (ADL), and spasticity.

RESULTS

The experimental group showed greater MEP amplitude (P=.001) in the ipsiH and shorter CSP duration in both the ipsiH (P=.042) and contraH (P=.038) compared with the control group. However, the reductions in RMT and AMT in both hemispheres were not significantly different between groups. Improvements in wrist extension strength in the more affected (P=.029) and less affected (P=.001) hand, upper extremity motor function (P=.04), and spasticity (P=.014) were greater in the experimental group. No significant difference in ADLs was detected between groups.

CONCLUSIONS

A combination of unilateral strength training and conventional physiotherapy appears to be a beneficial therapeutic modality for improving cortical excitability and some clinical outcomes in patients with stroke.

Acute renal failure due to severe Landry-Guillain-Barré syndrome

BACKGROUND

Blood urea nitrogen (BUN) >60 mg/dl has been reported to occur commonly in patient's with severe Landry-Guillain-Barré syndrome.

AIMS

To find out the cause for this high BUN we compared the renal function tests of 30 consecutive cases with severe Landry-Guillain-Barré syndrome to those of 30 controls.

RESULTS

Acute renal failure occurred in seven patients with Landry-Guillain-Barré syndrome and none of the control group. Acute renal failure was found more in cases with Landry-Guillain-Barré syndrome compared to controls (P=0.0049). Six out of seven cases with Landry-Guillain-Barré syndrome and acute renal failure had dysautonomia and became oliguric while being in a hypotensive state. Of 30 patients with Landry-Guillain-Barré syndrome seven cases died. From eight patients with dysautonomia six cases who had acute renal failure died. The mortality rate was higher in cases with dysautonomia and acute renal failure (P = 0.0001 and 0.00001, respectively). Interestingly no glomerular disease was found.

CONCLUSION

In conclusion acute renal failure can occur commonly in cases with severe Landry-Guillain-Barré syndrome particularly in those with dysautonomia, causing high mortality.

Validity and Reliability of the Persian Versions of National Institute of Health Stroke Scale and Modified National Institute of Health Stroke Scale in Hospitalized Patients

Background

National Institute of Health Stroke Scale (NIHSS) and Modified National Institute of Health Stroke Scale (mNIHSS) are two valid and reliable questionnaires that assess stroke severity. This study aimed to examine and compare the validity and reliability of Persian versions of NIHSS and mNIHSS in hospitalized patients.

Materials and Methods

The English versions of NIHSS and mNIHSS were translated to Persian (forward and backward), and three neurologists examined the face and content validity of both questionnaires. The Persian versions of NIHSS and mNIHSS were used in 75 hospitalized stroke patients (hemorrhagic and obstructive) admitted to Namazi teaching hospital, Shiraz, Iran. The reliability and validity of the Persian versions were examined by Cronbach's alpha coefficient and convergent validity.

Results

The values of Cronbach's alpha for Persian versions of NIHSS and mNIHSS were 0.81 and 0.86, respectively. The scaling success of convergent validity in NIHSS and mNIHSS were 80% and 100%, respectively.

Conclusion

The Persian versions of NIHSS and mNIHSS were reliable and valid. However, mNIHSS was more valid and reliable than NIHSS. Persian version of mNIHSS can be suggested to be used for assessing stroke severity in hospitalized stroke patients by neurologists and researchers.

Prevalence and Perceptions Toward Anabolicandrogenic Steroid Use Amongst University Students

Anabolic-androgenic steroids (AASs) are highly sought-after in order to achieve muscle growth and better physical attributes. The study was conducted to measure the prevalence and attitudes towards the use of AASs among university students. 1008 male students from Isfahan University, Iran, between the ages of 18 and 25 years (23.3 ± 1.2 years) completed a questionnaire that investigated participation in bodybuilding, level of sport competition, participation in sports and recreational activities, AASs use, prevalence, knowledge among users, attitudes, as well as intent to continue using AASs in the future. 8% of respondents had used AASs and 6% currently use AASs. 71% of users believed using only a small amount of AASs or using AASs with anti-toxic drugs would not result in any harm, 10% indicated that AASs were harmless and 19% admitted to taking AASs despite knowing the adverse effects. 33% of respondents believed that they needed to use AASs to ensure athletic success and 26% believed that athletes should be allowed to use AASs without consequence. The prevalent use of AASs is a public health concern which implies that educational programmes at university level are needed to educate students about the adverse effects of AASs use

Demographic and Technical Risk Factors of 30-Day Stroke, Myocardial Infarction, and/or Death in Standard- and High-Risk Patients Who Underwent Carotid Angioplasty and Stenting

BACKGROUND

Carotid angioplasty and stenting (CAS) is an accepted treatment to prevent stroke in patients with carotid artery stenosis. The purpose of this study is to identify risk factors for major complications after CAS.

MATERIALS AND METHODS

This is a prospective study that was conducted at Shiraz University of Medical Sciences in southern Iran from March 2011 to June 2014. Consecutive patients undergoing CAS were enrolled. Both standard- and high-risk patients for endarterectomy were enrolled. Demographic data, atherosclerotic risk factors, site of stenosis, degree of stenosis, and data regarding technical factors were recorded. Thirty-day stroke, myocardial infarction, and/or death were considered as the composite primary outcomes of the study.

RESULTS

A total of 251 patients were recruited (mean age: 71.1 ± 9.6 years; male: 65.3%). Of these, 178 (70.9%) were symptomatic, 73 (29.1%) were diabetic, 129 (51.4%) were hyperlipidemic, 165 (65.7%) were hypertensive, and 62 (24.7%) patients were smokers. CAS was performed for left internal carotid artery (ICA) in 113 (45.4%) patients. Fourteen (5.6%) patients had sequential bilateral stenting. Mean stenosis of operated ICA was 80.2 ± 13.8%. An embolic protection device was used in 203 (96.2%) patients. Pre- and postdilation were performed in 39 (18.5%) and 182 (86.3%) patients, respectively. Composite outcomes were observed in 3.6% of patients (3.2% stroke, 0% myocardial infarction, and 1.2% death). Left-sided lesions and the presence of diabetes mellitus were significantly associated with poor short-term outcome (p = 0.025 and p = 0.020, respectively).

CONCLUSION

There was a higher risk of short-term major complications in diabetic patients and for left carotid artery intervention.

Transcranial Doppler Ultrasonography in Beta-thalassemia Major Patients Without and With Thrombocytosis

Background

Beta-thalassemia is a type of anemia in which the patients may require splenectomy and this can lead to thrombocytosis with increased risk of stroke. Transcranial Doppler ultrasound is a method for determining cerebral vessel stenosis.

Objectives

The aim of this study was to investigate whether the risk of a future stroke secondary to cerebral artery stenosis can be predicted with the use of transcranial Doppler ultrasound in beta-thalassemia major patients.

Patients and Methods

This study included 54 beta-thalassemia major patients divided into 2 groups; group A consisted of 28 patients who have thrombocytosis secondary to a previous splenectomy and group B comprised of 26 patients who did not have a splenectomy with normal platelet count, as well as a control group of 30 healthy individuals.

Results

Transcranial Doppler ultrasound of the cerebral vessels were performed in all participants, and the results for each group were compared with the controls. In addition, patients were evaluated for evidence of high flow velocity in the cerebral vessels that met the clinically significant criteria of ≥ 50% stenosis. Transcranial Doppler ultrasound velocity criteria for > 50% stenosis, indicating a risk of stroke, were not documented in any patients but increase in cerebral blood velocities in many arteries in group A and in some arteries in group B were revealed.

Conclusion

Following splenectomy, thrombocytosis can predispose the patients to an increase in cerebral blood velocities more than respected with anemia. But by transcranial doppler ultrasonography no evidence of significant stenosis were found in intracerebral arteries to conclude that the beta-thalassemia major patients were more prone to the development of stroke secondary to this abnormality.

Prevalence of intracranial artery stenosis in Iranian patients with acute ischemic stroke using transcranial Doppler ultrasonography

BACKGROUND

The aim of this study is to determine the frequency of intracranial artery stenosis in patients with acute ischemic stroke in Iran.

METHODS

A total of 169 patients with acute ischemic stroke were eligible to participate and were enrolled in this study from January 2012 to February 2013. All the patients were admitted to the Nemazee ‎Hospital, affiliated to Shiraz University of Medical Sciences, Iran. They underwent transcranial Doppler (TCD) ultrasonography. Mean flow velocity (MFV) of basilar artery, vertebral artery, middle cerebral artery (MCA), anterior cerebral artery (ACA), and posterior cerebral artery (PCA) were evaluated.

RESULTS

A mean of patients' age was 67.80 ± 8.14 years. There were 83 men (49.1%) and 86 women (50.9%). Overall, 43 patients (25.4%), with a mean age of 66.7 ± 6.2 years, had intracranial stenosis. The number of men and women with intracranial stenosis was comparable (52.4% men vs. 47.6% women). Hypertension (P < 0.001), hyperlipidemia (P < 0.001), and diabetes mellitus (DM) (P < 0.001) were major risk factors for intracranial stenosis.

CONCLUSION

The prevalence of intracranial artery stenosis in patients with acute ischemic stroke is 25.4% which is comparable with previous reports from Iran and other Middle East countries.

Large-vessel stenosis in the patients with ischemic stroke in Iran: Prevalence, pattern, and risk factors

BACKGROUND

Large artery disease (LAD) is a common cause of stroke, but a little is known regarding its role in Iranian stroke patients. The current study investigates the prevalence and risk factors for cervicocephalic arterial stenosis in the patients with ischemic stroke using digital subtraction angiography (DSA).

METHODS

This was a prospective cross-sectional study performed in hospitals affiliated to Shiraz University of Medical Sciences from March 2011 to March 2013. Patients with ischemic stroke underwent noninvasive vascular and cardiac investigations to find the etiology of the stroke. Patients suspected of having large artery stenosis underwent DSA. The severity of the stenosis was calculated according to the North American Symptomatic Carotid Endarterectomy (NASCET) and Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial criteria. The presence of cigarette smoking, hyperlipidemia, hypertension, and diabetes mellitus were documented for all subjects.

RESULTS

A total of 3703 stroke patients were identified. Of them, 342 patients (62.3%, male) underwent DSA for LAD. The mean age at the time of angiography was 66.7±10.3 years. Extracranial and intracranial arteries were involved in 305 (89.2%) and 162 (47.4%), respectively. And 301 patients (88%) had anterior circulation and 128 patients (37.4%) had posterior circulation involvement. Diabetes mellitus but not age, sex, hypertension, hyperlipidemia, or smoking was significantly associated with intracranial involvement. (P = 0.002).

CONCLUSION

It can be concluded that the distribution of the large arterial atherosclerotic disease in Iran is similar to that seen in North America and Europe. Intracranial stenosis was more prevalent in diabetic patients.

Comparison of agitated saline mixed with blood to agitated saline alone in detecting right-to-left shunt during contrast- transcranial Doppler sonography examination

PURPOSE

To evaluate a technique for contrast agent preparation as mixing the patients' blood with agitated saline and to compare it with agitated saline alone in diagnosis of cardiac right-to-left shunt in regard to their sensitivity, time window, and distribution of artificially induced microembolic signals.

METHODS

Fifty-two patients with stroke who had Transesophageal echocardiography proven right-to-left shunt underwent contrast-transcranial Doppler sonography with injection of agitated (i) 9 ml saline with 1 ml air with Valsalva maneuver, (ii) 9 ml saline with 1 ml air without Valsalva maneuver, (iii) 8 ml saline, 1 ml of the patient's fresh blood and 1 ml air with Valsalva maneuver, and (iv) 8 ml saline, 1 ml of the patient's fresh blood and 1 ml air without Valsalva maneuver.

RESULTS

The sensitivity of the bilateral middle cerebral artery monitoring in diagnosis of right-to-left shunt was 94.2%, 71.2%, 96.2% and 76.9% for agitated saline with Valsalva maneuver, agitated saline without Valsalva maneuver, agitated saline and blood with Valsalva maneuver, and agitated saline and blood without Valsalva maneuver methods, respectively. Severe right-to-left shunt was detected in 100% of patients when agitated saline and blood with Valsalva maneuver was used. Application of Valsalva maneuver resulted in detection of more right-to-left shunt (P = 0.002).

CONCLUSION

Agitated saline mixed with blood with Valsalva maneuver is a sensitive method to detect right-to- left shunt, especially in the case of severe shunt. Mixing agitated saline with blood may increase the sensitivity of the test.

Neurological manifestations of Behçet's disease

OBJECTIVE

To determine the prevalence, clinical manifestations, and laboratory features of Neuro-Behçet's disease.

METHODS

This prospective study was carried out in the Behçet's 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.

RESULTS

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.

CONCLUSION

Neuro-Behçet's disease must be considered in the differential diagnosis of stroke in young adults, chronic meningitis, intracranial hypertension, multiple sclerosis, myelopathies, and peripheral neuropathies.

Interleukin 10 gene polymorphism in Iranian patients with multiple sclerosis

PURPOSE

IL-10 suppresses several activities of the immune response by inhibition of Th1 and Th2 cells.

METHODS

We studied 110 Iranian patients with clinically definite multiple sclerosis (MS) and 100 ethnic and age matched controls. Three single-nucleotide polymorphisms in the proximal region of IL-10 promoter gene (-1082/-819/-592) were analysed by amplification refractory mutation system (ARMS) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods.

RESULTS

The -1082 (G/A), -819 (T/C) and -592 (A/C) genotypes were similarly distributed between MS patients and the controls. There was no statistically significant difference in the allelic and genotype distribution between patients and controls. In addition, gender, course and progression index did not reveal any statistically significant differences in the allele and genotype distribution of IL-10 polymorphisms.

CONCLUSION

As a non-European patient population, according to our results, IL10 polymorphism is not associated with MS and its subtypes nor influences the disease progression.

The Prevalence and Factors Contributing to Hemodynamic Depression in Patients Undergoing Carotid Angioplasty and Stenting

BACKGROUND

Hemodynamic depression, including bradycardia and hypotension, is among the most common complications of carotid angioplasty and stenting.

METHODS AND MATERIAL

A prospective, cross-sectional study was conducted at Shiraz University of Medical Sciences in southern Iran from 2011 to 2013. Consecutive patients undergoing carotid angioplasty and stenting were included. Demographic data, atherosclerotic risk factors, preprocedural blood pressure, the site of stenosis, the degree of stenosis, and data regarding technical factors were recorded. Hemodynamic depression was defined as a systolic blood pressure less than 90 mmHg and/or heart rate less than 50 beat/min.

RESULTS

About 170 patients (67% male, mean age: 71+9.8, 55.9% right side, 82.9% symptomatic) were recruited. Mean degree of stenosis was 79.4% in operated side and 40.7% in nonoperated side. Predilation, postdilation, or both were conducted in 18(10.5%), 141(83%), 11(6.5%) patients respectively. Thirteen (7.6%), 41(24%), and 12(7%) of patients developed postprocedural bradycardia, hypotension or both, respectively. Two patients had a stroke after CAS and periprocedural mortality was 0%. Hemodynamic depression after CAS had a significant association with preprocedure blood pressure and the use of an open cell stent design, but not with atherosclerotic risk factors, site and/or degree of stenosis, predilation, or postdilation. Hemodynamic depression significantly increased hospital stay too.

CONCLUSION

Preprocedural hydration and close-cell stents may decrease the risk of poststenting hemodynamic depression.

Neurological manifestations of Behcet`s disease

OBJECTIVE

To determine the prevalence, clinical manifestations, and laboratory features of Neuro-Behcet`s disease.

METHODS

This prospective study was carried out in the Behcet`s 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.

RESULTS

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.

CONCLUSION

Neuro-Behcet`s disease must be considered in the differential diagnosis of stroke in young adults, chronic meningitis, intracranial hypertension, multiple sclerosis, myelopathies, and peripheral neuropathies.

The Effects of Recreation Therapy on the Habit of Smoking and Positive–Negative Symptoms Among Patients with Chronic Schizophrenia

Schizophrenia is a psychiatric condition that has detrimental outcomes on an individual’s thinking, understanding and feelings. However, it not only affects one’s actions and emotions, but also, and quite specifically, creates an avenue for such antisocial behavior as seclusion. Hence, it is important to highlight the necessary requirements for the recovery of schizophrenic patients and subsequently delve deeper into the signs and symptoms of schizophrenia itself, especially among patients who have been confined to psychiatric care for too long. The aim of this study was to determine the effects of recreation therapy on smoking as well as the positive-negative symptoms of schizophrenia among patients who have reached the chronic stage of this condition. Essentially, this was a semi-experimental study with one pretest and one posttest. 50 patients under psychiatric care, aged between 30 to 50 years, were selected and then equally divided into the control and experimental groups. The instruments for this research were the Anderson questionnaire and the smoking cigarette questionnaire, the latter being created by the researcher. Data were analyzed using descriptive and inferential statistics. To evaluate the hypothesis of research, this study relied on a covariance analysis. Based on the results, it can be said that there were significant (p ≤ 0.05) differences between the control and experimental groups related to smoking as well as the positive-negative symptoms of schizophrenia. It shows that 4 months of recreation therapy was able to decrease the prevalence of smoking (19.9%), in addition to the positive symptoms (18.3%) and negative symptoms (14.7%) of schizophrenia within the experimental group. It is hoped that the results of this study will encourage the use of recreation therapy as a practical and non-pharmacological form of treatment for patients with chronic schizophrenia.

Evaluation of transesophageal echocardiography in detecting cardiac sources of emboli in ischemic stroke patients

BACKGROUND

Embolus is one of the causes of ischemic stroke that can be due to cardiac sources such as valvular heart diseases and atrial fibrillation and atheroma of the aorta. Transesophageal echocardiography (TEE) is superior in identifying potential cardiac sources of emboli. Due to insufficient data on TEE findings in ischemic stroke in Iran, the present study was done to evaluate TEE in detecting cardiac sources of emboli. The main aim of this study was to describe the cardiogenic sources of emboli using TEE in the ischemic stroke patients.

METHODS

This is a cross-sectional study conducted during a 13-month period from January 2012 to February 2013 in Shiraz Nemazee teaching hospital. Patients admitted with stroke diagnosis were included; but hemorrhagic stroke cases were excluded. 229 patients with ischemic stroke diagnosis were included and underwent TEE.

RESULTS

Causes of cardiac emboli were detected in 65 cases (40.7%) and categorized to high-risk (29.7%) and potential risk (11%). High risk cardiac sources included atrial fibrillation (8.7%), mitral valve disease (MS or MI) 11 cases (4.75%), aortic valve disease (AS or AI) 8 (3.5%), prosthetic valve 3 (1.35%), dilated cardiomyopathy 45 (19.65%) and congestive heart failure with ejection fraction < 30% in 8 cases (3.5%). Potential cardiac sources of emboli comprised 7 cases (3.05%) of septal aneurysm, 4 (1.75%) left ventricular hypokinesia, 13 (5.7%) mitral annular calcification and 9 cases (3.95%) complex atheroma in the ascending aorta or proximal arch.

CONCLUSION

Our study showed that high risk cardiac sources of emboli can be detected using TEE in a considerable percentage of ischemic stroke patients. The most common high risk cardiac etiologies were dilated cardiomyopathy and valvular heart diseases.