Elyar Sadeghi-Hokmabadi; Abdoreza Ghoreishi; Reza Rikhtegar; Payam Sariaslani; Shahram Rafie; Alireza Vakilian; Ehsan Sharifipour; Masoud Mehrpour; Mohammad Saadatnia; Mohammad Mirza-Aghazadeh-Attari; Mehdi Farhoudi
Abstract
Background: Rates of intracranial hemorrhage (ICH) after intravenous thrombolysis (IVT) differ depending on ethnicity, one reason that few Eastern countries have approved a lower dose of alteplase. Data in this regard are scarce in the Middle Eastern region. Methods: The present retrospective study ...
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Background: Rates of intracranial hemorrhage (ICH) after intravenous thrombolysis (IVT) differ depending on ethnicity, one reason that few Eastern countries have approved a lower dose of alteplase. Data in this regard are scarce in the Middle Eastern region. Methods: The present retrospective study was performed on data extracted from the Safe Implementation of Treatments in Stroke (SITS) registry. Computed tomography (CT) image analysis was based on the SITS-Monitoring Study (SITS-MOST) definition for symptomatic ICH (SICH). Functional outcome at 3 months was assessed using the modified Rankin Scale (mRS). Multivariate logistic regression including adjusted analysis was used for comparison between groups. Results: Of 6615 patients, 1055 were enrolled. A total of 86% (n = 906) received a standard dose and 14% (n = 149) received a low dose of alteplase. Favorable 3-month outcome was achieved in 481 (53%) patients in the standard group and 71 (48%) patients in the low-dose group [adjusted odds ratio (AOR) = 1.24, 95% confidence interval (CI): 0.87-1.75, P = 0.218]. SICH occurred in 14 (1.5%) patients in the standard group and 3 (2%) patients in the low-dose group [odds ratio (OR) = 2.77, 95% CI: 0.36-21.04, P = 0.120]. At 3 months, mortality occurred in 145 (16.0%) patients in the standard group and 29 (19.4%) patients in the low-dose group (OR = 1.22, 95% CI: 0.78-1.91, P = 0.346). Conclusion: Low-dose compared to standard-dose alteplase for patients with acute ischemic stroke (AIS) was not associated with fewer hemorrhagic events and there was no significant difference in the favorable 3-month outcome (mRS: 0-2) or mortality rate.
Gulcin Benbir Senel; Ayse Deniz Elmali; Kaveh Mehrvar; Mehdi Farhoudi; Mohammad Aboutalebi; Mahsa Rezaei; Birsen Ince
Volume 18, Issue 4 , December 2019, , Pages 176-178
Abstract
Background: Multiple sclerosis (MS) is a neurologic disorder with a considerable global burden. During the last decades, some pharmaceutical treatments have been approved for patients with MS. Dimethyl fumarate (DMF) is one of these drugs which has been reported to have early promising results in recent ...
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Background: Multiple sclerosis (MS) is a neurologic disorder with a considerable global burden. During the last decades, some pharmaceutical treatments have been approved for patients with MS. Dimethyl fumarate (DMF) is one of these drugs which has been reported to have early promising results in recent studies, but the efficacy of this drug in patients with MS is still being studied in different parts of the world. In the present study, we evaluated the effectiveness of DMF therapy on reducing relapses, lesions, and disability in Iranian patients with MS.Methods: The present single-arm before-after study was approved by the Ethics Committee of Mashhad University of Medical Sciences, Mashhad, Iran [Iranian Registry of Clinical Trial (IRCT) code: IRCT20190121042439N1]. Every patient who was diagnosed with relapsing MS was considered eligible to enroll in the present clinical trial. Before receiving DMF therapy, the baseline liver function tests and complete blood count were obtained from all individuals. Also, a baseline brain magnetic resonance imaging (MRI) was obtained and Expanded Disability Status Scale (EDSS) was documented from all patients. After receiving 240 mg DMF twice daily for 12 months, the laboratory and imaging measurements as well as EDSS were repeated. Furthermore, the total number of relapses within the study period was recorded. Satisfaction with DMF treatment was determined by answering a yes-no question.Results: A total number of 50 patients enrolled in the study and most of them were female (80%). There was a significant decrease in EDSS score and gadolinium (GD)-enhancing lesions after the study period (P < 0.001 for each). Moreover, the attacks significantly dropped after the study period (P < 0.001) and 86% of patients were satisfied with their treatment.Conclusion: The findings of this study showed that 240 mg DMF administered twice daily can effectively reduce disability and provide satisfaction within the first year of therapy in patients with MS.
Elyar Sadeghi-Hokmabadi; Mohammad Yazdchi; Mehdi Farhoudi; Homayoun Sadeghi; Aliakbar Taheraghdam; Reza Rikhtegar; Sahar Mohammadi-Fallah; Rogayyeh Asadi; Elham Mehdizadeh-Far; Neda Ghaemian
Volume 17, Issue 1 , January 2018, , Pages 31-37
Abstract
Background: Tissue plasminogen activator (tPA) has been long approved as an efficacious treatment in patients with acute ischemic stroke (AIS); however, due to some serious complications, particularly intracranial hemorrhage (ICH), many physicians are still reluctant to use it liberally. This study sought ...
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Background: Tissue plasminogen activator (tPA) has been long approved as an efficacious treatment in patients with acute ischemic stroke (AIS); however, due to some serious complications, particularly intracranial hemorrhage (ICH), many physicians are still reluctant to use it liberally. This study sought to find potential prognostic factors in patients with AIS treated with tPA.Methods: A retrospective, hospital-bases observational study was conducted. Consecutively, a total of 132 patients with AIS treated with intravenous tPA, form June 2011 to July 2015 were enrolled. Inclusion and exclusion criteria were based on updated guidelines. Probable prognostic variables were examined separately in three distinct groups; the occurrence of ICH within 24 hours after treatment, poor 3-month outcome on the basis of modified Rankin Scale (mRS) and 3-month mortality.Results: Patients were 83 men (62.9%) and 49 women (37.1%) with a median age of 66 years [interquartile range (IQR)of 55-72]. Any type of hemorrhage, symptomatic hemorrhage [based on the European Cooperative Acute Stroke Study III (ECASS III) definition] within 24 hours posttreatment, poor 3-month outcome (mRS 3-6), and 3-month mortality were documented in 10.6%, 4.5%, 53.2%, and 23.6% of patients, respectively. Increased baseline blood glucose was a significant but dependent predictor of hemorrhage within the first 24 hours posttreatment. Dependent predictors of a 3-month poor outcome were high age, the National Institutes of Health Stroke Scale (NIHSS) at baseline, decreased admitting glomerular filtration rate (GFR), and the presence of atrial fibrillation (AF) rhythm, and ICH within 24 hours posttreatment. Only age [Odds ratio (OR) adjusted 1.05] and initial NIHSS (OR adjusted 1.23), however, were recognized as the independent variables in this regard. The only independent predictor of 3-month mortality was the initial NIHSS (OR adjusted 1.18).Conclusion: According to the findings of the present study, advanced age and high baseline NIHSS are two independent prognostic factors in patients with AIS treated with tPA.
Sheida Shaafi; Safa Najmi; Hamed Aliasgharpour; Javad Mahmoudi; Saeed Sadigh-Etemad; Mahdi Farhoudi; Negar Baniasadi
Volume 15, Issue 2 , April 2016, , Pages 63-69
Abstract
Background: The ketogenic diet (KD), high in fat and low in carbohydrate and protein, provides sufficient protein but insufficient carbohydrates for all the metabolic needs of the body. KD has been known as a therapeutic manner intractable epilepsy. In recent years, the effectiveness of KD drew attention ...
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Background: The ketogenic diet (KD), high in fat and low in carbohydrate and protein, provides sufficient protein but insufficient carbohydrates for all the metabolic needs of the body. KD has been known as a therapeutic manner intractable epilepsy. In recent years, the effectiveness of KD drew attention to the treatment of some other disorders such as Parkinson’s disease (PD). This study has evaluated the efficacy of KD on motor function in Parkinsonian model of rat and compared it with pramipexole.Methods: A total of 56 male Wistar rats weighing 200-240 g between 12 and 14 weeks of age were randomized in seven 8-rat groups as follows: Control group; sham-operated group; KD group; Parkinsonian control group; KD-Parkinsonian group; pramipexole-Parkinsonian group; and KD-pramipexole-Parkinsonian group. The results of bar test, beam traversal task test, and cylinder task test were compared between the groups.Results: The mean number of ketone bodies had increased significantly in the rats blood after KD. Regarding the results of the triad tests, no statistically significant difference was found between the controls and the sham-operated group. Among the Parkinsonian rats, better results were found in KD groups compared to the non-KD group. The KD enhanced the effect of pramipexole for motor function but did not reach a statistically significant level.Conclusion: The KD reinforced the motor function in Parkinsonian rats in our study. When the diet was combined with pramipexole, the effectiveness of the drug increased in enhancing motor function.
Mazyar Hashemilar; Mehdi Farhoudi; Samane Hosseini; Hanieh Moshayedi; Dariush Savadi Oskoui; Behzad Eskandar Oghli; Reza Rikhtegar
Volume 10, 1-2 , June 2011, , Pages 16-8
Abstract
Background: In patients with acute stroke and middle cerebral artery (MCA) stenosis, microembolic signals (MES) can predict further cerebral ischemia. Therefore, this study was designed to evaluate the prevalence of MES by transcranial Doppler (TCD) in patients with MCA stenosis under treatment of aspirin ...
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Background: In patients with acute stroke and middle cerebral artery (MCA) stenosis, microembolic signals (MES) can predict further cerebral ischemia. Therefore, this study was designed to evaluate the prevalence of MES by transcranial Doppler (TCD) in patients with MCA stenosis under treatment of aspirin or clopidogrel.Methods: A randomized clinical trial was performed on 40 patients with acute ischemic stroke in MCA territory. They were randomly allocated in two groups that treated with aspirin (80 mg daily) or clopidogrel (75 mg daily). Clinical and diagnostic work up was included evaluation of cerebrovascular risk factors, echocardiography, carotid color Doppler and brain imaging. TCD was performed between day 3 and 7 after symptoms onset to detect MES. All high intensity transient signals (HITS) were saved and analyzed offline.Results: Carotid stenosis was found in 13 (65%) patients of aspirin group and 12 (60%) of clopidogrel group. Four (30.8%) of aspirin group and 5 (41.7) of clopidogrel group had stenosis between 10%-50%. One patient in each group had more than 50% stenosis and the remainder had less than 10%. There was no significant difference between two groups. MES was detected in 6 (30%) of patients treated with aspirin and 4 (20%) of those treated with clopidogrel. It showed no statistically significant differences (P-value=0.46).Conclusion: Our results indicate a similar effect of aspirin and clopidogrel on frequency of MES in patients with MCA territory ischemic stroke.
