Shahram Oveisgharan; Fariborz Ghaffarpasand; Peter Sörös; Mustafa Toma; Nizal Sarrafzadegan; Vladimir Hachinski
Abstract
During the past 30 years, rate of coronary artery disease, as the main cause of sudden death, has decreased more than rate of sudden death. Likewise, cause of sudden death remains elusive in not a trivial portion of its victims. One possible reason is attention to only one organ, the heart, as the cause ...
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During the past 30 years, rate of coronary artery disease, as the main cause of sudden death, has decreased more than rate of sudden death. Likewise, cause of sudden death remains elusive in not a trivial portion of its victims. One possible reason is attention to only one organ, the heart, as the cause of sudden death. In fact, sudden death literature focuses more on the heart, less on the brain, and seldom on both. A change is required. In this paper, we first review the pathological findings seen in heart autopsies of sudden death victims after psychological stressors such as physical assault victims without internal injuries. Then, we summarize new studies investigating brain areas, like the insula, whose malfunctions and injuries are related to sudden death. Then, we review prototypes of neurological diseases and psychological stressors associated with sudden death and look at heart failure related sudden death providing evidence for the brain-heart connection. Finally, we propose a new look at sudden death risk factors considering both brain and heart in their association with sudden death, and review strategies for prevention of sudden death from this perspective.
Mahdieh Afzali; Shahram Oveisgharan; Sahebeh Rajabkhah; Siamak Abdi
Abstract
Background: Therapeutic plasma exchange (TPE) is the treatment of choice for many neurologic disorders. The safety of this procedure is a major concern for physicians. The aim of this study was to determine the complications of TPE in patients with neurologic disorders at a tertiary referral hospital. ...
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Background: Therapeutic plasma exchange (TPE) is the treatment of choice for many neurologic disorders. The safety of this procedure is a major concern for physicians. The aim of this study was to determine the complications of TPE in patients with neurologic disorders at a tertiary referral hospital. Methods: This retrospective cross-sectional study evaluated patients with various neurologic disorders receiving TPE in neurology department of Shariati Hospital, Tehran, Iran. Major and minor complications related to TPE were recorded. Results: Clinical information records of 417 TPE sessions (88 patients) were available. Mean age of patients was 40.0 ± 15.8 years. Underlying diseases included central demyelinating disorders, myasthenia gravis (MG), chronic neuropathy, Guillain-Barre syndrome (GBS), and autoimmune encephalopathy in 34.1%, 33.0%, 17.0%, 14.8%, and 1.1% of patients, respectively. Major complications occurred in 15.9% of patients and 37.5% of patients accounted for minor complications. Among major adverse effects, thrombosis, infection, and life-threatening complications were seen more commonly in patients with central vascular access (P = 0.005, P = 0.003, and P = 0.010, respectively). Conclusion: TPE complications were seen more commonly in patients with central vascular access. Therefore, use of peripheral vascular access and vigilant patient monitoring by trained health providers can reduce its complications.
Shahram Oveisgharan; Zahra Karimi; Siamak Abdi; Hajir Sikaroodi
Volume 18, Issue 2 , May 2019, , Pages 57-63
Abstract
Background: Transcranial direct current stimulation (tDCS) of the primary motor cortex of the lower limb has been exploited in the treatment of patients with stroke and spastic lower limb paresis. We examined this stimulation efficacy in the treatment of multiple sclerosis (MS)-related walking disability.
Methods: ...
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Background: Transcranial direct current stimulation (tDCS) of the primary motor cortex of the lower limb has been exploited in the treatment of patients with stroke and spastic lower limb paresis. We examined this stimulation efficacy in the treatment of multiple sclerosis (MS)-related walking disability.
Methods: In a single-center randomized double-blind clinical trial study, 13 patients with MS and walking disability and Expanded Disability Status Scale (EDSS) score of 3 to 6 were randomized to the real and sham stimulation groups. In the real tDCS stimulation, 7 patients received anodal 2.5 mA stimulation at 1 cm anterior to the Cz point for 30-minute daily sessions in 7 consecutive days. The other group received sham stimulation with the same protocol. The primary outcome of the trial was change in the Timed 25-Foot Walk (T25-FW) from before to after the stimulation. We also assessed the Multiple Sclerosis Walking Scale-12 (MSWS-12). We employed linear mixed effects model to examine the efficacy of tDCS stimulation on changing the outcomes.
Results: On average, patients who received real tDCS stimulation walked faster after 7 sessions of stimulation [Estimate = -2.7, standard error (SE) = 1.3, P = 0.049], while walking speed of sham stimulation recipients did not change. For every session of stimulation, recipients of real tDCS stimulation spent 2.7 seconds less for walking the 25 feet. Real tDCS stimulation was not effective in improving MSWS-12 scores.
Conclusion: tDCS stimulation of the lower limb motor cortex speeded up patients with MS in walking, but without improvement in patients’ mobility in daily activities.
Ahmad Bahonar; Alireza Khosravi; Fariborz Khorvash; Mohammadreza Maracy; Shahram Oveisgharan; Noushin Mohammadifard; Mohammad Saadatnia; Fatemeh Nouri; Nizal Sarrafzadegan
Volume 16, Issue 4 , October 2017, , Pages 201-209
Abstract
Background: As there was no evidence of long-term studies on stroke trend, stroke subtypes and its relationships to stroke risk factors and demographic characteristics in Iran, we aimed to evaluate 10-year trend of stroke incidence and stroke subtypes in Isfahan, Iran.Methods: In a hospital-based retrospective ...
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Background: As there was no evidence of long-term studies on stroke trend, stroke subtypes and its relationships to stroke risk factors and demographic characteristics in Iran, we aimed to evaluate 10-year trend of stroke incidence and stroke subtypes in Isfahan, Iran.Methods: In a hospital-based retrospective study, 24186 cases with the first-ever stroke were analyzed. We assessed the incidence trend of annual stroke and its subtypes [ischemic stroke )IS(, subarachnoid hemorrhage (SAH), and intracranial hemorrhage )ICH(] during the years 2003 to 2013 by sex, and studied the association of demographic and major stroke risk factors with incidence and mortality rate of stroke.Results: The mean age was 69.46 ± 14.87 years, and 49.29% of patients were women. IS was the most frequent type among all the types of strokes (76.18%). Stroke and its subtypes had decreasing incidence trend during the study period, except for SAH that increased. In addition, stroke and its subtypes had decreasing mortality trend during the study period, except for SAH that did not change anymore. Stroke mortality and incidence rates were lower in urban inhabitants compared to residents of rural areas [odds ratio (OR) = 0.763, P < 0.001].Conclusion: Despite the relatively high incidence of stroke over the study period, the incidence rate of stroke, especially ICH subtype, had a decreasing trend over the last decade in Isfahan. However, given the current young population in Iran, we can expect that the incidence of stroke would have an escalating trend in future.
Shahram Oveisgharan; Amir Babak Ghaemmaghami; Ahmad Bahonar; Nizal Sarrafzadegan
Volume 15, Issue 1 , January 2016, , Pages 9-15
Abstract
Background: Few investigators have reported case fatality and disability of Iranian patients with stroke. This study was designed to collect morbidity and case fatality data of hospitalized patients with stroke, and stroke care quality in Isfahan, Iran.Methods: From 2006 to 2011, from overlapping sources ...
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Background: Few investigators have reported case fatality and disability of Iranian patients with stroke. This study was designed to collect morbidity and case fatality data of hospitalized patients with stroke, and stroke care quality in Isfahan, Iran.Methods: From 2006 to 2011, from overlapping sources (discharge diagnoses, attending physicians, and hospitalization wards), all hospitalized patients with possible strokes were enrolled in the study, their hospital records were summarized by experienced personnel and reviewed by a neurologist with stroke experience. Patients were followed by phone calls or visited to their addresses and their 28th day functional status was checked by translated modified Rankin Scale (mRS). Forms and methods were derived from the World Health Organization (WHO) Monitoring Trends and Determinants in Cardiovascular Disease and STEPS projects.Results: A total of 9487 patients were identified to suffer from stroke. Their ages’ mean was 68.98 ± 13.63 years, and 50.0% were females. In hospital, case fatality was 16.5% and the 28th day case fatality was 25.6%. The greatest case fatality was among intracerebral hemorrhage (ICH) patients and the least among ischemic stroke (IS) ones. Case fatality was greater among female and older patients and those with the previous history of stroke. Among survivors, only 26.9% were functionally independent (mRS < 3) which was the greatest among subarachnoid hemorrhage (SAH) patients and least among ICH patients. None of the patients were admitted to specific stroke units or received thrombolytic therapy.Conclusion: The hospitalized patients with stroke in Isfahan have unfavorable outcome compared with their mates in developed countries. A low quality of stroke care may be responsible, and urgent attention is needed.
