Special Articles
Davood Sobhani Rad
Volume 13, Issue 3 , September 2014, Pages 113-118
Abstract
Pragmatics is defined as appropriate use of language either to comprehend ideas or to interact in social situations effectively. Pragmatic competence, which is processed in the right hemisphere, comprises a number of interrelated skills that manifest in a range of adaptive behaviors. Due to the widespread ...
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Pragmatics is defined as appropriate use of language either to comprehend ideas or to interact in social situations effectively. Pragmatic competence, which is processed in the right hemisphere, comprises a number of interrelated skills that manifest in a range of adaptive behaviors. Due to the widespread influence of language in communication, studying pragmatic profiles, by developing appropriate tools, is of importance. Here, a range of pragmatic theories and assessment instruments available for use in adult patients is reviewed.
Special Articles
Mohaddeseh Behjati; Masoud Etemadifar; Morteza Abdar Esfahani
Volume 13, Issue 3 , September 2014, Pages 119-126
Abstract
Multiple sclerosis (MS) is a chronic auto-immune disease. Most therapeutic strategies for treatment of this disease direct immune modulation and control of inflammatory processes. First-line therapeutic agents showed moderate efficacy and frequent side-effects with moderate efficacy in trials. Their ...
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Multiple sclerosis (MS) is a chronic auto-immune disease. Most therapeutic strategies for treatment of this disease direct immune modulation and control of inflammatory processes. First-line therapeutic agents showed moderate efficacy and frequent side-effects with moderate efficacy in trials. Their parental administration and limited long-term adherence restrict their efficacy compared with second-line therapies. Fingolimod as a second-line therapeutic agent has been shown to reduce annualized relapse rate, risk of disability progression and inflammatory activity of relapsing MS. Safety and efficacy FTY720: Safety and efficacy issues are the main metrics for judgment of drug efficacy. In this article, we focus on cardiovascular effects of FTY720 treatment. Effect of FTY720 on rate and rhythm, impact of FTY720 on endothelial cells, its atheroprotective effects, its effects on cardiac transplantation outcomes, vascular complications of FTY720, effects of FTY720 on endocrine functions and interaction of FTY720 with cardioactive agents are explained in this review article.
Special Articles
Ali Noureddine; Kavian Ghandehari; Mohammad Taghi Shakeri
Volume 13, Issue 3 , September 2014, Pages 127-130
Abstract
Background: Previous literatures have shown a transient ischemic attack (TIA) mimic rate of 9-31%. We aimed to ascertain the proportion of stroke mimics amongst suspected TIA patients. Methods: A prospective observational study was performed in Ghaem Hospital, Mashhad, Iran ...
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Background: Previous literatures have shown a transient ischemic attack (TIA) mimic rate of 9-31%. We aimed to ascertain the proportion of stroke mimics amongst suspected TIA patients. Methods: A prospective observational study was performed in Ghaem Hospital, Mashhad, Iran during 2012-2013. Consecutive TIA patients were identified in a stroke center. The initial diagnosis of TIA was made by the resident of neurology and final diagnosis of true TIA versus TIA mimics was made after 3 months follow-up by stroke subspecialist. Results: A total of 310 patients were assessed during a 3- month period of which 182 (58.7%) subjects were male and 128 (41.3%) were female. Ten percent of the patients was categorized as a TIA mimic. The presence of hypertension, aphasia, duration of symptoms, and increased age was the strongest predictor of a true TIA. Migraine was the most common etiology of stroke mimic in our study. Conclusion: It seems that many signs and symptoms have low diagno tic usefulness for discrimination of true TIA from non-cerebrovascular events and predictive usefulness of any sign or symptom should be interpreted by a stroke neurologist.
Special Articles
Seyed-Ali Javad Mousavi; Babak Zamani; Shahab Shahabi Shahmiri; Mohammad Rohani; Gholam Ali Shahidi; Elyas Mostafapour; Helia Hemasian; Hanieh Raji
Volume 13, Issue 3 , September 2014, Pages 131-137
Abstract
Background: The rapidity of progression of amyotrophic lateral sclerosis (ALS) to death or respiratory failure impacts patients, clinicians, and clinical investigators. The aim of this study is to evaluate of the pulmonary function tests (PFTs) in patients with ALS and the association between these PFTs ...
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Background: The rapidity of progression of amyotrophic lateral sclerosis (ALS) to death or respiratory failure impacts patients, clinicians, and clinical investigators. The aim of this study is to evaluate of the pulmonary function tests (PFTs) in patients with ALS and the association between these PFTs and survival Methods: A total of 36 ALS patients who PFTs, including vital capacity (VC), maximum mid-expiratory flow rate (MMEFR), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1), were available from the time of diagnosis were included in this study. Nonpulmonary characteristics assessed at the time of PFTs. Data were analyzed using chi-square, Student’s independent t-test, Kaplan-Meier, correlation, and receiver operating characteristic (ROC) curve.Results: The mean age of subjects was 55.36 (SD = 12.24) year, and the male to female ratio was 2.6. Twenty-Cve (69.4%) were died in 5 years period of our study. The mean and median survival time (In months) was calculated as 42.51 (95% co Cdence interval [CI] 33.64- 51.39) and 38 (95% CI 27.23-48.77) months, respectively. The rate of ALS survival was 74% at 1st year, 41% at 3rd year and 10% at 5th year of starting symptoms. The results of Kaplan-Meier test showed survival was significantly longer in the group with PFTs closer to normal. In addition, ROC analysis showed that FVC < 50% could potentially be a predictor of death in ALS patients (P = 0.003, area under curve = 0.649). Conclusion: We found single measures of upright FVC, FEV1 to be significantly associated with survival, even after controlling for relevant non-pulmonary patient characteristics. Our study demonstrated that upright FVC, FEV1, VC, and MMEFR are useful non-invasive measures in the prediction of survival in ALS.
Special Articles
Samira Yadegari; Shahriar Nafissi; Neda Kazemi
Volume 13, Issue 3 , September 2014, Pages 138-143
Abstract
Background: Incidence and predominant subtype of Guillain-Barre syndrome (GBS) differs geographically. Electrophysiology has an important role in early diagnosis and prediction of prognosis. This study is conducted to determine the frequent subtype of GBS in a large group of patients ...
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Background: Incidence and predominant subtype of Guillain-Barre syndrome (GBS) differs geographically. Electrophysiology has an important role in early diagnosis and prediction of prognosis. This study is conducted to determine the frequent subtype of GBS in a large group of patients in Iran and compare nerve conduction studies in axonal and demyelinating forms of GBS.Methods: We retrospectively evaluated the medical records and electrodiagnostic study (EDS) of 121 GBS patients who were managed in our hospital during 11 years. After regarding the exclusion criteria, patients classified as three groups: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), and acute motor sensory axonal neuropathy (AMSAN). The most frequent subtype and then electrophysiological characteristic based on the time of EDS and their cerebrospinal fluid (CSF) profile were assessed.Results: Among 70 patients :nally included in the study, 67% w re men. About 63%, 23%, and 14% had AIDP, AMAN, and AMSAN, respectively.AIDP patients represented a wider range of ages compared with other groups. Higher levels of CSF protein, abnormal late responses and sural sparing were more frequent in AIDP subtype. Five AMSAN patients also revealed sural sparing. Conduction block (CB) was observed in one AMAN patient. Prolonged F-wave latency was observed only in AIDP cases. CB and inexcitable sensory nerves were more frequent after 2 weeks, but reduced F-wave persistency was more prominent in the early phase.Conclusion: AIDP was the most frequent subtype. Although the electrophysiology and CSF are important diagnostic tools, classification should not be made based on a distinct finding.
Special Articles
Hanieh Moshayedi; Reza Ahrabi; Afshin Mardani; Saieed Sadigetegad; Mehdi Farhudi
Volume 13, Issue 3 , September 2014, Pages 144-148
Abstract
Background: Some studies in recent years showed that carotid intima-media thickness (IMT), indicator of the presence of atherosclerosis, was higher in non-alcoholic fatty liver disease (NAFLD) in comparison with normal subjects. They concluded that NAFLD patients ...
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Background: Some studies in recent years showed that carotid intima-media thickness (IMT), indicator of the presence of atherosclerosis, was higher in non-alcoholic fatty liver disease (NAFLD) in comparison with normal subjects. They concluded that NAFLD patients may be resulted in more cardiovascular events. Hence, we aimed to study the association of NAFLD and ischemic stroke.Methods: For this reason, 110 brain magnetic resonance imaging confirmed ischemic stroke patients and 110 patients age and sex matched controls went through liver ultrasound to detect NAFLD and common carotid ultrasound to measure IMT. Demographic and vascular risk factors were detailed for all subjects.Results: NAFLD was found in 47 (42.7%) of ischemic stroke patients and 25 (22.7%) of controls. By adjusting sex and age in table 2, odds ratio (OR) for NAFLD was 2.15 (95% con<dence interval [CI]: 1.25-3.71) that was statistically significant (P = 0.006). However, after adjusting for other confounding risk factors (waist circumference, hypertension, diabetes mellitus, low-density lipoprotein, triglyceride, alanine aminotransferase, aspartate aminotransferase, creatine, body mass index, cigarette smoking, and ischemic heart disease), the OR decrease to 1.68 (95% CI: 0.42-6.76) that was not statistically signi<cant (P = 0.460). The OR for IMT of right and left common carotid was 1.23 (95% CI: 0.48-3.15) and 1.24 (95% CI: 0.57-2.69), respectively that none of them were statistically significant.Conclusion: Although the risk of occurrence of ischemic stroke is higher in NAFLD patients, but NAFLD is not associated independently with ischemic stroke.
Special Articles
Behnaz Sedighi; Abbas Pardakhty; Hoda Kamali; Kaveh Shafiee; Bahar Naz Hasani
Volume 13, Issue 3 , September 2014, Pages 149-153
Abstract
Background: Cognitive impairment is one of the most crucial disorders among multiple sclerosis (MS) patients. Since MS is an inflammatory disease and Boswellia papyrifera has anti-inflammatory effects, the influence of B. papyrifera on cognitive impairment in MS ...
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Background: Cognitive impairment is one of the most crucial disorders among multiple sclerosis (MS) patients. Since MS is an inflammatory disease and Boswellia papyrifera has anti-inflammatory effects, the influence of B. papyrifera on cognitive impairment in MS patients has been investigated in the present study.Methods: In this clinical trial, 80 MS patients who referred to the clinic of Shafa Hospital, Kerman, Iran were selected. Having completed a written consent form, patients with relapsing remitting MS, with no occurrence of a new attack throughout 1 month before the study, with no pregnancy or breastfeeding entered the study. The patients were randomly divided into two groups; then Brief International Cognitive Assessment for MS (BICAMS) test was carried out. One group received B. papyrifera (capsule 300 mg, twice a day) while the other group received placebo with the same dose for 2 months. After 2 months of treatment, BICAMS was redone and changes were analyze .The significant change value on the before-after BICAMS points were considered to be 8, 13, and 7 points for the symbol digit modality test (SDMT), the California verbal learning test (CVLT), and the brief visual-spatial memory test revised (BVMT-R), respectively.Results: The patients’ mean age was 36.58 8.50 years. The mean duration of disease was 7.41 4.13 years. About 84.2% (n = 64) of the patients was female. In the BVMT-R, 13 patients (34.2%), who had already taken B. papyrifera, were shown to have significant improvement compared to the placebo group with no improvement (P < 0. 001). About 12 and 8 patients in the treatment and placebo groups in the SDMT, respectively (P = 0.200) and 17 and 12 patients in the treatment and placebo groups in the CVLT, respectively (P = 0.170) had signi@cant change values.Conclusion: B. papyrifera showed significant improvement in visuospatial memory, but had no effect on verbal memory and information processing speed.
Special Articles
Aliasghar Molana; Masoud Mehrpour; Nasim Vousooghi; Mahmoud Reza Hajighasem; Mohammad Taghi Joghataei
Volume 13, Issue 3 , September 2014, Pages 154-159
Abstract
Background: Migraine is a chronic neurological disorder, characterized by recurrent moderate to severe headaches. Worldwide migraine a=ects nearly 15%. Studies suggest that genes involved in the production of nitric oxide (NO) may act as genetic factors for migraine. NO synthase 3 (NOS3) ...
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Background: Migraine is a chronic neurological disorder, characterized by recurrent moderate to severe headaches. Worldwide migraine a=ects nearly 15%. Studies suggest that genes involved in the production of nitric oxide (NO) may act as genetic factors for migraine. NO synthase 3 (NOS3) by expressing enzyme NOS regulates endothelial derived NO. One class of medications used as first-line treatment in migraine prophylaxis is tricyclic antidepressants (TCAs). The aim of this study was to determine e=ects of NOS3 gene Glu298Asp polymorphism in the production of NO and response of patients to TCAs in migraine attacks.Methods: A total of 80 migraine patients were invited to participate in the study. Patients recorded the characteristics of their migraine attacks such as frequency of attacks and intensity of headaches for the 1st month of the study. Then peripheral blood samples were taken from all subjects in order to determine patients’ genotype distribution, mRNA expression level of NOS3 and NO content of plasma. Patients were then instructed to use 25 mg nortriptyline at night before bed for 3 months. At the end of 3rd month of the treatment patients again recorded the migraine characteristics for 1 month and blood sampling was performed in order to determine the level of plasma NO.Results: The patients’ genotype distribution for TT, GT, and GG was 9, 24, and 47 subjects, respectively. Mean NO level in patients with TT genotype was less in comparison to GT and GG genotypes before and after use of TCAs (P < 0.05). Mean intensity of headaches in patients with TT genotype was lower in comparison to GT and GG genotypes before and after use of TCAs (based on verbal numerical rating scale). Mean frequency of migraine attacks after use of TCAs was significantly decreased in all genotypes of NOS3 Glu298Asp polymorphism particularly in TT genotype (P < 0.05).Conclusion: Presence of T allele of the Glu298Asp polymorphism may be a factor for TT genotype patients to produce less NO and is a favorable factor for better response to TCAs in reducing migraine attacks in comparison to GT and GG genotypes.
Special Articles
Roya Abolfazli; Azam Elyasi; Mohammad Reza Javadi; Kheirollah Gholami; Hassan Torkamandi; Mohammad Amir-Shahkarami; Masoud Etemadifar; Zahra Nasr
Volume 13, Issue 3 , September 2014, Pages 160-167
Abstract
Background: Multiple sclerosis (MS) patients permanently confronted with serious challenges from treatment regimen. Developing a new questionnaire in MS management, through evaluation of patients’ perspectives and knowledge regarding treatment will help to identify ...
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Background: Multiple sclerosis (MS) patients permanently confronted with serious challenges from treatment regimen. Developing a new questionnaire in MS management, through evaluation of patients’ perspectives and knowledge regarding treatment will help to identify the sources of tension, and to build a therapeutic alliance. We purposed to describe MS patients’ understanding of their treatments.Methods: About 425 completed and returned questionnaire were assessed of a total of 500 recruited MS patients. The knowledge of correct using interferon-beta (IFN-β) and attitude toward medical care were assessed using self- reported questionnaires consisted of 25 items with validity of multidisciplinary panel and pre-testing on 20 patients.Results: Knowledge about IFN-β therapy was very low; however, attitude was at a high level. Female patients, self- injection ability, higher educational level, normal functional status, delay from the start of diagnostic workup to definite diagnosis, and being younger were related to a higher level of knowledge. Attitude was associated with functional status, family history of disease and the summary of knowledge variable.Conclusion: Developing educational interventions are needed for MS patients regarding to their low levels of knowledge.
Special Articles
Mahshid Hosseini Behbahani; Hamid Galehdari; Maryam Mohaghegh
Volume 13, Issue 3 , September 2014, Pages 168-171
Abstract
Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating and neurodegenerative disease of central nervous system with unknown causes. Etiology of MS involves both genetic and environment factors. The interleukin 7 receptor (IL7R) gene ...
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Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating and neurodegenerative disease of central nervous system with unknown causes. Etiology of MS involves both genetic and environment factors. The interleukin 7 receptor (IL7R) gene is a promising candidate for MS, because its involvement in the autoimmunity, regulation of the T-cell homeostasis, proliferation, and anti-apoptotic signaling.Methods: We investigated the association of the IL7R gene polymorphism rs6897932 in MS patients in a case and control study. In this case and control study participating, 127 relapsing-remitting MS (RRMS) patients (mean age: 32.25, age range: 16-57) selected according McDonald criteria, and 109 ethnically, sex and age matched healthy control (mean age: 27.44, age range: 14-63) with no personal or family history of autoimmune diseases were studied. DNA was extracted from whole blood using high pure polymerase chain reaction template preparatio kit from Roch Company. Amplification refractory mutation system method was applied to define the genotyping C/T within exon 6 of the IL7R gene among individuals.Results: Evaluation of the IL7R gene polymorphism revealed that the T allele and the C/T and T/T genotypes are present in 53.5%, 42.5%, 4.0%, and 68.8%, 26.6%, 4.6% in MS patients and controls, respectively. Comparison between alleles and genotypes in the MS patients and healthy controls show significant differences (P = 0.038).Conclusion: The distribution of the rs6897932 polymorphism is significantly different in our case/control study in Khuzestan Province. This single nucleotide polymorphism causes alternative splicing in exon 6 of the IL7R gene with possible influence of the autoimmunity.
Special Articles
Samia Younes; Yousra Cherif; Mouna Aissi; Wafa Alaya; Olfa Berriche; Amel Boughammoura; Mahbouba Frih-Ayed; Baha Zantour; Mohamed Habib Sfar
Volume 13, Issue 3 , September 2014, Pages 172-176
Abstract
Background: Non-ketotic hyperglycemia (NKHG) may increase the probability of seizures and movement disorders. Methods: We describe a series of 14 elders admitted for seizures and movement disorders linked to NKHG.Results: Twelve patients developed motor seizures and two others movement disorders. ...
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Background: Non-ketotic hyperglycemia (NKHG) may increase the probability of seizures and movement disorders. Methods: We describe a series of 14 elders admitted for seizures and movement disorders linked to NKHG.Results: Twelve patients developed motor seizures and two others movement disorders. Glucose levels varied 9.28 to 32 mmol/l, while osmolarity values varied from 302.28 to 328 mosmol/l. All patients responded well to insulin therapy and four of them needed anti-epileptic drugs.Conclusion: Seizures or movement disorders in elderly with NKHG could be misdiagnosed as neurological diseases. Blood glucose must be audited whenever patients with seizures or movement disorders are encountered, as the condition may quickly resolve when NKHG is controlled.Introduction: Seizures and movement disorders related to non- ketotic hyperglycemia (NKHG) have been reported with increasing frequency since the first case documented in 1965.1,2 The clinical spectr m of this syndrome is various with a severe course in elderly. It develops more quickly than other disorders of diabetes mellitus with hyperglycemia, but usually without evidence of ketosis.2,3 Since the syndrome often ensues during the course of any illness and yet has not been reported in diverse medical fields, doctors must become familiar with this preventable condition, especially in elders. Thus, only the prompt institution of appropriate insulin therapy will improve prognosis and hasten recovery.2,3
Special Articles
Anahid Safari; Esmail Jafari; Afshin Borhani-Haghighi
Volume 13, Issue 3 , September 2014, Pages 177-180
Abstract
Morning glory syndrome (MGS) is a rare congenital optic disc anomaly characterized by a funnel-shaped, excavated optic disc surrounded by chorioretinal pigmentary disturbance. The main ophthalomoscopic feature of the MGS is enlarged optic disc with a funnel shaped scleral defect; elevated peripapillary ...
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Morning glory syndrome (MGS) is a rare congenital optic disc anomaly characterized by a funnel-shaped, excavated optic disc surrounded by chorioretinal pigmentary disturbance. The main ophthalomoscopic feature of the MGS is enlarged optic disc with a funnel shaped scleral defect; elevated peripapillary chorioretinal pigmentation; and pale fluffy tissue of glial hyperplasia overlying the optic disc. Although most of the reported cases were isolated ocular abnormality, but it may occurs in association with other ophthalmic abnormalities such as cyst of the optic nerve atrophy, congenital cataract, microophthalmos, and aniridia. Craniofacial deformities such as cleft lip and palate, hypertelorism, dysplatic ears; renal abnormalities; and cardiac defects have also been reported with MGS. Herein, we present a case of MGS associated with multiple sclerosis - a rather unusual concurrence.
Special Articles
Alireza Khoshnevisan; Askar Ghorbani; Narges Sistany Allahabadi; Farshid Farzaneh; Sina Abdollahzadeh; Sepehr Soleymani; Vahidreza Ostovan
Volume 13, Issue 3 , September 2014, Pages 181-184
Abstract
Central nervous system infection is a rare complication of endovascular procedures. We report a 21-year-old woman presented with headache, nausea, vomiting, and right-sided hemiparesis 4 months after endovascular embolization of cerebral arteriovenous malformation. Investigations led to the diagnosis ...
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Central nervous system infection is a rare complication of endovascular procedures. We report a 21-year-old woman presented with headache, nausea, vomiting, and right-sided hemiparesis 4 months after endovascular embolization of cerebral arteriovenous malformation. Investigations led to the diagnosis of multiple brain abscesses. This is the sixth case report of brain abscess following endovascular interventions.
Special Articles
Mohammad Taher Rajabi; Seyed Ziaeddin Tabatabaie; Mohammad Bagher Rajabi; Yalda Abrishami; Seyedeh Simindokht Hosseini; James Oestreicher
Volume 13, Issue 3 , September 2014, Pages 185-187
Special Articles
Anahita Sadeghi; Behrouz Navabakhsh; Leila Aghaghazvini
Volume 13, Issue 3 , September 2014, Pages 188-190
Special Articles
Abdorreza Naser Moghadasi
Volume 13, Issue 3 , September 2014, Pages 191-192
Special Articles
Mehdi Farhoudi; Kaveh Mehrvar; Hadiseh Kavandi; Arash Aslanabadi
Volume 13, Issue 3 , September 2014, Pages 193-194
