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1.  Low levels of tissue factor pathway inhibitor increase the risk of cerebral venous thrombosis 
Decreased concentration of tissue factor pathway inhibitor (TFPI) is a risk factor for development of deep venous thrombosis and coronary heart disease, but there is no evidence for the relationship between TFPI and cerebral venous and sinus thrombosis (CVST). The aim of this study was to determine the level of TFPI in healthy population and in patients with CVST.
Materials and Methods:
We determined the plasma level of TFPI in 20 patients with CVST (cases) and 31 healthy volunteer subjects (as control group) by enzyme linked immunoassay method. We also examined the association between TFPI and the risk of CVST. Continuous variables were compared between groups using Student's t test, and odds ratio was calculated by multiple logistic regression analysis.
The mean TFPI was significantly lower in the CVST group compared with the control group (8.60 ± 4.05 ng/mL; 14.6 ± 8.6 ng/mL; P = 0. 005), respectively. The odds ratio for CVST associated with low (<25th percentile) levels of TFPI was 5.429 (95% CI, 1.487-19.82, P = 0.012).
Our investigation demonstrates that reduced TFPI may be one of the risk factors of CVST and associated with increasing the risk of developing CVST.
PMCID: PMC4300595  PMID: 25625112
Cerebral venous; sinus thrombosis; tissue factor pathway inhibitor
2.  Perspective on the hospital incidence rate of deep venous coagulopathy: Clinical and biochemical diagnostic markers 
Identifying factors contributing to the increased risk of deep venous thrombosis (DVT) in each population is vital, because of its life-threatening outcome. The current study aims to find the diagnostic performance of some laboratory coagulation markers for predicting DVT in an Iranian population complaining of DVT in the lower limbs.
Patients and Methods:
For this study, 66 consecutive patients with documented DVT, admitted to the Al-Zahra Hospital in Isfahan for the first time, were considered as the case group and 33 patients without DVT documentations were included as the control group. DVT was considered when there was visualization of thrombus or non-compressibility of the vein, confirmed by bilateral lower extremity compression Doppler ultrasonographic examination. Homocysteine, antiphospholipid, and anticardiolipin antibodies were measured in both groups by using sensitive ELISA kits. Protein C was measured via a functional clotting method, and prothrombin was measured by a kinetic, enzymatic assay.
Multivariable analysis showed that the serum homocysteine levels was potentially associated with the presence of DVT after adjusting for age and gender (OR: 1.038, 95% CI: 1.007-1.070, P = 0.017). Comparison of the C statistic showed a partially good discrimination of homocysteine for DVT, with the area under the receiver operating characteristic (ROC) curve being 0.614 and with the optimal cut-off value of 16.5 micromol/L (μmol/L) for men and 14.5 μmol/L for women.
Hyperhomocysteinemia could be considered as an independent risk factor for DVT, with an actual acceptable prognostic value, in the Iran population.
PMCID: PMC4283241  PMID: 25590032
Biochemical diagnostic; deep venous coagulopathy; incidence
3.  Factor V Leiden does not have a role in cryptogenic ischemic stroke among Iranian young adults 
Different risk factors have been suggested for ischemic stroke in young adults. In a group of these patients despite of extensive diagnostic work-up, the primary cause remains unknown. Coagulation tendency is accounted as a possible cause in these patients. Previous studies on factor V Leiden (FVL) as the main cause of inherited thrombophilia for clarifying the role of FVL in stroke have resulted in controversial findings. The current study investigates the role of this factor in ischemic stroke among Iranians.
Materials and Methods:
This case-control study was performed between September 2007 and December 2008 in Isfahan, Iran. The case group comprised of 22 patients of which 15 were males and 7 were females with age range of ≤50 years, diagnosed as ischemic stroke without classic risk factors and the control group consisted of 54 healthy young adults. After filling consent form, venous blood samples were obtained and sent to the laboratory for genetic examination.
No FVL mutation was found in the case group. There was one carrier of the mutation as heterozygous in the control group (relative frequency = 1.85%).
Based on our study, FVL might not be considered as an independent risk factor for ischemic stroke in Iranian individuals who are not suffering from other risk factors of ischemic stroke.
PMCID: PMC3988598  PMID: 24761388
Cryptogenic; factor V Leiden; stroke; young adults
4.  Reliability and Validity of the Migraine Disability Assessment Scale among Migraine and Tension Type Headache in Iranian Patients 
BioMed Research International  2014;2014:978064.
Introduction. MIDAS is a valid and reliable short questionnaire for assessment of headache related disability. Linguistic validation of Persian MIDAS and assessment of psychometric properties between tension type headache (TTH) and migraine were the aims of this study. Methods. Patients with migraine or TTH were included. At the first visit, we administered a headache symptom questionnaire, MIDAS, and SF-36. Patients filled out MIDAS in second and third visit within three and eight weeks after base line visit. Internal consistency (Cronbach α) and test-retest reproducibility (Spearman correlation coefficient) were used to assess reliability. Convergent validity and MIDAS capability to differentiate between chronic and episodic headaches (migraine and TTH) were also assessed. Results. The 267 participants had episodic migraine (EM-64%), chronic migraine (CM-13.5%), episodic TTH (ETTH-13.5%), and chronic TTH (CTTH-9). Internal consistency reliability was 0.8 for the entire sample, 0.72 for TTH, and 0.82 for migraine. Test-retest reliability for all questions between visit 1 and visit 2 varied from 0.54 to 0.71. Convergent validity was assessed using SF-36 as an external referent. Patients with episodic headaches (EM and ETTH) had significantly lower MIDAS scores than chronic headaches (CM and CTTH). Conclusion. Persian MIDAS is a valid and reliable questionnaire for migraine and TTH that can differentiate between episodic headache and chronic headache.
PMCID: PMC3914354  PMID: 24527462
5.  Vitamin D Status in Migraine Patients: A Case-Control Study 
BioMed Research International  2014;2014:514782.
Background. There have been few studies on the relation between vitamin D and migraine. We investigated the prevalence of vitamin D deficiency in migraine patients and compared it with a control group. We also evaluated the relationship of vitamin D deficiency with severity of migraine. Methods. 105 newly diagnosed migraine patients and 110 controls, matched for age, sex, socioeconomic status, education, and sun exposure, were enrolled during the spring of 2011. 25-Hydroxy vitamin D [25(OH)D] plasma levels were measured by chemiluminescence immunoassay. Results. The mean ± SE concentration of 25(OH)D was 13.55 ± 0.91 ng/mL in cases and 13.19 ± 1.19 ng/mL in controls. There was no significant difference in 25(OH)D concentration between cases and controls. We found no relationship between severity of headache and 25(OH)D status. Conclusions. We did not find any association between migraine and vitamin D status; also, severity of headaches was not related to 25(OH)D level. Further studies with larger sample sizes are required to confirm our results.
PMCID: PMC3910019  PMID: 24524078
6.  Prevalence and Prognosis of Cerebrovascular Accidents and its Subtypes Among Patients with Systemic Lupus Erythematosus in Isfahan, Iran: A Hospital Clinic-based Study 
The aim of the present study was to determine the prevalence and prognosis of cerebrovascular accident (CVA) and its subtypes among Iranian patients with systemic lupus erythematosus (SLE).
In a cross-sectional study, medical records of 575 SLE patients were reviewed. The patients developing CVA in their course of disease were extracted. In these patients, data about demographic features, lupus anti bodies, duration of the disease until CVA, CVA manifestation(s) and follow-up duration were gathered. In the next step, patients with any kinds of CVA were summoned to Neurology clinic to identify the grade of disability in each patient with CVA.
We identified 38 patients with CVA of which 6 (15.8%) were men and 32 (84.2%) were women. The most common subtype of CVA was small vessels thrombosis (21.05%) among the study patients and hemi paresis was the most prevalent initial presentation (39.47%). In 11 (28.9%) patients, SLE was initiated with CVA and in 3 (7.9%) patients CVA had happened in the 1st year of SLE. Anti-phospholipid antibodies (APLA) were positive in 29 (76.3%) patients. Mean modified Rankin Scale in patient with positive and negative serology for APLA was 0.93 ± 1.11 and 0.22 ± 0.66 respectively (P = 0.006).
Our study shows that 6.6% of Iranian SLE patients have CVA during their course of the disease. Small vessels thrombosis is the most common CVA subtype and hemi paresis is the most prevalent initial presentation. Moreover, we showed that the prognosis of CVA in Iranian SLE patients is not unfavorable.
PMCID: PMC3915465  PMID: 24555002
Cerebrovascular accident; stroke; systemic lupus erythamatosus
7.  Metabolic syndrome in migraine headache: A case-control study 
The correlation of metabolic syndrome and migraine headache was evaluated in some previous studies. However there is no study that compared the prevalence of metabolic syndrome in the patients with and without migraine. Control of coincidental factors such as metabolic syndrome reduces therapeutic resistance in migrainous patients. The aim of this study was to compare prevalence of metabolic syndrome in patients with and without migraine headache.
Materials and Methods:
200 migrainous patients diagnosed according to International Headache Society and 200 healthy controls without migraine enrolled in this study. Metabolic syndrome was diagnosed according to ATP III criteria in these two groups and compared with each other.
In this study, 17% (34) of migrainous patients and 15% (30) of healthy control without migraine had metabolic syndrome. (P = 0.585). Of the metabolic syndrome components, body mass index (P = 0.05) and waist circumference in migrainous (P = 0.03) were significantly more frequent.
Our results demonstrate that metabolic syndrome and migraine headache had not significant correlation; however, higher body mass index and waist circumference as metabolic syndrome components had correlated with migraine headache.
PMCID: PMC3963317  PMID: 24672559
Metabolic syndrome; migraine; insulin resistance
8.  Stroke in a patient with pulmonary arteriovenous fistula: A case report study 
Pulmonary arteriovenous fistula (PAVF) is a venous malformation that permits right to left shunting of blood, bypassing the pulmonary capillary bed. Often PAVFs are seen in association with hereditary conditions. On the other hand, isolated PAVFs are rare and asymptomatic. There have been few reports of isolated PAVF related complications. A patient was referred to us with dysarthria and diplopia and history of surgically-treated PAVF. Further evaluations revealed a stroke in thalamic region. We found an open PAVF in a case of thalamic stroke.
PMCID: PMC3908485  PMID: 24520551
Arteriovenous malformation; pulmonary fistula; stroke
9.  The Psychometric Properties of the Persian Migraine-Specific Quality of Life Questionnaire Version 2.1 in Episodic and Chronic Migraines 
The Scientific World Journal  2013;2013:950245.
Background. Migraine-specific quality of life (MSQ) is a valid and reliable questionnaire. Linguistic validation of Persian MSQ questionnaire, analysis of psychometric properties between chronic and episodic migraine patients, and capability of MSQ to differentiate between chronic and episodic migraines were the aims of this study. Method. Participants were selected from four different neurology clinics that were diagnosed as chronic or episodic migraine patients. Baseline data included information from MSQ v. 2.1, MIGSEV, SF-36, and symptoms questionnaire. At the third week from the baseline, participants filled out MSQ and MIGSEV. Internal consistency (Cronbach alpha) and test-retest reproducibility (intraclass correlation coefficients) were used to assess reliability. Convergent and discriminant validities were also assessed. Results. A total of 106 participants were enrolled. Internal consistencies of MSQ among all patients, chronic and episodic migraines, were 0.92, 0.91, and 0.92, respectively. Test-retest correlation of MSQ dimensions between visits 1 and 2 varied from 0.41 to 0.50. Convergent, item discriminant, and discriminant validities were approved. In all visits MSQ scores were lower in chronic migraine than episodic migraine; however, the difference was not statistically significant. Conclusion. Persian translation of MSQ is consistent with original version of MSQ in terms of psychometric properties in both chronic and episodic migraine patients.
PMCID: PMC3771439  PMID: 24068887
10.  Relationship between Vitamin D Receptor Gene Polymorphisms and Migraine without Aura in an Iranian Population 
BioMed Research International  2013;2013:351942.
Background. Inflammation has a key role in migraine pathophysiology. Vitamin D is an effective anti-inflammatory agent. The aim of this study was to investigate the association between migraine and two vitamin D receptor (VDR) polymorphisms (TaqI and FokI) and also the relationship between VDR polymorphisms and headache severity. Methods. In this case-control study we assessed 103 patients with newly diagnosed migraine without aura and 100 healthy subjects. Patients filled headache impact test-6 (HIT-6) as a tool to assess headache severity. Results. Genotype frequencies of VDR were significantly different between control and migraine patients. Heterozygote genotypes (Ff and Tt) were statistically more frequent in the migraine patients than the control subjects both for TaqI gene (P = 0.018; OR = 1.81, 95% CI = 1.03–3.18) and FokI gene polymorphisms (P = 0.001; OR = 2.91, 95% CI = 1.47–5.77). Also f and t alleles were more frequent in the migraine patients. Total HIT-6 score was significantly different between FokI heterozygote and homozygote patients (60.32 ± 1.87 versus 49.87 ± 2.69, resp., P = 0.004). Conclusions. In conclusion our results showed that TaqI and FokI gene polymorphisms are associated with migraine without aura in Iranians patients. Also headache severity in FokI heterozygote patients was significantly greater than in the homozygote patients.
PMCID: PMC3741896  PMID: 23984350
11.  Transcranial sonography on Parkinson's disease and essential tremor 
The study on transcranial sonocraphy (TCS) as a diagnostic test for Parkinson's disease (PD) has been neglected in some hospitals. The current study was conducted as the first study to investigate the utility of TCS for diagnosis of PD and its ability to distinguish PD from essential tremor (ET) in an Iranian population.
Materials and Methods:
TCS of substantia nigra (SN) was performed on 50 PD, 48 ET, and 50 healthy controls by two blinded investigators.
Bilateral SN margin over 0.20 cm2 was found in 39 (90%) and 7 (15%) in PD and ET patients, respectively. Furthermore, 4 (8%) of healthy control displayed this particular echo feature as well (false positives). SN hyperechogenicity ≥0.20 cm2 was considered as a cut-off point to detected PD. Accordingly, TCS proved 90% (95% confidence interval [CI]: 77.85-97.35) sensitive and 92% (95% CI: 80.75-97.73)specific for the detection of PD by visualizing the SN.
SN hyperechogenicity ≥20 cm2 is a specific feature of PD. Since, the symptoms of PD and ET might be overlapping; this method seems to be reliable to confirm PD diagnosis in doubtful clinical cases. Further studies in years to come are warranted to shed light on standardized data for Iranian to enhance the validity of TCS.
PMCID: PMC3743314  PMID: 23961280
Essential tremor; Parkinson; transcranial sonography
12.  Electrocardiographic changes in patients with refractory epilepsy 
Epilepsy is the second most common type of chronic neurological disease. Its diagnosis carries an excess mortality, which is 2-3 times higher than that of general population. Mortality rates are increased among patients with uncontrolled seizures. The aim of this study was to characterize the electrocardiogram (ECG) changes during pre-ictal, ictal and post-ictal states in pharmaco-resistant epilepsy patients.
Materials and Methods:
This retrospective study conducted by Department of Neurology and Department of Cardiology of Isfahan Medical University from September 2008 to December 2012, patients with medically refractory epilepsy who underwent standard pre-surgical assessment from Epilepsy ward of Kashani hospital in Isfahan city were recruited in this study.
The heart rate (HR) varied significantly throughout the record. Significant difference in HR was identified between ictal and pre-ictal periods (P = 0.000), furthermore, the difference between ictal and pre-ictal HR {mean = 63.867 ± 0.061, P = 0.000}, ictal and post-ictal HR {mean = 38.833 ± 0.067, P = 0.003}, and between pre- and post-ictal HR {mean = 25.033 ± 0.089, P = 0.000}, was significant.
ECG monitoring should be a part video- (electroencephalography) EEG monitoring to identify serious cardiac abnormalities, particularly in patients with refractory epilepsy.
PMCID: PMC3743315  PMID: 23961281
Electrocardiography; epilepsy; electrocardiogram monitoring
13.  Mutation analysis of CACNA1A gene in Iranian migrainous and review literatures 
There are contrary results about the role of CACNA1A gene in the causation of common migraine in different populations. However, migraine may be genetically heterogeneous and more studies in different families and populations are required for a definite conclusion. The aim of this study was to surveyed leukocyte genomic DNA mutation of CACNA1A in Iranian migraine patients with [MA] and without aura [MO] who has family history of migraine and we performed a narrative review of all studies that evaluated CACNA1A gene, non-hemiplegic migraine [MA and MO] and FHM [familial hemiplegic migraine].
Materials and Methods:
The 30 patients with family history of migraine were selected for mutations analysis for CACNA1A gene by PCR method. For review, we searched MEDLINE-PUBMED, ISI, Scopus and Cochrane databases up to December 2012.
Mutation analysis of the 4 exons of the CACNA1A gene in these patients revealed no mutations in this gene. Direct sequencing revealed a polymorphism previously reported G to A transition in the exon 16 [nt2369, G→A] in 9 patients. In review, the correlation of FHM loci [CACNA1A gene] with MA and MO has been showed in different population and only small population from Caucasians presented this correlation.
CACNA1A is most likely not a major susceptibility gene for common migraine in Iranian maigrainous. It's essential to study more on larger series and covering all 47 exons of the CACNA1A gene to confirm this hypothesis.
PMCID: PMC3743323  PMID: 23961289
CACNA1A gene; linkage; migraine; mutation
14.  Efficacy of Enalapril in Migraine Prophylaxis: A Randomized, Double-blind, Placebo-controlled Trial 
Some angiotensin converting enzyme (ACE) inhibitors have previously been shown to be effective in migraine prophylaxis. The aim of this study was to evaluate whether Enalapril is effective in migraine prophylaxis.
In this randomized, double-blind, placebo-controlled clinical trial, the effects of 10 mg Enalapril given daily were compared with those of matched placebo in 40 migraineurs for 2 months. Response to treatment was assessed at 0, 1, and 2 months after the start of intervention according to headache parameters like frequency, severity, and duration. This trial is registered with Iranian Registry of Clinical Trials (IRCT), number IRCT138711011570N1.
A significant effect on reducing migraine attack more than 50% at first and second months (P=0.016) occurred in Enalapril group. Indeed, at the first and second months of treatment, the severities (P=0.000 and P=0.000) and duration (P=0.037 and 0.003) in the Enalapril treated group were significantly lower than in the placebo group.
Enalapril may be effective in migraine prophylaxis according to its effect in decreasing the frequency, severity, and duration of headaches. The results support the previous suggestions on usage of ACE inhibitors in migraine prophylaxis.
PMCID: PMC3570915  PMID: 23413003
Angiotensin converting enzyme inhibitors; Enalapril; migraine disorders
16.  Oral contraceptive misuse as a risk factor for cerebral venous and sinus thrombosis 
Consumption of oral contraceptive pills (OCP) is a known risk factor for cerebral venous and sinus thrombosis (CVST) among women. We determined whether misuse of OCP could increase the risk of CVST in women.
A case-control study was conducted from 2003 to 2007 on 64 female patients with CVST admitted to Al- Zahra medical center and 232 healthy age-matched female OCP users as controls. Patients and controls were interviewed and misuse of OCP was categorized to taking OCP for self-treatment of dysfunctional uterine bleeding, for family planning without physician consult, or for delaying menstruation in purpose of religious customs or traveling, and taking OCP in high dose during the preceding year.
Among 64 cases and 232 controls, 30 (46.9 %) and 63 (27.2 %), respectively, had a history of OCP misuse (Odds Ratio = 2.36, 95% Confidence Intervals = 1.33 to 4.18, P = 0.002). Also, using cyproterone compound (Diane) was more frequent in the CVST group (P<0.001). Multivariate analysis controlling for age, OCP misuse, type of OCP, and history of coagulopathy showed that OCP misuse (P<0.001) and using Diane as the OCP (P = 0.006) were both independently associated with CVST.
OCP misuse can be considered as an additional predisposing factor for CVST among women and partly responsible for larger proportion of female patients with CVST. These findings should alarm the healthcare system to create strategies controlling the inappropriate use of OCP among Iranian women.
PMCID: PMC3526127  PMID: 23267395
Cerebral venous and sinus thrombosis; misuse; oral contraceptive
17.  The impact of prothrombin (G20210A) gene mutation on stroke in youths 
ARYA Atherosclerosis  2012;8(1):9-11.
Stroke in young adults is a known but abnormal disease. Several recent studies have discussed the correlation between existence of coagulation factors such as V Leiden and prothrombin mutation (G20210A) as risk factors for incidence of stroke. The present study investigated the frequency of prothrombin gene mutation and its impact on incidence of ischemic stroke in Iranian youth.
This was a case-control study using convenient sampling method on seventy six 18 to 50-year-old people provided that they did not have classical risk factors for stroke. Case group comprised 22 patients with ischemic stroke (15 males and 7 females). Fifty four healthy people (17 males and 37 females) were selected as the control group. Participants in both groups were recruited within 26 months (23.9.2007 to 21.11.2009) in Al-Zahra Hospital, Isfahan, Iran.
Prothrombin was not found in any of the studied patients. Heterozygous mutation was observed in one of the samples of the control group (1.85%).
Despite the known effect of prothrombin gene mutation on incidence of venous thrombosis, it does not seem this factor, as an independent factor, can be considered as a risk factor to create ischemic stroke in people who do not have other risk factor.
PMCID: PMC3448394  PMID: 23056093
Prothrombin Mutation; Stroke; Youth; Risk Factor
18.  The Effect of Statin Therapy in Stroke Outcome: A Double Blind Clinical Trial 
Through a clinical trial we evaluated statin therapy benefits over stroke outcome.
All patients with moderate stroke in Middle Cerebral Artery (MCA) were registered during February 2006 to February 2008, in Al Zahra Hospital, Isfahan, Iran. Among 55 patients who were enrolled in the present study, 25 subjects received 20 mg lovastatin daily, for 90 days after stroke attack (group 1) and 30 patients received no treatment (group 2). Patients were assessed at admission, 7 and 90 days after stroke. National Institutes of Health Stroke Scale (NIHSS) score was recorded in the day 1 and 7 in the hospital with a questionnaire and BARTHEL index was estimated 90 days after stroke incidence by a telephone survey or in an outpatient visit. Data were analyzed by means of χ2, ‘t’ test and Independent ‘t’ test.
NIHSS score measured in first day immediately after stroke attack and following 7 days, did not differ significantly in two groups. Moreover, BARTHEL index recorded within 90 days was not also different comparing group 1 and 2. After 90 days, no mortality was recorded in group 2, while one patient expired in group treating with statins (P-value>0.05).
We did not find statins administration to play any role in stroke recovery and consequent long-term prognosis. More researches with larger samples are needed to establish the possible favorable outcome of statins when administered in cerebrovascular diseases.
PMCID: PMC3278872  PMID: 22355480
Ischemic stroke; lovastatin; stroke prognosis; statins
19.  The effects of sodium valproate with fish oil supplementation or alone in migraine prevention: A randomized single-blind clinical trial 
Iranian Journal of Neurology  2012;11(1):21-24.
Omega-3 polyunsaturated fatty acids (PUFA) have beneficial effects on both specific and non-specific inflammatory reactions. The aim of this study was to evaluate the effect of dietary supplementation with fish oil in migraine prevention.
A 12-week, randomized, single-blind clinical trial was conducted from October 2008 to June 2009. A total of 67 patients (52 women, 15 men) with migraine headache were randomly allocated to 2 groups. In the first group, 38 patients (30 females with a mean age of 35 ± 9 year) received 400 mg/day sodium valproate. In the second group, 29 patients (22 females with a mean age of 36 ± 9 years) received sodium valproate 400 mg daily plus fish oil supplementation (180 mg). Response to the treatment was assessed at 0, 1, 2, and 3 months after start of the therapy.
A significant decrease in duration, monthly frequency, and severity of headache after month 1, 2, and 3 in comparison with month 0 occurred in both groups. There was a significant reduction in headache severity (P = 0.046) and frequency (P = 0.044) in the group with fish oil supplementation after month 1 in comparison with sodium valproate alone. In contrast, there was no significant difference between two treatment groups in duration of the headache after month 1. Mean intensity, mean duration and mean frequency of the attacks after month 2 and 3 were not significantly different between the two groups.
This study demonstrated that sodium valproate plus fish oil supplementation significantly reduces migraine headache more than sodium valproate alone but only at the beginning of the treatment.
PMCID: PMC3829229  PMID: 24250854
Fish Oil; Migraine; Sodium Valproate; Pain
20.  Polymorphism of Apo lipoprotein E gene and the risk of multiple sclerosis 
Apolipoprotein E (ApoE) gene encodes an important protein in reforming injuries of central nervous system (CNS). It is assumed that various ApoE alleles may be functionally different. The purpose of this study was to investigate the distribution of ApoE genotypes in multiple sclerosis (MS) patients in a small cohort of Iranians.
In this case-control study, blood samples of patients and healthy volunteers were collected (n = 40) from Neurology Clinic of Alzahra Medical Complex. The ApoE genotypes were determined using DNA extracted from the samples by polymerase chain reaction (PCR) techniques followed by digestion with HhaI restriction enzyme. The results were adjusted for age of MS onset, sex, expanded disability status scale (EDSS), and type of MS (primary or secondary progressive). Results were statistically analyzed using chi-square test.
The ApoE3/E3 genotype was detected in the majority of MS patients and the control group. Frequency distribution of E4 allele did not differ significantly between the two groups. There was no difference between ApoE allele and age of disease onset, sex, expanded disability status, or type of multiple sclerosis.
We found no significant differences in genotype frequency between patients with multiple sclerosis and the control group. Despite the fact that small sample size was a limitation for our study, it seems that ApoE polymorphism may not be useful as a marker for screening patients with multiple sclerosis.
PMCID: PMC3434891  PMID: 22973358
Apolipoprotein E; Allele; Multiple Sclerosis; Polymorphism; Gene
21.  Evaluation of the neuroprotective effect of dextromethorphan in the acute phase of ischaemic stroke 
Stroke is the second leading cause of death in the world. However, there is still no approved neuroprotective drug for acute ischaemic stroke. To clarify the neuroprotective efficacy and safety of dextromethorphan in stroke, the following study was carried out.
Material and methods
Forty patients with acute stroke causing moderate deficit were randomized to be treated with either dextromethorphan 300 mg per day or placebo for 5 days. Plasma level of dextromethorphan and its active metabolite was not evaluated in this study. The NIHSS score was calculated on day 5 and the Barthel activities of daily living index and Rankin score were checked after 3 months by a blinded investigator. Collected data were analysed using the t-test and χ2 test.
In the dextromethorphan-treated group, the mean NIHSS score was 16.8 ±3.9 at baseline, and was 14.2 ±4.8 for the placebo-treated group (p = 0.069). At day 5, there was also no significant difference regarding NIHSS score (p = 0.167). At the 3-month follow-up, there was no significant difference regarding Barthel scale and Rankin score between the dextromethorphan and placebo groups.
The results of our study suggest that although low-dose and short-term oral administration of dextromethorphan seems to be not neuroprotective, it does not worsen either patients’ condition or NIHSS score. Moreover, patients treated with dextromethorphan showed a significant reduction in seizures (complication after stroke), but had increased chance of MI and renal failure by almost 5% when compared to the placebo-treated groups. More prolonged studies with a higher number of cases are recommended.
PMCID: PMC3258743  PMID: 22295030
stroke; neuroprotection; dextromethorphan; treatment
22.  A case of intracranial malignant fibrous histiocytoma 
We describe a case of intracranial malignant fibrous histiocytoma which had infiltrated pons, cerebellum and basal surface of left temporal lobe without any visible mass. The patient presented with a sudden loss of consciousness and vomiting. Clinical findings, laboratory tests, imaging and examination of the cerebrospinal fluid tended to establish the diagnosis of an infectious condition than a malignancy. Without any response to the antibiotics and with a progressive deterioration of neurologic and mental condition, the patient died after 20 days. In the autopsy, histological and immunohistochemical study of the brain revealed the diagnosis of malignant fibrous histiocytoma (MFH).
PMCID: PMC3263113  PMID: 22279468
Malignant Fibrous Histiocytoma; Central Nervous System; Immunohistochemistry; Sarcoma; Autopsy
23.  Relationship Between Carotid Intima-Media Thickness with some Inflammatory Biomarkers, Ghrelin and Adiponectin in Iranians with and without Metabolic Syndrome in Isfahan Cohort Study 
ARYA Atherosclerosis  2010;6(2):56-61.
Recent studies have confirmed inflammatory factors and metabolic syndrome (MetS) as important cardiovascular disease (CVD) risk factors. Recently measurement of carotid intima-media thickness (IMT) has been used for evaluation of early atherosclerosis. This study was designed to assess the correlation between IMT with some inflammatory biomarkers, ghrelin and adiponectin in people with and without MetS in a cohort sample in Isfahan province.
Among participants of Isfahan Cohort Study (ICS) by random sampling, 88 participants were selected and divided into case (with MetS) and control (without MetS) groups. A questionnaire including demographic data and CVD risk factors was completed for all of the participants. Physical examination and blood pressure, height, weight and waist circumference measurements were done for all subjects. Vascular echocardiography was done for evaluation of IMT of each carotid artery of both sides. Interlukin-6 (IL-6), interlukin-10 (IL-10), highly sensitive C-reactive protein (hs-CRP), ghrelin and adiponectin levels were measured using ELIZA method. Data were entered in SPSS15 software and analyzed by t-test, chi square, Pearson correlation and linear regression analyze.
The mean waist circumference, BMI, systolic blood pressure, diastolic blood pressure, hs-CRP and IMT of left carotid artery were significantly higher in participants with Mets. There was significant correlation between left carotid IMT and IL-6 level in all patients (P = 0.03). After adjustment for age and sex, significant relationship in groups with MetS was only reported between the left IMT and IL-6 (P = 0.02). There was no relation between IMT and other inflammatory markers in subjects with and without MetS.
Significant correlation between IL-6 and IMT was reported in patients with MetS. While no significant correlation between IL-10, adiponectin and ghrelin with IMT was observed in metabolic syndrome group.
PMCID: PMC3347812  PMID: 22577415
Intima-media thickness (IMT); Carotid artery; hs-CRP; Ghrelin; Adiponectin IL-6; IL-10
24.  Differences in center of pressure trajectory between normal and steppage gait 
This pilot study aimed to assess the differences in center of pressure trajectory in neuropathic patients with steppage gait. Steppage gait has previously been evaluated by several biomechanical methods, but plantar pressure distribution has been much less studied. The purpose of this study was to analyze the changes in center of pressure trajectory using a force plate.
The steppage gait group was selected from the patients using drop foot brace (25 male) and the control group was selected from Isfahan university students (20 male). They walked at self- selected speed at a mean of ten trials (+2) to collect the center of pressure using a force plate. Center of pressure patterns were categorized into four patterns based on the center of pressure displacement magnitude (spatial features) through time (temporal features) when the longitudinal axis of the insole was plotted as the Y- axis and the transverse axis of the insole as X- axis during stance phase.
The horizontal angle measured from center of pressure linear regression was positive in the control group (4.6 ± 2.4) (p < 0.005), but negative in the patient group (- 2.3 ± 1.6) (p < 0.005).
The finding of this research measured center of pressure trajectory in steppage gait over time, which is useful for designing better shoe sole and also orthopaedic device and better understanding of stability in patients with drop foot.
PMCID: PMC3082780  PMID: 21526056
Classifications; Steppage Gait; Neuromuscular Disease; Force Plate

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