فهرست مطالب پیام سعادت

Neuropathic diseases are neurodegenerative conditions and a wide and difficult group of peripheral nerve diseases in humans. The aim of the present study was to investigate the effectiveness of acceptance and commitment therapy on pain coping strategies and pain self- efficacy in chronic neuropathic pain patients

This study was a semi-experimental study with a control group and included pre-test, post-test and follow-up. The statistical population, included all chronic neuropathic pain patients referring to Rohani Hospital and personal office of our neurologist in Babol City in 2022. 30 patients were selected by using purposive sampling method and randomly divided into two experimental (15 persons) and control (15 persons) groups. Both groups filled out the pain coping strategies and pain self- efficacy questionnaire  in the pre-test stage. Acceptance and commitment therapy was performed for the experimental group for 8 sessions (one 120 minute session/week), while control group did not receive any treatment. After completion of the treatment period for both groups, post-test and 2 months after the post-test, follow-up test were performed. Using SPSS-18 software, data were analyzed by repeated measures analysis of variance.

The results showed that in the post-test there was a significant difference between the two experimental and control groups in the scores of pain coping strategies subscales in diverting attention, reinterpretation of pain, catastrophizing, ignoring pain, prayer-hope, self-statement, increased pain behaviour and pain self-efficacy (P<0.01). The treatment results were maintained in the follow-up stage. 

The results of the present study indicated that acceptance and commitment therapy can be effective in improving pain coping strategies and increasing pain self- efficacy in the patients with chronic neuropathic pain.

Neuropathic diseases are neurodegenerative conditions and a wide and difficult group of peripheral nerve diseases in humans. Since well-being therapy emphasizes the high levels of six domains of psychological well-being, this study was conducted to investigate the effectiveness of well-being therapy on pain coping strategies and self-efficacy of patients with chronic neuropathic pain.

This clinical trial was conducted on 30 chronic neuropathic patients referred to Ayatollah Rouhani hospital in Babol and a neurologist's private office in two groups of experimental and control (n=15). Well-being therapy was performed in 8 sessions of 120 minutes, once a week for the experimental group, while the control group received the routine treatment. After the follow-up period, the control group also underwent psychotherapy. Both groups completed questionnaires of pain coping strategies (Rosenstiel and Keefe, 1985) and pain self-efficacy (Nicholas, 1989) in the pre-test, post-test and follow-up (two months after the post-test) and were compared.

The results showed that there was a statistically significant difference between the two experimental and control groups in the score of the subscales of pain coping strategies in distraction from pain (23.13±3.88 versus 11.47±7.34) (p<0.001), reinterpretation of pain (17.33±5.56 versus 13.0±8.65) (p=0.114), catastrophizing (10.0±6.24 versus 16.33±5.4) (p<0.001), ignoring pain (24.4±6.67 versus 12.6±5.11) (p<0.001), hoping/praying (29.13±9.97 versus 22.4±5.7) (p=0.031), self-talk (25±4.03 versus 21.2±4.79) (p=0.026), behavioral activation (20.47±4.43 versus 11.20±4.94) (p<0.001) and pain self-efficacy (43.2±9.45 versus 33.33±13.34) (p=0.027). These results were maintained in the follow-up period.

The present study showed that wellness therapy can be an effective intervention in improving pain coping strategies and increasing pain self-efficacy in chronic neuropathic patients.

Stroke is one of the main causes of death and disability in the world, and its treatment includes the re-supply of blood to the brain tissue using different methods, including alteplase injection. The aim of this study is to determine the outcome of treatment with intravenous alteplase.

This cross-sectional study was conducted on all stroke patients referred to Babol Rouhani Hospital in 2019-2021. Patients were divided into two groups receiving intravenous alteplase and routine and supportive treatment groups. Demographic information and the scores of National Institutes of Health Stroke Scale (NIHSS) to evaluate the improvement of stroke symptoms and Modified Rankin Scale (mRS) to evaluate the severity of disability in three periods of 7, 30 and 90 days were investigated and compared.

Out of 100 studied patients, 49 people were in alteplase group and 51 people were in routine and supportive treatment group. In examining the NIHSS scale of patients in three follow-up periods, there was a significant difference in the alteplase group compared to the routine and supportive treatment group (p<0.001). Moreover, regarding the mRS scale, on the 90th day (0.65±0.80 vs. 1.55±1.11) unlike the 30th day (1.65±1.07 vs. 1.31±0.92), there was a significant difference between the two groups receiving alteplase and the routine and supportive treatment group (p<0.001).

The results of the study showed that treatment with intravenous alteplase can have a suitable effect on neurological disorders after a stroke and can improve the level of disability in daily functioning in the long term, up to the 90th day of patient follow-up.

Aphasia is the most common communication disorder resulting from stroke. In this condition all modalities of language, including reading, writing, auditory perception, and oral speech may be affected. Aphasia is divided into two categories: fluent (Wernicke's aphasia, Transcortical sensory aphasia, conduction aphasia, and anomic aphasia) and non-fluent (Broca's aphasia, global aphasia, transcortical motor aphasia, and mixed transcortical aphasia). As a result, the types of aphasia depend on the area of brain damage. In this study, the relationship between fluent aphasia and non-fluent aphasia with the brain damage area was investigated in stroke patients admitted to hospitals affiliated with Babol University of Medical Sciences in 2018.

In this cross-sectional study, the diagnosis and discrimination of aphasia types were determined by performing the Persian version of the aphasia test and MRI/CT-scan images were taken to find the exact brain damage area. Data were analyzed in SPSS V26.

We studied 123 patients. There were 70 cases with aphasia (mean age: 68.16 years), including 41 men and 29 women. Frontal lobes (25.7%) and temporal lobes (25.7%) were the most common brain regions affected.

Damage to the frontal lobe and its surrounding areas is associated with incidence of aphasia, and damage to the temporal lobe and its surrounding areas is linked to the occurrence of fluent aphasia.

Neuropathic pain is a large and difficult group of peripheral nerve diseases, which are complicated to treat. This study was designed to determine the effectiveness of acceptance and commitment therapy (ACT) on psychological well-being and pain perception among patients with chronic neuropathic pain.

This clinical trial was performed on 30 patients with chronic neuropathic pain who were referred to the Rohani Hospital and private clinic of a neurologist in Babol (Iran) in 2022. The patients were randomly divided into an interventional and a control group. The patients completed the psychological well-being scale (Ryff) and pain belief and perception inventory (Williams and Thorn) in the pretest. Then, ACT (120 minutes) was performed for the interventional group, 8 sessions a week. The patients completed the scales after the treatment course and 2 months after the posttest.

In the first follow-up, there were significant differences between the two groups in terms of total score of psychological well-being (P<0.05), the subscales of self-acceptance (P<0.05), positive relationships with others (P<0.05), autonomy (P<0.05), environmental mastery (P<0.05), purpose in life (P<0.05), personal growth (P<0.05), the total score of pain perception (P<0.05), the subscales of belief in the stability of pain in the present (P<0.05) and belief in the mysteriousness of pain (P<0.05). The treatment results were maintained in the second follow-up phase. In the first follow-up, the subscales of belief in the continuation of pain in the future and belief in self-blame did not differ significantly between the two groups, but in the second follow-up, the subscales of belief in the continuation of pain in the future (P<0.05) and belief in self–blame (P<0.05) differed significantly between the two groups. In addition, the average psychological well-being in the intervention group was higher than that in the control group, and the average pain perception in the intervention group was lower than that in the control group.

This study shows the ACT could be an effective intervention for improving psychological well-being and pain perception among patients with chronic neuropathic pain.

Hyponatremia is associated with adverse outcomes and increased mortality in acute stroke patients. However, the role of hyponatremia as a negative prognostic indicator has been controversial. This study was conducted to determine the relationship between serum sodium level and impairment and disability in stroke patients in Babol, northern Iran.

This cross-sectional study was conducted in 6 months on 125 stroke patients admitted to Ayatollah Rouhani Hospital in Babol. The National Institutes of Health Stroke Scale and the Modified Rankin Scale were used to determine the impairment and disability caused by stroke. Venous blood was collected to determine the serum concentrations of sodium. The normal ranges were defined as 135-145 mEq/L.

Of 125 stroke patients, 108 cases (86.4%) were ischemic stroke. Eighty-two cases (65.5%) had hyponatremia. The type of stroke showed statistically significant difference with hyponatremia in 14 hemorrhagic stroke cases (17%) versus 68 ischemic stroke cases (83%) (p=0.01). Furthermore, the difference in gender showed statistically significant difference with hyponatremia in 49 women (59%), and 33 men (41%) (p=0.02). In hyponatremic patients, the severity of impairment at admission (p=0.01) and disability at discharge time (p=0.02) was higher than patients with normal sodium serum level. In patients with a history of smoking, 9 cases (21%) had normal sodium level while 33 cases (79%) had hyponatremia (p=0.03).

The results of the present study showed that the severity of impairment and disability at the time of discharge in stroke patients is related to serum sodium level. Therefore, paying attention and correcting serum sodium level should be considered more in acute stroke patients.

Multiple sclerosis affect the normal life of the affected patients. This study aimed to compare strength, range of motion and balance in multiple sclerosis patients in the active and inactive groups.

In this cross-sectional, Ex-post facto study, 72 Mazandaran patient's whit MS and 38 healthy controls participated voluntarily in four groups: active control (n=18), inactive control (n=20), active MS (n=27) and inactive MS (n=45). The maximum strength of quadriceps, trunk extensor, range of motion of Quadriceps, Hamstrings, Gastrocnemius and Soleus muscles in both legs and balance was assessed through static and dynamic tests. All findings were analyzed by one-way ANOVA.

The results showed significant differences in maximal strength (P = 0.008), strength of the trunk extensors (P = 0.001), static balance (P = 0.006), COP Changes with open eyes (P = 0.001), and closed eyes (P = 0.001) between the groups.

Contrary to the perception of people involved in MS that physical activity does not affect their functional or physiological symptoms, the results showed that given the difference between active and inactive people, it seems that exercise in these individuals results in minimum Eating symptoms associated with the disease, especially in balance and strength. KeyWords: Balance, Center of Pressure, Multiple Sclerosis, Range of motion, Strength

Elevated CRP level is independently associated with the excessive risk of ischemic stroke. However, there is currently no consensus on the use of CRP in detecting and tracking the progression of cerebrovascular diseases. The aim of this study was to determine the relationship between CRP and outcome in stroke patients.

This was an analytical cross-sectional study. Patients admitted with diagnosis of ischemic stroke were enrolled. Demographic, and clinical characteristics, medical history, drug abuse and tobacco use and severity of stroke (National Institute of Health Stroke Scale) were completed in checklist.

Of the total 214 patients, the serum CRP levels in 122 cases (57%) were positive. The mortality during the first week of hospitalization included 17 cases (8%). The differences in CRP serum level with underlying disease such as Diabetes Mellitus (82 cases (51%) of positive CRP vs. 77 cases (49%) of negative CRP, p= 0.007) and Hypertension (59 cases (50.4%) of positive CRP vs. 58 cases (49.6%) of negative CRP, p=0.03) were statistically significant. In addition, high CRP was seen in 10 thrombotic (91%) and 4 embolic (67%) of stroke expire patients (p= 0.034). The difference in CRP serum level in mortality cases was statistically significant (14 cases (82%) of positive CRP vs. 3 cases (18%) of negative CRP, p= 0.032).

The positive CRP serum level at the admission was accompanied by more severity of disability in stroke survivor. Checking serum level of CRP in admission is suggested for predicting disability and mortality rate during the first week of post-stroke hospitalization.

Low levels of vitamin D are associated with clinical effects such as gastrointestinal disorders, cardiovascular disorders, autoimmune disorders, neuropathic diseases, cancer and metabolic syndrome. Carpal Tunnel Syndrome (CTS) is the most common cause of compression neuropathy, which has recently been linked to vitamin D deficiency in the onset or severity of symptoms. Therefore, this study was performed to evaluate the serum levels of vitamin D in patients with carpal tunnel syndrome.

This case-control study was performed on 100 patients referred to the neurology clinic of Ayatollah Rouhani Hospital with clinical symptoms of CTS for at least 3 months and 100 patients as a control group who referred to the same clinic for nerve conduction velocity test and did not show symptoms of CTS in clinical examination and electrophysiology. Patientschr('39') function, disease severity and pain were measured based on the Boston Carpal Tunnel Questionnaire (BCTQ). Serum vitamin D levels were also measured and compared between the two groups.

The mean age of patients was 43.53±10.68 years and controls were 45.48±7.12 years. The mean serum vitamin D levels in patients and controls were 19.18±11.39 ng/dL and 21.39±15.93 ng/dL, respectively. In controls, 57 women suffered from vitamin D deficiency (p<0.05). There was no significant difference between the two groups in terms of disease severity, function status, pain severity, electrophysiological defect, involved hand, dominant hand and symptoms associated with vitamin D deficiency and there was a negative correlation in vitamin D levels with disease severity, function and pain of patients.

The results showed that there was a relationship between serum vitamin D levels and gender. In addition, a negative correlation was observed between serum vitamin D levels and patientschr('39') disease severity and function and electrophysiological defects.

Multiple sclerosis (MS) is a chronic and debilitating disorder that renders degeneration of myelin within Central Nervous System (CNS). This study aimed to investigate the strength and muscle activity in two models of patients with multiple sclerosis in comparison to healthy individuals.

In this cross-sectional study, a population of women and men with diseases of MS province of Mazandaran were chosen. After informed consent 45 individuals were included in Relapsing-remitting multiple sclerosis (RR) model, 22 in Secondary progressive multiple sclerosis (SP) model, and 38 as a control group. In order to measure the maximum power of quadriceps muscles Brzycki's formula was used, while dynamometer was employed for assessing trunk muscles. Furthermore, the activities of tibialis anterior, medial gastrocnemius, peroneus longus and soleus muscles were assessed. The data were analysed using one-way analysis of variance, and for comparing intergroup differences Tuckey post-hoc test was utilized. 

There was a significant difference between healthy and MS groups (P<0.05). Moreover, the mean activity (P=0.001), maximum activity (P=0.001), co-contraction (P=0.004) and power of muscles (P=0.001) were higher in RR model than in SP model.

Disease progress pattern shows that both power and activity of muscles first increase and then decline. Thus, the RR period can be the best time for maintaining physical condition of MS patients and the initial phases of this debilitating disorder can be decisive in mitigating the future symptoms.

Cognitive-behavioral therapy (CBT) is a treatment method based on evidence that emphasis on inefficient thoughts correction and maladaptive behavioral change. The objective was to investigate the effectiveness of CBT on perception and pain intensity in patients with chronic neuropathic pain. This research of quasi-experimental was performed among 30 chronic neuropathic patients who referred to Rohani hospital of Babol (Iran) in two groups of 15 based on pretest- posttest design. The CBT was performed for the experimental group in 10 sessions, each week 1 session of 120 minutes. Participants were re-evaluated 45 days after the sessions, and pain coping strategies was evaluated according to   diverting attention, reinterpretation of pain, catastrophizing, ignore of pain, prayer-hope, self-statement, increasing pain behaviour subscales and pain self-efficacy was also evaluated. Relatively, coping strategies questionnaire (Rosenstiel and Keefe) and pain self-efficacy questionnaire (Nicholas) were used in pretest, posttest and follow up in both experimental and control groups. This study showed that there was a significant difference between the subscales of pain coping strategies in the experimental and control groups in diverting attention (P<0.001), reinterpretation of pain (P<0.001), ignore of pain (P=0.02), self-statement (P=0.04), increasing of pain behaviour (P<0.001) and self-efficacy (P=0.004), but there was not a significant difference between the subscales of pain coping strategies in catastrophizing (P>0.05) and prayer-hope (P>0.05). The present study showed the CBT could be considered as an effective intervention on pain coping strategies and pain self-efficacy in patients with chronic neuropathic pain

 The involvement of factors such as serum lipids and lipoproteins concentration has been reported as a potential risk factor for cognitive impairment. This study aimed to investigate the effect of underlying factors and serum lipid levels on cognitive impairment in the elderly.  This cross-sectional study was conducted on 1519 elderly in Amirkola City by the census method, from September 2016 to March 2017 (6 months). The data collection tools were a background information form of older adults and the mini-mental state exam. The obtained data were analyzed in SPSS version 23 using descriptive statistics and inferential statistics such as the Kolmogorov-Smirnov test, the Chi-squared test, analysis of variance (1-way ANOVA) and Tukey’s post hoc test.  According to the results, 9% (13 elderly) of the study population had severe cognitive impairment. The results of the Chi-square test did not show a significant relationship between gender and cognitive impairment (P>0.05). The significant differences were found between age, blood pressure, total cholesterol, and low-density lipoproteins variables with the categorized groups of cognitive impairments of the elderly (P≤0.05).   Screening for cognitive impairments is one of the recommendations of this study. Early diagnosis and treatment of this disease, especially in high-risk groups such as women and elderly with hypertension and disrupted serum lipid profile can play an important role in controlling the disease and reducing the care burden.

The experience of pain consists of two sensory and emotional dimensions. The sensory dimension of pain indicates pain severity and the emotional dimension indicates pain perception. Since cognitive–behavioral therapy is an evidence-based treatment and emphasizes on the correction of dysfunctional thought processes and changing the maladaptive behaviors, this study was designed to investigate the effectiveness of cognitive – behavioral group therapy on pain perception and pain severity among patients with chronic neuropathic pain. This quasi-randomized trial was performed among 30 patients with chronic neuropathy referring to Rouhani Hospital in Babol in two groups of case and control (15 patients in each group). Cognitive – behavioral group therapy was performed in ten 120-minute sessions, held once a week for the experimental group. Participants were examined before the experiment and 45 days after the sessions, and the perception of pain was evaluated by the components of belief in pain permanence, self-blame, belief in pain constancy, mysteriousness of pain, and pain severity. The attainable score in The Pain Beliefs and Perceptions Inventory was 30 to -30, and in The West Haven-Yale Multidimensional Pain Inventory was 0 to 6. The results showed that there was a statistically significant difference between the two groups in the total score of pain perception (-8.87±7.40 vs. 1.6±93.30) (p=0.001), and the subscales of belief in pain permanence (-4.13±1.76 vs. 0.93±3.30) (p=0.04), belief in pain constancy (0.80±3.16 vs. -2.13±3.50) (p=0.04), mysteriousness of pain (-2.73±3.67 vs. 1.33±3.95) (p=0.003), and pain severity (2.19±1.28 vs. 3.64±1.27) (p=0.003). The present study showed that cognitive–behavioral group therapy could be an effective intervention for reducing the pain perception and pain severity in patients with chronic neuropathic pain.

Primary angiitis of the central nervous system (PACNS) is an inflammatory vasculitis with very low frequency and prevalence. It is not clear why the inflammatory process of this disease is limited to cerebrovascular disease without systemic manifestations. A case of primary angiitis of the central nervous system with cerebrovascular manifestations is reported here. 
CASE REPORT: The patient is a 50-year-old woman with headache, nausea, vomiting, and visual symptoms without clear motor impairment. Normocytic normochromic anemias tests and function tests of kidney, liver and thyroid and serology of infectious diseases were reported to be normal. The patient underwent brain imaging, and due to multiple lesions in both cerebral hemispheres and cerebellum, she underwent biopsy with a probable diagnosis of cerebral vasculitis. After histopathologic confirmation, the patient was discharged with glucocorticoid and cyclophosphamide therapy, and the symptoms subsided after one year follow-up. Based on the results of this case report, some general and common symptoms of the primary angiitis of the central nervous system should also be considered.

Background and Cognitive impairment is one of the common chronic diseases among elderly people which has huge social and economic burdens on the society but few studies have been conducted in this topic in north of Iran. The aim of this study was to assess the association between physical activity and some demographic features with cognitive impairments in elderly people in Amirkola, Iran.
This cross-sectional study was a part of the ‘Amirkola Health and Ageing Project’ (AHAP) that was carried out in 1390 elderly in 2011-2012. To measure cognitive status, the Mini Mental Estate Examination (MMSE) was used. The Physical Activity Scale for the Elderly (PASE) was also administered to assess physical activity levels. Data was analyzed in SPSS V19 using t-test, Chi-square, Pearson correlation, and logistic regression.
A total of 1390 elderly was studied including 763 (54.9%) males and 627 (45.1%) females. In this study, 421 elderly (30.3%) had abnormal MMSE and 1085 cases (78.1%) had low physical activity score. The mean of PASE was higher in people with normal MMSE (P=0.000) and a significant positive correlation was observed between physical activity and MMSE (r= 0.117, P= 0.000). Physical activity was found to be an effective variable on cognitive impairments.
This study showed low frequency of cognitive impairments in elderly with higher levels of physical activity. This correlation was more considerable in females.

Chronic musculoskeletal pain may persist for more than three months and is often resistant to treatment. The aim of this study was to examine the relationship between chronic musculoskeletal pain and vitamin D deficiency in the elderly population of Amirkola، Iran. This cross-sectional study was part of a health survey on the elderly population of Amirkola (AHAP=Amirkola Health and Ageing Project)، including 1616 senior citizens، aged ≥ 60 years. Overall، 857 individuals without rheumatoid arthritis، cancer، depression، diabetes or osteoarthritis were enrolled in this study. Demographic data were collected and a questionnaire on chronic musculoskeletal pain was applied. The anatomical site of pain was determined by inquiring the elderly. The serum level of vitamin D was measured in two groups with and without chronic pain، using the ELISA method. Vitamin D deficiency، insufficiency and sufficiency were defined as serum vitamin D levels of < 20، 20-29. 99 and ≥30 ng/ml، respectively. Among 857 participants، 599 (69. 9%) and 258 (30. 1%) cases were male and female، respectively. Moreover، 666 participants (77. 7%) complained of chronic pain. The most common sites of pain were the knees (54%)، back (40%)، feet (35. 7%) and shoulders (27. 5%)، respectively. Also، 41. 9% of the elderly had vitamin D deficiency. However، vitamin D level was not significantly different between the two groups (with and without chronic pain)، and frequency of chronic pain did not significantly vary between these groups. Based on the logistic regression model، gender (OR=2. 73، 95%CI=1. 78-4. 21، p=0. 001)، body mass index and physical activity (OR=0. 42، 95% CI=0. 28-0. 62، p=0. 001) had significant impacts on chronic pain. The results showed no significant relationship between vitamin D level and chronic musculoskeletal pain in the elderly population of Amirkola، Iran.

Coma state constitutes at least 3% of patients referring to hospital emergency unit. Knowing the common causes of coma in each region can be effective in preventing and treating these cases. The aim of this study was to assess the causes of loss of consciousness and coma state in patients referred to Ayatollah Rouhani hospital in Babol (2011-2012). This cross-sectional study was conducted on 108 patients with complaint of loss of consciousness presenting to the hospital emergency department of Ayatollah Rouhani hospital in Babol, Iran (2011-2012). Demographic characteristics, primary diagnosis and degree of coma were recorded and then clinical signs and causes of loss of consciousness were surveyed. Of 108 studied patients, 54 patients (50 %) were women and 54(50 %) were men. The mean age of the study population was 66.81±18.52 with a median of 72 years. Most common clinical signs were hemiparesis in 12(11.1%) and urinary incontinence in 11 cases (10.2%). Regarding the history of comorbid disease, there was hypertension in 42 patients (38.9%), stroke in 38(35.2 %) and diabetes in 37(34.3 %), respectively. In final diagnosis infectious diseases in 23 cases (21.3%) was the most etiology, cerebrovascular disease in 18(16.6%), metabolic causes in 16(14.8%), seizure disorder in 12(11.1%) and intoxication in 10(9.3%) were the other common causes. The results of this study showed that infectious diseases and cerebrovascular disease and metabolic disorders were most common causes of loss of consciousness but history of systemic disorders such as hypertension and previous neurological disease especially ischemic stroke were seen in many cases.