فهرست مطالب

Neurology - Volume:16 Issue: 55, 2017
  • Volume:16 Issue: 55, 2017
  • تاریخ انتشار: 1396/03/06
  • تعداد عناوین: 11
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  • Sima Rafiei, Sina Abdollahzadeh, Fariba Hashemi, Mohammad Ranjbar Pages 55-61
    Background
    The key challenge is how to encourage and retain health professionals in their work location. There is a list of policy options for this purpose but applying an appropriate and effective set of strategies requires a country level research. Our study aimed to identify retention strategies for neurosurgeons and examine both the importance and feasibility of the identified strategies using expert panels’ point of view.
    Methods
    First of all, a literature review was conducted to identify retention strategies for physicians. Then to gain consensus on the strategies and determine their importance and feasibility an expert panel was organized and a modified Delphi process was used.
    Results
    A total of 40 strategies were identified by the panel classified in seven categories of income and economic factors, professional/job factors, clinical infrastructure, personal/family factors, living condition and welfare, educational factors and career development, governmental regulations and management policies.
    Conclusion
    Based on the study results, three areas of economic incentives, personal and professional factors got the greatest priority in health professional planning for retention purposes.
    Keywords: Retention, Strategy, Health Human Resource, Health Professional, Health Manpower, Neurosurgeon, Workplace
  • Shima Shahjouei, Reza Bavarsad-Shahripour, Farhad Assarzadegan, Reza Rikhtegar, Masoud Mehrpour, Babak Zamani, Georgios Tsivgoulis, Andrei Alexandrov, Anne Alexandrov, Ramin Zand Pages 62-71
    Background
    Stroke is among the leading causes of mortality and permanent disability in the world. Iran is located in the stroke belt and has a high age-adjusted stroke incidence rate. In this multistep prospective qualitative study, we aimed at investigating the status and challenges of stroke management in Iran and explore possible solutions.
    Methods
    In the first and second phase, we attempted to define the status of stroke management in Iran by searching the relevant literature and conducting semi-structured interviews with health-care providers in thirteen hospitals located in seven large cities in Iran. In the third phase, we tried to recommend possible solutions based on international standards and experience, as well as interviews with stroke experts in Iran and the United States.
    Results
    Little public awareness of stroke symptoms and its urgency, low prioritization for stroke management, and an inadequate number of stroke-ready hospitals are some of the major obstacles toward timely treatment of stroke in Iran. Every hospital in our pool except two hospitals had guideline-based algorithms for the administration of intravenous thrombolysis. However, there was no single call activation system for stroke alert. Data from some of the centers showed that hospital arrival of stroke patients to final decision-making took 116-160 minutes. Although there were four endovascular programs in our target areas, there was no center with 24-hour coverage.
    Conclusion
    There are many challenges as well as potentials for improvement of stroke care in Iran. Improving public knowledge of stroke and establishing an organized and comprehensive stroke program in the hospitals will improve acute stroke management in Iran. The Iranian ministry of health should define and advocate the establishment of stroke centers, track the rate of death and disability from stroke, introduce pathways to improve the quality of stroke care through national data monitoring systems, and eliminate disparities in stroke care.
    Keywords: Stroke, Thrombolytic Therapy, Tissue Plasminogen Activator, Hospital Rapid Response Team, Quality Improvement, Iran
  • Mohammad Zare, Ali Asghar Okhovat, Ahmad Esmaillzadeh, Jafar Mehvari, Mohammad Reza Najafi, Mohammad Saadatnia Pages 72-77
    Background
    The usefulness of the modified Atkins diet (mAD) in refractory epilepsy in adults has been rarely investigated. We aimed to evaluate the efficacy of mAD in adult with refractory epilepsy.
    Methods
    In a controlled randomized clinical trial, we enrolled 66 refractory adult epileptic cases from February 2010 to December 2012. The patients were randomly divided into two groups, case groups (22 patients) used antiepileptic drugs and mAD and control group (32 patients) only use antiepileptic drugs. The primary outcome was at least 50% decrement in seizure frequency after 2 months of therapy.
    Results
    No significant difference was shown in our data between groups regarding baseline characteristic. The differences of mean seizure attack after 2 months (P 50% seizure decrease at 1 and after 2 months and 12 (35.3%) had 50% decrease in seizure frequency. Furthermore, in mAD group, the mean urinary ketone positivity was 1.75 ± 0.28 and increasing liver enzyme was shown 5 cases (14.7%) in mAD group and 5 cases (15.6%) in control group (P
    Conclusion
    The mAD may be effective as a cotherapy treatment for adults with refractory epilepsy and decrease 2.19 times seizure frequency in comparison with control groups. Trials with the more tolerant dietary regime, with larger sample size and longer duration, should be performed in future.
    Keywords: Epilepsy, Drug Refractory, Modified Atkins Diet, Adult
  • Rajaragupathy Sujatha, Subramanian Kavitha Pages 78-82
    Background
    Stroke makes a significant cause of morbidity and mortality worldwide. Although derangements in the lipid profile have been suggested as a risk factor for the development of stroke, various studies show inconsistent results on the association between lipid profile and stroke. A very few studies have commented on the status of lipid indices in stroke patients.
    Methods
    After obtaining ethical medical records of the study populations were analyzed, and data collected from patients admitted to the hospital with clinically diagnosed stroke and control group consisted of apparently healthy volunteers selected from the master health checkup department. Baseline characteristics and lipid profile parameters and the number of days of hospital stay for stroke patients were collected. Lipid indices were calculated using following formulae. Atherogenic index of plasma (AIP) = log triglyceride/high-density lipoprotein cholesterol (HDLc), Castelli’s Risk Index (CRI-I) = Total cholesterol/HDLc, CRI-II = Low density lipoprotein cholesterol/HDLc, atherogenic coefficient (AC) = (Total cholesterol−HDLc)/HDLc, and non-HDLc (NHC) = Total cholesterol–HDL.
    Results
    The study included 620 participants of which 290 were stroke patients and 330 healthy volunteers. 61% of stroke patients were hypertensives and 38% were diabetics 28% were both diabetic and hypertensives. In this study, the lipid parameters and the indices were significantly higher in stroke patients than the control group. Three indices, namely, CRI-I, AC, and NHC were found to be contributing to the risk of stroke significantly. There was no statistically significant correlation between the duration of hospital stay and lipid indices or individual parameters of lipid profile.
    Conclusion
    In this study, the atherogenic lipid indices were significantly higher in stroke patients compared to controls.
    Keywords: Stroke, Lipid Profile, Atherogenic Indices
  • Omidvar Rezaei, Hossein Pakdaman, Kurosh Gharehgozli, Leila Simani, Amir Vahedian Azimi, Sina Asadi, Zahra Sahraei, Mohammadreza Hajiesmaeili Pages 83-89
    After brain injuries, concentrations of some brain markers such as S100B protein in serum and cerebrospinal fluid (CSF) are correlated with the severity and outcome of brain damage. To perform an updated review of S100B roles in human neurocritical care domain, an electronic literature search was carried among articles published in English prior to March 2017. They were retrieved from PubMed, Scopus, EMBSCO, CINAHL, ISC and the Cochrane Library using keywords including “brain”, “neurobiochemical marker”, “neurocritical care”, and “S100B protein”. The integrative review included 48 studies until March 2017. S100B protein can be considered as a marker for blood brain barrier damage. The marker has an important role in the development and recovery of normal central nervous system (CNS) after injury. In addition to extra cerebral sources of S100B, the marker is principally built in the astroglial and Schwann cells. The neurobiochemical marker, S100B, has a pathognomonic role in the diagnosis of a broad spectrum of brain damage including traumatic brain injury (TBI), brain tumor, and stroke. Moreover, a potential predicting role for the neurobiochemical marker has been presumed in the efficiency of brain damage treatment and prognosis. However further animal and human studies are required before widespread routine clinical introduction of S100 protein.
    Keywords: Biologic Marker, Surrogate Marker, Serum Marker, S100B Protein, Progressive Patient Care
  • Mahmood Moosazadeh, Ravanbakhsh Esmaeili, Mohammad Mehdi Nasehi, Ghasem Abedi, Mahdi Afshari, Fereshteh Farshidi, Motahareh Kheradmand Pages 90-95
    Background
    Familial history of multiple sclerosis (MS) has been considered as one of the etiologic factors of MS by several studies. It is valuable to combine the results of these studies. The aim of this study is to estimate the pooled prevalence of familial MS in Iran using meta-analysis.
    Methods
    Using relevant keywords, national and international databanks were searched. Considering the significant heterogeneity between the results, random effect model was utilized to estimate the pooled prevalence of familial MS using Stata software.
    Results
    After screening the selected articles, 15 studies with total sample size of 6248 (from 60 to 1718) were identified eligible for final meta-analysis. Overall prevalence of familial MS in Iran was estimated as of 11.4% [95% confidence interval (CI): 8.7-14.1]. Point prevalence varied between 3.3% and 26.7%.
    Conclusion
    Our study showed that the familial prevalence of MS among Iranian people is relatively high. More studies are warranted to investigate the effect of familial history as a risk factor for MS.
    Keywords: Familial, Multiple Sclerosis, Meta-analysis, Prevalence, Iran
  • Yara Dadalti Fragoso, Joseph Bruno Bidin Brooks, Mateus Reghin Neto Pages 96-97
  • Omid Aryani, Mohammadreza Akbari, Masoud Aghsaei-Fard, Arash Mirmohammad-Sadeghi, Samira Yadegari Pages 98-99
  • Anis Riahi, Malek Mansour, Ines Bedoui, Hajer Derbali, Mariem Messelmani, Jamel Zaouali, Ridha Mrissa Pages 100-102
  • Ali Babashahi, Morteza Taheri Pages 103-104
  • Farnaz Sinaei, Farzad Fatehi Pages 105-106