فهرست مطالب

  • Volume:7 Issue: 3, 2020
  • تاریخ انتشار: 1399/05/22
  • تعداد عناوین: 12
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  • Zahid Hussain Khan, Mohammed AbdulZahra Sasaa, Mostafa Mohammadi *, Abbas Alipour, Asghar Hajipour Page 2
    Context

    Mortality related to intubation occurs as a result of multiple factors such as patient's condition, operator's skills, equipment use, intubation time, duration of laryngoscopy and intubation, and drugs and dosage used for endotracheal intubation (ETI).

    Objectives

    This systematic review and meta-analysis aimed to determine mortality related to intubation and the overall intensive care unit (ICU) mortality rate in adult general ICUs.

    Methods

    We performed a systematic review and meta-analysis on randomized clinical trials and cohort and cross-sectional research from three electronic databases with hand searching. The studies reported mortality related to intubation and the overall ICU mortality rate in adult general ICUs. Our search resulted in 28 published articles without any restriction on date and language. The systematic review and meta-analysis was performed to examine mortality related to intubation and the overall ICU mortality rate.

    Results

    We found 7,866 articles in the literature review from the three databases based on our keywords, of which 28 studies were eligible to include in the study. We observed that mortality related to intubation and the overall ICU mortality rate in intubated patients were 1% and 30%, respectively.

    Conclusions

    This was the first comprehensive systematic review on mortality related to intubation and the overall ICU mortality rate in adult general ICUs, which showed the current care of ETI. However, it was associated with increased complications, which may increase mortality.

    Keywords: Meta-Analysis, Intensive Care Units, Systematic Review, Endotracheal Intubation, Mortality Rate, Overall ICU Mortality
  • Seyed Vahid Mousavi, Elmira Agah, Abbas Tafakhori * Page 3
    Context

    Osteopontin (OPN) is a matrix phosphoprotein expressed by a variety of tissues and cells, including the immune system and the nervous system. Previous studies have shown that OPN may have a role in neurodegenerative diseases, including multiple sclerosis, Parkinson’s disease, and Alzheimer’s disease.

    Objectives

    The present study aimed to systematically review studies investigating the role of OPN in amyotrophic lateral sclerosis (ALS) patients or the disease animal model.
    Evidence Acquisition: We searched the Cochrane Library, PubMed, Web of Science, and Scopus to find relevant articles published up to January 20, 2019. Both human and animal model studies of ALS were considered.

    Results

    A total of nine articles (four human studies and five animal model studies) were included. Two of the human studies reported that the CSF levels of OPN were higher among ALS patients compared to controls. The other two human studies found that OPN levels in cortical neurons did not differ significantly between ALS cases and the non-neurological control group. One of the studies found that the expression level of OPN in astrocytes was similar between ALS patients and the control group, but the level of microglial OPN significantly increased in ALS cases. Four of the animal model studies reported that the expression of OPN mRNA in spinal cord microglia significantly increased during the disease progression. The remaining animal model study found that OPN was selectively expressed by fast fatigue-resistant and slow motor neurons (MNs), which are resistant to ALS, and that the OPN expression was low among fast-fatigable MNs.

    Conclusions

    Prompt microglial activation is a hallmark pathology of ALS, and OPN is among the most widely expressed proteins by these activated glial cells. Therefore, OPN might have a role in ALS pathogenesis. The existing evidence is not sufficient to justify whether OPN has a neurotoxic or neuroprotective role in ALS. We encourage researchers to investigate the role of OPN in ALS pathogenesis more extensively.

    Keywords: Systematic Review, Osteopontin, Amyotrophic Lateral Sclerosis, SPP1
  • Hossein Yousefi Banaem, Reza Goharani, Mohammadreza Hajiesmaeili, Arash Tafrishinejad, Masoud Zangi, Mahdi Amirdosara, Masoud Nashibi * Page 4
    Context

     Bispectral Index (BIS) was introduced in 1960 to monitor the depth of anesthesia in the operating rooms. It has been recently used to monitor the sedation in the critically ill patients hospitalized in intensive care and neurocritical care units (NCCU).

    Evidence Acquisition

     Patients in the NCCU, particularly those with prolonged mechanical ventilation require appropriate adjustments in the administration of sedative drugs. Similarly, those who require neuro protection with barbiturates need to be closely monitored in the depth of their coma.

    Results

    BIS may be a useful tool in this situation, and it can also help shorten the duration of mechanical ventilation by determining the appropriate time to eliminate patients from mechanical ventilation. We conducted a literature search to evaluate the utility of BIS monitoring in the NCCU patients with subarachnoid hemorrhage, intracranial hemorrhage, coma, cerebral hypoxia, status epilepticus and traumatic brain injury.

    Conclusions

    BIS monitoring may be a useful adjunct to take care of the patients. However, further studies with a larger population and better design are required to substantiate the role of BIS monitoring in the care of NCCU patients.

    Keywords: Monitoring, Bispectral Index, Neurocritical Care
  • Mansoureh Togha *, Reza Rahmanzadeh, Shiva Nematgorgani, Zahra Yari, Soodeh Razeghi Jahromi, Farshid Refaeian Page 5
    Background

    B-group vitamins can potentially contribute to migraine prophylaxis through various mechanisms. We conducted a quasi-experimental study to assess the efficacy and tolerability of a combination of vitamins B1, B6, and B12 (Neurobion) for prophylaxis of menstruation-related migraine attacks.

    Methods

    Women diagnosed with menstrual-related migraine, both chronic and episodic headaches, were enrolled. The patients began Neurobion therapy one week before the menstruation cycle, and repeated the injection for three consecutive months; each ampoule contained 100 mg of vitamins B1 and B6 as well as 1000 μg of vitamin B12. Neurobion was used as an add-on therapy for patients receiving the same prophylactic therapy during the last two months before the start of the study. The outcome parameter examined the severity of menstrual-related migraine attacks on a 10-point visual analog scale (VAS).

    Results

    Three hundred eighty-three patients (169 with chronic migraine and 214 with episodic migraine) were included in the final analysis. The patients received treatment with a combination of vitamins B1, B6, and B12 with positive results. The mean intensity of menstrual-related migraine attacks was reduced from 6.7 on the 10-point VAS to 3.2 (P < 0.001) in patients with chronic migraine. The mean severity of menstrual-related migraine attacks was also reduced from 7.2 to 3.7 in patients with episodic migraine (P < 0.001). There was no significant difference in the reduction of headache severity between the two groups of migraineurs (P = 0.985).

    Conclusions

    Neurotropic vitamins, including pyridoxine, thiamine, and cyanocobalamin yielded significant reductions in the severity of menstrual-related migraine attacks. Neurobion as a combination of vitamins B1, B6, and B12 appears to be well-tolerated and beneficial as an adjuvant in treatment and prophylaxis of menstrual-related migraine attacks. Further large-scale trials with long-term follow-up will be required to confirm our results.

    Keywords: Headache, Migraine, Vitamin B12, Prophylaxis, Vitamin B6, Neurobion, Neurotropic Group B, Vitamins Vitamin B1
  • Ahmed Nasreldein *, Ghaydaa Ahmed Shehata, Lobna Abdel Wahid Ahmed, Mohamed Fathy Mahmoud, Khaled Osama Mohamed Page 6
    Background

    Diabetes is an important risk factor of extra and intracranial stenosis and hence can cause cerebrovascular stroke. In Egypt, prevalence of asymptomatic extra and intracranial blood vessels stenosis in diabetic patients is still unknown.

    Objectives

    To estimate the prevalence of asymptomatic extra and intracranial vessels stenosis.

    Methods

    100 Patients with Type-2 Diabetes (T2D) were recruited consecutively from diabetes clinic of the department of internal medicine at Assiut University Hospitals in the period from 1st January 2016 to 31st January 2017. A detailed history was obtained for all participant. As well, thorough-out physical and neurologic examination were carried out for patients. All patients underwent extra cranial and transcranial colour coded ultrasound by two independent investigators. Patients with history of cerebrovascular stroke and transient ischemic attacks were excluded.

    Results

    36% of patients had increased IMT, 6% had stenosis 50-69% and 2% had stenosis ≥ 70%. There was a positive correlation between age and increased IMT (r = 0.272) (P = 0.006) and between uncontrolled DM and increased IMT (r = 0.211) (P = 0.035). 26% of patients had stenosis of < 50% in vertebral artery (21% in V0 segment, 5% in V1 segment); being male and uncontrolled diabetes escalate the stenosis risk. MCA pulsatility index was found to be higher among old diabetics in comparison to younger diabetics and control group (r = -0.225) (P = -0.025). Also, the longer the time since T2D onset, the higher was MCA PSV (r = 0.244) (P = 0.014).

    Conclusions

    The cerebral blood vessels atherosclerotic changes (mainly extracranial) are higher among diabetics in comparison to healthy controls.

    Keywords: Atherosclerosis, Intracranial, Type 2 DM, Duplex, Egyptian, Extracranial, Vessels
  • Abderrahmane Achbani*, Sofiane Ait Wahmane, Mohamed Elatiqi, Hasnaa Sine, Ahmed Kharbach, Ahmed Belmouden, Mohamed Nejmeddine Page 7
    Background

    Parkinson’s disease is the second most frequently reported neurodegenerative disease, behind Alzheimer’s disease. In Morocco, enough information are not available about its prevalence, progression, and characteristics, particularly in Southern regions of the country.

    Objectives

    The current study aimed to investigate gender and age differences in the sociodemographic and clinical profile of Parkinson’s disease patients in southern Morocco.

    Methods

    A cross-sectional descriptive study was conducted on a selected cohort of 180 patients, previously diagnosed with Parkinson’s.

    Results

    The results showed that the onset of the disease was earlier in females compared to males. Besides, we found that the prevalence of rigidity symptoms was slightly higher in younger patients and in patients aged 61 to 70 years old, at the onset of the disease. Importantly, the results showed that the initial symptoms of males were different than females. According to the Hoehn and Yahr scale, the majority (82.6%) of patients of both genders were in the early stage of the disease. Additional statistical analyses, confirmed that the severity of the disease was strongly related to gender (P = 0.02).

    Conclusions

    The findings confirmed that males and females had different clinical motor characteristics in the initial symptoms and progression of Parkinson’s disease. Nevertheless, experimental studies should be conducted to arrive at a real understanding of what underlies these differences.

    Keywords: Age, Gender, Parkinson’s Disease, Difference, Clinical Profile, Hoehn Yahr Scales
  • Ebrahim Behzad, Mojdeh Ghabaee, MohammadReza Bigdeli, Farshid Noorbakhsh, Ali Gorji, Mahmoudreza Hadjighassem * Page 8
    Background

    Spreading depolarization is associated with the extension of lesion size and complications in some important neurological diseases such as stroke, epilepsy, migraine, and traumatic brain injury.

    Objectives

    This study aimed to reveal some molecular aspects of spreading depolarization and suggesting new therapeutic targets for its control by changing the function of different astrocytic and neuronal ion channels.

    Methods

    The effects of nortriptyline on spreading depolarization in cortical and hippocampal tissues and on the electrophysiological properties of CA1 hippocampal pyramidal neurons were assessed by extra- and intracellular recording, following washing rat brain slices by the drug.

    Results

    Nortriptyline made a significant increase in the amplitude of spreading depolarization in cortical and hippocampal tissues relative to control but did not change the duration significantly in each of the tissues. No significant difference was found in the effects of spreading depolarization on the electrophysiological properties of the CA1 pyramidal neurons between nortriptyline and control groups.

    Conclusions

    The stimulating effect of nortriptyline on spreading depolarization is probably related to the augmentation of extracellular potassium collection in the cortex and hippocampus due to inhibition of astrocytic potassium scavenging function. This change can make more neurons prone to depolarization and increase the overall amplitude of spreading depolarization waves. Further studies should assess the effect of enhancing the clearance function of astrocyte-specific inwardly rectifying potassium channels, Kir4.1, or preventing other factors contributing to spreading depolarization on control of the process.

    Keywords: Epilepsy, Migraine, Stroke, Traumatic Brain Injury, Nortriptyline, Spreading Depolarization, Kir4.1 Channels
  • Peyman Saberian, Mostafa Sadeghi, Parisa Hasani Sharamin, Fatemeh Dadashi, Yasamin Mohammad Esmaeil, Elnaz Vahidi * Page 9
    Background

    One of the most frequent complaints that emergency medical services (EMS) deal with is seizure. The missions of EMS on these cases may lead to transferring the patient to the emergency department (ED).

    Objectives

    Therefore, the present study was conducted to compare the short-term outcome of transported versus not-transported cases.

    Methods

    Our population sample was selected retrospectively from medical records in Tehran EMS center for 6 months in which the plan was transferring to a specific hospital. The cases were divided into transported or not-transported. W extracted and compared the cases’ demographic data, vital signs, conducted prehospital management, patient disposition, Outcome Seizure Patient Transfer Emergency Medical Services and their short-term outcome.

    Results

    We evaluated 486 cases, 173 of whom were males (35.6%) and the mean age of patients was 34.8 ± 32.0 years old. 329 (67.7%) and 157 (32.3%) were in the not-transported and the transported group, respectively. Among all not-transported cases, we could follow 172 patients, 52 of whom had gone to hospital during the next 72 hours. 22 out of the 52 cases were discharged from ED the same day. Overall, the ED discharge rate was significantly more in the transported group (P < 0.001). Short-term mortality had no significant difference in the two study groups (P = 1.00).

    Conclusions

    Most of the not-transported patients did not go to the hospital during further 72 hours, and some were hospitalized. Most of the patients transported to the hospital were discharged from the ED. The short-term mortality rate was not different.

    Keywords: Outcome, Seizure, Patient Transfer, Emergency Medical Services
  • Hanan Helmy, Rasha M. Elrewainy, Youssef Elbalawy, Asmaa Sabbah * Page 10
    Background

    Motor imagery training is a cognitive process in which an internal representation of a movement is activated in working memory. The movement is mentally rehearsed, without any physical activity. Task-specific training emphasizes the repetitive practice of skilled movement to enhance functional abilities in hemiparesis.

    Objectives

    To investigate whether task specific training preceded by motor imagery or task specific training alone was more effective for facilitating sit to stand in patients with stroke.

    Methods

    Thirty male patients with stroke were selected from the Cairo University Outpatient Clinic; the median age of participants was 54.5 ± 3.51 years and they were divided equally into two groups. Patients in study group A (n = 15) received motor imagery training for 15 minutes followed by task specific training for 45 minutes, as well as a selected physical therapy program 3 times per week for 6 weeks. The control group B (n = 15) received task specific training for 45 minutes, as well as a selected physical therapy program 3 times per week for 6 weeks. The Fugl-Meyer section of the lower extremity (FMA-LE), Timed up and go test (TUG), and Biodex Balance system were assessed before and after treatment.

    Results

    The results were highly significant for all variables including FMA-LE, TUG and Biodex Balance system in favor of the study group, post treatment. (P = 0.0004, P = 0.0001 and P = 0.0001, respectively).

    Conclusions

    Motor imagery training results in greater improvement in sit to stand ability when used in conjunction with task specific training, rather than task specific training alone.

    Keywords: Stroke, Hemiparesis, Sit to Stand, Motor Imagery, Task Specific Training
  • Fardin Yousefshahi, Juan Francisco Asenjo, Hossein Majedi * Page 11
    Introduction

    Ultrasound-guided nerve blocks have enhanced our abilities to selectively and effectively suppress certain nerves to accomplish specific goals, including blockade a localized seizure muscle movement without affecting the seizure threshold or level of the consciousness.

    Case Presentation

    This is a case report of the blockade of the movement of a chewing muscle by the continuous (catheter-based) mandibular nerve block in a 27 years old man with high-frequency partial seizures in facial muscles who was a candidate for seizure focus ablation. An out-of-plane approach was used to insert a catheter near the mandibular nerve to provide intermittent or continuous peripheral nerve block. This report demonstrated that a continuous block of the mandibular nerve could effectively facilitate the seizure focus mapping and ablation.

    Conclusions

    We can selectively suppress the contractures of a certain muscle in partial seizures by a continuous block of the responsible nerve. This blockade can facilitate seizure focus mapping and ablation.

    Keywords: Epilepsy, Seizures, Nerve Block, Mandibular Nerve, Trigeminal Nerve, Mastication
  • Mahbobeh Sajadi, Fahimeh Davodabady *, Mohsen Ebrahimi Monfared Page 12
    Background

    Fatigue, sleep disorders, and anxiety are common symptoms in multiple sclerosis (MS) patients. MS reduced the quality of life by these symptoms in patients. Studies have shown that foot reflexology may reduce some problems of this disease.

    Objectives

    The present randomized controlled trial study investigated the effect of reflexology on fatigue, sleep quality, and anxiety in patients with multiple sclerosis.

    Methods

    This study included 63 patients with MS referred to Arak MS society in 2018 - 2019. Reflexology and placebo intervention had applied twice a week for 4 weeks, and each session lasted about 30 - 40 minutes. Fatigue Impact scale (FIS), Pittsburgh sleep quality index (PSQI) and state-trait anxiety inventory (STAI) was used for data collection before and after the intervention. A significant statistical level was considered 0.05. Data were analyzed using the SPSS software (V. 16.0).

    Results

    Significant improvement was observed in physical fatigue (P = 0.042), sleep quality (P = 0.001) and anxiety (P = 0.034) in the reflexology group after the intervention. Fatigue Impact Scale (FIS) revealed a decrease in fatigue level in MS patients, but these alterations were not significant (P = 0.134).

    Conclusions

    Reflexology is a non-invasive, simple, affordable, and low-cost nursing intervention that can be helpful in reducing physical fatigue, anxiety, and improving sleep quality of people with MS.

    Keywords: Anxiety, Multiple Sclerosis, Sleep Quality, Fatigue, Reflexology