فهرست مطالب امیررضا برومند

HTLVI infection is an endemic disease of Khorasan state in Iran. Distribution of Multiple Sclerosis (MS) is different around the world. Methods and Materials: Data of MS patients were taken of MS registries for interferon prescription in Razavi, Northern and Southern Khorasan provinces. MS was diagnosed by neurologists based on McDonald criteria. Records from clinics and hospital based researches consitituted data of distribution of patients infected with HTLV1 with or without spastic paraparesis in Razavi and Southern Khorasan provinces. Serologic tests of blood and/or CSF for HTLV1 and neuroexam by neurologists formed the methodology of HTLV1 investigation. Statistical centers of health deputy of medical universities in the Khorasan provinces provided the population data. Total Prevalence of MS in Razavi, Northern and Southern Provinces of Khorasan is 12.9, 8.7 and 5.3 cases per 100000 population respectively. Prevalence of MS in female population of Razavi, Northern and Southern provinces of Khorasan is 19.9, 11.2 and 8.3 cases per 100000 women respectively. Prevalence of MS in male population of Razavi, Northern and Southern Provinces of Khorasan is 5.9, 6.2 and 2.5 cases per 100000 men respectively. Total prevalence of HTLV1 infection in Razavi and Southern provinces of Khorasan is 2.4 and 0.5 cases per 100000 population respectively. Prevalence of HTLV1 infection in female population of Razavi and Southern provinces of Khorasan is 2.9 and 0.3 cases per 100000 women respectively. Prevalence of HTLV1 infection in male population of Razavi and Southern provinces of Khorasan is 1.9 and 0.6 cases per 100000 men respectively. Spastic paraparesis was found in 46 % and 50% of cases infected with HTLV1 in Razavi and Southern provinces of Khorasan respectively. Frequency rate of MS is less than half in Southern province compared to Razavi province of Khorasan. HTLVI infection is 10 times more frequent in female population of Razavi compared to Southern province. There is considerable difference in geographical distribution of MS and HTLV1 cases in Khorasan territory.

Progressing stroke (PS) and Crescendo Transient Ischemic Attacks (CTIA) are generally accepted, though unproven, indications for urgent anticoagulation and there remains evidence-free practice of intravenous heparin therapy in these patients. Methods and Materials: Consecutive PS and CTIA patients admitted in Mashhad Ghaem hospital during 2007- 2008, enrolled in a prospective observational study. PS and CTIA patients underwent intravenous heparin therapy 1000 units per hour for 3 days without bolus dose. PS and CTIA patients who had a contraindication of intravenous heparin therapy received 80 mg Aspirin per day. Early clinical courses including improvement, stabilization, deterioration and development of residual stroke were evaluated in two therapeutic groups of PS and CTIA patients.. 170 PS patients (103 males, 67 females) with mean age 60.4±12.3 years and 88 CTIA patients (50 males, 38 females) with mean age 60.1± 6.8 years were investigated. 141 PS and 64 CTIA patients received a short period of intravenous heparinization. The distribution of subtypes of early clinical course into two therapeutic groups of PS and CTIA patients was significantly different X2=10.487, df=2, p=0.005 and X2=6.72, df=2, p=0.035 respectively. Distribution of residual stroke in two therapeutic groups of PS and CTIA patients was not significantly different X2=1.443, df=1, p=0.23, OR=0.557 (0.212-1.462) and X2=1.01, df=1, p=0.315, OR=0.617 (0.24-1.587) respectively. PS and CTIA patients who received a short period of intravenous heparin therapy have significantly more probability of improvement and less probability of deterioration in their early clinical course.