فهرست مطالب masoud mehrpour

Stroke is one of the most debilitating diseases among adults worldwide and leads to persistent rehabilitation needs even at the chronic stage. Achieving good postural control is a critical requirement for daily activities which enhances quality of life (QoL) in patients with stroke. There is increasing evidence that transcranial direct current stimulation (tDCS) can be considered a promising adjunct technique to improve motor recovery after stroke. Evidence of augmented neuroplasticity after tDCS suggests that paired rehabilitation followed by consecutive use of tDCS may optimize recovery outcomes. Although a few randomized controlled trials have been conducted on upper limb rehabilitation in chronic stroke using tDCS, no study focused on balance training in chronic stroke patients. The present randomized, sham-controlled, double-blinded clinical study addresses brain stimulation targeting postural control using tDCS in chronic stroke.

The study participants included chronic ischemic stroke individuals with postural control impairments who passed the exclusion criteria. Active or sham anodal tDCS was delivered to the lesioned leg motor cortex combined with balance training. The experimental group received active anodal tDCS stimulation (2 mA) for 20 min, daily for 5 days paired with balance training. Linear and nonlinear approaches were used to analyze postural sway changes pre-and post-intervention. Postural sway fluctuation, functional balance assessment using the Berg balance scale, and timed up-and-go test were conducted to compare the active and sham groups. 

This trial could have significant implications for balance rehabilitation after stroke in the ambulatory setting. If effective, this novel approach may improve rehabilitation protocol in this population.

Rates of intracranial hemorrhage (ICH) after intravenous thrombolysis (IVT) differ depending on ethnicity, one reason that few Eastern countries have approved a lower dose of alteplase. Data in this regard are scarce in the Middle Eastern region.

The present retrospective study was performed on data extracted from the Safe Implementation of Treatments in Stroke (SITS) registry. Computed tomography (CT) image analysis was based on the SITS-Monitoring Study (SITS-MOST) definition for symptomatic ICH (SICH). Functional outcome at 3 months was assessed using the modified Rankin Scale (mRS). Multivariate logistic regression including adjusted analysis was used for comparison between groups.

Of 6615 patients, 1055 were enrolled. A total of 86% (n = 906) received a standard dose and 14% (n = 149) received a low dose of alteplase. Favorable 3-month outcome was achieved in 481 (53%) patients in the standard group and 71 (48%) patients in the low-dose group [adjusted odds ratio (AOR) = 1.24, 95% confidence interval (CI): 0.87-1.75, P = 0.218]. SICH occurred in 14 (1.5%) patients in the standard group and 3 (2%) patients in the low-dose group [odds ratio (OR) = 2.77, 95% CI: 0.36-21.04, P = 0.120]. At 3 months, mortality occurred in 145 (16.0%) patients in the standard group and 29 (19.4%) patients in the low-dose group (OR = 1.22, 95% CI: 0.78-1.91, P = 0.346).

Low-dose compared to standard-dose alteplase for patients with acute ischemic stroke (AIS) was not associated with fewer hemorrhagic events and there was no significant difference in the favorable 3-month outcome (mRS: 0-2) or mortality rate.

Myxoma may cause systemic embolization and frequently presents as ischemic stroke. 

There have been debates about whether it is safe to use recombinant tissue plasminogen activator (rt-PA) in patients with cardiac myxoma who referred with ischemic stroke to the hospitalchr('39')s emergency. 

The patient was a young case of atrial myxoma with initial presentation of acute cerebral infarction symptoms who was treated with intravenous rt-PA with no complications.

The case provides an evidence of the efficacy and safety of intravenous rt-PA in cases of cardiac myxoma. However, we cannot always expect thrombolytic therapy to be effective, especially in tumor emboli.

Subclinical atherosclerosis is the asymptomatic phase of carotid atherosclerosis, and its early diagnosis is important to prevent cerebrovascular diseases. Although the vitamin D plays a role in the structure of vessels, the association between the serum level of vitamin D and subclinical atherosclerosis has not been well-studied. We aimed to investigate the association between serum vitamin D level and carotid artery intima-media thickness (CIMT) in Iranian population. One hundred individuals with the age range from 20 to 50 years with no history of cardiovascular risk factors were selected for the analysis. Measurements of serum25-hydroxyvitamin D3 [25(OH) D3] concentration and CIMT were made. Confounding factors such as diabetes, hypertension (HTN), smoking, alcohol, tobacco, dyslipidemia, cardiovascular disease (CVD), high body mass index (BMI), history of drug intake especially calcium, vitamin D, statins, and anti-hypertensive drugs were considered and then excluded from our study. The mean serum vitamin D level was 15.55 ± 0.42 ng/ml, whereas in the increased intima-media thickness (IMT), it was 12.50 ± 9.50 ng/ml. 55% of the subjects were diagnosed with subclinical atherosclerosis (IMT ≥ 0.75 mm). Mean IMT was 0.74 ± 0.12 mm; however, it was higher (0.86 ± 0.30) in severe vitamin D deficiency group. The analysis showed an association between serum 25(OH) D3 level and CIMT (P = 0.002). 44% of those participants with subclinical atherosclerosis had also a severe vitamin D deficiency, while only 13% of normal people had a severe vitamin D deficiency. Also, a correlation was observed between severe vitamin D deficiency and the presence of plaque or higher IMT. Serum 25(OH) D3 level was inversely correlated with CIMT in our investigated subjects with no cardiovascular risk factor.

Knowledge of variations in the origin of vertebral artery (VA) is indispensable to vascular surgeons. Aberrant origin of vertebral artery on either side is an uncommon finding. There are unilateral and bilateral variability in VA origin.

We present a case of vertebral artery dissection who was found to have bilateral VAs aberrant origin. The right VA took origin from the right common carotid artery (CCA) which is a completely a rare finding, and the left VA originated from the arch of aorta.

Unlike most similar reported cases, the VA diameter at origin was larger on the left than on the right side. The possible embryological mechanism is discussed.

Alterations of neuroplasticity and cortical excitability are important pathophysiological factors in stroke. Modulation of the neuroplasticity has been proposed as an underlying mechanism of recovery in different neurological disorders. But it is not still clear how the CNS faces the complexity of muscle control. Neuroplastic processes may be used for the functional improvement of stroke, in particular for improving cortical functions. Neuromotor synergies is one of the most attractive hypotheses in motor control. Emerging evidence suggests that rehabilitation efforts that challenge to maximize the extent of neuroplastic changes can provide the greatest potential for rehabilitation success. A better understanding of the basic mechanisms of neuroplasticity will guide advances in neural repair and rehabilitation. Resolving the relationship of neural plasticity and individual field differences and may also have important clinical utility in developing appropriate neurorehabilitation outcomes and recovery. The objective of the present study was to review evidence of the effect of neuroplasticity on neuromotor synergies in healthy and stroke individuals on rehabilitation programs.

In the present systematic review study, we investigated the neuroplasticity interventions in stroke individuals. Articles published between January 2005 and January 2017 were reviewed. We searched for five keywords (neuroplasticity, motor learning, muscle synergy, rehabilitation, and stroke) using ProQuest, PubMed, Web of Science, and Google Scholar.

After initial screening and deleting irrelevant studies, 41 studies were chosen for the analysis. Studies were assessed and analyzed methodologically. Proper interventions were selected according to the least error criteria and outcome. Using a targeted selection approach. During the review process, eight articles were selected as the main articles for the review.

Considering the results of the current study, it seems that the neuroplasticity affects the domain of rehabilitation and muscle synergy in individuals with stroke and provides a desirable environment for plasticity-based intervention aimed at motor learning in this population. Large studies with long follow-ups are needed to explain the beneficial effects of neuroplasticity based training combined with rehabilitation protocols.

Postural stability is essential for performing everyday activities. The central nervous system (CNS) must modify balance control to provide stability to intrinsic and external perturbations. Methods considered as the main candidates for ultimate promotion of neural plasticity could be used for rehabilitation to enhance motor performance. The Transcranial Direct Current Stimulation (tDCS) as a non-invasive brain stimulation tool is applied over the cortex to accentuate and/or accelerate neural effects on network connectivity. This study aimed to address the impact of tDCS intervention on balance recovery. We postulated that tDCS induces neuroplasticity that is fundamental for refining motor behaviors such as postural stability during rehabilitation. The present review discusses the tDCS application over the important areas of the CNS that are responsible for the sensorimotor processing of balance-relevant information. We searched ProQuest, PubMed, Science Direct, Cochrane, and Google Scholar for randomized, controlled trials that assessed the efficacy of tDCS intervention in improving balance impairment following neurologic disorders and enhancing postural stability in a healthy population. Recent studies provide insights into the effects of tDCS on postural stability. Based on the defined criteria, there is a positive response to tDCS, but the underlying neural mechanisms are yet unknown. We suggest that interventions promoting more neural plasticity are crucial for better balance training outcomes and improved effectiveness of rehabilitation programs. Balance recovery after tDCS needs to be more investigated. The tDCS might be considered as an adjunct preventive strategy to provide functional recovery and reduce the adverse effects of balance impairment.

To determine whether it is possible to predict intravenous thrombolytic therapy (IVT) outcome after 3 months in acute ischemic stroke patients who are candidate to receive recombinant tissue plasminogen activator (rt-PA), before rt-PA administration based on their risk factors and some available laboratory results.

We enrolled 118 ischemic stroke patients who were treated with standard dose of Alteplase in our hospital. Baseline characteristics, door-to-needle time (DTN), onset-to-treatment time (OTT), the National Institute Health Stroke Scale (NIHSS), systolic and diastolic blood pressure on admission, history of diabetes, hypertension, dyslipidemia, coronary artery disease (CAD), previous ischemic stroke, atrial fibrillation (AF), laboratory results were retrospectively collected. The modified Rankin Scale (mRS) was recorded after 3 months of admission and patients were divided into good (mRS£ 2) and poor (mRS>2) outcome groups. Chi-square test and t-test were used for categorical and continuous variables, respectively. Predictors for outcome after 3 months were studied by multivariable logistic regression.

Good outcome was seen in 60 (51%) patients and poor outcome was seen in 58 (49%) patients. Significant predictors for outcome at 3 months according to multivariable regression analysis were NIHSS score (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.498-0.750; p<0.001), SBP (OR, 0.95; 95% CI, 0.925-0.991; P=0.01), AF (OR, 0.09; 95% CI, 0.013- 0.708; P=0.02), CAD (OR, 17.08; 95% CI, 0.013-0.708; p=0.003).

Higher NIHSS score, higher SBP on admission, AF and history of CAD could be the independent predictors of outcome after IVT in acute ischemic stroke patients.

A number of patients with symptoms of acute cerebral ischemia may have other causes called stroke mimics (SM). The prevalence of SM can be as high as 31% in some reports, and these patients are potentially at the risk of intravenous thrombolysis (IVT) therapy and its complications. This study was designed to determine the prevalence of our center ’s SM among patients who received IVT, their baseline characteristics, final diagnoses, and outcomes.

We reviewed the medical records of all patients who received IVT between June 2015 and November 2017. The following variables were collected: demographic characteristics, past medical history, onset-to-needle (OTN) time, door-to-needle (DTN) time, National Institutes of Health Stroke Scale (NIHSS) score at admission, brain imaging, and all paraclinic findings. Functional outcome at discharge based on modified Rankin Scale (mRS) was also assessed.

12 out of 165 (7.1%) patients including 8 men and 4 women were finally diagnosed with SM. The median age and NIHSS score at presentation were 60 years and 7, respectively. Final diagnoses were seizure (n = 6), hemiplegic migraine (n = 2), conversion (n = 1), and alcohol intoxication (n = 1). All patients were discharged with a mRS score of 0 and 1 without experiencing any thrombolytic adverse effects.

None of the patients with SM experienced any adverse effect of tissue plasminogen activator (tPA) including hemorrhage and all of them reached good mRS score. This shows that tPA is generally safe and the risk of treating patients with SM is very low and making a vital treatment decision may outweigh the risk of neglected cases in a time-sensitive setting.

Echogenic liposomes (ELIPs) encapsulate drugs and gas bubbles within lipid vesicles. The destruction of ELIPs in response to MHz and kHz ultrasound waves has been studied previously. Applying ultrasound above a certain threshold causes encapsulated gas bubbles destruct rapidly by fragmentation or more slowly by acoustically driven diffusion. This study compares the destruction of recombinant tissue plasminogen activator (rtPA) -loaded echogenic liposomes using three frequency protocols: 130 kHz, 1 MHz and dual (130 kHz + 1 MHz). In gel phantom, ELIPs were imaged by diagnostic ultrasound system and simultaneously destructive ultrasonic fields were applied at different intensities in each protocol. Images were analyzed. According to the results, 80% decline in MGV (mean of gray value) relative to initial MGV was associated with ELIPs fragmentation. At 130 kHz, results showed an 80% decline in MGV and fragmentation happened at all applied ultrasound intensities (0.01 W/cm2 as fragmentation threshold). In MHz and dual protocols, on average, less than 50% decline in MGV was observed which indicated an acoustically driven diffusion. Our study shows that kHz protocol fragments ELIPs more effectively than other two protocols. For better results, dual frequency protocols need optimized combination of frequencies and phases

Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) can involve multiple systems and cause stroke-like episodes and status epilepticus.
A 48-year-old female with history of early fatigability, migraine-type headaches, and bilateral sensory-neural hearing loss presented 3 episodes of serial seizures. On admission she was affected by Wernicke aphasia and, then, right hemiparesis. Investigations showed elevated arterial lactate and ragged red fibers on muscle biopsy.
Though more commonly diagnosed during childhood, some cases of adult-onset MELAS syndrome are reported. This syndrome should be considered in patients with stroke-like events in adults without cerebrovascular risk factors and difficult-to-treat seizures.

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.
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.
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.
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.

The paced auditory serial addition test (PASAT) was primarily developed to assess the effects of traumatic brain injury on cognitive functioning. Working memory (WM) is one of the most important aspects of cognitive function, and WM impairment is one of the clinically remarkable signs of aphasia. To develop the Persian version of PASAT, an initial version was used in individuals with aphasia (IWA).

In this study, 25 individuals with aphasia (29-60 years) and 85 controls (18-60 years) were included. PASAT was presented in the form of recorded 61 single-digit numbers (1 to 9). The participants repeatedly added the 2 recent digits. The psychometric properties of PASAT including convergent validity (using the digit memory span tasks), divergent validity (using results in the control group and IWA group), and face validity were investigated. Test-retest reliability was considered as well.

The relationship between the PASAT and digit memory span tests was moderate to strong in the control group (forward digit memory span test: r= 0.52, p According to our results, the PASAT is a valid and reliable test to assess working memory, particularly in IWA. It could be used as a feasible tool for clinical and research applications.

We aimed to determine the effect of lavandula angustifolia essential oil (LEO) on IL-23 and brain-derived neurotrophic factor (BDNF) gene expressions in peripheral blood mononuclear cells (PBMCs) of relapse-remitting MS (RRMS) patients.
LEO was prepared using the hydrodistilation method on the plants aerial parts. 8 female RRMS patients and 8 healthy sex and age matched controls were entered into this study. PBMC cells were separated using Ficoll method and were treated with a concentration of 225 µg/ml LEO which and then the mRNAs were used for determining the effects of LEO on IL-23 and BDNF gene expressions using Quantitative Real Time PCR technique. Moreover in order to determine the anti-inflammatory effects of LEO, we measured the gene expression of IL-6 and IL-23 in stimulated healthy PBMC cells treated with LEO.
Results showed that there is no significant difference between PBMC of patients compared to healthy controls in case of IL-23 gene expression. Moreover, LEO has no significant effect on gene expression of IL-23 in PBMC of neither patients nor control. Also the results showed that BDNF gene expression is reduced to 41% compared to healthy controls and LEO can increase the BDNF gene expression by 81% in patients PBMCs. Moreover we observed that LEO can significantly reduce the LPS stimulated IL-6 gene expression in healthy PBMCs but had no significant effect on IL-23 gene expression.
The present study demonstrated that L.angustifolia essential oil may have a protective effect against neuron damage via increasing the gene expression of BDNF in PBMCs from RRMS patients. However, further studies are necessary to confirm our results.

The aim of this study was to evaluate whether higher serum levels of insulin-like growth factor-I (IGF-I) in the acute phase of ischemic stroke are associated with less severe strokes and better functional outcome in a period of 12-month follow-up.
From October 2014 to August 2015, patients with the diagnosis of acute ischemic stroke admitted to the stroke unit of Firoozgar Hospital, Tehran, Iran, entered this prospective study. National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) for stroke scores were used to measure the severity and outcomes of an acute ischemic stroke at the time of admission and 1 year after the stroke, respectively.
A total of 60 acute ischemic stroke patients (28 male, 32 female) with the mean age of 71.1 ± 9.0 years were evaluated for the serum level of IGF-I at the time of admission to the stroke unit of Firoozgar Hospital. There was seen a significant correlation between the IGF-I serum level and the MRS scores (P = 0.020; correlation coefficient = −0.32). IGF-I serum level had no significant correlation with NIHSS scores.
These results support that the higher serum levels of IGF-I at the time of stroke is associated with a significant better outcome in a 1-year period of follow-up. However, this hormone serum level seems not to have a predictable value for the ischemic stroke severity. Further studies are required to clarify the neuroprotective mechanisms of IGF-I in ischemic stroke process.

Stroke is the second common cause of deaths and the third common cause of disability-adjusted life years worldwide in 2010, so knowledge of risk factors within a certain country is an essential step in reducing the stroke rate and resulting disease burden .
Methods & Materials: This was a case–control study to determine and assess risk factors influencing ischemic stroke. In this study, 72 stroke patients hospitalized in Firoozgar Hospital of Tehran city for ischemic stroke from June 2012 to September 2013 were considered as a case group, and 72 individuals were selected as a control group that referred to the same laboratory of the hospital due to the causes other than risk factors for cardiovascular disease. The association between various risk factors such as history of cardiovascular disease, hypertension, diabetes mellitus, migraines, and stroke has been investigated. Multivariate regression analysis was implemented to estimate the odds ratio (OR) of each risk factor for stroke events.
Findings showed that according to multivariate logistic regression, factors such as a history coronary heart disease (OR = 23.33, P = 0.002) and hypertension (OR = 6.9, P = 0.001), low high-density lipoprotein (HDL) (OR = 6.84, P Following this hospital-based study of Iranians, we demonstrated that among various risk factors, history of coronary heart disease, hypertension, as well as low HDL, and history of coronary heart disease and cerebrovascular disease in first degree relatives are the strongest independent predictors of stroke.

Post-stroke dysphagia is common and is associated with the development of pneumonia. To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with traditional dysphagia therapy (TDT) on swallowing function in patients with post-stroke dysphagia.
In this single-subject study, four patients with dysphagia post-stroke included. The patients received the rTMS applied to the intact cerebral hemisphere at 1 Hz with train of 1200 for 5 consecutive days combined with TDT 3 days per week for 6 weeks. The main outcome measure was the Mann Assessment of Swallowing Ability (MASA). Measurements were taken before, after the end of 5th, 10th, 15th treatment sessions, and after the end of the treatment (18th session).
The MASA scores improved in all patients following treatment. The maximum and minimum change in level between the baseline phase and treatment phase was and . The greatest percentage improvement was observed after 5th treatment sessions ranging between 11 and 35%. The treatment trend was upward shown by the directions of the slopes indicated by positive values (.1-.7). The dysphagia was resolved after 10th treatment session in all participants. The aspiration resolved in two participants after the 5th treatment session and resolved in another 2 participants after the 10th treatment session.
The combination therapy of rTMS plus TDT improved swallowing function in patients with post-stroke dysphagia. Further research with a larger sample size is recommended.

Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy in patients with hypothyroid. The diagnosis of CTS is usually clinical and confirmed by electrodiagnostic (EDX) procedures. This study aimed to describe the diagnostic accuracy of high-resolution ultrasonography (US) as an alternative method to nerve conduction study (NCS) for the diagnosis of subclinical CTS in patients with hypothyroidism.
Between April 2013 and November 2014, from the patients with the diagnosis of hypothyroidism referring to the institute of endocrinology and metabolism of Firoozgar Hospital, Tehran, Iran, those who met our inclusion criteria entered this cross-sectional study. The patients divided into two groups of subclinical CTS with the age- and gender-matched control group. US measurements of the median nerve cross-sectional area (CSA) in the CT inlet were compared with the NCS results as the gold standard diagnostic test.
A total number of 152 wrists of 76 hypothyroid patients were examined in this study. The mean of median nerve CSA at the tunnel inlet was 9.96 ± 2.20 mm2 for the CTS group and 7.08 ± 1.38 mm2 for the control group (P According to our findings, US has an acceptable diagnostic value to confirm CTS in hypothyroid patients. However, it may not replace NCS due to low sensitivity.

Stroke in young adults is rare but can be devastating for the affected individuals and their families. Some triggers of stroke may be acute but transient effects on the pathophysiological condition while other factors may be effective overa longer period.
Methods & Materials:This study was a case-crossover study on 18 young adults. The study included patients aged 15-49 years who hospitalized for ischemic stroke for the first time from June 2012 to September 2013. In this study, mental health status was considered during the 6-month period so that exposure within 1 month of stroke onset (hazard period) was compared with exposure during five control periods of 1 month preceding the hazard period.
Conditional logistic regression showed there was an association between mental health and stroke so that for every 5 unit increase in mental health, odds of stroke will increase about 13-fold.In the other words, much higher scores on mental health, mental health condition weaker.
Mental health status is associated with the occurrence of ischemic stroke in young adults so that whatever mental health condition weaker odds of ischemic stroke incidence is high.

To determine whether Islamic fasting would change cerebral blood flow during Ramadan. The study group comprised 20 subjects (16 males and 4 females) on a regimen of 1 month food and water intake restriction, according to Islamic fasting ritual. Subjects were evaluated for cerebral bolo flow through a middle cerebral artery (MCA) by means of transcranial Doppler (TCD), the day before starting Ramadan fasting and the day after the month of Ramadan. Our results showed no statistically significant changes after Ramadan in cerebrovascular hemodynamic, in comparison before Ramadan. Although some studies showed metabolic changes during Ramadan fasting (increasing hematocrite, decreasing amount of hemoglobin, dehydration, platelet aggregation, and lipid profile alternations) the findings suggest that Islamic fasting has no significant effects on cerebral blood flow.

Hemorrhagic Transformation (HT) of Ischemic Stroke (IS) is a detrimental complication. This study investigated the association between serum ferritin level and HT in patients with massive IS of middle cerebral artery.
Thirty patients with massive IS of middle cerebral artery were enrolled in this prospective cohort study. They were divided into two groups based on the serum ferritin level, lower or greater than 164.1ng/ml at the first 24 hours after admission. To investigate the incidence of HT in the two groups, we observed them for two weeks.
During the two- week observation, the incidence of HT was two persons (13.3%) in the group with the serum ferritin level of lower than 164.1ng/ml, and eight persons (53.3%) in the other group. This difference was statistically significant between the two groups (p=0.02). The relative risk of HT was 4 (95% CI: 1.012-15.8) in the patients with massive IS of middle cerebral artery and the serum ferritin level greater than 164.1ng/ml.
This study revealed that the serum ferritin level greater than 164.1ng/ml in the first 24 hours after admission is a reasonably important predictor for HT of IS. Conducting studies on factors affecting the serum ferritin level are suggested.

Firoozgar Comprehensive Stroke Center started up as the first organized care unit in the country in 2014; this study was performed to investigate quality indicators such as reduction in mortality, morbidity and hospital stay.
Two groups of ischemic stroke patients were compared. The first group had been admitted in general neurology ward (non-stroke unit patients) and the second one received specialized stroke care in the stroke unit within a period of two years (stroke unit patients). Non-stroke unit patients were selected from a pool of patients admitted two years before establishment of stroke unit. Variables compared were factors such as modified Rankin Scale (mRS), confinement days in stroke unit or Intensive Care Unit, total days of hospitalization, history of prior stroke, receiving recombinant tissue plasminogen activator (rtPA) and the stroke category indicating anterior or posterior circulation infarct. Quantitative testing was conducted using independent t-test as well as “Mann-Whitney U Test”; Chi-squared test was used for qualitative testing.
A total number of 129 patients enrolled in the study (66 cases of non-stroke unit patients and 63 cases of stroke unit patients). The average total days of hospitalization were 17.32 (95% CI: 0.15-36.1) in non-stroke unit patients and 21.19 (95% CI: 4.99 - 38.1) in stroke unit patients (p=0.2). Results for stroke unit patients showed a lower mRS score (OR=1.48, p=0.01).
It was concluded that stroke unit patients tend to have a better outcome and a lower mRS score at discharge. No significant difference in hospitalization period was noted between the two groups.