shahram rafie

Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) has been considered as primary therapy in ischemic stroke patients. Alteplase is prescripted as the thrombolytic therapy for more than two decades. Tenecteplase is a new type of tPA that is reported to have beneficial effects in recent years. The present research focused on the effectiveness and the side effects of tenecteplase in the ischemic stroke.

Here we administrated 0.25 mg/kg tenecteplase in 36 individuals with acute ischemic stroke in the first 4.5 hours of stroke occurrence. The NIHSS in baseline, 24 hours, 7 days after and the modified Rankin scale (mRS) at 90 days were assessed. The primary efficacy outcome was reduction of at least 4 points in the NIHSS during 7 days and the secondary efficacy outcome was defined as mRS 0 and 1 at 90 days. The safety outcome was evaluated based on the symptomatic intracranial hemorrhage (ICH) and death occurance during 90 days.

The mean NIHSS at baseline was 12.7±4.6, and the mean NIHSS corresponding to 24 hours after admission was 9.6±4.8. The mean 7-day NIHSS was 7.6±4.4. The primary and secondary efficacy outcomes were met in 18 (50%) and 22 (61.1 %) of the patients respectively. Symptomatic ICH was observed in one patient with lung cancer who died of respiratory failure.

This study confirmed the efficacy and safety of tenecteplase in thrombolysis for acute ischemic stroke treatment. Tenecteplase appears to be an appropriate therapy as thrombolytic agent against ischemic stroke.

Precise categorization of the causes of ischemic stroke (IS) is crucial for optimizing stroke treatment and assessing the prognosis of patients. This cross-sectional study aimed to determine the risk factors and various subcategories of IS in Iranian patients. The study included all patients with IS referred to Golestan Hospital (Ahvaz, Iran) for one year. Their demographics and clinical data were collected. The etiology of IS was classified based on the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. A total of 1100 patients with IS were evaluated, 658 were male and 442 were female. They had an average age of 66 years (ranging between 20 and 99 years). The majority of them were in the 61-80 age group. The prevalence of risk factors for IS included hypertension (HTN) (71.4%), diabetes (50.4%), smoking (42.4%), history of previous stroke (28%), dyslipidemia (15.4%), and cardiovascular disease (22.5%). Three months after admission, the mortality rate was 10.7% and the majority of patients exhibited a lower level of disability based on the modified Rankin Score (mRS) compared to the time of admission. The frequency of all risk factors, except for HTN, differed significantly between genders (P<0.05). Furthermore, the prevalence of risk factors varied significantly among different stroke etiologic subgroups (P<0.05). The most common etiological factors identified by TOAST classification were associated with large artery atherosclerosis (LAA) and small artery occlusion (SAO). Significant variations were observed in the prevalence of different etiologic subtypes of stroke among genders and across different age groups.

 Diabetic neuropathy pain is a common pain condition that has a major negative impact on health-related quality of life. However, despite many studies, it remains difficult to treat neuropathic pain. This study aimed to compare the efficacy of duloxetine with high tone power therapy (HTPT) in diabetic peripheral neuropathic pain.

 The study is a single-centre, phase III clinical trial comparing the effect of HTPT versus treatment with duloxetine in diagnosed diabetic neuropathy patients between October 2019 to December 2020. In the case group, the HTPT was used with a four-second duration for 30 minutes daily. This treatment was continued twice a week for 10 sessions. The control group received duloxetine (30 mg/m2 once a day). The treatment response was assessed based on the VAS score.

 The results showed that in both groups, there was a significant reduction in pain severity. In HTPT group, the average pain decreased from 7.36 to 4.6 and in duloxetine group from 7.7 to 4.8. During 8 measurements after the intervention; decrease in VAS score was higher in HTPT group (5.6) than in duloxetine group (6.5) in the first and fourth times after the intervention (P-Value=0.01). Further analysis demonstrated a positive correlation between pain severity and age so that, the pain also increases with  advancing age.

 The results of the present study showed that both duloxetine and high tone therapies are safe and effective methods for neuropathic pain relief.

Amyotrophic lateral sclerosis (ALS) is an uncommon and aggressive neurodegenerative disorder that influences the lower and upper motor neurons. There are low eligible drugs for ALS treatment; in this regard, supplemental and replacement treatments are essential. There are relative studies in the field of mesenchymal stromal cells (MSCs) therapy in ALS, but the different methods, differently used medium, and difference in follow-up periods affect the outcome treatment.

The current survey is a single-center, phase I clinical trial to evaluating the efficacy and safety of autologous bone marrow (BM)-derived MSCs through intrathecal administration in ALS patients. MNCs were isolated from BM specimens and cultured. The clinical outcome was evaluated based Revised Amyotrophic Lateral Sclerosis Functional Rating (ALSFRS-R) Scale.

Each patient received 15 ± 3 × 106 cells through subarachnoid space. No adverse events (AEs) were detected. Just one patient experienced a mild headache after injection. Following injection, no new intradural cerebrospinal pathology transplant-related was observed. None of the patients’ pathologic disruptions following transplantation were detected by magnetic resonance imaging (MRI). The additional analyses have shown the average rate of ALSFRS-R score and forced vital capacity (FVC) reduction have decreased during 10 months following MSCs transplantation versus the pretreatment period, from -5.4 ± 2.3 to -2 ± 3.08 ALSFRS-R points/period (P = 0.014) and -12.6 ± 5.22% to -4.8 ± 14.72%/period (P < 0.001), respectively.

These results have shown that autologous MSCs transplantation reduces the disease’s progression and has favorable safety.

Beta-thalassemia intermedia (BTI) is a type of hemoglobinopathy with an increased risk of cerebrovascular accidents, and transcranial cerebral Doppler ultrasonography (TCD) through determining the mean cerebral blood flow velocity (CBFV) can serve to predict the risk of a developing stroke. This study aims to compare patients with beta-thalassemia intermedia and healthy individuals in terms of the cerebral blood flow velocity.

This research was a case control study on 35 BTI patients and 25 healthy subjects. The patients were categorized into three age groups including 7-10, 11-15 and 16-20 years old. The mean CBFVs were compared between the two groups. The factors of age, gender, serum ferritin level, hemoglobin level, spleen size, thrombocytosis, and thalassemia genotypes were evaluated for their effects on CBFVs.

Mean CBFVs were significantly higher in all the intracranial arteries of BTI patients compared to normal subjects (p-value < 0.05). The hemoglobin levels showed a negative correlation between the left and right vertebral arteries of BTI patients in terms of blood flow velocity (p-value < 0.05). The mean CBFVs in the left vertebral and basilar arteries were negatively correlated to age in BTI. There was no correlation among ferritin level, thrombocytosis, splenomegaly, splenectomy, XmnI polymorphism, and cerebral blood flow velocity in the BTI patients group (p-value > 0.05).

This study showed that cerebral blood flow velocities of BTI patients were higher than normal control group. In addition, CBFVs were not affected by factors such as gender, serum ferritin, platelet count, size of spleen and XmnI genotype, however, there was negative correlation between age and hemoglobin level with CBFVs.

According to the American Heart Association and American Stroke Association (AHA/ASA) guidelines, in acute stroke, the door-to-computed tomography (CT) scan (DTC) time should be less than 25 minutes, and time to injection of recombinant tissue-type plasminogen activator (r-tPA) [door-to-needle (DTN) time] should be less than 60 minutes.

We had a tendency to prospectively collect the clinical and time information of patients who received r-tPA during one year after the initiation of prehospital notification (PN). Patients were divided into three groups, covering patients transferred by Emergency Medical Service (EMS) with and without PN, and non-EMS. We then contrasted the impact of EMS with PN and EMS use on onset-to-needle time (ONT), and the neurological outcome. Good outcome was determined as Modified Rankin Scale (MRS) ≤ 2 at 3-month follow-up.

Among 102 studied patients, 64% were transferred by EMS, of whom 53.9% entered PN. Compared with non-PN groups, EMS with PN group showed significantly shorter DTN and DTC time, as well as ONT.

Our study showed that EMS with PN, rather than EMS, significantly improved stroke outcome by shortening of ONT.

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.

Alteplase is a thrombolytic drug that is produced by recombinant DNA technology. Tissue plasminogen activator enzymewhich converts plasminogen to the active form of plasmin is also produced by the same technology; it causes fibrinolysis and clot dissolution. This study aimed to compare the efficacy and complications of Alteplase injection in patients with acute ischemicstroke (AIS(during the first 3hours and 3-4.5hours after the onset of symptoms.

In this study, patients with AIS who were referred to Golestan Hospital of Ahvaz city during 2018-2019 were selected. Information was collected by a checklist.

The results showed that the mean Modified Rankin Scale(mRS)for 3 months and 6 months (p-value: 0.91 for 3months and p-value: 0.80 for 6months) and National Institutes of Health Stroke Scale(NIHSS)(p-value: 0.21) were not significantly different between both groups; statistically, no significant relationship was observed between them. The incidence of complications after treatment was almost similar, in both groups.

Finally, it was concluded that complications and efficacy of rt-PA (Alteplase) injection were not statistically different, between the two groups under study.

Migraine is one of themost common hereditary disease, and considerable attention is always paid to trigger factors of migraine attacks and drugs effective in the prophylaxis of such complications. Recent studies are indicative of the high prevalence of migraine together with restless legs syndrome (RLS). Some hypotheses about a common dysfunction in dopamine synthesis in both diseases are proposed. However, no single mechanism to explain this concurrence and no effective drug for patients with these two diseases is found yet.

The current study aimed at investigating the effect of pramipexole, an effective agent in the relief of RLS, through a randomized, clinical trial on the frequency of migraine headache attacks during three months.

In the current study, the patients with concomitant migraine and RLS were divided into two groups. One group (case) received propranolol and pramipexole, and the other group (control) received propranolol and placebo. The two groups were questioned before and after the intervention about themigraine disability assessment score (MIDAS), frequency, and severity of migraine attacks.

According to the results, the MIDAS scores of the case group showed a greater reduction compared to that of the control group (52.67% vs. 35.74%). Moreover, the mean frequency of migraine attacks showed a greater reduction in the case group than in the control group (62.38% vs. 39.85%).

The current study results showed that pramipexole can be effective in reducing the frequency of migraine attacks and improving patients’ activities of daily living.

Movement is the main identity and the base of knowledge and practice in physical therapy; thus, the advances in motor control science, and motor learning and development are linked to physical therapy clinical activity. The purpose of this narrative review article was to describe a prominent approach in motor control with potential to better understanding and diagnosis of movement dysfunctions, the uncontrolled manifold (UCM).

In this narrative review, databases such as PubMed, Web of Science, and Google Scholar were searched from 1999 till 2017, using the key words “Synergy”, “Uncontrolled Manifold”, “Motor Control”, and “Anticipatory Synergy Adjustment”.

Finally, 37 studies were included. Most studies discussed the degree of freedom problem in human movements, history of synergy, characteristics of synergy, introducing the uncontrolled manifold approach as a tool for quantifying the synergy, and clinical applications of this method in the assessments of movement dysfunctions.

Using this method provides the ability to identify the connections between functional activities with motor synergies, synergy strength index, and the anticipatory synergy adjustments. The uncontrolled manifold offers a science-based approach to guide clinical decision making on whether synergies have to be broken, reinforced, or created new synergies in patients with movement dysfunctions.