جستجوی مقالات مرتبط با کلیدواژه « Stroke » در نشریات گروه « پزشکی »

The relationship between rehabilitation and motor recovery after stroke, as well as the impact of time on recovery, remains unclear. The widely accepted theory of “critical window for recovery” suggests that the most substantial recovery occurs within 3 to 6 months post-stroke, leading to the cessation of physical therapy during the chronic stage. However, recent studies have shown that neuroplasticity and treatment responsiveness extend beyond this critical window. Patients in chronic and late chronic stages still exhibit enhanced sensitivity to therapy. Artificial intelligence (AI) plays a significant role in predicting and understanding neuroplasticity by analyzing complex data through advanced computational methods. AI algorithms identify patterns, develop predictive models, and uncover hidden relationships, shedding light on the dynamics of neuro-plastic changes. Personalized rehabilitation approaches can be optimized through AI by tailoring treatment plans based on individual characteristics. AI’s potential in predicting and understanding neuroplasticity can advance our knowledge of brain plasticity mechanisms and improve personalized treatment strategies for stroke and related conditions.

 Stroke is considered as one of the most important causes of emergency medical services (EMS) dispatch worldwide. Stroke is a time-sensitive condition and rapid transport of the patients improves the prognosis. In this study, we described prehospital emergency response times for stroke patients in Isfahan, Iran. 

 In the current cross-sectional descriptive study, suspected stroke patients who were transported by EMS in Isfahan, Iran, from June 2022 to June 2023 were included. The data was extracted from patients’ files. The time interval between the receipt of a call and the EMS arrival at the scene (arrival time), the time interval between on-scene EMS arrival and the ambulance departure to the medical center (stroke scene time), and the time it takes to reach the medical center (transport time) were collected. 

  Overall, 79 patients with a mean age of 71.56 ± 12.03 were included. EMS diagnosed 63 (79.75%) of the patients with a definite diagnosis and 14 (17.72%) with probable stroke. Two false negative results were found. The average arrival time, was 11.56 ± 6.60 minutes, on-scene stroke time was 13.85 ± 7.23 minutes and the average transport time was 11.90 ± 6.08 minutes. The mean total EMS response time was 37.90 ±11.29 minutes. 

 Overall, our study showed that while the EMS transport time is longer than ideal, the total time to transport to the hospital is short enough not to affect the outcome. EMS was also found to be adept at spotting the signs of stroke and rapidly starting the process of treatment.

Stroke is the leading cause of severe physical and cognitive disability across the globe. 

The present study sought to compare the effect of Kootker's cognitive behavioral therapy (CBT) combined with transcranial direct current stimulation (tDCS) or pharmacotherapy with citalopram on the improvement of depression symptoms and working memory of stroke patients. 

In this study, we adopted a quasi-experimental pretest-posttest control group design. The population of this study included all stroke sufferers who were referred to a neurology clinic in Zahedan in 2022. Among this population, 45 cases were selected via the available sampling method and randomly assigned to three groups (n=15). To assess depression, Beck's Depression Inventory and N-back tests were employed at pre-test, post-test, and 3-month follow-up. The first experimental group underwent CBT and 20 sessions of anodal stimulation of the dorsolateral prefrontal cortex, while the second experimental group underwent CBT and 10 mg citalopram daily. The control group did not receive any intervention. 

The results of mixed analysis of variance highlighted the short-term and long-term effectiveness of both interventions in the improvement of depression symptoms of stroke patients (P<0.05), and no difference was observed between the efficacy of the two combined interventions. Furthermore, the combined intervention of CBT and tDCS had a short-term effect on the improvement of working memory. 

As evidenced by the obtained results, it can be concluded that both combined interventions can be of great help in improving depression symptoms among stroke sufferers.

Hypertension and diabetes are two common metabolic disorders that often coexist in the same individual. Their concurrence increases the risk of cardiovascular  isease, renal dysfunction, and other complications. Cardiovascular disease is the primary cause of morbidity and mortality in individuals with diabetes, and hypertension further aggravates this condition. Interestingly, hypertensionand diabetes share several common pathophysiological mechanisms including insulin resistance, vascular inflammation, endothelial dysfunction, obesity, and oxidative stress suggesting a cross?talk between these two conditions that could potentially contribute to the development of other human diseases. Effective management of diabetes should include a multifaceted approach that addressesnot only glycemic control but also blood pressure (BP) and lipid control. Treatment plans should be individualized to each patient’s needs and should involve a combination of lifestyle modifications and medications to achieve optimal control. With the availability of newer antidiabetic medications such as SGLT inhibitors and GLP1 receptor agonists, it is crucial to consider their potential to reduce BP, enhance kidney function, and lower the risk of cardiovascular diseases when initiating treatment for glycemic control. A more profound comprehension of the shared underlying mechanisms between these conditions could pave the way for the development of innovative therapeutic approaches to tackle them. Our review offers an in?depth analysis of the literature, providing a holistic view of the mechanisms underlying diabetes?hypertension comorbidity and its implications on heart and kidney diseases. The present article concludes by discussing current approaches for managing hypertensive diabetic patients to create a set of comprehensive individualized recommendations.

Stroke is recognized as the second leading cause of death and the primary cause of disability in developing and underdeveloped countries. This study investigated the time trend of calls for suspected stroke received by the Emergency Medical Services (EMS) from 2013 to 2019 in Shiraz, Iran.

This was a descriptive - ecological study using time series data. The necessary data were extracted from the Shiraz Emergency Medical Center from 2013 to 2019. Excel 2013 and SPSS (version 24.0) were used for data analysis. The results were then presented in figures and tables.

From 2013 to 2019, the EMS call center in Shiraz City received 844,004 calls, of which 6,620 were suspected stroke cases. The number of suspected stroke cases demonstrated a steady trend within a certain range from 2013 to 2016. However, there was a significant increase between 2016 and 2017, after which the number of stroke cases reached relative stability. In the short-term seasonal trend, we found that the number of suspected stroke cases reported to EMS was higher in cold seasons compared to warm seasons.

The results showed that the long-term trend of reported suspected stroke cases to EMS is currently stable, following a previous increase in Iran.

Strokes rank among the leading causes of death and disability worldwide, with acute ischemic stroke (AIS) on the rise in Iran. Thrombolytic drugs constitute a primary treatment for ischemic stroke. However, due to limited studies in Iran, there exists hesitation among physicians regarding their administration. This study aims to assess the efficacy of these drugs on AIS patients.

In a clinical trial, 80 patients with ischemic stroke were divided into treatment and control groups. Both groups were assessed upon admission and 72 hours later using the National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (mRS) scores at discharge. The treatment group received Alteplase (0.9mg/kg), while the control group received standard care. Statistical analysis was performed using SPSS 20.

The mean NIHSS ± SD scores at admission and 72 hours later in the treatment group were 10.0±3.51 and 4.55±8.75, respectively, compared to 8.53±3.52 and 7.88±9.21 in the control group, showing a significant difference in favor of the treatment group (P < 0.001). Similarly, the mean mRS± SD score in the treatment group was 1.68±1.79, significantly lower than the control group's 3.15±1.61 (P < 0.001).

 Intravenous Alteplase administration proved effective in treating patients with ischemic stroke, significantly reducing neurological complications and disabilities compared to standard medical care.

Perception of speech in noise (SIN) is based on the accurate extraction of spectral and temporal cues. Disruption of this process can reduce the productivity of the spectral and temporal features of the target stimulus and speech recognition in noise. Auditory processing disorder is one of the main challenges of people with stroke, which leads to social, mental, and even physical failures. This study aimed to investigate the spectral and temporal processing abilities of people with stroke compared to healthy peers.

In this study, participants were 15 patients with stroke referred to the neurology clinic of Imam Khomeini Hospital and 30 healthy people aged 20–60 years. Spectral Modulation Detection Test (SMDT), Pitch Pattern Sequencing Test (PPST), Random Gap Detection Test (RGDT) and QuickSIN tests were performed for all participants. The mean scores of the two groups were compared.

Patients with stroke had poorer performance in SMDT, PPST, RGDT and QuickSIN tests (p<0.001) compared to healthy subjects. The results showed that there was a significant correlation between SIN test with temporal and spectral processing in the normal group, but the correlation pattern was different in people with stroke. The scores of all the tests were not significantly different between the right and left ears.

The results showed that people with stroke have poorer performance in all tests compared to normal people and have more problems in speech perception in challenging areas.

The month of "Ramadan" is a remarkable instance of strong influences of culture and religion in Iranian people's behaviors and habits. Studies have reported different results in the rate of incidence, hospitalizations, time pattern and risk factors affecting stroke during fasting. This study was conducted with the aim of determining the incidence and factors related to stroke in the month before, during and after fasting in Yasuj, Iran.  This retrospective cross-sectional study was conducted on stroke patients referred to Yasuj hospitals, Iran from January 2018 to December 2020 (Shaban, Ramadan and Shawwal 1443 AH). Complete medical records of 40 stroke patients with inpatient records were used. Stroke cases were separated by month, based on age, gender and other risk factors, as well as the time of incidence of stroke. Data were analyzed using SPSS v.28 software. According to the findings of this study, 23 patients (57.5%) were male and 17 patients (42.5%) were female. The number of hospitalized patients with stroke in the months of Shaban, Ramadan and Shawwal were 12, 12 and 13 respectively. No significant correlation was observed in terms of the incidence of stroke during the month of Ramadan and other two months. In addition, there was no any significant difference between different months in terms of the studied variables (stroke history, cardiovascular diseases, hypertension, hyperlipidemia, and smoking).  This study indicated that fasting in Ramadan does not increase the incidence of stroke. Proper medical advice can significantly prevent strokes during Ramadan.

Hand function impairment causes limitations in activities of daily living among stroke survivors. Dexteria app therapy is a game-based therapy with the use of a touchscreen gadget that involves various hand movements. This study evaluates the effect of Dexteria app therapy on hand function in sub-acute stroke survivors.

This study included 26 subacute stroke survivors, randomly allocated into 2 groups as follows: Group A (n=13) received conventional hand therapy while group B (n=13) received Dexteria app therapy. Both groups received 21 sixty-min therapy sessions. Gross hand function and fine manipulative hand function were assessed using the Brunnstrom hand recovery voluntary control grades and the Jebsen hand function test, respectively.

Inter-group comparison using the Wilcoxon rank sum test of the mean difference between groups A and B showed a significant difference in the Brunnstrom hand recovery voluntary control grades Z value which equaled -3.272 with P=0.001 and Jebsen hand function test Z=-3.0 and P=0.002.

Dexteria app therapy showed significant improvement in gross motor function and fine motor hand function than conventional therapy in sub-acute stroke survivors.

Effective self-management practices post-stroke have been shown to decrease mortality rates and enhance the quality of life for patients. While existing studies have explored various factors impacting self-management, further investigation is necessary to identify key determinants that influence self-management and aid in preventing recurrent strokes. This study aims to identify the factors that influence self-management among stroke survivors to prevent recurrent attacks. A cross-sectional study was conducted in April 2023 a stroke foundation in Bali, Indonesia, involving 116 post-stroke patients recruited through non-probability consecutive sampling. Data collection utilized the Stroke Self-Management Questionnaire, with analysis performed using chi-square and logistic regression methods. Gender and age did not exhibit significant associations with self-management. However, regression analysis revealed that education (P=0.002, OR=2.136), previous stroke history (P<0.001, OR=4.122), and pre-existing medical conditions (P=0.011, OR=7.151) were significantly correlated with self-management. The study highlights the significance of education level, prior stroke experience, and comorbid conditions as influential factors affecting self-management and the likelihood of recurrent stroke attacks. Understanding these determinants is crucial for designing tailored interventions and support systems to enhance self-management practices in stroke patients.

This study aimed to examine the effects of complex respiratory exercise therapy on diaphragmatic thickness and the auxiliary respiratory muscle activity of stroke patients.

The study aims to investigate the effect of complex breathing exercises on diaphragm thickness and respiratory muscle activity on the paretic and nonparetic sides of stroke patients and provide basic clinical data.

A clinical sample of 30 patients with Stroke was randomly assigned to either the Experimental Group (n=15), which underwent complex respiratory exercises, or the Control Group (n=15), which served neurodevelopmental treatment alone. The intervention comprised four 40-minute sessions per week for six weeks, followed by a post-test after the six weeks. And compare intra-group variations, a paired t-test was employed, while ANCOVA was used for inter-group variations.

Concerning intra-group changes, in the case of the experimental group, significant differences appeared in the diaphragm thickness and all muscles on the paretic and nonparetic sides (p<0.01) (p<0.001). In the case of the control group, significant increases in muscle activity appeared only in the rectus abdominis muscle and the external oblique abdominal muscle on the paretic and nonparetic sides (p<0.05) (p<0.01). Concerning differences between the groups, there were significant differences in the thickness of the diaphragm on the paretic and nonparetic sides, the muscle activity of only the sternocleidomastoid muscle on the paretic side, and the sternocleidomastoid muscle, the rectus abdominis muscle, and the external oblique abdominal muscle on the nonparetic side (p<0.05) (p<0.01) (p<0.001).

Complex breathing exercises were found to increase the thickness of the diaphragm and improve the respiratory muscles safely and effectively in stroke patients. Therefore, it is thought that complex breathing exercises can be used as an effective intervention method to improve breathing in stroke patients. Therefore, more diverse studies using complex breathing exercises are needed.

Cerebrovascular accident dramatically impacts patients’ lives. However, this chronic disease could be managed by boosting self‑care and following healthy behaviors. Accordingly, this trial sought to specify the impact of a training program established on the theory of planned behavior on the self‑care of clients with this condition.

This trial was performed on 80 clients, who were selected using a random numbers table and divided into two equal groups to receive either usual care alone or usual care plus a training program based on the theory of planned behavior (five in‑hospital individual sessions for 5 weeks and weekly phone follow‑ups for 2 months after discharge). Self‑care and the dimensions of the theory of planned behavior were investigated at baseline and 2 months after the last in‑hospital session using the standardized Shah version of the modified Barthel index and a researcher‑made questionnaire, respectively.

The mean score of self‑care was significantly higher in the experimental arm at the posttest (Mann–Whitney = 506.00, p = 0.005). Also, the increase in mean change of self‑care from baseline to posttest was significantly more in the experimental arm (t78= ‑6.6, p < 0.001). Such findings were also found for all dimensions of the theory of planned behavior.

Based on results, nurses and health policymakers can incorporate training based on the theory of planned behavior into routine care programs for patients with cerebrovascular accident to boost their self‑care. The implemented intervention also could be reproduced in other contexts. Hence, further trials are requested to specify the sustainability of the findings.

Symptoms of depression, sleep, and fatigue in stroke patients are associated with each other, and intervention development for improving of these symptoms is needed. This study aimed to examine the effects of hot red bean bag on depression, sleep state, sleep satisfaction, and fatigue among Korean stroke patients.

A quasi-experimental pretest-posttest control group design was employed. The study participants included 57 stroke patients (Intervention: n=28, Control: n=29) in a hospital in Seoul, South Korea from Aug 2017 to Mar 2018. Hot red bean bag, as an intervention, was heated in a 2,450 MHz microwave oven for 3 min, and applied for 30 min at 41±6 ℃ in the lower limbs of the intervention group for 5 days.

There were statistically significant differences on depression (P<0.001), sleep state (P<0.001), sleep satisfaction (P<0.001), and total fatigue (P<0.001) between the two groups.

Hot red bean bag was an effective intervention for decreasing depression and total/subcategories fatigue, and for improving sleep state and sleep satisfaction of Korean stroke patients. Research on complementary and alternative therapies for stroke patients needs be studied continuously.

 Cerebrovascular accident (CVA), also known as stroke, is a vascular syndrome that is the second leading cause of death in the world after ischemic heart disease. Transient ischemic attacks (TIAs) is a warning sign for CVA so that 20% of patients with TIA experience a subsequent stroke within 90 days. Hence, identification of laboratory markers is crucial for the prognosis and diagnosis of patients with CVA and TIA. Changes in some laboratory markers occur in patients with CVA and TIA. Thus, the present study aimed to evaluate hepatic and renal function tests and routine hematological markers in patients with CVA and TIA.

 The present study was a cross - sectional analytical study. The study population was patients with CVA and TIA who were hospitalized in Abadan and Khorramshahr educational hospitals from March 21, 2019, to March 19, 2020. One hundred patients with CVA and one hundred patients with TIA were randomly selected and the necessary information (age, sex, liver enzymes, renal function tests, FBS, and routing hematologic markers including CBC, ESR, PT and PTT) of the patients was collected from HIS (Hospital Information System) of Abadan and Khorramshahr educational hospitals. Liver, kidney and hematologic diagnostic markers were evaluated by age and gender. Data analysis was performed using a t -test (to compare gender difference of laboratory markers in CVA and TIA groups) and one-way ANOVA (to compare laboratory markers among age groups of patients with CVA and TIA). Simple linear regression was used to examine the relationships between changes in FBS (mg / dl) and changes in laboratory diagnostic factors.

 The results of this study showed that the highest frequency of patients with CVA (n= 130, 27.3%) and TIA (n= 49, 23.8%) was observed in the age group of 55-64 years. The results indicate that the mean level of some laboratory markers such as FBS (CVA: 174.32 ± 105.83; TIA: 150.32 ± 83.32), creatinine (CVA: 1.37 ± 1.32; 1.42 ± 1.09), LDH (CVA: 696.29 ± 344.90; TIA: 538.17 ± 230.76), and ESR (CVA: 52.41 ± 37.61; TIA: 14.00 ± 8.40) was higher than the normal range in both CVA and TIA. The mean of SGOT (34.10 ± 26.40 IU / L) and ALK (331.44 ± 370.78 IU / L) enzymes were higher than normal only in CVA patients and the mean of SGPT (33.08 ± 38.55 IU / L) was higher than normal only in TIA patients. It was also observed that in patients with CVA, with each unit increase in FBS, a significant increase occurs in K+ level (P < 0.001), WBC (P= 0.003), and RBC (P= 0.031) count, as well as a significant decrease in Na+ level (P= 0.008).

 The results of the present study showed an increase in the level of FBS, ESR and LDH both in CVA and TIA. While SGOT and ALK increased only in CVA patients, SGPT showed an increase only in TIA patients.

It has recently been suggested that acid-base imbalances may play a role in some types of cardiovascular diseases and metabolic disorders. The aim of this study is to investigate the association between dietary acid load and common non-communicable diseases (NCDs).

In this cross-sectional study, 1800 participants were enrolled in a cohort study in Shahrekord. Data were collected using a Food Frequency Questionnaire (FFQ). The potential renal acid load (PRAL) was calculated using the intestinal absorption of five nutrients including protein, potassium, phosphorus, magnesium, and calcium. The association of dietary acid load with NCDs was investigated in two models. Then, the raw model was adjusted by including calorie intake and age; after adjusting the effect of the two variables, the association between dietary acid load and the studied NCDs was not statistically significant.

The mean age of the participants was 51.49±9.27 years, and 941 (52.27%) of them were female. Mean±SD acid load score was -6.88±23.23. The results showed that there was a significant association between dietary acid load and age (P=0.005), weight (P=0.0001), waist circumference (P=0.016), hip circumference (P=0.0001), waist-to-hip ratio (P=0.01), body mass index (P=0.004), and triglyceride (P=0.012). In the raw model, a significant association was observed between dietary acid load and hypertension (OR=0.57, 0.39-0.8).

In this study, no significant association was observed between dietary acid load and NCDs, but the variable was associated with weight and body mass index as the most important risk factors for NCDs.

Although several studies have been published about COVID-19, ischemic stroke is known yet as a complicated problem for COVID-19 patients. Scientific reports have indicated that in many cases, the incidence of stroke in patients with COVID-19 leads to death. 

The obtained mathematical equation in this study can help physicians’ decision-making about treatment and identification of influential clinical factors for early diagnosis. 

In this retrospective study, data from 128 patients between March and September 2020, including their demographic information, clinical characteristics, and laboratory parameters were collected and analyzed statistically. A logistic regression model was developed to identify the significant variables in predicting stroke incidence in patients with COVID-19. 

Clinical characteristics and laboratory parameters for 128 patients (including 76 males and 52 females; with a mean age of 57.109±15.97 years) were considered as the inputs that included ventilator dependence, comorbidities, and laboratory tests, including WBC, neutrophil, lymphocyte, platelet count, C-reactive protein, blood urea nitrogen, alanine transaminase (ALT), aspartate transaminase (AST) and lactate dehydrogenase (LDH). Receiver operating characteristic–area under the curve (ROC-AUC), accuracy, sensitivity, and specificity were considered indices to determine the model capability. The accuracy of the model classification was also addressed by 93.8%. The area under the curve was 97.5% with a 95% CI.

The findings showed that ventilator dependence, cardiac ejection fraction, and LDH are associated with the occurrence of stroke and the proposed model can predict the stroke effectively.