A Spatial Variation Analysis of In-Hospital Stroke Mortality Based on Integrated Pre-Hospital and Hospital Data in Mashhad, Iran.

Background: Despite significant advances in the quality and delivery of specialized stroke care, there still persist remarkable spatial variations in emergency medical services (EMS) transport delays, stroke incidence, and its outcomes. Therefore, it is very important to investigate the possible geographical variations of in-hospital stroke mortality and to identify its associated factors.

Methods: This historical cohort study included suspected stroke cases transferred to Ghaem Hospital of Mashhad by the EMS from March 2018 to March 2019.

Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative.

Background: There is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19.

Methods: This multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation.

National Guidelines for Cognitive Assessment and Rehabilitation of Iranian Traumatic Brain Injury Patients.

Background: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran.

Methods: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME).

Clinical Trial of Subcutaneous Steroid Injection in Patients with Migraine Disorder.

Background: Neurologic literature on therapeutic effect of subcutaneous corticosteroids in patients with migrainous chronic daily headache is scarce. The aim of this research is to assess the therapeutic effects of this management in such patients.

Methods: Consecutive patients with migrainous chronic daily headache enrolled a prospective before-after therapeutic study during 2010-2013.

Gaps and hurdles deter against following stroke guidelines for thrombolytic therapy in Iran: exploring the problem.

Background: Insufficient information is available on the barriers that explain low rates of thrombolytic therapy for acute ischemic stroke (AIS) in developing countries compared with rates in developed societies. By the present study, we aimed to assess the implementation of thrombolytic therapy in the northeast of Iran to explore the gaps and hurdles against thrombolysis as the generally accepted treatment for AIS.

Methods: In a 1-year cohort study among AIS patients admitted to the second largest tertiary neurologic referral center in Iran, those who met the prespecified selection criteria were treated with intravenous recombinant tissue plasminogen activator (rtPA).

Differentiation of true transient ischemic attack versus transient ischemic attack mimics.

Background: Previous literatures have shown a transient ischemic attack (TIA) mimic rate of 9-31%. We aimed to ascertain the proportion of stroke mimics amongst suspected TIA patients.

Methods: A prospective observational study was performed in Ghaem Hospital, Mashhad, Iran during 2012-2013.

Decompressive craniectomy after unsuccessful intravenous thrombolysis of malignant cerebral infarction.

Background: Intravenous recombinant tissue plasminogen activator (rt-PA) is an approved treatment for acute ischemic stroke within 4.5 h of symptoms onset. Decompressive craniectomy (DC) has been shown as an effective therapeutic modality in malignant middle cerebral artery (MCA) infarction.

Challenging comparison of stroke scales.

Stroke scales can be classified as clinicometric scales and functional impairment, handicap scales. All studies describing stroke scales were reviewed by internet searching engines with the final search performed on January 1, 2013. The following string of keywords was entered into search engines; stroke, scale, score and disability.

Safety assessment of anticoagulation therapy in patients with hemorrhagic cerebral venous thrombosis.

Background: Anticoagulation therapy is a routine treatment in patients with hemorrhagic cerebral venous thrombosis (CVT). However, fear of hemorrhagic complications and deterioration course following anticoagulation often disturbs the responsible physician.

Methods: This was a Prospective observational study on consecutive CVT patients with hemorrhagic venous infarction or subarachnoid hemorrhage (SAH) admitted in Ghaem Hospital, Mashhad, Iran, during 2006-2012.

Design of a standard Iranian protocol of Intravenous thrombolysis with tissue plasminogen activator: A national project.

Standard protocols should be established for treating eligible stroke patients with tissue plasminogen activator (TPA) (recommendation class I, level of evidence B). The Iranian standard protocol of Intravenous Thrombolysis with recombinant Tissue Plasminogen Activator (IVTTPA) is the best possible and easy to use method for performing intravenous thrombolysis in Iran. This protocol overcomes problems and limitations of IVTTPA in Iran.

Randomized clinical trial of intravenous valproate (orifil) and dexamethasone in patients with migraine disorder.

Background: Intravenous Valproate (IVVP) has been used in the treatment of migraine in some studies; however, it is far better known in the management of status epilepticus.

Methods: Consecutive patients with migraine in our Headache Clinic were enrolled in this prospective, randomized clinical trial in 2011. The patients were randomized into two therapeutic groups, one receiving 900 mg IVVP (Orifil) and the other 16 mg IV Dexamethasone (IVDEX) diluted in 150 CC normal saline and infused for 10 minutes.

Exploring gender distribution in patients with acute stroke: A multi-national approach.

Background: Gender distribution of acute stroke patients varies considerably among stroke registries throughout the world, but factors responsible for this phenomenon remained vastly unknown.

Materials And Methods: Using data from prospective hospital-based stroke registries in China (n = 752 acute stroke patients), Germany (n = 96054), India (n = 1500), and Iran (n = 1392), this descriptive study explored gender distribution of stroke patients and its determinants. In addition, the proportions of males and females to be expected in fictive study populations were calculated, and differences in gender distribution between stroke databases throughout the world were described.

Is opium addiction a risk factor for ischemic heart disease and ischemic stroke?

Background: The main source of studies about effects of opium consumption on heart and brain attacks originates from Iran Therefore the aim of the present study was to assess opium addiction as a probable influencing factor for ischemic heart disease and ischemic stroke.

Materials And Methods: A cross-sectional study was carried out in two Cardiology and Neurology clinics in Eastern Iran in 2011. Diagnosis of Ischemic Heart Disease (IHD) and Ischemic Stroke (IS) was made by Cardiologist and Stroke Neurologist respectively.

Risk factors of short-term stroke recurrence in patients with minor ischemic cerebrovascular events.

Background: Assessing the risk of recurrent ischemic events in patients with transient ischemic attack (TIA) and minor ischemic stroke (MIS) is of a great importance in clinical practice.

Methods: Consecutive patients with TIA or MIS who were visited in Ghaem Hospital, (Mashhad, Iran) were enrolled in a prospective cohort study during 2010 to 2011. Diagnosis of TIA or MIS was accomplished by a stroke neurologist.

Comparative interrater reliability of Asian Stroke Disability Scale, modified Rankin Scale and Barthel Index in patients with brain infarction.

Background: This study tried to develop an Asian Stroke Disability Scale (ASDS) and compared its interrater reliability with modified Rankin Scale (mRS) and Barthel Index (BI).

Methods: Three items including self-care, mobility, and daily activities were selected as variables for development of the ASDS. The variables were provisionally graded on a 2- to 4-point scale based on the importance of each item.

Assessment of ABCD² scale in patients with transient ischaemic attack or stroke.

Background And Purpose: Stroke risk prediction scores have been designed to stratify risk of recurrent cerebrovascular events in patients with transient ischaemic attack (TIA) or minor ischaemic stroke (MIS).

Material And Methods: Consecutive patients with TIA or MIS referring to Ghaem Hospital, Mashhad presenting within 24 hours from the onset of symptoms were recruited to the prospective cohort study between 2010 and 2011. MIS was defined as an ischaemic stroke with National Institutes of Health Stroke Scale (NIHSS) score < 4.

Inter-rater reliability of modified Alberta Stroke program early computerized tomography score in patients with brain infarction.

Background: The Alberta Stroke Program Early Computerized Tomography Score (ASPECTS) was used to detect significant early ischemic changes on brain CT of acute stroke patients. We designed the modified ASPECTS and compared it to the above system based on the inter-rater reliability.

Methods: A cross-sectional validation study was conducted based on the inter-rater reliability.

The ABCD(2) Score is Highly Predictive of Stroke in Minor Ischemic Stroke Patients.

Stroke risk prediction scores have been designed to stratify risk of recurrent cerebrovascular events in transient ischemic attack (TIA) and minor ischemic stroke (MIS) patients. Consecutive TIA or MIS patients referred to Ghaem Hospital, Mashhad were enrolled in a prospective cohort study during 2010-2011. Only TIA or MIS patients presenting within 24 h from the onset of symptoms were recruited.

Development and validation of the Asian Migraine Criteria (AMC).

Physicians often do not use the International Classification of Headache Disorders (ICHD-II) for diagnosis of migraine in their routine clinical practice. The diagnosis of headache subtypes in 453 patients was made by headache experts according to the ICHD-II and the likelihood ratios (LR) of clinical characteristics of migraine were calculated in Part I of the study. Asian headache specialists designed the Asian Migraine Criteria (AMC) based on these LR and their experience.

Interesting basis of vertebrobasilar arterial territory.

Background: Vertebrobasilar arterial territory nourishes one-quarter of human brain. It constitutes some vital and strategic parts of the central nervous system.

Methods: A number of keywords (vertebral, basilar, artery, and territory) were searched in MEDLINE (Ovid and PubMed) as well as Google, ProQuest, Scopus, Cochrane Library, and Science Direct online databases.

Results of surgical and nonsurgical treatment of aneurysms in a developing country.

Background. The impact of invasive methods of treatment on results in developing countries may differ from that in developed countries. Methods.

Barriers of thrombolysis therapy in developing countries.

The developing world carries the highest burden of stroke mortality and stroke-related disability. The number of stroke patients receiving r-tPA in the developing world is extremely low. Prehospital delay, financial constraints, and lack of infrastructure are main barriers of thrombolysis therapy in developing countries.

Results of surgical and non-surgical treatment of aneurysms in iran.

Background: Direct surgery or endovascular procedures are an accepted way of treating patients with Aneurismal Subarachnoid Haemorrhage (SAH). However the impact of invasive methods of treatment on results in developing countries may differ from that in developed countries.

Methods: This is a prospective clinical study of consecutive patients with Subarachnoid Haemorrhage (SAH) admitted in Ghaem hospital in Mashhad during 2005-2010.

Clinical evaluation of patients with spinal cord infarction in mashhad, iran.

Background. Spinal Cord Infarction (SCI) is a rare and disabling disease. This hospital-based study was conducted for clinical evaluation of SCI patients in east of Iran.