No abstract

Aims: Our main target was to investigate the relationship of blood pressure (BP) unawareness and poor antihypertensive drug adherence with the clinical outcomes of the stroke including hospitalization time, degree of disability, and mortality rate. Methods and results:In this cross-sectional study, we evaluated 530 eligible patients (male ¼ 313; female ¼ 217), aged 18 years and older who had a proven diagnosis of nontraumatic first-ever stroke and were referred to the Shahid Beheshti Hospital of Hamadan, Iran, during the period from March 2019 to September 2021. The prevalence of BP unawareness was 19.6%, and 31.8% of antihypertensive drug users (14.3% of all studied population) had poor drug adherence, in which, older age, male gender, marriage, rural residence, and smoking were associated with the lack of appropriate drug adherence. There was no significant difference between patients with diverse stroke types (ischemic or hemorrhagic) from the points of BP awareness and adherence to antihypertensive drugs; nevertheless, patients with a positive history of cardiac diseases had a significantly higher awareness of their BP status (P ¼ 0.037). BP unawareness was associated with poor clinical prognosis, and could significantly increase stroke mortality (P ¼ 0.001) and disability (P < 0.001) rates as well as the duration of hospitalization (P < 0.001). Moreover, those who survived the stroke (modified Rankin Scale < 6) had the highest odds to be aware of their BP status (adjusted odds ratio [AOR] ¼ 2.380 [95% confidence interval [CI] ¼ 1.39-4.07]). Additionally, nonsmokers (AOR ¼ 7.740), urban residents (AOR ¼ 3.314), and literate patients (AOR ¼ 2.092) had the highest odds of having appropriate drug adherence. Conclusion:Stroke mortality and morbidity rates can be significantly modified by persuading people to monitor their BP regularly and maximize antihypertensive medication adherence. In the meantime, increasing the literacy level in society and reducing the smoking rate can play important roles in achieving these goals.

Introduction: During the COVID-19 pandemic, various complications have been reported in patients with this infection worldwide, including a wide range of neurological disorders. In this study, we have reported a novel neurological complication in a 46-years-old woman who was referred due to a headache following a mild COVID-19 infection. Also, we have had a quick review of previous reports of dural and leptomeningeal involvements in COVID-19 patients. Case Report: The patient's headache was persistent, global, and compressive with radiation to the eyes. The severity of the headache was increased during the disease course and was exacerbated by walking, coughing, and sneezing but decreased with rest. The high severity of the headache disrupted the patient’s sleep. Neurological examinations were completely normal, and laboratory tests did not have abnormal findings except for an inflammatory pattern. Finally, in the brain MRI, a concurrent diffuse dural enhancement and leptomeningeal involvement were observed, which is a new finding in COVID-19 patients and has not been reported so far. The patient was hospitalized and treated with Methylprednisolone pulses. After completing the therapeutic course, she was discharged from the hospital in good condition and with an improved headache. A repeated brain MRI was requested 2 months after discharge, which was completely normal and showed no evidence of dural and leptomeningeal involvements. Conclusion: Inflammatory complications of the central nervous system caused by COVID-19 can occur in different forms and types, and clinicians should consider them.

Background: The thyroid gland plays an important role in regulating the body's metabolism. On the other hand, primary hyperthyroidism is one of the most common disorders of the endocrine system. Therefore, we aimed to investigate the differences between outcomes of drug therapy with Methimazole & Propylthiouracil (PTU), radioactive Iodine therapy, and surgical procedures as the three most common therapeutic options for primary hyperthyroidism- in patients with Graves' disease, toxic thyroid adenoma, and Toxic Multi Nodular Goiter (TMNG). Methods: This observational study was performed prospectively, and after applying the exclusion criteria, 316 patients with a definite diagnosis of TNMG, toxic adenoma, or Graves' disease, remained in the study. For each patient, one of the therapeutic methods of administration of anti-thyroid drugs, the use of radioactive Iodine, or the use of thyroid surgery was chosen and applied, and during the study period, all patients were followed and evaluated. Results: In this study, 316 patients with primary hyperthyroidism were evaluated, of which 238 (75.31%) patients had Graves' disease, 23 (7.27%) patients had toxic adenoma, and 55 (17.40%) patients had TNMG. The symptoms of thyrotoxicosis syndrome were more common in Graves' disease than in other groups. In this study, 63.82% of drug takers, 20.90% of radioactive Iodine receivers, and 5.26% of patients who had gone under surgery became euthyroid. In addition, 83.27% of drug consumers did not have any side effects. Most patients receiving radioactive Iodine and surgical procedures developed hypothyroidism after treatment, while only 1.70% of those taking anti-thyroid drugs developed this complication. Nevertheless, the failure rate in the drug therapy was highest among all three methods by a percentage of 34.47%. Conclusion: This study suggests a prominent role of drug therapy in the treatment of patients with Graves' disease and TMNG, and in contrast, reduces the role of radioactive Iodine in the treatment of these diseases. However, it is difficult to comment on the treatment of toxic thyroid adenoma based on the findings of this study.