Rheumatic heart disease (RHD) is the leading cause of heart disease worldwide, accounting for 90% of all heart disorders in women of childbearing age, and also accounts for 10% to 15% of maternal mortality.

BACKGROUND: Helicobacter pylori (H. pylori) infection has been associated with atherosclerosis of coronary arteries but there is lack of data regarding possible association between chronic H. Pylori infection and cerebral noncardioembolic ischemia. We evaluated H. pylori serum antibody titers in patients with cerebral non-cardioembolic ischemic stroke.METHODS: This was a cross-sectional study carried out in Alzahra hospital, Isfahan, Iran. 96 patients with ischemic stroke were enrolled in this study. Control group were selected from healthy blood donors. IgG and IgA antibodies to H. pylori were detected using a rapid enzyme linked immunosorbent assay. Quantitative variables and categorical variables were compared using t student and chi-square tests.RESULTS: There were 21 cases of hypertension and 5 cases of diabetes mellitus among patients. Patients and controls were similar regarding serum IgA and IgG titers as well as positivity. There were 13 and 15 cases of positive IgA and 44 and 39 cases of positive IgG among patients and controls, respectively. Also, there were 7 and 9 cases of both positive IgA and IgG in patients and controls, respectively. No differences were found between the two groups in IgA or IgG titers or positivity (p>0.05).CONCLUSIONS: Patients with stroke were not different regarding either H. Pylori IgA or IgG positivity or the antibody titers. Comparing genetic typing of H. pylori in patients with or without stroke and diagnosis of H. pylori with more specific and sensitive tests such as stool antigen test are recommended.

Background:  , Some studies showed the cerebrovascular manifestation in patients with recently pandemic coronavirus 2 named the coronavirus disease 2019 , (COVID‑, 19). However, there are rare reports about stroke subtypes in these patients. Here, we reported the stroke subtype in patients with laboratory‑, confirmed diagnosis of COVID‑, 19 and treated at our hospitals, which are located in Isfahan, Iran. Materials and Methods: This is a retrospective, observational case series. Data were collected from March 01, 2020, to May 20, 2020, at three designated special care centers for COVID‑, 19 of Isfahan University of Medical Sciences. The study included 1188 consecutive hospitalized patients with laboratory‑, confirmed diagnosis of COVID‑, 19. Results: Of 1188 COVID‑, 19 , patients, 7 , (0. 5%) patients developed stroke. Five (0. 4%) had ischemic arterial stroke, 1 (0. 08%) hemorrhagic stroke and 1(0. 08 %) cerebral venous and sinus thrombosis.  , Sixty percent of ischemic stroke were cardioembolic stroke , (CE) and the rest 2 , (40%) were embolic stroke of undetermined source. Three male patients , (40%) had stroke as a presenting and admitted symptom of COVID‑, 19. Four patients , (57%) had severe COVID‑, 19. Conclusion: Stroke was an uncommon manifestation in COVID‑, 19 , patients. CE was a common subtype of stroke in COVID‑, 19 , patients in our centers.

Background: Cardioembolism is among the most important causes of ischemic stroke around the world. A pilot double-center study evaluated the subtypes of cardioembolic mechanisms in stroke patients in two different racial subtypes.Methods: This prospective clinical study was conducted on 100 stroke patients in Mackenzie Hospital in Canada and 100 stroke patients who were age and sex matched in Ghaem Hospital in Mashhad, Iran in 2007. All of the Canadian patients were of white North American race and all of the Iranian ones of white Persian race. The diagnosis of ischemic stroke was made by stroke neurologists.Assessment of the cardioembolic mechanisms was made based on the standard method. The frequency of ischemic heart disease, congestive heart failure and atrial fibrillation was detected in the two studied groups.Results: 92 males and 108 females with ischemic stroke were studied. The influence of race on the frequency rate of ischemic heart disease, congestive heart failure and atrial fibrillation was not significant. However, rheumatic mitral valve disease was significantly more frequent among the Iranian group. The effect of race on the frequency rate of other cardioembolic mechanisms was not significant in each gender separately. However, atrial fibrillation was significantly more frequent in Canadian females.Conclusions: There was no significant difference in the frequency rate of cardioembolic mechanisms between North American and Persian stroke patients except for rheumatic mitral valve disease.

Background: Both Transthoracic Echocardiography (TTE) and Transesophgeal Echocardiography (TEE) are effective investigation tools to detect cardioaortic sources of embolism in ischemic stroke. Nevertheless, there are still uncertainties about the costeffectiveness of these methods in non-selected patients with acute stroke. Objectives: This study aimed to investigate the cost-effectiveness of TTE and TEE using a decision analytic model in non-selected patients with acute ischemic stroke with or without clinical and radiological signs of embolic pattern. Patients and Methods: This cross-sectional cost-effectiveness study was performed in Nemazee hospital affiliated to Shiraz University of Medical Sciences from January 2014 to April 2014. TTE and TEE were performed for all 65 consecutive patients with ischemic stroke (51. 3% male, mean age of 69. 7 ± 17. 9 years). The required data were direct costs related to performance of TTE and TEE, which were obtained from the patients’ bills in their charts. A decision analytic model was implemented to assess the cost-effectiveness of these two methods, which demonstrated an Incremental Cost-Ef-fectiveness Ratio (ICER). Effectiveness was determined based on the number of disorders diagnosed using each of the two echoes confirmed by two cardiologists. All analyses were done using Tree Age Pro 2011. Results: The results showed that TEE was more expensive than TTE in non-selected patients. Performing TEE increased the cost by 1494 USD and the effectiveness by 7%. As per ICER equation, for each increment unit in the effectiveness, performing TEE would increase the cost by 213. 4 USD compared to TTE. TEE was cost-effective in comparison to TTE regardless of age factor considering the cutoff of Gross Domestic Product (GDP) by three for ICER. Moreover, TTE was cost-effective in 41-60-and 61-80-year-old age groups, while TEE was cost-effective in the 41-60-year-old age group. However, none of the techniques was cost-effective in patients above 81 years old. Conclusions: The results of this study can help reduce the unnecessary use of echocardiography by considering the age group and their corresponding risk factors for developing ischemic stroke.

Background: The hospital-based stroke registry is useful for understanding diverse clinical characteristics of stroke related to geographical, racial, or environmental differences. Methods: The Khorasan Stroke Registry was established for evaluation of incidence, clinical manifestations, risk factors, topography, and etiology of ischemic stroke in Southern Khorasan, Iran, during 2001 – 2005. Consecutive stroke patients underwent a standard battery of diagnostic investigations by a stroke neurologist. Topography and etiology of brain infarction was determined based on the Practical Iranian Criteria classification. Results: The incidence of ischemic stroke in Khorasan population is 43.17 cases per 100,000 people per year. During a 5-year period 1,392 ishemic stroke patients (738 females, 654 males) were evaluated in the Khorasan Stroke Registry. Atherosclerosis constituted 53.6% of etiologies followed by uncertain causes (19.9%), cardioembolism (11.8%), and miscellaneous etiologies (2.9%). Eleven point seven percent of our patients had both atherosclerosis and cardioembolic mechanisms. Rheumatic valvular disease was present in 44.8% of cardioembolic strokes and caused 4.31 preventable stroke cases per 100,000 Iranian population per year. Hypertension and history of ischemic cerebrovascular events were the most frequent risk factors, 53.1% and 22.3% respectively. In-hospital mortality of our ischemic stroke patients was 7.3%. Conclusion: High frequency of atherosclerotic etiology in the Khorasan Stroke Registry is because of its classification criteria, which does not separate small vessel territory infarcts as a different etiologic subtype. Rheumatic valvular disease is an important cause of stroke in Khorasan population.