Mitochondrial Dysfunction in Multiple Sclerosis: A Systematic Review

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system (CNS) and is characterized by a high degree of heterogeneity in progression and treatment response. Mitochondrial dysfunction is increasingly recognized as an important feature of MS pathology and may be relevant for clinical disease progression. This paper systematically reviews published evidence concerning the role of mitochondrial abnormalities with MS. Literature searched using the Web of Science, PMC/Medline via PubMed and Scopus databases up to May 2017 with no time and language limitation. After quality assessment, 9 articles were included in the study. All data extraction was conducted by two reviewers independently. Based on the results of the studies, it seems that mitochondrial DNA abnormality and mitochondrial dysfunction may be due to primary inflammation in MS or may be occurred itself before any inflammation, but definitely contributes to axonal degeneration and disease progression. Mitochondrial abnormality contributes to axonal degeneration in MS and disease progression

Effectiveness of Behavior Management Intervention in Migraine With a Focus on Comorbid Depressive

Background: Migraine negatively affects sufferers’ physical and mental health and social and economic status. Objectives: This study compared the effectiveness of behavior management therapy and pharmacotherapy in reducing migraine-related disabilities with and without focusing on comorbid depressive symptoms. Materials & Methods: This quasi-experimental study has a pre-test-post-test design with a control group. The study was conducted on migrainous patients with comorbid depressive symptoms referred to neurology clinics in Rasht City, Iran, in 2021. A total of 18 female patients were selected using purposive sampling based on neurological diagnosis and the diagnostic and statistical manual of mental disorders (DSM-5) criteria for depressive disorder. The participants were randomly assigned to two groups after matching regarding age and severity of depression. Combined therapy (behavior management intervention [BM] and pharmacotherapy [P]) was performed in two groups during eight sessions, with (case group) and without (control group) focusing on comorbid depressive symptoms. The data were collected using the Beck depression inventory (BDI-II), the headache disability inventory (HDI) , and the headache diary (HD) and analyzed using multivariate analysis of covariance. Results: The first therapeutic approach was significantly superior to the second in reducing migraine-related disabilities (F(2, 13)=10.43, P<0.05, Wilks Lambda=0.384, partial Ƞ2=0.616). Conclusion: Combined therapy (BM & P) focusing on comorbid depressive symptoms can be an alternative or complementary therapeutic method to reduce various disabilities in migraine patients

Education of Medical Professionalism and the Role of Educators of Guilan University of Medical Sciences, Iran, According to its Residents

Background & Objective: There are many reasons that it is necessary to change the culture, educational environment, and curriculum of medical education toward addressing and developing the fundamentals of medical professionalism. The primary objective of this study was to assess the attitudes of residents about training professionalism in the School of Medicine in Guilan University of Medical Sciences, Iran. Methods: This descriptive study was conducted on 189 residents of Guilan University of Medical Sciences based on a questionnaire adjusted to culture and ethical issues of Iran in 2011-12. The reliability and validity of the questionnaire was confirmed. The data were analyzed by t-test and using the Stata statistical software. Results: In this study, 140 residents from 14 fields participated with mean age of 32.2 ± 4.49 years. More than 50% of residents rated the success of medical professionalism education programs as medium to high. More than 40% of them have considered the effect of role model educators, in the education of these principles, to be great. 62.9% of residents agreed with the theoretical–practical teaching of these principles. Conclusion: The degree of success of educational programs in various fields of medical professionalism was acceptable, but needs improvement. The residents acknowledge that they learn the principles of professionalism from their educators in a hidden educational curriculum, but believe that they must also be taught in theoretical and practical units. Keywords Medical professionalism Medical residents Education Role modelin

Migraine headache in Multiple Sclerosis. Is more frequent among MS patients?

Objectives. Multiple sclerosis (MS) is a chronic disease of the central nervous system that is associated with inflammation, demyelination of neurons and gliosis. There are different reports about the association between migraine and MS. Taking note of headaches experienced by people with MS and providing appropriate treatment can help enhance their quality of life. We aimed to determine the frequency of migraine headache in MS patients. Materials and methods. This was a descriptive cross-sectional study, conducted in 2020 among 125 MS patients referred to neurology clinic of Poursina Hospital or registered in Guilan MS Registry System and 125 controls with minor head trauma in Rasht. After obtaining written consent, all the subjects were asked to fulfil a checklist about their demographics, MS and headache characteristics by phone call. Outcomes. In this study 96 RRMS, 19 PPMS and 10 SPMS patients participated among which frequency of mild, moderate and severe disability was 74.4%, 22.4% and 3.2%, respectively. The frequency of migraine in MS patients was significantly higher than the control group [28.8% (n=36) vs. 12.8% (n=16) p=0.002]. After adjusting the confounding factors a significant relationship was found between MS and migraine (OR: 2.76, p = 0.004). Conclusions. MS patients experience migraine headaches approximately twice the general population

COVID-19 Infection and Seropositivity in Multiple Sclerosis Patients in Guilan in 2021

Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. COVID-19 has presented a significant challenge to the care providers of patients with MS. Objectives: The present study aimed to investigate the frequency of COVID-19 infection and its seropositivity in MS patients in Guilan, Iran, in 2021. Materials & Methods: In this analytical-cross-sectional study, all patients with relapsing-remitting MS registered in the Guilan MS Association with an expanded disability status scale of less than 5 who were referred for evaluation participated in the study. Information related to the clinical and serological symptoms of COVID-19 infection, changes in drug use, and the occurrence of new attacks were collected. Serological results of COVID-19 (IgG) among them were registered. Results: In total, 260 patients with MS (78.8% women, and 21.2% men) with a Mean±SD age of 38.7±9.9 years, and a Mean±SD duration of MS of 8.9±4.9 years were investigated. The most commonly used drugs were Dimethyl fumarate, Interferon, and Rituximab, respectively. Thirty-three patients (12.6%) had a clinical COVID-19 infection, of which 32 people had a mild and only one had a critical infection. Eight patients (1.3%) had positive COVID-19 IgG tests. No significant relationship was found between the COVID-19 infection with the type of medication, medication change, clinical attack of MS, and co-morbidities (P>0.05). Conclusion: A few patients had positive COVID-19 IgG tests and clinical COVID-19 infection. The vast majority had mild disease, and the clinical attack was not related to COVID-19 infection

Stroke Associated with SARS-CoV-2 Infection and its Pathogenesis: A Systematic Review

Introduction: In this systematic review, we will discuss the change of stroke incidence during the COVID-19 pandemic period and the proposed mechanisms of the relationship between SARS-CoV-2 and stroke. Methods: Web of Science, PMC/Medline, and Scopus databases were searched until July 2020 without time and language limitations. After quality assessment, 22 articles were included in this study. Results: Based on the results, it is impossible to conclude any definite relationship between the rising or decreasing stroke frequency or the shift in the ischemic and hemorrhagic ratio and SARS-CoV-2 infection. However, it appears that SARS-CoV-2 infection has some correlation with stroke. The supposed mechanisms for the SARS-CoV-2-related hemorrhagic stroke include 1) SARS-CoV-2-related vasculopathy with the endothelial damage of small vessels, 2) viral infection-induced platelet dysfunction or thrombocytopenia, and 3) activation of the proinflammatory cascade leading to coagulopathy. The helpful strategies are receiving therapeutic anticoagulation for high D-dimer or a known thrombus due to SARS-CoV-2 infection, as well as using extracorporeal membrane oxygenation (ECMO) in some patients. Furthermore, the possible mechanisms for the SARS-CoV-2-related ischemic stroke include 1) dysregulation of angiotensin-converting enzyme 2 (a key host cellular receptor for SARS-CoV-2)-related physiologic functions, 2) endothelial cell damages, 3) thrombo-inflammation, and 4) coagulopathy and coagulation abnormalities related to SARS-CoV-2 infection.  Conclusion: A better understanding of the SARS-CoV-2 pathogenesis and its relation to neurologic abnormalities such as stroke can help to design new therapeutic approaches

Direct and Indirect Timing Functions in Unilateral Hemispheric Lesion

Introduction: The neural substrates of temporal processing are not still fully known. The majority of interval timing studies have dealt with this subject in the context of “Explicit timing” (computing the time intervals explicitly). The hypothesis “Implicit timing” (implicitly using temporal processing to improve function) has also proposed. This lesion study addressed explicit and implicit timing paradigms simultaneously using identical experimental tasks. Methods: In this case-control study, 15 patients with Right Hemisphere Damage (RHD) and 15 patients with Left Hemisphere Damage (LHD) and 15 age-matched normal subjects were included. Participants performed a temporal reproduction task (assessing explicit timing) and a temporal prediction task (assessing implicit timing) in two sub- and supra-second intervals. Results: Our results showed that RHD can lead to significantly lower accuracy in the temporal reproduction task in sub-second (p=0.005) and supra-second (p=0.001) intervals, compared with the normal subjects. Also, LHD led to perturbation in temporal prediction task by an increase in reaction time (lower accuracy) in sub- (p=0.011) and supra-second (p=0.006) time intervals than the normal subjects.  Conclusion: Overall, our findings suggested that there is a right hemispheric bias in the neural substrate of explicit timing, in both sub- and supra-second intervals. Furthermore, for the first time in a lesion study, we showed the evidence of left-hemispheric bias in neural substrates of implicit timing

Expression of Matrix Metalloproteinase-2 and -9 in Meningioma

Background: Meningioma is one of the most common tumors of the central nervous system. It was shown that meningioma had up-regulated expression of Matrix Metalloproteinases (MMPs) that involved in cell growth, angiogenesis and metastasis.  Objectives: The aim of the study was the assessment of serum MMP-2 and -9 levels in patients with different grades of meningioma.  Materials & Methods: The study included the number of 66 normal control and 101 patients with different grades of meningioma (42 cases of grade I, 38 grade II and 21 grade III). The serum samples was recruited between March 2013 and August 2017 at the Departments of neurology and neurosurgery, in an academic hospital affiliated to Guilan University of Medical Sciences, in the north of Iran. MMP-2 and -9 levels determined by Enzyme Linked Immunosorbent Assay (ELISA). All data presented are expressed as mean±Standard Error of the Mean (SEM). Statistical analysis was done using one-way ANOVA by SPSS software, version: 24.0 and only values with P≤0.05 were considered as significant  Results: We showed that the level of MMP-2 and -9 in the serum samples of patients with meningioma was higher than in controls (P<0.01). We also showed that all serum samples from patients and controls, presented MMP-2 and -9 expression, whereas, starting from grades I to III meningioma, a significant increase of MMP-2 and -9 protein expression was observed (P<0.05).  Conclusion: It is concluded that MMP-2 and -9 are a constant composition of human serum. It is also concluded that MMP-2 and -9 might be involved in the pathophysiology of meningioma and their detection in serum may be useful in classifying meningioma