Fatigue in multiple sclerosis is a diagnostic challenge: A cross-sectional study

Introduction: Multiple sclerosis (MS) is a chronic and unpredictable demyelinating disease of the central nervous system (CNS). While MS is mostly known for muscle weakness, numbness, and pain, but fatigue is the most common complaint of this condition. Despite this fact, MS related fatigue is one of the most misunderstood symptoms. Methods: A non-interventional study of 100 individuals was conducted in the MS clinic, Tabriz University of Medical Sciences. Patients were divided into groups with and without complaints of fatigue. The course of the disease was determined for all patients. To quantify fatigue, the Modified Fatigue Impact Scale (MFIS) was used. Furthermore, mood disorders, pain, disability, nocturia, insomnia, and spasticity were evaluated among the patients. Results: Overall, fatigue was diagnosed in 61 through 100 patients. Depression was reported in 23 patients of whom 19 had fatigue (P=0.015). 40 patients showed anxiety 33 of which had fatigue (P>0.001). 53 patients of whom reported to have pain (76 patients) showed fatigue (P=0.001). Insomnia was reported in 27 patients, where 21 of them had fatigue (P=0.036). Nocturia was reported in 10 patients, of whom 9 had fatigue (P=0.047). Spasticity was detected in 9 patients, all of whom had fatigue (P=0.012). Conclusion: There are several factors directly and indirectly associated with fatigue that are either fatigue-induced, caused by fatigue, or showing a two-way relationship with it. Understanding these links and attempting to reduce them will improve the quality of life for these patients

Iranian clinical practice guideline for amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegeneration involving motor neurons. The 3–5 years that patients have to live is marked by day-to-day loss of motor and sometimes cognitive abilities. Enormous amounts of healthcare services and resources are necessary to support patients and their caregivers during this relatively short but burdensome journey. Organization and management of these resources need to best meet patients' expectations and health system efficiency mandates. This can only occur in the setting of multidisciplinary ALS clinics which are known as the gold standard of ALS care worldwide. To introduce this standard to the care of Iranian ALS patients, which is an inevitable quality milestone, a national ALS clinical practice guideline is the necessary first step. The National ALS guideline will serve as the knowledge base for the development of local clinical pathways to guide patient journeys in multidisciplinary ALS clinics. To this end, we gathered a team of national neuromuscular experts as well as experts in related specialties necessary for delivering multidisciplinary care to ALS patients to develop the Iranian ALS clinical practice guideline. Clinical questions were prepared in the Patient, Intervention, Comparison, and Outcome (PICO) format to serve as a guide for the literature search. Considering the lack of adequate national/local studies at this time, a consensus-based approach was taken to evaluate the quality of the retrieved evidence and summarize recommendations

A Novel Action Selection Architecture in Soccer Simulation Environment Using Neuro-Fuzzy and Bidirectional Neural Networks

Multi-Agent systems have generated lots of excitement in recent years because of its promise as a new paradigm for conceptualizing, designing, and implementing software systems. One of the most important aspects of agent design in AI is the way agent acts or responds to the environment that the agent is acting upon. An effective action selection and behavioral method gives a powerful advantage in overall agent performance. We define a new method of action selection based on probability/priority models, we thereby introduce two efficient ways to determine probabilities using neuro-fuzzy systems and bidirectional neural networks and a new priority based system which maps the human knowledge to the action selection method. Furthermore, a behavior model is introduced to make the model more flexible

Designing a low-noise, high-resolution, and portable four channel acquisition system for recording surface electromyographic signal

In current years, the application of biopotential signals has received a lot of attention in literature. One of these signals is an electromyogram (EMG) generated by active muscles. Surface EMG (sEMG) signal is recorded over the skin, as the representative of the muscle activity. Since its amplitude can be as low as 50 μV, it is sensitive to undesirable noise signals such as power-line interferences. This study aims at designing a battery-powered portable four-channel sEMG signal acquisition system. The performance of the proposed system was assessed in terms of the input voltage and current noise, noise distribution, synchronization and input noise level among different channels. The results indicated that the designed system had several inbuilt operational merits such as low referred to input noise (lower than 0.56 μV between 8 Hz and 1000 Hz), considerable elimination of power-line interference and satisfactory recorded signal quality in terms of signal-to-noise ratio. The muscle conduction velocity was also estimated using the proposed system on the brachial biceps muscle during isometric contraction. The estimated values were in then normal ranges. In addition, the system included a modular configuration to increase the number of recording channels up to 96

Improvement of Industrial Radiography for Defect Detection of Oil and Gas Pipelines in Weld Regions by Image Processing

Industrial Radiography is one of the oldest and most usable of non-destructive methods for studying the defects inside the weld regions of pipelines. It sounds, to increase the quality of radiographic images inside the film and to decrease the weld commentary errors. It is necessary to have a system or method to improve the accuracy of recognition and detection of defects in the weld regions. In this research work, by using digital image processing methods, a new method has been proposed to improve the quality of the images on radiographic films of weld regions. The proposed method has been tested by 60 pieces of radiographic films of weld regions with different quality. The results showed the proposed algorithm and method has the ability to detect the defects inside the weld regions with 100% precision for the films with high and normal quality and with 87% and 47% precisions for the films with low and very low qualities respectively

Improving Diagnosis of Heart Disease by Analyzing Chaotic Indices of ECG Signals

Electrocardiogram (ECG) signals are the most popular non-invasive approach for diagnosis of heart irregularities and indications of possible heart diseases. Previous studies have shown that ECG signals do not have a linear distribution and contain a variety of non-linear dimensions. In the present research we have treated the ECG signals as time-series data and applied chaos indices analysis. Utilizing data from MIT_BIH Database, the present study has improved the past research by analysing chaotic indices such as Lyapunov Exponent (λmax), and Correlation Dimension to ECG signal data from healthy individuals and heart patients. We present appropriate algorithms for reconstruction of Phase Space and estimations of the model parameters using Lyapunov Exponent and CorrelationDimension.We then present the results from reconstruction of Phase Space based on chaotic indices, and fuzzy classifier, to discriminate healthy individuals (NSR) from the heart patients.The heart patients include those with Arterial Fibrillation (AF) and those with Left Bundle Branch Block (LBBB). These results ascertain the effectiveness of application of chaotic distribution to ECG data in improving the heart disease diagnosis

Electrodiagnostic Evaluation of Peripheral Nervous System Changes in Patients with Multiple Sclerosis

Background: There is supportive evidence that multiple sclerosis (MS) could potentially affect the peripheral nervous system. We assessed peripheral sensory and motor nerve involvement in patients with MS by a nerve conduction velocity test. Methods: We studied 75 patients who had a relapsing-remitting or secondary progressive pattern. We measured amplitude, latency, conduction velocity, Hoffmann reflex (H-Reflex), and F-Waves. Results: The amplitude of the right tibial, right proneal, left tibial, left proneal, and left median motor nerves was less than the mean for the normal population. Right ulnar sensory conduction in the patients showed an amplitude that was less than that of the normal population; there was no significant change in the amplitude of other sensory nerves. Latencies of the right and left median and right proneal motor nerves and left ulnar sensory nerves were statistically less than that of the normal population. Mean motor conduction velocity and F-wave conduction did not differ significantly from the normal population. H-reflex latencies of the right and left lower limbs were significantly more prolonged than those of the normal population. Conclusion: Our results suggest possible peripheral motor nerve abnormalities in MS patients, especially with the amplitude of the motor nerves; however, our results do not demonstrate any significant difference among the nerve conduction velocity parameters of sensory nerves between MS patients and the normal population

Iranian clinical practice guideline for amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegeneration involving motor neurons. The 3-5 years that patients have to live is marked by day-to-day loss of motor and sometimes cognitive abilities. Enormous amounts of healthcare services and resources are necessary to support patients and their caregivers during this relatively short but burdensome journey. Organization and management of these resources need to best meet patients' expectations and health system efficiency mandates. This can only occur in the setting of multidisciplinary ALS clinics which are known as the gold standard of ALS care worldwide. To introduce this standard to the care of Iranian ALS patients, which is an inevitable quality milestone, a national ALS clinical practice guideline is the necessary first step. The National ALS guideline will serve as the knowledge base for the development of local clinical pathways to guide patient journeys in multidisciplinary ALS clinics. To this end, we gathered a team of national neuromuscular experts as well as experts in related specialties necessary for delivering multidisciplinary care to ALS patients to develop the Iranian ALS clinical practice guideline. Clinical questions were prepared in the Patient, Intervention, Comparison, and Outcome (PICO) format to serve as a guide for the literature search. Considering the lack of adequate national/local studies at this time, a consensus-based approach was taken to evaluate the quality of the retrieved evidence and summarize recommendations