Microbiomes and Pediatric onset multiple sclerosis (MS): A systematic review

Background: Gut microbiomes play a role in developing and regulating autoimmune diseases such as multiple sclerosis (MS). We designed this systematic review to summarize the evidence of the effect of gut microbiota in developing pediatric-onset MS. Methods: PubMed, Scopus, EMBASE, Web of Science, Google Scholar, references of the references and conference abstracts were comprehensively searched by two independent researchers. The search was done on January 1st, 2023. Data regarding the total number of patients, the name of the first author, publication year, country of origin, mean age, duration of the disease, body mass index (BMI), type of MS, Expanded Disability Status Scale (EDSS), age at disease onset and stool composition were extracted. Results: A literature search revealed 4237 published studies. After removing duplicates, we had 2045 records for evaluation. Twenty-three full texts were evaluated, and four case-control studies remained for systematic review. Three studies were conducted in the United States and one in the Netherlands. The number of participants in included studies ranged between 24 and 68. The mean age of patients at the time of study varied between 11.9 and 17.9 years, and the mean age at the onset of the disease ranged between 11.5 and 14.3 years. Most included patients were female. The results show that median richness (the number of unique taxa identified, which was provided by two studies) was higher in controls, and also Margalef index, which was reported by one study was higher in control group than the case group. The results of two studies also demonstrated that median evenness indexes (taxon distribution, Shannon, Simpson) were higher in control groups, as well as PD index (Faith's phylogenic diversity metric). Conclusion: The result of this systematic review (including four studies) showed disruption of the microbiota-immune balance in pediatric-onset MS cases

The diagnostic performance of magnetic resonance imaging (MRI) in the evaluation of breast ultrasound non-mass lesions: a systematic review

Aim: The purpose of this study is to conduct a systematic review of the current knowledge regarding the diagnostic performance of MRI in the investigation of non-mass lesions of the breast. Method: Up to July 2022, PubMed, Scopus, Web of Science, and Embase were searched comprehensively. All studies examining the diagnostic performance of MRI in non-mass lesions were included except review articles, articles published in a language other than English, and case reports or series of cases. A literature review and data extraction were performed by two independent reviewers. A checklist for cross-sectional studies developed by the Joanna Briggs Institute (JBI) was used to assess sources of bias. Results: The systematic review included two studies. If any enhancement is present on MRI, most ultrasound NMLs will exhibit a non-mass-enhancement. We found that the distribution of non-mass enhancement lesions was primarily segmental and regional. The highest number of malignancies is associated with segmental distributions, since 81.8% of the cases with segmental enhancement were ductal carcinomas, specifically DCIS. Conclusion: Non-mass lesions of the US that do not enhance in MRI have a good prognosis. Breast cancer is very unlikely in these cases, so follow-up is acceptable unless there is a suspicion of malignancy on mammography. In cases where regional and segmental enhancement of NMLs occurs on CE-MRI, ductal carcinomas may be present, and a pathological examination is warranted

The association between marital quality and diabetes mellitus: A systematic review

Abstract Background and Aims Marital relationship and its quality are among the major psychological factors affecting the multiple aspects of a person's health status. Chronic diseases are also among the factors that affect various aspects of the lives of millions of people including their marital quality status. One of the most important underlying chronic diseases is diabetes. Since the correlation between diabetes mellitus and marital quality has been neglected, this systematic review, as the first one, aims to investigate the association between marital quality and diabetes mellitus. Methods A comprehensive search was conducted among three databases (Medline, Scopus, and Web of Science) until September 2021, which resulted in 189 articles. After assessing the studies based on the inclusion criteria, 14 studies were included. Results The included studies were divided into two general groups. The first group consisted of 3 articles examining the effect of factors related to diabetes on marital quality, and the second group included 11 articles studying the effect of marital quality on diabetes and its factors. In general, the articles investigating the impact of diabetes‐related factors on marital quality showed that diabetes has negative impacts on levels of marital quality. Also, the articles investigating the impact of marital quality on diabetes‐related factors, showed that higher marital quality is associated with a lower risk of developing diabetes, a better quality of life in patients with diabetes, and better adherence to diabetes care regimen. The results regarding diabetes management were conflicting. Gender was mentioned as an important modulator in some of the investigated relationships. Conclusion Marital quality remarkably influences diabetes‐related factors and is itself affected by the condition resulting from diabetes in individuals with diabetes mellitus. However, further studies are required due to the limited number of studies investigating this correlation

Impact of menopause on relapse rate and disability level in patients with multiple sclerosis (MS): a systematic review and meta-analysis

Abstract Background Menopause is a physiologic phase in women’s lives. Findings regarding multiple sclerosis (MS) course through menopause are diverse. So, we designed this systematic review and meta-analysis to estimate the impact of menopause on relapse rate, and disability status in women with MS. Methods PubMed, Scopus, EMBASE, Web of Science, and google scholar were systematically searched by two independent researchers on January 1st, 2023. They also evaluated conference abstracts, and references of the included studies. In addition, data regarding the total number of participants, name of the first author of the publication, publication year, country of origin, disease duration, disease type, annual relapse rate, and Expanded Disability Status Scale (EDSS) before and after menopause were recorded. Results A literature search revealed 1024 records. Twenty-one full texts were evaluated, and finally, four studies were included for meta-analysis. Mean ARR before menopause ranged between 0.21 and 0.37, and after menopause ranged between 0.13 and 0.08. The SMD of mean ARR ranged between − 1.04, and − 0.29, while the pooled SMD was estimated as -0.52(95% CI: -0.88, -0.15) (I2 = 73.6%, P = 0.02). The mean EDSS before menopause ranged between 1.5 and 2, and after menopause ranged between 2 and 3.1. The SMD of EDSS ranged between 0.46, and 0.71. The pooled SMD of EDSS change (after menopause-before menopause) estimated as 0.56(95% CI: 0.38, 0.73)(I2 = 0, P = 0.4). Conclusion The result of this systematic review and meta-analysis show that menopause can be associated with relapse rate reduction, unlike increase in disease-related disability in women with MS

The relationship between cumulative dose of immunosuppressive agents and COVID‐19‐associated mucormycosis: A multicenter cross‐sectional study

Abstract Background and Aims Immunosuppressive therapy has a key role in developing coronavirus disease‐2019 (COVID‐19)‐associated mucormycosis. In this study, we investigated the effect of the type and cumulative dose of immunosuppressive agents on COVID‐19‐associated mucormycosis. Methods We designed a descriptive cross‐sectional study involving three COVID‐19 hospitals in Iran. Clinical and demographic data were gathered from the medical records and checked by two independent researchers to minimize errors in data collection. Results Seventy‐three patients were included in the study. The mean age of cases was 57.41 (SD = 12.64) and 43.8% were female. Among patients, 20.5% were admitted to the intensive care unit (ICU) during COVID‐19. Furthermore, 17 patients (23.29%) had a history of diabetes mellitus. Sixty‐nine patients (94.52%) had a history of receiving corticosteroids (dexamethasone) during treatment of COVID‐19, and of those, five patients (6.85%) received Tocilizumab beside. The mean cumulative dose of corticosteroids prescribed was 185.22 mg (SD = 114.738). The average cumulative dosage of tocilizumab was 720 mg (SD = 178.89). All of the included patients received amphotericin B for mucormycosis treatment, and 42 survived (57.53%). Also, there was a significant relationship between hospitalization in ICU for COVID‐19 and the mucormycosis outcome (p = 0.007). However, there weren't any significant associations between cumulative doses of immunosuppressive drugs and mucormycosis outcome (p = 0.52). Conclusion The prevalence of COVID‐19‐associated mucormycosis is increasing and should be considered in the treatment protocols of COVID‐19. Controlling risk factors such as diabetes, malignancy and the administration of immunosuppressive agents based on recommended dosage in validated guidelines are ways to prevent mucormycosis