The effect of interferon-beta1a on relapses and progression of disability in patients with clinically isolated syndromes (CIS) suggestive of multiple sclerosis

Objectives: In 85 of young adults with multiple sclerosis (MS), onset is a subacute clinically isolated syndrome (CIS) of the optic nerves, brain stem or spinal cord. The advent of disease-modifying treatments for MS has increased attention on early stages of the disease. Therefore, the aim of this study was to evaluate the effect of interferon on relapses and progression of disability in patients with a CIS. Patients and methods: This randomized, clinical trial was conducted in 25 patients who presented with a CIS indicative of MS. They were evaluated in two groups: 11 patients who were receiving interferon-beta1a (Rebif, Serono) subcutaneous injections three times a week (group A), and 14 patients who were not receiving disease-modifying treatment (group B). The progression of disability was determined using the Kurtzke Expanded Disability Status Scale (EDSS) and the numbers of new relapses were recorded during 21 months of follow-up. Results: The mean numbers of new relapses and changes in EDSS at the end of study period were 0.68 (standard deviation S.D. = 0.80) and -1.09 (S.D. = 0.49), and 1.79 (S.D. = 1.05) and -0.64 (S.D. = 0.49) in groups A and B, respectively. Statistical analysis showed that disease-modifying treatment with interferon-beta1a may reduce relapses (P = 0.007) and prevent progressive disability (P = 0.034). Conclusion: Interferon-beta1a significantly delayed progression to disability and incidence of new relapses. © 2007 Elsevier B.V. All rights reserved

Rivaroxaban for the treatment of cerebral venous thrombosis

Background: New Oral Anticoagulants (NOACs) such as Rivaroxaban are introduced as alternatives to conventional vitamin-K antagonists in the long-term treatment of thrombotic events due to their lower bleeding risk. There is a lack of evidence on the effectiveness and safety of Rivaroxaban in Cerebral venous thrombosis (CVT). This study aims to assess the effectiveness and bleeding risk of Rivaroxaban in comparison with Warfarin for the treatment of CVT. Materials and methods: 36 patients with diagnosis of CVT were included. Clinical and background information was assessed on admission and patients were followed for at least 12 months. Measured outcomes were modified Rankin Scale (mRS), evidence of recanalization on contrast-enhanced Brain MR venography (MRV) and major or minor bleeding. Patients were divided into two groups according to the type of oral anticoagulant (Rivaroxaban vs Warfarin). Groups were compared in terms of final outcomes and side effects. Result: Overall, 13 (36.11) patients received Warfarin and 23 (63.89) received Rivaroxaban. Optimal mRS score (0�1) was attained in 9 of 10 (90) of patients treated with Rivaroxaban and 19 of 22 (86.36) of patients received Warfarin. MRV showed complete or partial recanalization in 12 of 14 (85.71) patients treated with Rivaroxaban and all patients in the Warfarin group. There was no significant difference between the two groups in terms of major and minor hemorrhage. Conclusion: Rivaroxaban holds promise for the treatment of CVT. © 2021, The Author(s)

Body roundness index and waist-to-height ratio are strongly associated with non-alcoholic fatty liver disease: A population-based study

Background: A strong association between obesity and non-alcoholic fatty liver disease (NAFLD) has been reported. Objectives: This study was conducted to evaluate if new obesity indices, including a body shape index (ABSI) and body roundness index (BRI), have stronger associations with NAFLD than waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR). Methods: In this cross-sectional study, we utilized the data of 4,872 participants aged 18 74 years from a cohort study conducted among 6,143 subjects in northern Iran. Logistic regression analysis was performed on NAFLD as the outcome and obesity measures (based on Z-score values) as potential predictors. Receiver operating characteristic (ROC) analyses were conducted, in which NAFLD was considered as a reference variable and obesity measures as classification variables. The discriminatory ability of the obesity measures was reported based on area-under-the-curves, and the related cut-off points of BRI and WHtR were determined using the Youden index (YI). Results: Based on our results, BRI (OR = 5.484 for men and OR = 3.482 for women) and WHtR (OR = 5.309 for men and OR = 3.854 for women) showed a higher association with NAFLD than ABSI (OR = 1.363 for men and OR = 1.003 for women) and WHR (OR = 3.123 for men and OR = 1.628 for women). The optimal cut-off points for BRI were 4.00 (sensitivity = 82.7, specificity = 70.8) for men and 5.00 (sensitivity = 83.3, specificity = 71.7) for women. The optimal cut-off points for WHtR were 0.533 (sensitivity = 82.7, specificity = 70.8) for men and 0.580 (sensitivity = 83.3, specificity = 71.7) for women. Conclusions: While BRI and WHtR have equally strong associations with NAFLD, ABSI and WHR have weaker associations with NAFLD than BRI and WHtR. � 2016, Kowsar Corp

Rituximab and risk of COVID-19 infection and its severity in patients with MS and NMOSD

Background: Choosing a safe disease modifying therapy during the COVID-19 pandemic is challenging. This case series study was conducted to determine the incidence rate and the course of Covid-19 infection in MS/NMOSD patients treated with Rituximab. Methods: In this study, we designed a web-based questionnaire. Baseline information such as patient- reported walking disability, total number of Rituximab infusions received, delayed injections, occurrence of any relapse, and the use of corticosteroids during the pandemic were collected. Also, information regarding the Covid-19 pandemic such as adherence to self-isolation, any recent exposure to an infected individual and the presence of suggestive symptoms were collected. In case of positive test results, patients were grouped into 2 categories; mild to moderate and seriously ill and outcomes were evaluated as favorable (improved/ discharged) and unfavorable (expired). Results: Two hundred fifty-eight patients with Multiple Sclerosis were enrolled in this study, 9 of the subjects (3.4) were confirmed positive for Covid-19, five of which required hospitalizations (55.5), two patients required ICU admission (22.2) and 2 two patients died (22.2). None of these patients ever mentioned using corticosteroids during the pandemic. In comparison to MS patients who were not receiving disease modifying therapy (DMT), our study indicated a higher incidence of Covid-19 infection, higher ratio of serious illness and a higher fatality ratio. Conclusions: Rituximab seems not to be safe enough during the pandemic. © 2021, The Author(s)

Seroepidemiological study of leptospirosis in Ghaemshahr Mazandaran province-Iran, Sept-Oct 2004

Background and purpose: Leptospirosis is a zoonotic spirochetal disease caused by coming into contact with water or soil contaminated with urine of the infected animals such as sheep, hours, cow, rat and etc. Farmers, animal husbands, veterinarians and those practicing aqua sport are at risk.Materials and Methods: This study was undertaken in 13 villages of Ghaemshahr City (September 2004) in which because of previous epidemiological observation the probability of this disease was high. Study was descriptive cross sectional with randomized case selection. Five ml of venous blood was taken from each case and tested using an ELISA method. Information about age, sex, job, area of living, symptoms such as fever, headache, mialgia, diarrhea, nausea during this or past summer were gathered.Results: Serological data showed that prevalence of leptospirosis was 29.4 % .There is no relation between sex and positive serological results (54.8% women & 54.18% men).Conclusion: Leptospirosis in studied area is epidemic and due to its high morbidity, mortality and economical impact,heath education to people would help to control the disease and chemoprophylaxis can also be used

Developing the Persian version of the homophone meaning generation test

Background: Finding the right word is a necessity in communication, and its evaluation has always been a challenging clinical issue, suggesting the need for valid and reliable measurements. The Homophone Meaning Generation Test (HMGT) can measure the ability to switch between verbal concepts, which is required in word retrieval. The purpose of this study was to adapt and validate the Persian version of the HMGT. Methods: The first phase involved the adaptation of the HMGT to the Persian language. The second phase concerned the psychometric testing. The word-finding performance was assessed in 90 Persian-speaking healthy individuals (20-50 year old; 45 males and 45 females) through three naming tasks: Semantic Fluency, Phonemic Fluency, and Homophone Meaning Generation Test. The participants had no history of neurological or psychiatric diseases, alcohol abuse, severe depression, or history of speech, language, or learning problems. Results: The internal consistency coefficient was larger than 0.8 for all the items with a total Cronbach's alpha of 0.80. Interrater and intrarater reliability were also excellent. The validity of all items was above 0.77, and the content validity index (0.99) was appropriate. The Persian HMGT had strong convergent validity with semantic and phonemic switching and adequate divergent validity with semantic and phonemic clustering. Conclusion: The Persian version of the Homophone Meaning Generation Test is an appropriate, valid, and reliable test to evaluate the ability to switch between verbal concepts in the assessment of word-finding performance

Increased serum brain-derived neurotrophic factor in multiple sclerosis patients on interferon-b and its impact on functional abilities

Objectives: To investigate the potential role of disease-modifying therapies (DMTs) used to treat multiple sclerosis on inducing brainderived neurotrophic factor (BDNF) production. Methods: A total of 82 patients entered the study. Sixty (73) patients were on DMTs (15 on Avonex, 13 on Rebif, 27 on Betaferon, 3 on Mitoxantrone, and 2 on IVIg), whereas 22 received no DMTs. The degree of neurological impairment was recorded using the expanded disability status scale (EDSS). Serum BDNF levels were assessed using the Sandwich ELISA method. We compared mean serum BDNF levels among patient groups based on whether or not they were on DMTs, and the specific agent used. Then, the relationship between BDNF levels and EDSS scores was assessed. The receiver operating characteristic (ROC) curve was used to calculate a cutoff value by which serum BDNF could predict the degree of disability. Results: The study sample had a mean age of 34.6 years, mean EDSS score of 3.8, and mean BDNF level of 198.9 pg/mL. Patients on interferon-b 1b therapy had significantly higher levels of BDNF compared with patients on Mitoxantrone or patients not on DMTs (237.6, 68.6, and 155.9, respectively; P = 0.003). The degree of neurological impairment correlated negatively with BDNF levels

Transbulbar B-mode sonography in multiple sclerosis without optic neuritis; clinical relevance

Objective: Trans bulbar B-mode sonography (TBS) is a recently proposed method but there is little known about its diagnostic accuracy in patients with multiple sclerosis without acute optic neuritis. Therefore we assessed the correlation between OND, ONSD and OND/ONSD ratio with clinical/para clinical parameters. Methods: In a comparative study, we intended to examine possible differences in optic nerve diameter (OND) and optic nerve sheath diameter (ONSD) between 60 patients with multiple sclerosis (MS) and 60 individuals as matched healthy controls. Results: The OND, ONSD and OND/ONSD ratio in both eyes showed significantly lower amounts in patients compared to healthy controls (p < 0.05). There were no correlations, between either OND or ONSD and factors including gender, age, P100 amplitude, disease duration, history of optic neuritis and number of T2 lesions in MRI (P � 0.05). Expanded disability status scale (EDSS) and p100 Latency were correlated with both OND and ONSD values (P < 0.05). Conclusions: TBS showed significantly lower amounts of OND, ONSD and OND/ONSD ratio in MS patients without current attack compared to their healthy controls indicating a subclinical axonal loss over time. It is suggested that TBS could be an applicable tool for early detection of optic nerve damages along with clinical and para-clinical findings. © 2020 Elsevier B.V

The Factor Structure of the Twelve Items General Health Questionnaire (GHQ-12): a Population Based Study

Mental health is a key component of general health based on world health organization (WHO) definition of health. A short form of the general health questionnaire (GHQ-12) has been widely used as an assessment tool of general and mental health. This study was designed to evaluate the properties of the Persian version of this questionnaire. Of 6140 subjects aged 10�90 years of a cohort study of Northern Iran, the relevant data of 5074 individuals aged �18 years were considered for analysis. Confirmatory factor analysis was conducted to evaluate the six models including one-dimensional model, one-dimensional model with correlated errors on negative items, two-dimensional model based on negative and positive statement items, two-dimensional model based on social dysfunction and psychological distress, three-dimensional model based on anxiety/depression, social dysfunction and loss of confidence and finally one-dimensional model with an additional factor for the negatively phrased items. The best fit indices belonged to one-dimensional model with correlated errors on negative items with �2 = 686.8, df = 39, CFI = 0.953, RMSEA = 0.057 (95CI: 0.054�0.061), SRMR = 0.0317, AGFI = 0.952, TLI = 0.920 and AIC = 764.8 and also three-dimensional model with �2 = 860.7, df = 51, CFI = 0.941, RMSEA = 0.056 (95CI: 0.053�0.059), SRMR = 0.0343, AGFI = 0.955, TLI = 0.923 and AIC = 915.0. In the comparison between these two best models we had ��2 = 174.2, �df = 12, p-value < 0.001 in favor of the one-dimensional model. One-dimensional model with correlated errors on negative items showed the best fitting indices with our population. © 2017, Springer Science+Business Media Dordrecht and The International Society for Quality-of-Life Studies (ISQOLS)

The Factor Structure of the Twelve Items General Health Questionnaire (GHQ-12): a Population Based Study

Mental health is a key component of general health based on world health organization (WHO) definition of health. A short form of the general health questionnaire (GHQ-12) has been widely used as an assessment tool of general and mental health. This study was designed to evaluate the properties of the Persian version of this questionnaire. Of 6140 subjects aged 10�90 years of a cohort study of Northern Iran, the relevant data of 5074 individuals aged �18 years were considered for analysis. Confirmatory factor analysis was conducted to evaluate the six models including one-dimensional model, one-dimensional model with correlated errors on negative items, two-dimensional model based on negative and positive statement items, two-dimensional model based on social dysfunction and psychological distress, three-dimensional model based on anxiety/depression, social dysfunction and loss of confidence and finally one-dimensional model with an additional factor for the negatively phrased items. The best fit indices belonged to one-dimensional model with correlated errors on negative items with �2 = 686.8, df = 39, CFI = 0.953, RMSEA = 0.057 (95CI: 0.054�0.061), SRMR = 0.0317, AGFI = 0.952, TLI = 0.920 and AIC = 764.8 and also three-dimensional model with �2 = 860.7, df = 51, CFI = 0.941, RMSEA = 0.056 (95CI: 0.053�0.059), SRMR = 0.0343, AGFI = 0.955, TLI = 0.923 and AIC = 915.0. In the comparison between these two best models we had ��2 = 174.2, �df = 12, p-value < 0.001 in favor of the one-dimensional model. One-dimensional model with correlated errors on negative items showed the best fitting indices with our population. © 2017, Springer Science+Business Media Dordrecht and The International Society for Quality-of-Life Studies (ISQOLS)