Does the multiple sclerosis (MS) map need to change again? An update of MS prevalence in Mazandaran province of Iran in 2018

Background: Information of Previous studies on the prevalence of MS, including our study conducted 12 years ago, used to shape global prevalence map of MS. According to those results, Iran placed in medium-prevalence MS region in the world Atlas of MS 2013.This study aimed to investigate the prevalence of MS in Mazandaran province after 12 years and the need for possible changes in the global map of the prevalence of MS. Methods: We included all MS patients living in Mazandaran province in 2018 in this descriptive cross-sectional study. We updated our pre-existing registration questionnaires which included demographic information and medical data of MS patients by interview. We obtained the demographic profile of Mazandaran province from the most recent census in 2016 and the National Civil Registry of the Mazandaran province for calculating prevalence of MS. Results: The total number of MS patients in Mazandaran was 2418 (25.8 male and 74.2 female) with a female to male ratio of 2.9. Based on the local population of 3,332,556, (50.4 male and 49.6 female), this study showed a prevalence of 72.5 per 100,000 for MS in this region. The prevalence of this disease by gender was 37.1 per 100,000 for men and 108.5 per 100,000 for women. The mean (SD) age of the patients at the time of the study was 38.5 (10.1) years with a minimum of 15 and a maximum of 75 years. The most common type of MS was Relapsing-Remitting MS with 86. Conclusions: All recent studies showed significant upward trend in the prevalence of MS around the world. Based on the results of our study and many other studies in Iran, the Atlas of MS prevalence map needs to be update. Iran's status should be changed to the high-prevalence of MS in the new Atlas. Due to the increasing prevalence of MS, we suggest an adjustment in the Global MS Prevalence Scale. © 2020 The Author(s)

Cognitive functions in epileptic patients on lamotrigine and other antiepileptic drugs

Background and purpose: Anti-epileptic drugs (AEDs) can affect cognitive functions. The purpose of this study was to investigate the effects of lamotrigine (LT) on cognitive functions of patients with epilepsy. Materials and methods: A study with retrospective cohort design was carried out in which we assessed cognitive functions of 20 IGE patients attending Sari Bu Ali Hospital, and 12 healthy subjects. The control group was matched for age, sex, and educational level. Standardized neuropsychological tests were used to evaluate cognitive functions. The study was analyzed applying one-way ANOVA and Tukey Test in SPSS. Results: Compared with the control group, LT group showed poor performance in Stroop test and verbal fluency test-semantic test (P<0.05). The group on other drugs were also found to have poor performance in verbal fluency test (phonetic and semantic), forward digit span task, and Stroop test compared with those of the control group (P<0.05). Conclusion: Compared with LT, other AEDs had more adverse effects on cognitive functions which could be due to their effect on channels and release changing stimulatory neurotransmitters. © 2019, Mazandaran University of Medical Sciences. All rights reserved

Age and sex-adjusted incidence and yearly prevalence of multiple sclerosis (MS) in Mazandaran province, Iran: An 11-years study

Introduction: The incidence rate of MS is a valuable indicator of the recent changes in the risk of this disease, and it is widely implicated for health planning purposes. Objectives: This study aims to determine the MS incidence over the past eleven years in Mazandaran province and to compare it with the other parts of Iran and the world. Materials and methods: This retrospective study is conducted in Mazandaran province by using registered data in the files of the patients with their consent. The yearly crude incidence rates, age, and sexspecific incidence rates and directly standardized incidence rates of this population are calculated, and the temporal changes in the incidence rates are analyzed. Results: 662 (26) male patients with the mean (SD) age of 32.6 (9.48) and 1884 (74) female patients with the mean (SD) age of 31.9 (9.15) are studied. The direct standardized incidence rate of MS was 3.28 in 100.000 in 2008 and reached 4.17 in 100.000 in 2018, and this increase was significant (p<0.05). Also, the yearly prevalence of MS increased from 24.4 to 72.5 in this period. Conclusions: The MS incidence has increased in Mazandaran. The potential role of some genetic or environmental factors needs further investigation. Copyright © 2020 Cheraghmakani et al

Evaluation of Clinical Characteristics of Patients with Non-Traumatic Subarachnoid Hemorrhage

BACKGROUND AND OBJECTIVE: Subarachnoid hemorrhage (SAH) is a common and horrible disease and high rate of neurological complications. Misdiagnosis leads to increased mortality and delayed onset of treatment. This aim of study was to investigate the clinical characteristics of patients with SAH in Mazandaran. METHODS: This research is descriptive and retrospective study on 110 non-traumatic SAH. Variables include age, sex, headache, swallowing disorder, speech impairment, syncope, hemiplegia, seizure, nausea and vomiting, as well as risk factors such as hypertension(HTN), diabetes(DM), hyperlipidemia(HLP), alcohol consumption, smoking, Ischemic heart disease(IHD) was extracted from the patients file. FINDINGS: The mean age of patients was 53±16.92 years. The most common non-traumatic SAH in the age group over 40, especially 40 to 60 years. The average hospital length of stay was 14.7±4.77 days. Hypertension (47.3%) is highest prevalence in the study population compared with other risk factors include DM,HLP,IHD,smoking,alcohol consumption and the headache was 80% and hemiplegia was 11.8%. CONCLUSION: All patients with sudden headaches, especially headaches that have a history of hypertension must be accurate and complete evaluation for SAH

Molecular epidemiology and antifungal susceptibility profiles of clinical Cryptococcus neoformans/Cryptococcus gattii species complex

Introduction. Limited data regarding the epidemiology and susceptibility profiles of cryptococcosis are available in the Middle East. Aim. Our study aimed to evaluate the molecular diversity, mating types and antifungal susceptibility pattern of Cryptococcus species (n=14) isolated from 320 suspected patients with cryptococcosis. Methodology. The URA5 gene was subjected to restriction fragment length polymorphism and sequence analysis. In addition, in vitro antifungal susceptibility testing was performed by Clinical and Laboratory Standards Institute (CLSI) M27-A4 and M59 guidelines. Results. Overall, 14 (4.4) patients were confirmed as cryptococcosis. Based on molecular type, 85.7 and 14.3 of the isolates were C. neoformans VN I and VN II, respectively. Phylogenetic analysis of URA5 gene sequences revealed clustering of VN I and VN II isolates into two distinct clades with a substantial difference within each molecular type. Voriconazole and 5-fluorocytosine, respectively, had the lowest (0.031 μg ml�1) and highest (8 μg ml�1) MICs. The epidemiological cutoff values (ECVs) for amphotericin B, fluconazole, voriconazole and 5-fluorocytosine encompassed �97 of all 14 C. neoformans VN I species. However, according to the CLSI document M59, ECVs for itraconazole (7; 50 of the isolates) and for posaconazole (1; 7.1 of the isolate), were one log2 dilution higher than the wild type range. Combinations of amphotericin B with 5-fluorocytosine, amphotericin B with fluconazole and fluconazole with 5-fluorocytosine exhibited synergistic effects against 37, 31 and 12.5 of the isolates, respectively. Conclusion. Our findings may significantly contribute to the development of management strategies for patients at a higher risk of cryptococcosis, particularly HIV-positive individuals. © 2020 The Author