Seyyed Hosein Mortazavi; Abdorreza Naser Moghadasi; Amir Almasi-Hashiani; Mohammad Ali Sahraian; Hooman Goudarzi; Sharareh Eskandarieh
Articles in Press, Accepted Manuscript, Available Online from 03 April 2023
Abstract
Background: Multiple sclerosis (MS) is a chronic central nervous system disease, and primary progressive multiple sclerosis (PPMS) is one the main types of MS, which has unknown environmental risk factors. The present study was conducted with the aim to identify the association of waterpipe and ...
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Background: Multiple sclerosis (MS) is a chronic central nervous system disease, and primary progressive multiple sclerosis (PPMS) is one the main types of MS, which has unknown environmental risk factors. The present study was conducted with the aim to identify the association of waterpipe and cigarette smoking, substance abuse, and alcohol consumption with the risk of PPMS development.Methods: A population-based, case-control study was conducted in Tehran, Iran, on 146 PPMS cases and 294 controls. PPMS cases were diagnosed and confirmed by neurologists. Standard random digit dialing was used to select sex-matched healthy control participants from the same source population as the cases. Logistic regression analysis was used to estimate unadjusted and adjusted odds ratios (OR).Results: In total, 440 subjects participated in the study. PPMS was associated with ever smoking cigarettes [OR = 2.48; confidence interval (CI) = 1.44-4.27], and passive smoking (OR = 2.20; CI = 1.34-3.62). However, having ever smoked waterpipe was not significantly associated with PPMS risk (OR = 1.19; CI = 0.62-2.26). Those who had all 3 types of smoking had an accumulative OR that was 10.45 times higher than that in individuals without any type of smoking (OR: 10.45; 95% CI = 3.5-31.2). We did not find any significant association between PPMS risk and substance abuse and alcohol consumption.Conclusion: Cigarette smoking and being exposed to passive smoking are important risk factors for developing PPMS; in addition, the use of 3 types of smoking, showed an OR higher than that in those without any smoking. Considering the global increase in tobacco smoking, this finding emphasizes the importance of interventional programs for the prevention of tobacco smoking.
Abdorreza Naser Moghadasi; Saeed Vaheb; Sara Hamtaei-Ghashti; Aysa Shaygannejad; Mozhdeh Askari; Vahid Shaygannejad; Mohmmad Ali Sahraian; Mahsa Ghajarzadeh
Articles in Press, Accepted Manuscript, Available Online from 18 March 2023
Abstract
Background: Fear of relapse and re-infection during the coronavirus disease 2019 (COVID-19) pandemic can affect people with chronic relapsing diseases, such as multiple sclerosis (MS). We evaluated fear of re-infection, anxiety, and relapse during the COVID-19 pandemic in Iranian people with MS.Methods: ...
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Background: Fear of relapse and re-infection during the coronavirus disease 2019 (COVID-19) pandemic can affect people with chronic relapsing diseases, such as multiple sclerosis (MS). We evaluated fear of re-infection, anxiety, and relapse during the COVID-19 pandemic in Iranian people with MS.Methods: This multicenter, cross-sectional study was performed in the MS clinic of Sina Hospital, Tehran, Iran, and Hakim Private Hospital, Isfahan, Iran, between January and April 2022. We asked the participants to fill out validated Persian versions of Fear of Relapse Scale (FoR), and Beck Anxiety Inventory (BAI) questionnaires and answer a binary question about their fear of getting reinfected with COVID-19. Results were reported as mean ± standard deviation (SD) for continuous variables or frequencies for categorical variables. For continuous variables which did not have a normal distribution, we reported the median and interquartile range (IQR). Spearman correlation coefficient between anxiety score and FoR score was calculated. An independent samples t-test was used to compare continuous variables.Results: Three hundred and sixty-eight patients participated in this study. The median scores of FoR and BAI were 49.7 and 34.3, respectively. Fifty-three had new relapses in their last infection. Thirty-six percent of the patients had a fear of getting COVID-19 again, and 43% had a fear of relapse during infection. Three hundred and twenty-three had two doses of COVID-19 vaccine; the most frequent type of vaccine was Sinopharm. There was a significant difference between the median FoR scores among patients with and without relapse during the last COVID-19. There was also a significant positive correlation between anxiety score and FoR (r = 0.49, P < 0.001).Conclusion: More than one-third of enrolled cases had fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) re-infection. Patients who experienced exacerbation of symptoms even in the form of relapse or pseudo relapse (possible clinical relapse) had a higher fear of infection.
Fereshteh Ghadiri; Zahra Ebadi; Elnaz Asadollahzadeh; Mohammad Ali Sahraian; Amirreza Azimi; Samira Navardi; Hora Heidari; Zohreh Abna; Marzieh Aboutorabi; Iman Adibi; Seyed Mohammad Baghbanian; Sepideh Paybast; Maryam Poursadeghfard; Samaneh Hosseini; Sareh Shahmohammadi; Mehran Ghaffari; Hamidreza Ghalyanchi-Langroodi; Masoud Ghiasian; Hoda Kamali; Ebrahim Kouchaki; Farzad Mehrabi; Ehsan Mohammadianinejad; Mohammad Ali Nahayati; Abdorreza Naser Moghadasi
Articles in Press, Accepted Manuscript, Available Online from 10 April 2023
Abstract
Background: Data on perioperative risk stratification in patients with multiple sclerosis (MS) are limited. In this regard, the present study was conducted to investigate Iranian specialists’ approach to surgical counseling for patients with MS (PwMS).Methods: 21 MS specialists were asked about ...
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Background: Data on perioperative risk stratification in patients with multiple sclerosis (MS) are limited. In this regard, the present study was conducted to investigate Iranian specialists’ approach to surgical counseling for patients with MS (PwMS).Methods: 21 MS specialists were asked about 11 case scenarios with different MS disease statuses, disease-modifying therapies (DMTs), and urgency of the operation. The reasons for refusing surgery or factors that have to be considered before surgery were studied.Results: Overall, Fleiss Kappa was estimated to be 0.091 [95% confidence interval (CI): 0.090-0.093, P < 0.001] indicating a very poor level of agreement among responders.Conclusion: PwMS face surgery for various reasons. Risk assessment of surgery, the effect of various drugs such as anesthetics and DMT on patients, as well as many other aspects of MS are issues challenging the practitioners. Clarifying the various dimensions of these issues requires further research.
Fereshteh Ghadiri; Omid Mirmosayyeb; Mohammad Ali Sahraian; Abdorreza Naser Moghadasi; Mahsa Ghajarzadeh
Articles in Press, Accepted Manuscript, Available Online from 13 March 2023
Abstract
Background: Fingolimod is approved in relapsing-remitting multiple sclerosis (RRMS) with the recommended dose of 0.5 mg daily. To tackle possible adverse events, some clinicians may reduce the dose of fingolimod, mainly in the alternate-day form. We systematically reviewed the literature for efficacy ...
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Background: Fingolimod is approved in relapsing-remitting multiple sclerosis (RRMS) with the recommended dose of 0.5 mg daily. To tackle possible adverse events, some clinicians may reduce the dose of fingolimod, mainly in the alternate-day form. We systematically reviewed the literature for efficacy measures of this method.Methods: PubMed (Medline®), Web of Science, Embase, Scopus, and the Cochrane Library databases were searched until April 9, 2021. Clinical studies (other than case reports and case series), in English, were included. Then, publications concerning alternate dose fingolimod (including every other day, every two or three days) were selected. Those studies concerning reduced daily dose (any daily dose less than 0.5 mg/day) were excluded to focus on alternate dosing.Results: Four observational studies were included. Data on Ohtani et al. study were limited. Three other studies were of good quality based on the Newcastle-Ottawa Scale. A total of 296 patients on the standard dose were compared to 276 patients on the alternate dosage. The most common reason for switching to the alternate dose was lymphopenia, followed by elevated liver enzymes. Two studies concluded that the alternate dosing could be a safe, yet effective strategy in patients with intolerable adverse effects of daily dose. However, Zecca et al. warned about the high possibility of disease reactivation. Due to the differences in outcome measures of the studies, meta-analysis was not applicable.Conclusion: This systematic review highlights the ambiguity of evidence on safety and efficacy of alternate dosing of fingolimod, encouraging further research on the subject.
Fardin Nabizadeh; Abdorreza Naser Moghadasi
Articles in Press, Accepted Manuscript, Available Online from 05 March 2023
Fereshteh Ghadiri; Elnaz Asadollahzadeh; Zahra Ebadi; Mohammad Ali Sahraian; Amirreza Azimi; Samira Navardi; Hora Heidari; Zohreh Abna; Marzieh Aboutorabi; Iman Adibi; Seyed Mohammad Baghbanian; Sepideh Paybast; Maryam Poursadeghfard; Samaneh Hosseini; Sareh Shahmohammadi; Mehran Ghaffari; Hamidreza Ghalyanchi-Langroodi; Masoud Ghiasian; Hoda Kamali; Ebrahim Kouchaki; Farzad Mehrabi; Ehsan Mohammadianinejad; Mohammad Ali Nahayati; Abdorreza Naser Moghadasi
Volume 22, Issue 1 , January 2023, , Pages 1-7
Abstract
Background: People with multiple sclerosis (MS) and their physicians recognize cognitive retention as an important desired outcome of disease-modifying therapies (DMTs). In this study, we attempted to gather the opinions of Iranian MS experts regarding the treatment approach toward clinical ...
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Background: People with multiple sclerosis (MS) and their physicians recognize cognitive retention as an important desired outcome of disease-modifying therapies (DMTs). In this study, we attempted to gather the opinions of Iranian MS experts regarding the treatment approach toward clinical cases with different physical and cognitive conditions.Methods: Opinions of 20 MS specialists regarding the best approach to 6 case scenarios (with different clinical, cognitive, and imaging characteristics) were gathered via a form.Results: The estimated kappa of 0.16 [95% confidence interval (CI): 0.159-0.163; P < 0.001] suggested a poor degree of agreement on the treatment choice among the professionals.Conclusion: Although most specialists agreed with treatment escalation in cases with cognitive impairment, there was no general agreement. Furthermore, there was not enough clinical evidence in the literature to develop consensus guidelines on the matter.
Nasim Rezaeimanesh; Naghmeh Abbasi; Mohammad Ali Sahraian; Amirreza Azimi; Soodeh Razeghi-Jahromi; Abdorreza Naser Moghadasi
Volume 22, Issue 1 , January 2023, , Pages 23-29
Abstract
Background: It seems that patients with multiple sclerosis (MS) are at a higher risk for coronavirus disease 2019 (COVID-19) implications due to being subjected to immunomodulatory or immunosuppressive treatments. Besides, obesity as a risk factor may lead to more adverse consequences. The relationship ...
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Background: It seems that patients with multiple sclerosis (MS) are at a higher risk for coronavirus disease 2019 (COVID-19) implications due to being subjected to immunomodulatory or immunosuppressive treatments. Besides, obesity as a risk factor may lead to more adverse consequences. The relationship between obesity and COVID-19 morbidity and outcomes in Iranian patients with MS still remains unclear.Methods: A cross-sectional study was conducted in Sina Hospital, Tehran, Iran. Patients with MS were asked to complete an online questionnaire in the Google Form format. Demographic information, clinical information including MS disease-related factors, COVID-19-related factors, and anthropometric information were recorded. Totally, 492 patients filled the questionnaire during two weeks in November 2021, by the response rate of 21.6%. Body mass index (BMI) was categorized based on the standard classification of the World Health Organization (WHO). The logistic regression was used to examine the risk of morbidity and chi-square test/one-way analysis of variance (ANOVA) was employed to determine the difference regarding severity and symptoms among groups.Results: In the fully adjusted model, the odds ratio (OR) of COVID-19 morbidity in class II obese participants was significantly 5.41 times higher than that in the normal BMI group [OR: 5.41, 95% confidence interval (CI): 1.00-29.09]. COVID-19 severity was significantly different among BMI groups (P = 0.024). Respiratory symptoms (P = 0.05) as well as gastrointestinal (GI) symptoms (P < 0.01) of COVID-19 were more prevalent among class I and class II obese patients compared with overweight, normal weight, and underweight groups. Moreover, no one in the class I and class II obesity groups reported COVID-19 morbidity without any symptoms (P = 0.04).Conclusion: The results of the current study support the view that obesity could play a key role in susceptibility to COVID-19 morbidity and severity of the symptoms in patients with MS. The findings recommended that neurologists pay more attention to patients' BMI during this pandemic.
Maryam Shafaei; Fereshteh Ghadiri; Amirreza Azimi; Abdorreza Naser Moghadasi; Mahdi Hakiminezhad; Mohammad Ali Sahraian
Volume 21, Issue 4 , October 2022, , Pages 201-205
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the central nervous system (CNS) that prompts immediate potent treatment. Delaying treatment could leave debilitating sequelae. As erythropoietin (EPO) has shown neuroprotective effects, we studied the effects of adding ...
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Background: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the central nervous system (CNS) that prompts immediate potent treatment. Delaying treatment could leave debilitating sequelae. As erythropoietin (EPO) has shown neuroprotective effects, we studied the effects of adding EPO to intravenous methylprednisolone (IVMP) in patients with acute attacks of NMOSD.Methods: NMOSD cases with acute attacks were included. Cases of optic neuritis (ON) and those with myelitis were separated. After randomization [with block sizes of 2 (1:1 ratio)], the patients in the intervention group received IVMP 1000 mg/day and intravenous (IV) EPO 20000 U/day for five days. IVMP 1000 mg/day and normal saline (NS) were administered in the control group. Staged eye score and motor forces were evaluated in the patients with ON and myelitis, respectively, at the time of the attack and three months later. Primary patient allocation and clinical assessments were blinded to the physicians.Results: Mean age of participants was 53.87 ± 11.53 years. At follow-up, in the ON arm, the median improvement in staged eye score was 2 in the control and 5 in the intervention group. The difference was significant (P < 0.001). In the myelitis group, none of the patients in the control group had improvement in motor forces. All the patients in the intervention group showed substantial improvement with minimal or no remaining weakness. The difference was statistically significant (P = 0.029).Conclusion: The results show the possible benefit of adding EPO to the classic IVMP in attacks of NMOSD in both visual and motor aspects.
Mohammad Reza Fattahi; Arad Iranmehr; Roghayyeh Saeedi; Mohammad Ali Sahraian; Rozita Doosti; Abdorreza Naser Moghadasi
Volume 21, Issue 4 , October 2022, , Pages 230-235
Abstract
Background: Despite special global considerations which have been made to prioritize vaccination of people with multiple sclerosis (MS), some are reluctant to get vaccinated. This study was aimed to evaluate the attitude toward coronavirus disease-2019 (COVID-19) vaccine and its probable correlations.Methods: ...
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Background: Despite special global considerations which have been made to prioritize vaccination of people with multiple sclerosis (MS), some are reluctant to get vaccinated. This study was aimed to evaluate the attitude toward coronavirus disease-2019 (COVID-19) vaccine and its probable correlations.Methods: Considering the study objectives, two valid questionnaires including Fear of COVID-19 Scale (FCV-19S) and attitude questionnaires were administered pre and post COVID-19 vaccination among people with MS.Results: The questionnaires were administered among 349 people with MS pre and post vaccination. The mean age of participants was 38.78 ± 8.68 (range: 19 to 64) years. They all received the first dose of COVID-19 vaccine (Sinopharm). Although about 90% of participants felt satisfied after getting vaccinated and respected the preventive actions like social distancing and wearing face mask after vaccination, about 40% of them did not recommend vaccination to other patients. None of the demographic data was predictor of attitude score in COVID-19 vaccine and the only effective factor regarding fear of COVID-19 among people with MS was gender (P = 0.001). It was found that the more a patient’s fear score was, the more he/she felt satisfied after vaccination. Those patients who had got the influenza vaccine last year felt more satisfied with the vaccine and accepted the COVID-19 vaccine easier than others.Conclusion: This study revealed that there was an inverse correlation between fear of coronavirus and less trust in the vaccine in patients with MS. However, it should be mentioned that the patients felt more satisfied after COVID-19 vaccination.
Zahra Ebadi; Abdorreza Naser Moghadasi
Volume 21, Issue 4 , October 2022, , Pages 251-255
Fardin Nabizadeh; Mohammad Balabandian; Mohammad Reza Rostami; Mahsa Owji; Mohammad Ali Sahraian; Maryam Bidadian; Fereshteh Ghadiri; Nasim Rezaeimanesh; Abdorreza Naser Moghadasi
Volume 21, Issue 3 , July 2022, , Pages 144-150
Abstract
Background: Cognitive impairments in patients with multiple sclerosis (MS) are suggested as a prognostic factor for disease development, and consequently higher disability and more deficits in daily and social activities. In this regard, we aimed to investigate the association between quality of life ...
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Background: Cognitive impairments in patients with multiple sclerosis (MS) are suggested as a prognostic factor for disease development, and consequently higher disability and more deficits in daily and social activities. In this regard, we aimed to investigate the association between quality of life (QOL) and cognitive function in patients with MS.Methods: We conducted a cross-sectional study on patients with relapsing-remitting MS (RRMS). General characteristic variables were carried out, and then all patients underwent assessments such as Multiple Sclerosis Quality of Life-54 (MSQOL-54), Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS), Expanded Disability Status Scale (EDSS), Beck Depression Inventory-II (BDI-II), and North American Adult Reading Test (NAART).Results: In the present study, a total of 92 patients, including 76 women with a mean disease duration of 6.82 ± 4.80 years were involved. Results of simple Pearson correlation revealed a significant positive relation between California Verbal Learning Test (CVLT) total learning with MSQOL mental health (r = 0.267, P = 0.017) and physical health (r = 0.299, P = 0.007). After adjusting for potential confounders, there was a negative correlation between MSQOL mental health with Delis-Kaplan Executive Function System (D-KEFS) (r = -0.303, P = 0.015) and Judgment of Line Orientation (JLO) (r = -0.310, P = 0.013). Besides, MSQOL physical health was negatively associated with Brief Visuospatial Memory Test-Revised (BVMT-R) in the adjusted model (r = -0.270, P = 0.031).Conclusion: There is a statistically significant association between specific aspects of cognitive decline and QOL. Therefore, more attention should be paid to cognitive impairment in patients with MS as based on our findings, it is significantly associated with QOL.
Fereshteh Ghadiri; Mohammad Ali Sahraian; Amirreza Azimi; Abdorreza Naser Moghadasi
Volume 21, Issue 3 , July 2022, , Pages 151-155
Abstract
Background: Now that the majority of the population has been immunized with two-dose vaccines, debates over the third booster dose have been raised. We studied the viewpoint of cases with multiple sclerosis (MS) on this matter.Methods: In a cross-sectional study, a google form containing questions about ...
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Background: Now that the majority of the population has been immunized with two-dose vaccines, debates over the third booster dose have been raised. We studied the viewpoint of cases with multiple sclerosis (MS) on this matter.Methods: In a cross-sectional study, a google form containing questions about participants’ characteristics, the history of coronavirus disease 2019 (COVID-19) infection and vaccination, and opinions on the third dose was designed.Results: Of 1067 responders, only 16 (1.5%) were not vaccinated at all. The most used vaccine type was Sinopharm BBIBP COVID-19 vaccine (BBIBP-CorV) (n = 1002, 93.9%). Generally, 58 (5.4%) cases were hospitalized due to COVID-19. Of those with full vaccination, 134 (13.3%) got COVID-19 infection after the second dose. Only 13 participants (1%) did not agree with the third dose, while 564 (53.0%) believed that a booster dose was needed. Of all, 488 (45.7%) declared that they did not have a final idea and would follow the instructions by the experts. A significant association was found between not receiving the first two doses and not believing in the third dose (P = 0.001). 692 patients declared their reasoning for the importance of the third dose. All the cases who thought the administered vaccine was not efficient enough had received Sinopharm BBIBP-CorV. Those who got infected after full vaccination were more uncertain about the efficacy of the vaccine [odds ratio (OR): 2.6, 95% confidence interval (CI): 1.6-4.2].Conclusion: It seems that the majority of the Iranian patients with MS expect the authorities to administer a third booster dose, especially if scientifically validated.
Nasim Rezaeimanesh; Roghayyeh Saeedi; Mohammad Ali Sahraian; Fereshteh Ghadiri; Abdorreza Naser Moghadasi
Abstract
Background: Cognitive dysfunction is one of the problems that patients with neuromyelitis optica spectrum disorder (NMOSD) suffer from. We aimed to assess the association between demographic and clinical features as well as body mass index (BMI) and cognitive function in patients with NMOSD.Methods: ...
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Background: Cognitive dysfunction is one of the problems that patients with neuromyelitis optica spectrum disorder (NMOSD) suffer from. We aimed to assess the association between demographic and clinical features as well as body mass index (BMI) and cognitive function in patients with NMOSD.Methods: A cross-sectional study was performed on 41 patients with definite diagnosis of NMOSD. Serum status of neuromyelitis optica immunoglobulin G (NMO-IgG) was determined using enzyme-linked immunosorbent assay (ELISA) method. Cognitive function was assessed by Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery which is validated for Persian people before and North American Adult Reading Test (NAART).Results: The mean score of NAART test was higher in participants with normal weight compared with overweight patients (40.47 ± 3.51 vs. 36.00 ± 5.74, P = 0.02). Current age was negatively correlated with Delis-Kaplan Executive Function System (D-KEFS)-Sorting (P = 0.05, r = -0.30). The correlation of duration of disease and cognitive performance was not significant (P > 0.05). Higher physical disability based on Expanded Disability Status Scale (EDSS) was correlated with lower results in Brief Visuospatial Memory Test-Revised (BVMT-R) (P < 0.01, r = -0.50), California Verbal Learning Test-second edition (CVLT-II)-Delayed Recall (P = 0.02, r = -0.35), and Symbol Digit Modalities Test (SDMT) (P = 0.03, r = -0.33) subtests of MACFIMS. Annual relapse rate was indirectly correlated with CVLT-II (P = 0.03, r = -0.34) and CVLT-II-Delayed Recall (P = 0.01, r = -0.38). Male participants obtained better scores in Paced Auditory Serial Addition Test (PASAT) subtest (P = 0.05). NMO-IgG seropositive patients had poorer performance in terms of CVLT-II-Delayed Recall, Controlled Oral Word Association Test (COWAT), and D-KEFS-Descriptive (P < 0.05). Participants with bachelor and master education degrees showed significantly better results compared to those with high school degree (P < 0.05).Conclusion: Investigating the clinical and demographic factors affecting cognitive impairment can increase the awareness of health care providers for early diagnosis of cognitive impairment in patients with NMOSD and increase the quality of health services.
Marzieh Mahboobi; Abbas Khashandish; Abdorreza Naser Moghadasi; Mohammad Ali Sahraian; Maryam Bahrami-Hidaji; Farnaz Etesam
Abstract
Background: Depression and anxiety are the most prevalent psychological symptoms in patients with multiple sclerosis (MS) and have a significant impact on quality of life (QOL) and disability progression in the patients. Therefore, it is very important to find ways to reduce the impact of these disorders ...
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Background: Depression and anxiety are the most prevalent psychological symptoms in patients with multiple sclerosis (MS) and have a significant impact on quality of life (QOL) and disability progression in the patients. Therefore, it is very important to find ways to reduce the impact of these disorders on patients with MS. The data suggest that self-disclosure may be beneficial in improving symptoms of depression and anxiety in many chronic diseases. Due to the scarcity of related studies, this cross-sectional research aimed to evaluate the relations between self-disclosure, anxiety, and depression in patients with MS. Methods: 112 patients with MS from several referral outpatient MS clinics participated in the study. Data were extracted using socio-demographic questionnaire to determine clinical variables and patient characteristics, Distress Disclosure Index (DDI) to assess self-disclosure, Hospital Anxiety and Depression Scale (HADS) to evaluate mood states, and Kurtzke Expanded Disability Status Scale (EDSS) recorded by an experienced neurologist. Results: Multiple linear regression analysis with controlling disease variables demonstrated distress disclosure as an independent factor to predict anxiety and depression in the patients (P < 0.05). Results also presented a significant, positive relationship between hospitalization history and disability levels with anxiety and depression. These findings clearly state that these two variables can accurately predict a heightened state of anxiety and depression in patients with MS. Conclusion: This study provides empirical support for the positive role of disclosure in decreasing the negative emotions in MS. Further studies are needed to clarify the effects of disclosing MS in different cultural and situational contexts.
Sharareh Eskandarieh; Mohammad Ali Sahraian; Abdorreza Naser Moghadasi
Abstract
Background: The national multiple sclerosis (MS) registry is aimed at monitoring and improving quality of care and providing feedback to improve health outcomes by systematic recording of data. In 2018, the nationwide MS registry of Iran (NMSRI) was initiated for collecting epidemiological data and information ...
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Background: The national multiple sclerosis (MS) registry is aimed at monitoring and improving quality of care and providing feedback to improve health outcomes by systematic recording of data. In 2018, the nationwide MS registry of Iran (NMSRI) was initiated for collecting epidemiological data and information on health care provision for patients with MS. The aim of the current study was to introduce the role of implementing coronavirus disease 2019 (COVID-19) scale-up registry protocol in NMSRI and arrange the national MS generality with information obtained during the COVID-19 pandemic. Methods: The NMSRI group set up a program with crucial elements to collect the data of patients with MS who developed COVID-19. All MS cases with confirmed diagnosis of COVID-19 were enrolled in this study. New elements were considered to be added into the dataset, including demographic characteristics, definite diagnosis of COVID-19 and its symptoms, history of comorbidities, history of medications and hospitalization, changes in magnetic resonance imaging (MRI), and infection outcomes. Results: The COVID-19 data collection program was designed in NMSRI to collect data of MS cases with COVID-19 infection. The data collection protocol was explained to neurologists through an online training workshop. To the date of the study, 21 centers from 17 provinces of Iran were involved in the COVID-19 databases promoting NMSRI and 612 participants were registered successfully. Conclusion: We extended an agreement on data collection and developed it in NMSRI with various contributors to discover a critical need for COVID-19 awareness and monitor clinical training in MS.
Fereshteh Ghadiri; Mohammad Ali Sahraian; Abdorreza Naser Moghadasi
Nasim Rezaeimanesh; Shadi Ariyanfar; Mohammad Ali Sahraian; Abdorreza Naser Moghadasi; Zeinab Ghorbani; Soodeh Razegh-Jahromi
Abstract
Background: The environmental risk factors of neuromyelitis optica spectrum disorder (NMOSD) are not fully specified.Regarding the evidence on the possible protective effects of whole grains and legumes against inflammatory disorders, we examined the association between the mentioned dietary components ...
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Background: The environmental risk factors of neuromyelitis optica spectrum disorder (NMOSD) are not fully specified.Regarding the evidence on the possible protective effects of whole grains and legumes against inflammatory disorders, we examined the association between the mentioned dietary components and NMOSD. Methods: 70 patients with NMOSD with definite diagnosis and 164 hospital-based controls were included in this case-control investigation. Data on demographic, clinical, and anthropometric characteristics were collected. Dietary habits of participants were assessed using a previously validated food frequency questionnaire (FFQ) containing 168 food items. Daily intakes of whole grains and legumes were calculated and classified in quartiles. The odds of suffering from NMOSD according to the quartiles of whole grains and legumes were measured in the form of logistic regression models. Results: The mean amount of whole grains (115.29 vs. 44.14 g) and legumes (59.43 vs. 34.50 g) consumption was significantly higher in the control group versus the case group. There was a reverse association between whole grains or legumes and NMOSD odds in both models [P < 0.05, odds ratio (OR) < 1]. In the fully-adjusted model, 90% [95% confidence interval (CI): 0.02-0.39] and 92% (95% CI: 0.01-0.52) reduction in NMOSD odds was observed in the third and fourth quartiles of whole grains intake, respectively. Higher intake of legumes in the third and fourth quartiles led to 81% (95% CI: 0.05-0.71) and 95% (95% CI: 0.01-0.27) reduction in the odds of NMOSD, respectively. Conclusion: Aligned with the results of other investigations on inflammatory disorders, our results suggested a negative association between whole grains and legumes and NMOSD odds.
Fereshteh Ghadiri; Mohammad Ali Sahraian; Abdorreza Naser Moghadasi
Hossein Maroufi; Abdorreza Naser Moghadasi; Hossein Rezaei-Aliabadi; Mohammad Ali Sahraian; Sharareh Eskandarieh
Abstract
Background: The association betweenmedical history and primary progressive multiple sclerosis (PPMS) development has not been well documented in the pertinent literature.The possible association between 23 medical diseases and PPMS occurrence was assessed in the present study. Methods: In order to figure ...
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Background: The association betweenmedical history and primary progressive multiple sclerosis (PPMS) development has not been well documented in the pertinent literature.The possible association between 23 medical diseases and PPMS occurrence was assessed in the present study. Methods: In order to figure out the possible association between several medical histories and PPMS occurrence, the present population-based case-control study examined 143 PPMS cases in Tehran, Iran, from 2019 to 2020. Diagnosis of PPMS was confirmed by neurologists based on the 2017 McDonald criteria. Sex-matched healthy controls (n = 143) were selected using the random-digit dialing (RDD) technique. Face-to-face and telephone interviews were conducted for gathering the data. The conditional logistic regression model was used to calculate adjusted and unadjusted odds ratio (OR) at a 95% confidence interval (CI). Results: A significant association was found between PPMS development and diseases like depression (OR = 3.12, 95% CI: 1.49-6.53), migraine (OR = 0.19, 95% CI: 0.05-0.67), infectious mononucleosis (OR = 13.16, 95% CI: 2.74-63.17), hypothyroidism (OR = 3.20, 95% CI: 1.23-8.30), and kidney failure (OR = 3.76, 95% CI: 1.41-9.99). Conclusion: Lifetime history of depression, infectious mononucleosis, hypothyroidism, and kidney failure might increase the risk of PPMS development, while individuals with positive history of migraine disease are at lower risk for developing PPMS.
Mohammad Ali Sahraian; Abdorreza Naser Moghadasi; Sharareh Eskandarieh
Abstract
Background: After intensified economic sanctions against Iran, decreased welfare of patients were more recognizable. The present study was aimed at identifying the challenges and stress level experienced by patients with multiple sclerosis (MS) regarding treatment and health care services in 2018-2019 ...
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Background: After intensified economic sanctions against Iran, decreased welfare of patients were more recognizable. The present study was aimed at identifying the challenges and stress level experienced by patients with multiple sclerosis (MS) regarding treatment and health care services in 2018-2019 after strengthening of economic sanctions against Iran. Methods: A cross-sectional study was conducted on MS patients in Tehran, Iran. A structured questionnaire was designed to measure the main variables addressing the challenges and stress level of MS patients with respect to receiving care and treatment services. Results: In total, 1039 MS patients were enrolled into the study. Among the patients who answered yes to the selected questions, 873 (85.8%) and 837 (86%) were concerned about medicine unavailability and supply and purchase of internationally branded medicine, respectively. Moreover, 671 (70.3%) subjects were concerned about replacing their medicines with cheaper alternatives due to financial problems and 427 (41.4%) were unwilling to continue their treatment due to the economic burden of MS. In total, 795 (82%) were concerned about the effectiveness of Iranian drugs in comparison with internationally branded drugs. Generally, 970 (93.53%) subjects had experienced increased current living costs and 711 had experienced (68.82%) reduced nutrition quality, which (OR: 2.68; 95% CI: 1.99, 3.60) was significantly higher among subjects who had an income of less than or equal to 250 US$ per month Conclusion: The sanctions can impose greater stress and hardship on patients due to the unavailability and costs of medicines. Iran should manage health care quality and provide services to prevent the adverse effects of sanctions on MS patients and guarantee patients’ right to receive well-established medication and health services.
Fatemeh Sadat Asgarian; Ali Keyhani; Abdorreza Naser Moghadasi; Moahammad Ali Sahraian; Farnaz Etesam
Abstract
Background: Considering the high probability of suicidal behaviors in multiple sclerosis (MS) population of other countries and the unlikeliness of its diagnosis in patients with MS by specialists, the current research targets the frequency of suicidal thoughts and mood symptoms in a group of patients ...
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Background: Considering the high probability of suicidal behaviors in multiple sclerosis (MS) population of other countries and the unlikeliness of its diagnosis in patients with MS by specialists, the current research targets the frequency of suicidal thoughts and mood symptoms in a group of patients with MS in Iran. Also, we investigated the relationships among suicidal thoughts, anxiety, depression, anticipated stigma, social support, some disease characteristics, and sociodemographic factors. Methods: A sample of 276 subjects were selected from community-based MS clinics and referral out-patient MS clinic of Sina Hospital affiliated to Tehran University of Medical Sciences, Tehran, Iran. Participants completed the Patient Health Questionnaire (PHQ), the Hospital Anxiety and Depression Scale (HADS), the Chronic Illness Anticipated Stigma Scale (CIASS), the Multidimensional Scale of Perceived Social Support (MSPSS), and a personal information questionnaire. Results: 36.2% of the participants had suicidal thoughts. Suicidal ideation was significantly more likely among people who reported higher anxiety and depression scores or anticipated stigma from their friends and families. Women and patients with higher education experienced suicidal ideation more frequently than others. Conclusion: The importance of comorbidities of suicidal thoughts with anticipated stigma, depression, and anxiety in patients with MS, emphasizing the need for paying attention to it, and considering effective therapeutic interventions focused on alleviating perceived stigma as well as mood symptoms.
Sama Bitarafan; Elmira Karimi; Abdorreza Naser Moghadasi; Razieh Sadat Kazemi-Mozdabadi; Zinat Mohammadpour; Mohammad Ali Sahraian
Abstract
Background: Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) with the most common complaint of fatigue. A high number of patients with MS are interested in taking dietary supplements as a complementary therapy. We propose a specially formulated supplement for patients ...
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Background: Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) with the most common complaint of fatigue. A high number of patients with MS are interested in taking dietary supplements as a complementary therapy. We propose a specially formulated supplement for patients with MS and aim to evaluate its effects on fatigue. Methods: This study was a triple-blind, randomized, placebo-controlled trial using a stratified randomization method according to sex. 46 eligible patients participated in the study, 23 in the placebo group and 23 in the intervention group. The intervention group received two capsules of multivitamin-mineral (MVM) daily for 3 months. Measurements of fatigue and cytokines were performed in all patients at the baseline and after the 3-month intervention Results: Finally, information of 41 participants was used for data analysis. However, fatigue was decreased after supplementation than before, in the intervention group (P = 0.005). There was no significant difference (P = 0.090) between the change of fatigue score in the MVM group (-3.00 ± 4.42) and the control group (-0.40 ± 5.14). Among cytokines, Interleukin 4 (IL-4) significantly increased in the intervention group compared to the placebo (P = 0.030). Conclusion: Our study showed that the present MVM probably could improve the inflammatory state and fatigue in patients with MS.
Soodeh Razeghi-Jahromi; Rozita Doosti; Zeinab Ghorbani; Roghayyeh Saeedi; Maryam Abolhasani; Naeemeh Akbari; Fatemeh Cheraghi-Serkani; Abdorreza Naser Moghadasi; Amirreza Azimi; Mansoureh Togha; Mohammad Ali Sahraian
Abstract
Background: Among multiple sclerosis (MS) related symptoms and complications, fatigue might impact roughly 90% of patients. Decline in cognitive function is one of the other complications that occur in the first years after disease onset. The Mediterranean diet is one of the well-known anti-inflammatory ...
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Background: Among multiple sclerosis (MS) related symptoms and complications, fatigue might impact roughly 90% of patients. Decline in cognitive function is one of the other complications that occur in the first years after disease onset. The Mediterranean diet is one of the well-known anti-inflammatory dietary approaches. Therefore, this study aimed to explore the effects of a modified Mediterranean-like diet on cognitive changes and fatigue levels in comparison with a conventional standard diet over a 1-year follow-up. Methods: In the current single-blind randomized controlled trial, 34 MS patients in the Mediterranean- like diet group and 38 patients in the standard healthy diet group were studied for 1 year. The dietary interventions were modified each month by an expert nutritionist. MS-associated fatigue level was evaluated using the Modified Fatigue Impact Scale (MFIS). Cognitive assessment was also performed using Minimal Assessment of Cognitive Function in MS (MACFIMS). Results: Intergroup comparisons demonstrated that after considering confounding variables in ANCOVA, fatigue scores appeared significantly lower in patients who were treated with the Mediterranean-like diet than those in the standard healthy diet group [Mean 95% confidence interval (CI)}: 33.93 (32.97-34.89) and 37.98 (36.99-38.97), respectively; P < 0.001]. However, the intergroup analysis of cognitive status only showed a difference in the mean score of Brief Visuospatial Memory Test-Revised (BVMT-R) subtest of the MACFIMS. The BVMT-R was higher among standard healthy diet patients compared to the Mediterranean-like diet group after the intervention following adjustment for covariates [Mean (95% CI): 23.73 (21.88-25.57) and 20.56 (18.60-22.51), respectively; P = 0.020]. Conclusion: In conclusion, the results of this study highlighted the higher protective effects of the Mediterranean-like diet against MS-related fatigue than the standard healthy diet. However, no significant improvement was observed in the cognitive status of MS patients after a 1-year treatment with the Mediterranean-like diet. More randomized clinical trials with larger sample sizes are needed to elucidate the effects of dietary modifications on MS-associated symptoms and complications.
Abdorreza Naser Moghadasi
Volume 18, Issue 4 , December 2019, , Pages 190-191
Abstract
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Sharareh Eskandarieh; Abdorreza Naser Moghadasi; Mohammad Ali Sahraian; Amir Reza Azimi; Negar Molazadeh
Volume 18, Issue 3 , August 2019, , Pages 93-98
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a neuroinflammatory demyelinating disease caused by the presence of a highly specific serum autoantibody marker, NMO-immunoglobulin G (NMO-IgG), that reacts against the water channel aquaporin-4 (AQP4). The present study examined the association ...
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Background: Neuromyelitis optica spectrum disorder (NMOSD) is a neuroinflammatory demyelinating disease caused by the presence of a highly specific serum autoantibody marker, NMO-immunoglobulin G (NMO-IgG), that reacts against the water channel aquaporin-4 (AQP4). The present study examined the association between NMO-IgG sero-positivity and environmental factors such as cigarette smoking.
Methods: A cross-sectional study was conducted in Sina Hospital, a tertiary referral center in Tehran, Iran. All the patients with a definite diagnosis of NMOSD were involved in this study. The enzyme-linked immunosorbent assay (ELISA) was used to examine the AQP4-IgG status. To assess the association between NMO-IgG sero-positivity and cigarette smoking, a researcher-made questionnaire covering patients’ lifestyle information on smoking habits was designed and administered using the structured face-to-face interviews with the patients.
Results: The positive and negative NMO-IgG results were found in 44 (46.8%) and 50 (53.2%) patients, respectively. The increased NMO-IgG sero-positivity odds were observed among the lifetime smokers [odds ratio (OR) = 3.24, 95% confidence interval (CI): 1.16-9.08], current smokers (OR = 6.08, 95% CI: 1.26-29.39), and passive smokers (OR = 2.22, 95% CI: 1.10-4.50).
Conclusion: Lifetime and current smoking as well as passive smoking can be regarded as risk factors for NMO-IgG sero-positivity. Smoking with its immunological effects can lead to the production of autoantibodies such as NMO-IgG.
