Aim/Introduction. This study was carried out to assess the incidence and risk factors of diabetic foot ulcer (DFU). Materials and Methods. In this prospective cohort study in a university hospital, ...all the participants were examined and followed up for new DFU as final outcome for two years. To analyze the data, the variables were first evaluated with a univariate analysis. Then variables with P value < 0.2 were tested with a multivariate analysis, using backward-elimination multiple logistic regression. Results. Among 605 patients, 39 cases had DFU, so we followed up the remaining 566 patients without any present or history of DFU. A two-year cumulative incidence of diabetic foot ulcer was 5.62% (95% CI 3.89–8.02). After analysis, previous history of DFU or amputation OR = 9.65, 95% CI (2.13–43.78), P value = 0.003, insulin usage OR = 5.78, 95% CI (2.37–14.07), P value < 0.01, gender OR = 3.23, 95% CI (1.33–7.83), P value = 0.01, distal neuropathy OR = 3.37, 95% CI (1.40–8.09), P value = 0.007, and foot deformity OR = 3.02, 95% CI (1.10–8.29), P value = 0.032 had a statistically significant relationship with DFU incidence. Conclusion. Our data showed that the average annual DFU incidence is about 2.8%. Independent risk factors of DFU development were previous history of DFU or amputation, insulin consumption, gender, distal neuropathy, and foot deformity. These findings provide support for a multifactorial etiology for DFU.
Multiple sclerosis (MS) is a chronic, predominantly immune-mediated degenerative disease of the central nervous system. Due to prolonged use of immunomodulatory and immunosuppressive medications, ...vaccine hesitancy could be common among MS patients. Our main aim in the current study was to evaluate the willingness and acceptability of COVID-19 vaccination in patients with MS. In our multicenter cross-sectional questionnaire-based clinical study, 892 patients completed the questionnaire between May to June 2021. The questionnaire consisted of demographic data, MS disease-related factors, history of COVID-19 infection/vaccination, and any existing comorbidities. Statistical analysis was performed using SPSS software version 19. Overall, 68% of the participants expressed willingness to be vaccinated. Major causes of vaccine refusal in our patients were the fear of reducing the efficacy of disease modifying drugs (DMDs) upon vaccination as well as distrusting the vaccines and overestimation bias in the power of their innate immunity and potential COVID-19 resistance. Some demographic factors affected vaccination enthusiasm in our study. Our findings did not show significant correlation between the age and comorbidity and vaccine willingness. Only one-third of our patients received their vaccine information from healthcare providers. The majority of them received these data from official broadcasting channels and social media. However, despite several concerns, the willingness of COVD-19 vaccination in the Iranian MS patients is remarkable.
Findings have indicated that increased usage of mobile phones may be concomitant with higher rate of headache attacks due to the low radiofrequency electromagnetic fields (RF-EMF). The aim of this ...study was to determine the effects of low RF-EMF on the treatment outcome in migraine patients.
This cohort study was performed on 114 migraine patients referred to the Neurology Clinic of Golestan Hospital in Ahvaz, Southwest Iran, from September 2014 to March 2015. Patients with migraine were interviewed using a standardized questionnaire exploring mobile phones, Wi-Fi devices and fixed-line telephone use as RF-EMF sources. After 3 months, we determined patients' response to treatment. Generalized estimating equation (GEE) tests were carried out to analyze data, using SPSS version 17.
Out of 114 individuals who participated, 82 (71.9%) were female and 32 (28.1%) cases were male. The number and severity of migraine headaches were correlated significantly with an increased use of mobile phones during day and Wi-Fi per week (p<0.05). The usage of fixed-line telephones had no significant relationship with the study variables (p>0.05).
It is recommended that the patients with migraine headache limit mobile phone use and instead, use the fixed-line telephone for their daily telecommunications.
BACKGROUND:Continuity in multiple sclerosis (MS) care has been cited as a critical feature of this care and necessary to improve medical outcomes.
PURPOSE:This exploratory and descriptive research ...attempts to identify continuity of care from the experience and perspective of patients with MS at two teaching hospitals and the MS Society in Ahvaz, Iran.
METHODS:In this study, 23 patients with MS were selected through purposeful sampling. Data were collected through in-depth and unstructured interviews and were analyzed using an inductive thematic analysis approach.
RESULTS:Four main themes emerged from the analysishuman-oriented attention, the necessity of purposeful planning, importance of responsibility, and caring with empathetic sensing.
CONCLUSIONS/IMPLICATIONS FOR PRACTICE:Because of the importance of professional caring practice to continuity of care for patients with MS, we suggest that healthcare providers should include these aspects in care planning.
•Neuromyelitis Optica Spectrum Disorders is an autoimmune inflammatory demyelinating disease of the central nervous system.•There have been many reports on its association with other disorders ...including systemic and organ specific autoimmune diseases.•Here, we reviewed other immune mediated diseases associated with NMOSD and try to categorize them.
Neuromyelitis Optica (NMO) is an autoimmune inflammatory demyelinating disease of the central nervous system (CNS) which predominantly involves optic nerves and spinal cord. Since the introduction of Neuromyelitis Optica Spectrum Disorders (NMOSD) as a separate entity, there have been many reports on its association with other disorders including systemic and organ-specific autoimmune diseases. Here, we reviewed other immune-mediated diseases associated with NMOSD and tried to categorize them.
The present review was conducted using the PUBMED database based on papers from 1976 (i.e., since the first NMO comorbidity with SLE was reported) to 2017. We included all articles published in English. The keywords utilized included Neuromyelitis optica, Neuromyelitis Optica Spectrum Disorders, Devic's disease, in combination with comorbidity or comorbidities.
Diseases with immune-based pathogenesis are the most frequently reported co-morbidities associated with NMOSD, most of which are antibody-mediated diseases. According to literature, Sjogren's Syndrome (SS) and Systemic Lupus Erythematosus (SLE) are the most frequently reported diseases associated with NMOSD among systemic autoimmune diseases. Further, myasthenia gravis in neurological and autoimmune thyroid diseases in non-neurological organ-specific autoimmune diseases are the most reported comorbidities associated with NMOSD in the literature.
NMOSD may be associated with a variety of different types of autoimmune diseases. Therefore, systemic or laboratory signs which are not typical for NMOSD should be properly investigated to exclude other associated comorbidities. These comorbidities may affect the treatment strategy and may improve the patients' care and management.
Background: Optic neuritis is an inflammation of the optic nerve. Because of importance of vision for human, management of optic neuritis is an important issue in neurology. Objectives: This study ...aimed at assessing the effect of oral steroid treatment after intravenous (IV) methylprednisolone therapy on demyelinating optic neuritis. Materials & Methods: 60 Patients with first episode of acute demyelinating optic neuritis who referred to a neurology clinic in an academic hospital in south-west of Iran in 2015-2016 included in this randomized double-blind clinical trial study (No: IRCT2015102724735N1). They were divided into two groups with (A) and without (B) tapering oral steroid treatment after IV methylprednisolone. Visual acuity and color vision were measured before treatment, before oral tapering, 1 and 3 months after treatment. Independent t-test in SPSS software version 20 was used to analyze the data. P<0.05 was considered as the level of significance. Results: Visual acuity in two groups did not have any significant difference in any time point of assessment (P>0.05).Frequency of color vision abnormality in groups A and B were at baseline (53.3% vs. 56.6%) (P=0.796), before oral tapering (43.3% vs. 30%, P=0.284), 1 month after treatment (23.3% vs. 30%, P=0.559), 3 months after treatment (0% vs. 23%, P=0.011). Conclusion: Oral steroid treatment after IV methylprednisolone pulse therapy improves color vision after 3 months in patients with demyelinating optic neuritis but has no effect on visual acuity.
Background: Migraine is considered as one of the most common and disabling diseases of the nervous system that has a great impact on quality of life (QOL) and a little risk of neurologic ...complications such as stroke. Migraine aura is known to be the result of cortical spreading depression and is associated with higher risk of this complication. Thus, the present study was conducted with the aim to compare the effects of topiramate as an antiepileptic, and propranolol in patients with migraine with aura.
Methods: The present randomized clinical trial was conducted on patients with migraine with aura referred to the neurology clinic of Golestan Hospital, Ahvaz, Iran, in the period of 2019-2020. The patients were randomized into two groups and received either topiramate or propranolol. The Migraine Disability Assessment Scale (MIDAS) score was evaluated before and at the end of three months after initiating the treatment.
Results: Reduction in the MIDAS score in patients taking topiramate (-16.94) was greater than that in the propranolol group (-14.5), but this difference was not statistically significant (P > 0.005). No significant relationship was found between gender and changes in the MIDAS score after the treatment of both groups (P > 0.050). However, the changes in the MIDAS score were greater in younger patients, and this relationship was statistically significant (P < 0.050).
Conclusion: There was no significant difference in the efficacy of topiramate and propranolol in patients with migraine with aura. No significant relationship was found between gender and changes in the MIDAS score after the treatment in both groups, but the reduction in the MIDAS scores was significantly higher in younger patients of both groups.
Evidences from cultured cells and animal models of ischemia suggest that lithium has neuroprotective and neurotrophic effects and may play a desirable role in reducing infarct volume and even ...improving the brain insults from stroke. The aim of this study was to evaluate the efficacy of lithium in early motor recovery of patients after ischemic stroke.
Eighty patients with first ever stroke, allocated randomly in lithium, 300 mg twice daily, or placebo. Treatment was initiated 48 hours after stroke and continued for 30 days. Modified National Institute of Health Stroke Scale (mNIHSS) and hand subsection of Fugl-Meyer Assessment (hFMA) were used to evaluate impairment on the fifth and 30th day of treatment.
Sixty-six subjects (32 subjects in the lithium group and 34 subjects in the placebo group) completed the study. There were no significant differences in the improvement in mNIHSS (P=0.40) and hFMA (P=0.07) after 30 days. However, a subgroup analysis showed that patients with cortical strokes in the lithium group had significantly better improvement in both mNIHSS and hFMA in comparison to the placebo group (P=0.003). Approximately 44% (n=14) of patients in the lithium group, mainly from the cortical stroke subgroup, regained more than 25% of full function based on hFMA, whereas this rate in the placebo group was 14.7% (n=5; P=0.009).
The observed discrete difference between the lithium group and the placebo group in the cortical stroke subgroup may suggest an enhanced motor recovery after stroke by using an early treatment with a low dose of lithium carbonate. However, a larger trial with more patients with cortical stroke is needed to investigate this effect better.
Studies have shown an increase in the incidence of MS in Iran. The aim of our study was to evaluate the relationship between environmental exposure and MS in Iran. This case-control study was ...conducted on 660 MS patients and 421 controls. Many environmental factors are compared between the two groups. Our findings demonstrated that prematurity (OR = 4.99 (95% CI 1.34–18.68),
P
= 0.017), history of measles and mumps (OR = 1.60 (95% CI 1.05–2.45),
P
= 0.029; OR = 1.85 (95% CI 1.22–2.78),
P
= 0.003, respectively), breast feeding OR = 2.90 (95% CI 1.49–5.65),
P
= 0.002, head trauma in childhood (OR = 8.21 (95% CI 1.56–43.06),
P
= 0.013), vaccination in adulthood (OR = 4.57 (95% CI 1.14–18.41),
P
= 0.032, respectively), migraine (OR = 3.50 (95% CI 1.61–7.59),
P
= 0.002), family history of MS, IBD, migraine, and collagen vascular diseases (OR = 2.73 (95% CI 1.56–4.78),
P
< 0.001, OR = 3.14 (95% CI 1.460–6.78),
P
= 0.004; OR = 3.18 (95% CI 1.83–5.53),
P
< 0.001; OR = 1.81 (95% CI 1.03–3.20),
P
= 0.040, respectively), stressful events (OR = 32.57 (95% CI 17.21–61.64),
P
< 0.001), and microwave exposure (OR = 3.55 (95% CI 2.24–5.63),
P
≤0.001) were more in the MS group. Sun exposure (OR = 0.09 (95% CI 0.02–0.38),
P
= 0.001), dairy and calcium consumption (OR = 0.44 (95% CI 0.27–0.71),
P
= 0.001), diabetes mellitus (OR = 0.11 (95% CI 0.01–00.99),
P
= 0.049, and complete vaccination during childhood appeared to decreased MS risk. Our results investigated many risk factors and protective factors in Iran.
•Western Europe had the highest prevalence of MS during 1990 to 2017.•The Middle East North Africa (MENA) region had an increasing trend for MS incidence during 1990 to 2017.•The age group of 25–29 ...years had the highest risk of MS in all regions during 1990 to 2017.Females had higher incidence, prevalence, and DALY of MS compare to males in all regions during 1990 to 2017.•The incidence of MS in Iran was constantly increasing during 1990 to 2017 and surpassed Western Europe since 2013.
Multiple sclerosis (MS) is the most common immune mediated disorder of the central nervous system (CNS). This study compares the worldwide occurrence and epidemiologic burden of MS in the Middle East and Northern Africa (MENA) region and Western Europe from 1990 to 2017.
This study used data from the global burden of disease (GBD) studies. Initially, all age and age-specific values were estimated and then, these values were compared among the mentioned areas. In addition, the changes of sex distribution of MS according to incidence, prevalence, and disability-adjusted life years (DALYs) were calculated. The trend of MS incidence was also compared among the MENA region countries.
According to MS incidence per 100,000 populations during 1990 to 2017, the occurrence of new cases has decreased slightly in the world (from 0.7 to 0.65) and Western Europe (from 2.55 to 2.50). Except Iran with a sharp rise of 2 to 2.8, there was a slow increase in the MENA region (from 0.9 to 1). The MS prevalence, between 1990 and 2017, in all ages was stable in the world and the MENA region except a steady increase in Iran and highest value in Western Europe. In this study, we determined the age-specific incidence of MS in all regions from 1990 to 2017. Although data showed a different trend of changes between age groups and regions, the group age 25–29 years had the highest risk of MS incidence. Based on gender, the incidence, prevalence, and DALY of MS in all regions were higher in female.
From 1990 to 2017, Western Europe had the highest MS prevalence and the MENA region had a relatively stable trend for MS incidence. In particular, in Iran, the MS incidence has been constantly increasing and has surpassed Western Europe since 2013.
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