Aims
Obstructive sleep apnea (OSA) is characterized by episodic sleep state–dependent upper airway collapse. OSA can markedly decrease quality of life (QoL) and productivity. Continuous Positive ...Airway Pressure (CPAP) has been used as an effective treatment for OSA. Recently, uvulopalatopharyngoplasty (UPPP) treatment has emerged as effective management among patients with OSA, especially non-adherent ones to conventional therapies such as CPAP. Our aim was to determine whether CPAP and UPPP treatment could improve the quality of life in patients with moderate OSA.
Design
Prospective.
Setting
Patients with moderate OSA, confirmed by polysomnography from March 2019 to March 2020, participated. CPAP and UPPP treatments were considered for patients according to their preferences. The Sleep Apnea Quality of Life Index (SAQLI) questionnaire before and after treatment was completed.
Methods
Change in their QoL was compared between the CPAP group and UPPP treatment. In addition, QoL was compared between these groups and patients who did not receive any of these treatment methods.
Results
Seventy-eight patients were included in treatment groups, 40 using CPAP and 38 undergoing UPPP treatment. Furthermore, 10 patients who did not receive treatment were considered the control. Both methods of treatment significantly (p < 0.001) improved QoL, but UPPP treatment was superior (p = 0.042) to CPAP. There was a poor correlation between post-treatment BMI (0.037), Respiratory Disturbance Index (RDI) (0.096), age (0.022), and post-treatment SAQLI score.
Conclusion
Based on these results, CPAP and UPPP treatment can improve QoL. UPPP treatment could be considered an effective arm of OSA management among the study population.
There is often a fear of social stigma experienced by people with multiple sclerosis (pwMS), which negatively impacts the quality of their lives (QoL). Currently, no Persian-validated questionnaire ...is available to assess this issue in pwMS. This study aimed to assess the validaty and reliability of the Persian version of Reece Stigma Scale Multiple Sclerosis (RSS-MS) questionnaire for pwMS.
This cross-sectional was conducted between January and February 2023 in Isfahan, Iran. The demographic and clinical information and the RSS-MS and Multiple Sclerosis Impact Scale-29 (MSIS-29) questionnaires were recorded from pwMS. The content validity index (CVI) and content validity ratio (CVR) have been used to evaluate validity. To identify the factors supporting the MS-related stigma, an exploratory factor analysis (EFA) was conducted.
The present study recruited 194 pwMS. Based on factor analysis, only two factors had eigenvalues ≥ 1.0 and exhibited high internal consistency. The Cronbach's α coefficient for internal consistency of the RSS-MS scale was 0.822. More evidence for the construct validity suggested that having higher levels of stigma is significantly correlated with psychological (r = 0.468, p-value < 0.001) and physical dimensions (r = 0.585, p-value < 0.001) of MSIS-29. Expanded Disability Status Scale, disease duration, and treatment duration did not show a significant correlation with stigma (p-value > 0.05).
This study indicated that the modified version of the RSS-MS scale in the Persian language showed acceptable validity and reliability for evaluating the stigma among Persian pwMS. Furthermore, this study emphasizes the cruciality of monitoring and addressing stigma among pwMS, as it can potentially enhance medical, psychological, physical, and QoL outcomes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Depression and anxiety are commonly observed in people with multiple sclerosis (pwMS). There is a growing body of literature supporting the hypothesis that personality traits can influence the mood ...disorders. This study aimed to investigate the personality traits and their relationships with depression and anxiety among pwMS.
234 pwMS were involved in this cross-sectional study. Personality traits, depression, and anxiety were assessed using the NEO Five-Factor Inventory (NEO-FFI) and Hospital Anxiety and Depression Scale (HADS), respectively. Pearson's correlation coefficient and generalized linear model were employed to evaluate the relationships between demographic and clinical characteristics, NEO-FFI, and HADS subscales.
In pwMS, longer disease duration was significantly associated with lower level of conscientiousness (β = - 0.23, p = 0.008) and agreeableness (β = - 0.2, p = 0.01). Moreover, higher expanded disability status scale (EDSS) of pwMS had a significant relationship with higher level of neuroticism (β = 0.89, p = 0.01). Increased level of neuroticism was significantly correlated with lower level of extraversion (r = - 0.28, p < 0.001), openness (r = - 0.37, p < 0.001), agreeableness (r = - 0.31, p < 0.001), and conscientiousness (r = - 0.45, p < 0.001). PwMS with higher level of conscientiousness showed more extraversion (r = 0.23, p < 0.001), openness (r = 0.61, p < 0.001), and agreeableness (r = 0.41, p < 0.001). Elevated level of neuroticism was significantly associated with higher level of anxiety (β = 0.47, p < 0.001) and depression (β = 0.11, p < 0.001) among pwMS.
The co-occurrence of depression and anxiety is probably associated with neuroticism among pwMS. Additionally, the impact of personality traits extends to influencing key disease aspects such as physical disability and disease duration in MS.
Abstract
Background
Parkinson's disease (PD) is one of the most common neurodegenerative conditions in the world and, when combined with dementia, can lead to immense cerebral volume loss. Of ...significant importance among all cerebral regions, is the hippocampus. This region plays a pivotal role in memory, and understanding its pathological alterations can answer vital questions regarding dementia. As such, we designed this study to compare the hippocampal volumes of PD patients with dementia (PDD) versus PD without dementia.
Methods
PubMed, Web of Science, Scopus, and Embase were searched for relevant studies. We also searched the references sections of all included studies. The original search began in March 2022 and was extended to the end of July 2022. All related data were extracted from the studies. If the studies were conducted on patients from comparable patient groups, the most recent study with the most extensive data set would be included.
Results
A statistically significant difference was observed comparing the raw hippocampal volumes in participants with PDD and PD (
p
value = 0.01). In a comparison of normalized hippocampal volume between PDD and PD, there was a statistically significant difference (
p
value < 0.01), as well.
Conclusion
Although further research is required to illuminate the temporal relation between the onset of dementia and hippocampal atrophy in demented PD individuals, the present study highlights the importance of utilizing volumetric studies on memory‐related cerebral regions to diagnose the initiation of dementia in the early stages.
Key points
The present study highlights the importance of utilizing volumetric studies on memory‐related cerebral regions to diagnose the initiation of dementia in the early stages. Compare the hippocampal volumes between Parkinson's disease patients with and without dementia.
•MS patients were at a higher risk of COVID-19 infection following vaccination compared to other neurological disorders (OND) patients.•NMOSD patients had a higher risk of COVID-19 infection after ...vaccination than OND patients.•The safety profile of COVID-19 vaccination in CNS demyelinating diseases seems to be similar to that in OND.•Serological monitoring and supplementary doses of CVOID-19 vaccine are recommended in MS and NMSOD patients.
Vaccination constitutes a crucial preventive measure against COVID-19 infection. Concerns have been raised regarding the efficacy of vaccines in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients due to various immunomodulatory medications and potential adverse events that may impact neurological function. This study aimed to explore the implications of COVID-19 vaccination within MS and NMSOD patients and compare it with other neurological disorders (OND).
In this cross-sectional study conducted in Isfahan, Iran, baseline data and information on COVID-19 infections and vaccinations were collected from MS, NMOSD, and OND patients between September 2021 and September 2022. The predominant neurological disorders identified among OND patients encompassed headache, epilepsy, and Parkinson’s disease. Logistic regression analysis was employed to compare COVID-19 vaccination outcomes among different patient groups, presenting odds ratios (OR) with 95% confidence intervals (CI).
The study included 1,307 participants, with 738 having MS, 96 having NMOSD, 76 having clinically isolated syndrome (CIS), and 397 having OND. Significantly higher odds of post-vaccination COVID-19 infection were detected in MS (OR = 3.86, p < 0.001) NMOSD (OR = 2.77, p = 0.015) patients than OND patients. The prior history of COVID-19 infection and the type of vaccine administered did not demonstrate significant associations with the likelihood of post-vaccination COVID-19 infection in MS and NMOSD patients (p > 0.05 for all). There were no significant differences in the rates of adverse events in MS, NMOSD, and OND patients, except the second dose, where NMOSD patients had lower odds than OND patients (OR = 0.55, p = 0.019).
Although the safety profile of COVID-19 vaccination in MS and NMOSD was similar to that in OND, the rates of post-vaccination COVID-19 infection in MS and NMOSD seem higher than OND. These findings highlight the importance of regular serological monitoring and the potential advantages of supplementary vaccine doses in MS and NMOSD patients.
Background: Rituximab, a monoclonal antibody that targets and eliminates CD20+ B cells, has shown effectiveness in decreasing disease activity in patients with multiple sclerosis (pwMS). This study ...aimed to investigate disability, motor function, and volumetric magnetic resonance imaging (MRI) changes after one-year rituximab administration in secondary progressive MS (SPMS) patients. Methods: This longitudinal prospective study was conducted from January 2019 to October 2020 on SPMS patients undertreatment with rituximab at the Kashani MS Clinic in Isfahan, Iran. Expanded Disability Status Scale (EDSS), timed 25- feet walk test (T25-FW), and 9-hole Peg test (9-HPT) were utilized to evaluate the disability status. All patients underwent disability assessment tests and brain MRI at the baseline and after one-year rituximab treatment. MRI measurements such as lesion load, cortical atrophy, and spinal cord atrophy at C2-C3 levels were assessed with the Siemens 1.5-tesla Avanto MRI machine. The Spearman correlation was performed to determine the association between disabilities and volumetric MRI factors. Results: 31 pwMS were included (39.9±6.9 years, 64.5% females). PwMS receiving rituximab experienced stable MRI volumetric parameters, disability, and motor function. Deep white matter lesion volume was increased during follow-up (0.26±0.19 at baseline to 0.38±0.29 one year later). The mean EDSS, T25-FW, and 9-HPT did not change significantly after treatment with rituximab within 12 months (p > 0.05). Significant correlations were found between the white, gray matter volumes and the 9-HPT test of the left and right hand at follow-up (p < 0.05), as well as the T25-FW and the C1-C2 cross-sectional area at baseline (r=-0.444, p=0.016). Conclusion: As a result of the administration of rituximab, disability, brain atrophy, cervical spinal cord area, and lesion load did not change significantly during 12 months in SPMS. The role of rituximab in SPMS management needs further research with longer follow-up.
Studies have demonstrated that people with multiple sclerosis (pwMS) experience visual impairments and neurodegenerative retinal processes. The disability progression in pwMS may be associated with ...retinal changes assessed with optical coherence tomography (OCT). This meta-analysis aims at synthesizing the correlations between OCT measurements of disability in pwMS.
We systematically searched four databases (PubMed/MEDLINE, Embase, Scopus, and Web of Science) from inception to November 2022, then conducted a meta-analysis using a random effects model to determine the pooled correlation coefficient(r) between OCT measurements and disability scales by R version 4.2.3 with the meta version 6.2-1 package.
From 3129 studies, 100 studies were included. Among 9051 pwMS, the female-to-male ratio was 3.15:1, with a mean age of 39.57 ± 6.07 years. The mean disease duration and Expanded Disability Status Scale (EDSS) were 8.5 ± 3.7 and 2.7 ± 1.1, respectively. Among the pooled subgroup analyses, macular ganglion cell inner plexiform layer (mGCIPL) in patients with relapsing-remitting (pwRRMS) and peripapillary retinal nerve fiber layer (pRNFL) in patients with progressive MS (pwPMS) had strong correlations with EDSS, r = -0.33 (95% CI: -0.45 to -0.20, I
= 45%, z-score = -4.86, p < 0.001) and r = -0.20 (95% CI:-0.58 to 0.26, I
= 76%, z-score = -0.85, p = 0.395), respectively. According to subgroup analysis on pwMS without optic neuritis (ON) history, the largest correlation was seen between EDSS and macular ganglion cell complex (mGCC): r = -0.39 (95% CI: -0.70 to 0.04, I
= 79%, z-score = -1.79, p = 0.073).
OCT measurements are correlated with disability in pwMS, and they can complement the comprehensive neurological visit as an additional paraclinical test.
Systematic review and meta-analysis.
The current study aimed to assess the efficacy and safety of Onabotulinum toxin A (OBTX-A) treatment for neurogenic detrusor overactivity (NDO) in spinal cord ...injury (SCI) patients.
Iran.
All relevant articles of clinical trials and cohort studies indexed in PubMed/MEDLINE, Embase, Scopus, and Web of Science databases up to September 6, 2022, that addressed OBTX-A treatment for NDO following SCI were included. The quality of eligible studies was evaluated using Cochrane criteria. Also, the weighted mean difference (WMD) was measured with a random-effect model.
Regarding the overall efficacy after OBTX-A treatment in the short term, volume per void (VV) (WMD = 118.8, 95% CI: 90.9-146.7, p < 0.01), incontinence-quality of life (IQoL) (WMD = 24.3, 95% CI: 15.8-32.8, p < 0.01), and maximum cystometric capacity (MCC) (WMD = 144.5, 95% CI: 132.3 to 156.7, p < 0.01) significantly increased, while maximum detrusor pressure during storage (MDP) (WMD = -30.5, 95% CI: -35.9 to -25.1, p < 0.01) showed a significant decrease. Furthermore, compared to the placebo group at the 200-unit dose, there was a significant increase in MCC (WMD = 113.5, 95% CI: 84.7 to 142.3, p < 0.01) and a significant decrease in MDP (WMD = -27.2, 95% CI: -39.2 to -15.1, p < 0.01). Urinary tract infection (UTI), hematuria, and autonomic dysreflexia were the most common side effects, occurring at rates of 29.6%, 14.8%, and 13.4%, respectively.
Our findings highlighted the effectiveness and safety of OBTX-A as a promising treatment of NDO following SCI.
Giant cell tumors of bone (GCTB) are infrequent tumors that usually impact the epiphyses of long bones and uncommonly manifest in the ribs. Herein, we report a case of asymptomatic GCTB directly ...invading the lung tissue.
A 36-year-old man was referred to our emergency department with only left chest pain. Computed tomography revealed a large heterogeneous solid cystic mass in the left lung apex and amorphous calcification and distraction in the posterior part of the left fourth rib. Histological examination also exhibited that the GCTB originated from the rib. The patient underwent an en-bloc resection with no recurrence in his one-year follow-up.
GCTB is characterized by osteoclast-like multinucleated giant cells and can exhibit aggressive local behavior. GCTB in the rib is rare, mainly found in the posterior arc. Radiographic features include lytic lesions with bone remodeling, often seen eccentrically in long bone epiphyses. Aggressive tumors may show cortical destruction and soft tissue extension. Surgery is often recommended for GCTB management, aiming for complete resection with sufficient surgical margins.
The absence of well-defined diagnostic criteria hinders the accurate diagnosis of GCTB, making a comprehensive assessment through radiological and histological examinations crucial. Upon physical examination, GCTB should be considered in the differential diagnosis for mediastinal lesions, regardless of their size. Furthermore, surgical removal can be taken into account as the primary treatment strategy for tumors that originate from the posterior arc of the ribs, such as GCTB.
•GCTB has rare occurrences in atypical sites like the ribs with aggressive behavior.•VATS can be useful in GCTB, providing surgical precision and ensuring tumor removal.•Long-term follow-up is essential for GCTB, given its tendency to recur.
Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are two of the most vicious demyelinating diseases of the central nervous system (CNS), and distinguishing them at baseline ...by means of clinical characteristics can be challenging. Herein, we aimed to systematically review radiological indicators that can distinguish NMO patients from MS patients.
MEDLINE, Scopus, EMBASE, and Web of Science databases were searched online till July 1, 2022, to retrieve relevant investigations. All the studies that reported any diagnostic test accuracy measure on radiological makers to differentiate MS from NMOSD, at baseline, were included. Meta-analyses were conducted on two sets of markers: a) lesions adjacent to the body of a lateral ventricle and in the inferior temporal lobe, and b) lesions adjacent to the body of a lateral ventricle accompanied by inferior temporal lobe lesions, u-fiber, and Dawson's finger type lesions (the combined criteria).
Our meta-analysis on the diagnostic efficiency of lesions adjacent to the body of a lateral ventricle and in the inferior temporal lobe suggests this marker has a mean sensitivity, specificity, PPV, and NPV of 69.75% 95%CI: 58.35% - 78.86%, 96.10% 95% CI: 93.21% - 97.79%, 96.37% 95% CI: 93.54% – 97.98%, and 66.89% 95% CI: 60.92% – 72.36%, respectively. Moreover, the differentiating efficiency of lesions adjacent to the body of a lateral ventricle accompanied by inferior temporal lobe lesions, u-fiber, and Dawson's finger type lesions (the combined criteria) had a mean sensitivity, specificity, PPV, and NPV of 83.66% 95% CI: 76.19% - 89.12%, 90.64% 95% CI: 84.41% - 94.55%, 91.77% 95% CI: 88.07% - 94.39%, and 94.88% 95% CI: 54.57% - 99.65%, respectively.
The finding of this study supports the theory that radiological markers have significant potential in the differential diagnosis of MS and NMOSD at baseline, and when utilized alongside clinical manifestations, can further aid physician distinguish the two conditions.
