Epidemiology of multiple sclerosis in Iran: A systematic review and meta-analysis

Understanding the meaning of the lived experience "maternal role" in women with multiple sclerosis and planning a supportive program: a combined exploratory study protocol

BACKGROUND

The maternal role is one of the most challenging yet rewarding roles that women experience in their lives. It begins when a woman becomes pregnant, and as the pregnancy progresses, she prepares to fulfill her role as a mother. A woman's health plays a crucial role in her ability to fulfill the maternal role. Multiple sclerosis (MS), as an autoimmune disease, presents unique challenges in achieving this role. Failing to fulfill the maternal role can have lasting consequences for both the mother and the baby. Given the increasing number of women with MS of reproductive age in Iran and the absence of specific programs for this group during pregnancy and postpartum, researchers have decided to develop a supportive program by exploring the meaning of the maternal role and identifying the needs of these women during this period.

METHODS/MATERIALS

This study will be conducted in 3 stages. The first stage involves a qualitative study to explore the meaning of the "maternal role" in women with MS through a descriptive and interpretive phenomenological approach based on Van Manen's method. Data will be collected through semi-structured interviews with pregnant women with MS and mothers with MS who have children under one-year-old, recruited from the Multiple Sclerosis Society of Mashhad, Iran. The second stage will involve designing a support program based on the findings of the phenomenological study, literature review, and exploratory interviews. A logical model will guide the development of the program, and validation will be conducted using the nominal group technique.

DISCUSSION

This study is the first of its kind in Iran to explore the meaning of the maternal role and develop a support program for women with MS. It is hoped that the results of this study will help address the challenges of motherhood faced by these women.

Prevalence and incidence of multiple sclerosis in Isfahan, Iran between 1996 and 2021: A population-based study

BACKGROUND

There has been no recent comprehensive epidemiological study on a large and stable population of multiple sclerosis (MS) in Isfahan. Therefore, we conducted this study to estimate the incidence and prevalence of MS in Isfahan province from 1996 to 2021.

METHOD

In this population-based study, we utilized the dataset from the Vice-Chancellor's Office of Isfahan University of Medical Sciences, which registers all people diagnosed with MS (PDWM) in Isfahan province, excluding those residing in Kashan city. We measured crude incidence and prevalence of MS, separated by sex, and based on age of MS onset, as well as changes in age of MS onset during observation.

RESULTS

A total of 9,909 PDWM were included in our study. The incidence during the time period of 1996-2000 was 5.4/100,000 (1.1/100,000 per year), which subsequently increased to 14.1 (2.8/100,000 per years) and 31.1 per 100,000 (6.2/100,000 per year) during 2001-2005 and 2006-2010, respectively. There was a further increase to 70.9/100,000 (14.2/100,000 per year) in 2011-2015, but it remained stable at 71.8/100,000 (12/100,000 per year) during the period of 2016-2021. In 2016, the age-standardized incidence rates of pediatric-onset, adult-onset, and late-onset MS were 1.8/100,000, 31.4/100,000, and 17.5/100,000, respectively. The prevalence of MS in 2021 was 183.9/100,000. The female/male new case ratio was 4.5 during 1996-2000, decreasing to 4.0, 3.9, 3.9, and 2.9 in the subsequent four five-year periods. The mean age of RRMS onset was 26.3 ± 8.1 between 1990 and 1999, 28.5 ± 8.3 during 2000-2009, and increased to 32.8 ± 9.6 in 2010-2019.

CONCLUSION

This study shows that Isfahan has one of the highest incidence rate and prevalence ratio of MS in the region. We observed an increase in the incidence rate during the first decade, followed by stability in the last two five- and six-year periods. Further studies are needed to identify the reasons behind the change in incidence of MS in Iran.

Demyelinating plaque-associated uveitis

PURPOSE

To report the clinical and fluorescein angiographic (FA) features of demyelinating plaque-associated uveitis (DPU), a subset of uveitis in which patients have demyelinating plaques on the brain/cervical magnetic resonance image (MRI) but do not meet the criteria for multiple sclerosis (MS).

METHODS

In this retrospective observational study, Persian Patients were diagnosed with DPU and included if (1) they never satisfied the MS criteria, (2) all other possible etiologies were excluded, and (3) they were followed for at least 2 years.

RESULTS

After a median follow-up of 3 years (interquartile range, 2.0-5.3), 8 out of 40 (20%) patients diagnosed with DPU were excluded as they subsequently met the MS criteria. Of remaining 32 patients studied, the mean age was 36.3±9.9 (range 20-56 years), and 30 (93.8%) were female. Twenty-four (75.0%) showed bilateral involvement and 27 (84.4%) had insidious-chronic course. Uveitis was classified as intermediate (with or without anterior uveitis) in 29 (90.6%) and isolated anterior in 3 (9.4%) patients. Nine (28.1%) patients had at least one systemic neurological complaint. Ocular findings were: granulomatous keratic precipitates in 43/44 (97.7%) eyes; snowballs in 25/52 (48.1%) eyes; snowbanks in 4/52 (7.7%) eyes; cystoid macular edema in 20/56 (35.7%) eyes; and optic neuritis in 5/56 (8.9%) eyes. Visual acuity was ≥ 20/40 in 39 eyes (69.6%) at presentation which improved to 46 eyes (81.2%) at 2-year follow up. The two most frequent findings in FA were optic disc leakage/staining in 44/52 (81.5%) eyes, and peripheral retinal perivascular leakage in 39/52 (76.9%) eyes, which in 14/52 (26.9%) eyes extended beyond the equator.

CONCLUSION

DPU usually presents as a bilateral chronic granulomatous intermediate and, less often, isolated anterior uveitis, especially in females. Most are neurologically asymptomatic. Visual outcome is generally favorable. In FA, peripheral retinal perivascular leakage is common. DPU patients have an increased tendency to develop MS and should be prohibited from anti-TNF treatment.

Optical coherence tomography in multiple sclerosis

Background

Multiple sclerosis (MS) is a chronic neurodegenerative disease that damages myelinated fibers within the central nervous system. Data obtained using optical coherence tomography (OCT) have recently been identified as a potential biomarker for this disease. We aimed to measure circumpapillary retinal nerve fiber layer thickness (cpRNFLT) using OCT and to compare the results in healthy participants with those of individuals having clinically definitive MS with and without a history of optic neuritis.

Methods

This cross-sectional study recruited patients with clinically confirmed MS, with and without optic neuritis, and healthy individuals as a control group. We documented demographic characteristics, duration of MS, and time elapsed since the episode of optic neuritis. All participants underwent a thorough ocular examination and measurement of total, superior, and inferior cpRNFLT using swept-source OCT.

Results

In participants with MS, women outnumbered men in the subsets with (90%) and without (64%) optic neuritis. The control group comprised approximately similar numbers of men and women. There was a statistically significant difference in total, superior, and inferior cpRNFLT between study groups (all P < 0.001). Pairwise comparisons revealed significantly thinner total, superior, and inferior cpRNFLTs in patients having MS with and without (all P < 0.001) optic neuritis when compared with the controls. We found significantly higher total, superior, and inferior cpRNFLTs in women than in men (all P < 0.05). However, we found no significant correlation between total, superior, or inferior cpRNFLT and patient age, duration of MS, or time elapsed since the optic neuritis episode (all P > 0.05), except for a significant moderate inverse correlation between patient age and total cpRNFLT (r = - 0.41; P < 0.05), indicating a loss of total cpRNFLT with age.

Conclusions

Patients with clinically confirmed MS, with or without optic neuritis, had a significantly decreased cpRNFLT compared to that of healthy individuals. There was a significant inverse correlation between age and total cpRNFLT and a difference in cpRNFLT between the sexes, indicating that age and sex may influence the measurement of cpRNFLT using OCT in patients with MS. As a screening tool, OCT should be used along with other existing diagnostic modalities for patients with definite or suspected MS. Further longitudinal studies including various classifications of MS with or without isolated episodes of optic neuritis, along with diagnostic accuracy studies, could provide more robust conclusions on the suitability of OCT as a biomarker of MS.

The prevalence of depression and anxiety among Iranian people with multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

There is significant inconsistency regarding the prevalence rate of depression and anxiety among people with multiple sclerosis (MS) in Iran. We sought to conduct this comprehensive meta-analysis to assess the prevalence of depression and anxiety in Iranian multiple sclerosis patients.

METHODS

A systematic search was conducted on 14 March 2023 in PubMed/MEDLINE, Web of Science, Scopus, Embase, and Iranian national databases. All studies assessing the prevalence of depression and anxiety among Iranian people with MS were included. We used the NEWCASTLE-OTTAWA tool for quality assessment. We pooled the prevalence of individual studies using the random effect model.

RESULTS

Our systematic search showed 23 articles that meet the eligibility criteria. Most of the included studies were cross-sectional. The most used questionnaire to assess depression and anxiety were Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS), respectively. The overall prevalence of depression and anxiety among Iranian people with MS was 47% (95%CI: 39%-55%%, I2 =94%) and 51% (95%CI: 36%-66%%, I2 =97%), respectively. The results of subgroup and meta-regression analyses showed assessment scale used and the province was significantly associated with the prevalence of the outcomes. Tehran had the most studies published on this topic. The prevalence of depression and anxiety was highest in Kermanshah province. The funnel plot and Egger's regression test did not show a significant source of funnel plot asymmetry for depression (p-value = 0.8138), and anxiety (p-value = 0.8259).

CONCLUSION

Our study indicates that a significant proportion of people with MS in Iran are affected by depression and anxiety.

Barriers to and Facilitators of Adjustment Among Iranian Multiple Sclerosis Patients: A Qualitative Study

Patients with multiple sclerosis (MS) experience various physical symptoms and psychosocial problems that disrupt their normal life, and adapting to these conditions is vital for them. Many factors that serve as facilitators of and barriers to achieving adjustment should be identified to be able to help the patients. This study was conducted to explain the experiences of patients with MS regarding the facilitators of and barriers to adjustment using conventional content analysis. The participants consisted of 18 patients, one nurse, one physician, and one patient companion, who were selected from the Multiple Sclerosis Clinic of BouAli, northern Iran, through purposive sampling. Data were collected through individual, in-depth, and semi-structured interviews and analyzed using the method recommended by Elo and Kyngäs (2008). The data analysis generated five subcategories as facilitators and five subcategories as barriers. The subcategories of facilitators included family's appropriate behavior with the patient, occupation, studying and information gathering, religious beliefs, and turning attitude into disease simplification and optimism. The subcategories of barriers were concerns about the uncertain future of the disease, physicians' poor communication and behavior, society's poor attitude, economic problems, and unsatisfactory support by the government and insurance companies. The results showed that a set of individual, environmental, and social factors serves as facilitators of or barriers to the process of adjustment to MS in patients. Gaining knowledge about these factors in congruence with the sociocultural context of the society, as derived from people's real experiences, can help healthcare staff and the family of these patients provide more efficient assistance to the patients for achieving adjustment earlier.

Experiences of persons with multiple sclerosis of a collaborative care programme: A qualitative study

AIM

This study aimed to explain the experiences of individuals with multiple sclerosis (MS) about the collaborative care programme.

DESIGN

This qualitative study was conducted from July 2021 to March 2022.

METHODS

We conducted this study with individuals with MS who participated in the collaborative care programme in Hamadan, Iran. A purposive sampling with maximum variety was applied to recruit patients until data saturation. Eventually, 18 patients consented and were interviewed using a semi-structured interview guide. The transcriptions of audio-checked interviews were analysed using a conventional content analysis approach of Graneheim and Lundman by MAXQDA 10, 2010 edition.

RESULTS

The study identified three main categories. that emerged from the participants' experiences of collaborative care: the 'Beginning of Communication', which included two subcategories, 'Introduction and Acquaintance with Each Other' and 'Formation of Trust'; 'Mutual Interaction', which included three subcategories, 'Dialogue', 'Mutual Goal Setting' and 'Mutual Agreement of Care Solutions'; and 'Exchange of Targeted Behaviors', which included six categories, Implementation of Strategies for 'Nutritional Behaviors', 'Sleep and Rest', 'Constipation Relief', 'Promotion of Physical Activity and Exercise', 'Fatigue Reduction' and 'Stress Management'.

CONCLUSIONS

The findings highlight the statistically significant role of collaborative care in MS management. Utilizing these research findings can update the development of interventions based on collaborative care, which can provide appropriate support to individuals with MS.

PATIENT OR PUBLIC CONTRIBUTION

Individuals with multiple sclerosis.

The psychometric properties of the Persian version of the Multiple Sclerosis Self-Management Scale-Revised: A cross-sectional methodological study

Backgrounds and Aims

Patients with multiple sclerosis (pwMS) need self-management (SM) skills to manage their symptoms and problems. An essential step to SM improvement is accurate SM assessment using valid and reliable instruments. The aim of this study was to evaluate the psychometric properties of the Persian version of the Multiple Sclerosis Self-Management Scale-Revised (MSSMS-R).

Methods

This cross-sectional methodological study was conducted from December 2021 to June 2022. The face, content, and construct‎ validity of MSSMS-R were evaluated. Construct validity was evaluated through confirmatory factor analysis (CFA) and evaluating convergent and discriminant‎ validity using the data obtained from 210 randomly selected MS patients. The reliability of the scale was also evaluated through the test-retest stability and the internal consistency evaluation methods.

Results

The face validity was confirmed and the content validity ratio and index values of all items were more than 0.62 and 0.79, respectively. CFA revealed the acceptable construct validity of the scale after omitting items 21 and 22. In convergent and discriminant validity evaluation, the total score of MSSMS-R had significant positive correlation with the total mean scores of the Multiple Sclerosis Self-Efficacy Scale (r = 0.36; p < 0.001) and the physical health composite‎ (r = 0.31; p < 0.001) and the mental health composite‎ (r = 0.39; p < 0.001) dimensions of the 54-item Multiple Sclerosis Quality of Life scale ‎and significant inverse correlation with the total mean score of the Beck Depression Inventory (r = -0.28; p < 0.001). The Cronbach's alpha values of the scale and its subscales were 0.86 and 0.65-0.90 and their test-retest intraclass correlation coefficients were 0.97 and 0.95-0.99, respectively.

Conclusion

The Persian MSSMS-R is a valid and reliable scale and can be used in future studies for SM assessment among pwMS.

Economic and Social Standing of Individuals in Iran Diagnosed with Multiple Sclerosis

BACKGROUND

Multiple sclerosis (MS) may be affected by socioeconomic status (SES). This study aims to explore the determinants of SES among Iranian patients with MS and examine how these factors relate to disability and disease progression.

METHODS

All patients with MS listed in the nationwide MS registry of Iran (NMSRI) until January 8, 2022, were included in this population-based study.

RESULTS

Among the 5153 patients, most were female (74.5%), married (70.8%), and did not hold an academic degree (53.8%). Unemployment (OR: 3.75) and being unmarried (OR: 2.60) were significantly associated with Expanded Disability Status Scale (EDSS)≥6, and the time to progression was shorter in the unemployed group (P value: 0.03). There was also a significant negative correlation between the time to progression and the age at disease onset.

CONCLUSION

The study suggests that providing financial and social support to MS patients and their families through investment could reduce both individual and societal burdens.

Effect of support based on family centered empowerment model on care burden in family caregivers of patients with multiple sclerosis

Introduction

Family caregivers of patients with multiple sclerosis (MS) are at risk of care burden that may lead to a detrimental effect on their quality of life (QoL), physical and mental well-being. This study aimed to determine the effect of the family-centered empowerment model (FCEM) on the care burden of caregivers of patients with MS.

Methods

This quasi-experimental study was conducted using convenience sampling on 60 caregivers of patients referring to the Multiple Sclerosis Clinic in Ghaem Hospital, Mashhad, Iran. The participants were assigned to FCEM and control groups based on the days they were referred to the MS clinic. Data collection tools included the Zarit Caregiver Burden Inventory (CBI), completed in the intervention and control groups before and 1 month after the intervention. The support based on FCEM was provided during eight 45-60-min sessions, and the control group received the medical center's routine training. Data were analyzed by Chi-square, independent t-test, analysis of covariance, and repeated measure tests.

Results

The results of the present study showed that all demographic characteristics were homogeneous at the baseline. Before the intervention, no significant difference was observed between the two groups regarding mean scores of care burden. Based on the repeated measure test, there was no significant treatment and time interaction in changes in care burden.

Conclusion

The FCEM has no significant effect in alleviating the care burden. It is recommended to observe the necessary considerations regarding the context of this type of intervention and to carry out further investigations in different intervals.

Evaluation of the prevalence of bovine leukemia virus DNA in peripheral blood mononuclear cells of multiple sclerosis patients

Multiple sclerosis (MS) is an immune system-mediated neurodegenerative disease. Recent studies suggest that viral agents, especially the Epstein Barr virus (EBV), are etiological agents for MS. The roles of other viruses in MS have been investigated. Studies have shown an increase in the level of antibodies against bovine leukemia virus (BLV) in patients with MS. In this regard, our study aimed to examine the presence of BLV DNA in peripheral blood mononuclear cells (PBMCs) of MS patients in Iran. In this cross-sectional study, the presence of BLV in 109 Iranian MS patients and 60 healthy controls was evaluated. The isolated PBMCs were used for DNA extraction and PCR, using specific primers for two distinct genes. The mean age of the participants was 39 ± 9.5 years, and 27 (24.77%) of them were male. Clinical evaluation of these patients showed the most frequent MS type to be relapsing-remitting MS (RRMS) (71; 65.14%). BLV evaluation did not show any BLV DNA presence in the PBMCs of individuals in either the MS or healthy control groups. Therefore, our study showed no evidence of BLV infection in Iranian MS patients.

Assessing the psychometric properties of persian version of Zarit Burden interview among family caregivers of patients with multiple sclerosis

BACKGROUND

Caring for patients with multiple sclerosis (MS) imposes a great burden on caregivers and affects their lives in various aspects. This study aimed to evaluate the psychometric properties of Persian version of 22-item Zarit Burden Interview (ZBI-22) among family caregivers of patients with MS.

METHODS

This methodological study was conducted in Fars province, southern of Iran. For this purpose, 120 family caregivers were recruited to participate in the study from January to March 2022. Zarit Burden Interview (ZBI) was translated into Persian through forward-backward method. Face and content validity were assessed. Construct validity was assessed using exploratory factor analyses (EFA), and its reliability was assessed by measuring internal consistency and testretest stability.

RESULTS

According to face validity, the impact scores of all items were more than 1.5. Content validity ratio and content validity index values of all 22 items were 0.64-1 and 0.82-1, respectively. The scalelevel CVI/Ave was 0.97. Based on the results of factor analysis, five factors with eigenvalues more than 1 were extracted, which altogether explained 62.62% of the total variance of ZBI score. Among 22 items, one item was deleted during EFA validity assessment. Factor loading values ranged from 0.40 to 0.88. The reliability of the scale was confirmed (total Cronbach's alpha of the ZBI = 0.88). Moreover, testretest stability assessment revealed no significant difference between test and retest scores (P > 0.05). The intraclass correlation (ICC) for the ZBI and ICCs among its factors were 0.88 and 0.6-0.86, respectively.

CONCLUSION

The Persian version of five-factor structure ZBI can be a valid and reliable scale, and it can be used to assess caregiver burden among family caregivers of patients with MS in Iran.

Responsiveness of Persian 12-Item multiple sclerosis walking scale: a replication study

OBJECTIVE

To re-explore the responsiveness of the Persian version of Multiple Sclerosis Walking Scale-12 (MSWS-12p) to physiotherapy intervention and determine the minimally clinically important change (MCIC). This study followed a prospective cohort design. Patients with MS (PwMS) underwent physiotherapy treatment for 10 sessions. The outcome measures were the MSWS-12p and Timed 25-Foot Walk test (T25-FW). Data was collected before and after ten sessions of physiotherapy. The effect sizes and the area under receiver operating characteristics curve (AUC) and MCIC were calculated.

RESULTS

Thirty PwMS (16 female, mean age 43.07 years) participated in the study. The effect sizes for MSWS-12p were moderate (0.52, 0.64). The change scores of MSWS-12p showed excellent correlation with the dichotomized smallest detectable change (SDC) criterion (Eta coefficient test = 0.84). There was no correlation between the MSWS-12p total change scores and the T25-FW (r = - 0.14, p = 0.45). The AUC was perfect and the MCIC for the MSWS-12p was calculated 10.0 points. The MSWS-12p is responsive and demonstrates changes after physiotherapy. Changes > 10.0 points on MSWS-12p total score should be considered as true improvement after physiotherapy.

Epidemiological parameters of multiple sclerosis in Chaharmahal and Bakhtiari Province, Iran

Background: Multiple sclerosis (MS) is a neurological disease with a high burden and disability. There are reports of various medications' side effects on patients with MS. The aim of the study is to determine the characteristics and medicine usage distribution among patients with MS in Chaharmahal and Bakhtiari Province in Iran. Methods: This registry-based cross-sectional study was performed among MS cases in Chaharmahal and Bakhtiari Province. The epidemiological data were collected from the nationwide MS registry of Iran (NMSRI) from 2019 to 2022. The information collected included age, sex, family history, type of MS, age at MS onset and diagnosis, MS symptoms, physical condition, and history of medication use. All tests were performed at a significance level of 0.05 using SPSS software. Results: A total of 416 patients included in this study. Among them, 325 individuals (78%) were women with mean ± standard deviation (SD) of age of 37.35 ± 8.51 years. No significant difference was observed between men and women in terms of age, type of MS disease, family history of MS, and physical condition (P > 0.05). The results showed that the Expanded Disability Status Scale (EDSS) score in female patients (1.41) was different from the EDSS score in male patients (1.77) (P < 0.05). Most of the patients often used interferon beta (IFN-β). Conclusion: The results provided new insight into the epidemiology and medicine patterns of patients with MS in Chaharmahal and Bakhtiari Province. The epidemiological situation of MS in this province is similar to other parts of Iran. Planning according to national programs is suggested for the management and control of MS.

Ongoing increase in incidence and prevalence of multiple sclerosis in south-eastern Iran: A three decade study

BACKGROUND

Prevalence of multiple sclerosis has been increased during the last decades throughout the world. Epidemiological studies could improve our understanding relating to its intrinsic and extrinsic causes.

OBJECTIVES

The current study has been conducted to determine the epidemiological features of MS in south-eastern Iran which is a semi-tropical area with different ethnicities.

METHODS

This longitudinal descriptive study was carried out in south-eastern Iran, based on information of MS patients registered at Zahedan University of Medical Sciences database from 1990 to 2020.

RESULTS

A total of 1045 cases were enrolled into the study. The age-standardized prevalence ratio of MS increased to 42.2/100,000 population by 2020. These figures showed increasing trends both in females and males and reached to 61.5 and 22.6 per 100,000 population, respectively by the year 2020. Likewise, the total incidence rate grew to its maximum amount of 4.5 in 2015. Female incidence also revealed an upward trend and peaked in 2016 to 6.4 while male incidence rate reached at its highest level of 1.8 in 2009.

CONCLUSION

MS prevalence ratios and incidence rates in south-eastern Iran have been increasing steadily, especially in women during the last three decades. The south-eastern part of Iran should be considered a high-risk region.

Impact of Multiple Sclerosis on Foot Health and Quality of Life: A Prospective Case-Control Investigation

Objectives: To assess quality of life or factors related to the foot and general health and to determine the impact taking into account foot health status in people with multiple sclerosis (MS). Methods: 50 subjects with MS and 50 healthy subjects were studied using the Foot Health Status Questionnaire, that is a validated and is reliable tool was used to assess foot health and quality of life. This instrument comprise four domains for evaluate the foot health (foot function, foot pain, footwear and general foot health) in the first section and for measure the general health comprise four domains (general health, physical activity, social capacity and vigor) for second section and was use for all participants. Results: In both groups of the sample, 50% (n = 15) were men and 50% (n = 35) women, and the mean age in the case group was 48.04 ± 10.49 and the control group was 48.04 ± 10.45 were recruited. A statistically significant difference (p < 0.05) was shown for foot function, general foot health, general health, physical activity and vigor domains, stating that people with MS have a lower related to foot health (lower FHSQ scores) compared to healthy subjects who have higher FHSQ scores. There were no statistically significant differences (p > 0.05) for the scores of the other domains of the FHSQ (foot pain, footwear and social capacity). Conclusion: Patients with MS suffer a negative impact on the quality of life related to foot health, which appears to be associated with the chronic disease.

The efficacy and safety of ginger supplementation in patients with multiple sclerosis: A rationale and study protocol for a double-blind randomized controlled trial

Background and Aims

Multiple sclerosis (MS) is a chronic disease characterized by axonal damage, demyelination, inflammation, oxidative stress, and immune cell infiltration. This disease is the first cause of nontraumatic disability in young adults leading to a decline in patients' quality of life. Patients with MS may also suffer from gastrointestinal symptoms due to the disease or prescription drugs. Unfortunately, no treatment for MS has been discovered yet, and prescribed drugs can only help control its clinical course. Interestingly, recent animal studies have shown positive effects of ginger administration in the MS model. Therefore, we aim to determine the effect of ginger supplementation on neurofilament light chain, matrix metalloproteinase-9, interleukin-17, nitric oxide, complete and differential blood counts, disability status, quality of life, gastrointestinal symptoms, and body mass index (BMI) in MS patients.

Methods

This study is a double-blind randomized controlled trial. Fifty-two patients with relapsing-remitting MS will be assigned to intervention and control groups using stratified permuted block randomization. The intervention and control groups will take 1500 mg/day ginger and placebo (as corn) supplements for 12 weeks, respectively. All outcomes will be assessed before and after the trial. Serum concentrations of neurofilament light chain, matrix metalloproteinase-9, and interleukin-17 will be measured by enzyme-linked immunosorbent assay. Nitric oxide serum levels will be detected using colorimetry. Complete and differential blood counts will be assessed by an automated hematology analyzer. Disability status, quality of life, and gastrointestinal symptoms will be evaluated by the Expanded Disability Status Scale, MS Impact Scale, and Visual Analog Scale, respectively. BMI will be calculated by dividing weight in kilograms by height in meters squared. Potential side effects of ginger supplementation will also be closely monitored during the study.

Trial Registration

This protocol was registered at the Iranian Registry of Clinical Trials (www.irct.ir) under the registration number IRCT20180818040827N3.

Medicinal herbs and multiple sclerosis: Overview on the hard balance between new therapeutic strategy and occupational health risk

Multiple sclerosis (MS) is an autoimmune disease characterized by demyelination and axonal loss of the central nervous system (CNS). Despite its spread throughout the world, the mechanisms that determine its onset are still to be defined. Immunological, genetic, viral, and environmental factors and exposure to chemicals may trigger MS. Many studies have highlighted the anti-inflammatory and anti-oxidant effects of medicinal herbs, which make them a natural and complementary treatment for neurodegenerative diseases. A severe reduction of several MS symptoms occurs with herbal therapy. Thus, the request for medicinal plants with potential beneficial effects, for MS patients, is constantly increasing. Consequently, a production increase needs. Unfortunately, many medicinal herbs were untested and their action mechanism, possible adverse effects, contraindications, or interactions with other drugs, are poorly or not investigated. Keeping in mind the pathological mechanisms of MS and the oxidative damages and mitochondrial dysfunctions induced by pesticides, it is important to understand if pesticides used to increase agricultural productivity and their residues in medicinal plants, may increase the risk of developing MS in both workers and consumers. Studies providing some indication about the relationship between environmental exposure to pesticides and MS disease incidence are few, fragmentary, and discordant. The aim of this article is to provide a glance at the therapeutic potential of medicinal plants and at the risk for MS onset of pesticides used by medicinal plant growers and present in medicinal herbs.

The effect of applying the nursing process based on the Theory of Goal Attainment on activities of daily living and quality of life in persons with multiple sclerosis during COVID-19 pandemic: a clinical trial

BACKGROUND

The chronic nature of multiple sclerosis (MS) affects patient's activities of daily living (ADL) and quality of life (QOL). Nursing interventions based on patients' active participation in goal-setting can be beneficial in improving ADL and QOL.

AIMS

This study aimed to determine the effect of applying the nursing process based on King's Theory of Goal Attainment (TGA) on ADL and QOL of persons with multiple sclerosis (PwMS) during the COVID-19 pandemic.

METHODS

In this clinical trial, 70 patients referred to the MS Society of Hamadan, Iran, were recruited using the convenience sampling method and randomly assigned into 2 groups. A 4-stage TGA was developed and implemented for the intervention group for a month. Data were gathered by ADL, instrumental ADL (IADL), and QOL questionnaires, and Goal of Attainment Scale (GAS) before and 2 months after the intervention.

RESULTS

Intervention group achieved a higher number of prioritized goals (p < 0.001) and reported higher QOL (P < 0.001) and instrumental ADL (IADL; P = 0.002) than the control group.

CONCLUSIONS

Given the results, TGA could effectively promote mutual goal attainment, QOL, and IADL for PwMS during the COVID-19 pandemic.

TRIAL REGISTRATION

ClinicalTriasl.gov Identifier: IRCT20201210049668N1.

Prescription trends of disease-modifying treatments for multiple sclerosis in Iran over the past 30 years

BACKGROUND

Iran, as a middle income country, is one of the places with high and rising prevalence of multiple sclerosis (MS). Regarding the substantial economic burden, reviewing the trend in prescribed disease modifying treatments (DMTs) could be of help. Here we studied the DMT information of nearly 14000 MS cases and its trends change for 30 years to improve health services to patients.

METHODS

The population base of this descriptive-analytical (cross-sectional) study consisted of all MS patients in the nationwide MS registry of Iran (NMSRI), up to August 1, 2021. Registrars from 15 provinces, 24 cities, 13 hospitals,8 MS associations, 16 private offices, and 7 clinics had entered the data.

RESULTS

Overall, 14316 cases were enrolled. The majority (76.1%) were female. The youngest and eldest patients were 5 and 78 years old, respectively. Diagnosis delay was under one year in most cases (median: 0, IQR: 0 - 1). Most (61.4%) had RRMS. Generally, platform injectables (IFN beta, glatiramer acetate) were the most used DMTs until 2010. It seems that introduction of newer agents (antiCD20s and oral DMTs) resulted in a decrease in the use of former drugs since around 2015. Some unusual practices are prominent such as using not approved DMTs for PPMS over the years, or administering high efficacy drugs like natalizumab for CIS. The results indicate the remaining popularity of first line injectable DMTs in female and pediatric patients.

DISCUSSION

Mean age (SD) at onset in our study (29 ± 8.8) is near the statistics in Asia and Oceania (28 ± 0.7). Concerns about COVID-19 had a noticeable impact on administering high efficacy drugs like rituximab and fingolimod. However, in male patients this approach has not been the case. It may be related to more aggressive disease course in this group. The other possible explanation could be planning for pregnancy in female cases. The popularity of platform injectable drugs in pediatric MS may be related to its favorable safety profile over the years. Another point in this group, is the superiority of rituximab over other highly efficient medications.

Expression and diagnostic values of MIAT, H19, and NRON long non-coding RNAs in multiple sclerosis patients

Background

Multiple sclerosis (MS) is a chronic inflammatory disease. Various long non-coding RNAs (lncRNAs) appear to have an important role in the pathophysiology of MS. This study aimed at evaluating the expression levels of lncRNAs, MIAT, H19, and NRON in peripheral blood of MS cases to a healthy control group. We collected blood samples of 95 MS cases (76 relapsing–remitting (RR) and 19 secondary progressive (SP) MS) and 95 controls. We used quantitative real-time PCR for the evaluation of gene expression. The correlation between expression with clinical parameters was analyzed by a multiple linear regression model. Receiver operating characteristic (ROC) curve analysis was carried out to detect the diagnostic potential of lncRNAs levels according to the area under the curve (AUC).

Results

MIAT, H19, and NRON were significantly increased in the RRMS and SPMS subgroups compared to the controls. We found that the H19 and MIAT expression significantly were higher in SPMS compared with RRMS. Patients with RRMS had a greater level of the average NRON expression is compared with SPMS patients. The expression level of H19 significantly was higher in females relative to male patients. Based on the area under curve (AUC) values, NRON had the best performance in the differentiation of MS patients from controls (AUC = 0.95, P < 0.0001). A combination of MIAT, H19, and NRON expression levels could be useful in differentiating MS patients with 93.6% sensitivity, 98.9% specificity, and diagnostic power of 0.96 (P < 0.0001).

Conclusions

The levels of MIAT, H19, and NRON in peripheral blood could be important biomarkers for MS diagnosis.

Short quality of life scale: A cross-cultural validation in Iranian patients with multiple sclerosis

Health-related quality of life (HRQoL) is the prioritized measure in multiple sclerosis (MS) patients. The short quality of life scale (SQoL) developed by Devy et al. (2013) is an MS-specific and abbreviated scale with ten items suitable for routine medical care settings. The current study reported the cross-cultural validation of the scale in the Persian language. A total of 455 convenient MS patients with a mean age of 38.39 (9.28) ranged from 18 to 64 filled out the primary measure and the validating measures, including hospital anxiety and depression scale, visual analogue scale - quality of life, and a single index of the number of past-year MS relapse. The confirmatory factor analysis on original structure indicated an acceptable model fit. However, a modestly modified structure composing of physical-functional dimension (items #1-3), mental dimension (items #5-8), and pain & energy dimension (items 4 & 9,10) was also exposed with a sound fit and a meaningful structure. The overall internal consistency reliability was sound (0.88), and the concurrent validity was confirmed. The Persian short quality of life scale (P-SQoL) is the first translated and validated version of the scale, surfacing significant implications. Further cross-cultural investigations are recommended to re-examine current findings. The classic and recent suggestions concerning the close interplay between the immunity system and the psychological system and the implications based on Iran's context are discussed.

The effects of continuous care model using a smartphone application on adherence to treatment and self-efficacy among patients with multiple sclerosis

Background

Adherence to disease-modifying therapy is important in patients with Multiple Sclerosis (MS) to increase the positive outcomes and improve the quality of life. This study aimed to determine the effects of Continuous Care Model (CCM) using a smartphone application on adherence to treatment and self-efficacy among MS patients.

Methods

This quasi-experimental study with pre/posttest design was conducted on 72 MS patients in Shiraz, Iran from June 2020 to August 2021. The samples were randomly assigned to intervention (n = 36) and control (n = 36) groups. In the intervention group, the CCM using a smartphone application was implemented during two months. However, no intervention was performed for the control group. The data were collected using the self-report Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ) and MS Self-Efficacy Scale (MSSS) at baseline and two and four months after the intervention.

Results

The results showed an improvement in adherence to treatment and self-efficacy in the intervention group compared to the control group after implementing the virtual CCM and at the two-month follow-up (p < 0.001).

Conclusions

Implementing the CCM using a smartphone application resulted in improvements in the MS patients’ adherence to treatment and self-efficacy. It can be concluded that providing care using an interactive multimedia application can improve the outcomes as well as patients’ satisfaction, especially during the COVID-19 pandemic. Therefore, this approach is recommended to be used for nurses, healthcare providers, and clinicians.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01785-x.

Temporal Incidence and Prevalence Trends of Multiple Sclerosis in Markazi Province, Iran

BACKGROUND

The epidemiology of multiple sclerosis (MS) exhibits significant variability all over the world. Additionally, the incidence and prevalence of the disease are geographically diverse in the different provinces of Iran.

OBJECTIVES

Due to the lack of a research about the epidemiology of MS in the Markazi province of Iran, the present study aimed to estimate its prevalence and incidence in this province.

METHODS

This cross-sectional register study was conducted according to the data related to the MS Society of Markazi province. The inclusion criteria were definite MS during 2010-2019, residence in Markazi province, and membership in the MS society of Markazi province. The annual incidence and prevalence of MS (per 100,000 person-years) were computed by sex and age groups. Further, age-standardized prevalence and incidence rates were calculated based on the Iranian population. A gamma regression model with log link was utilized for comparing the rates over time statistically. The prevalence and incidence rates were computed by using Excel, and R 4.0.5 was applied to fit the gamma model.

RESULTS

In the study, the total number of MS cases was 1,391, among whom 1,098 (78.9%) and 293 (21.1%) were females and males, respectively. The onset of MS occurred at the mean (S.D) age of 31.76 (8.98) years with a female/male ratio of 3.75. During the study period (2010-2019), the incidence rate of the disease was on the decline, while the prevalence rate elevated, by indicating a rising trend in MS prevalence in both sexes.

CONCLUSION

The results represented the decreasing and increasing trend of the incidence and prevalence of MS in Markazi province over the recent years. The province is one of the regions with a high prevalence and incidence rate of MS compared to the national and global statistical data.

Evaluation of S100A12 and Apo-A1 plasma level potency in untreated new relapsing-remitting multiple sclerosis patients and their family members

Multiple sclerosis is an inflammatory disease of the spinal cord and brain. Receptor for advanced glycation end products and Apolipoprotein A1 (Apo-AI) have been recommended to have a pathogenic role in the neuroinflammatory disorder as multiple sclerosis. The purpose of this research was to measure the plasma levels of S100A12 and Apo-A1 in the first-degree family of relapsing–remitting multiple sclerosis (RRMS) patients. Plasma levels of S100A12 & Apo-A1 were evaluated via enzyme-linked immunosorbent assay in the thirty-five new cases of untreated patients with deterministic RRMS according to the McDonald criteria, twenty-four healthy controls, and twenty-six first-degree members of untreated RRMS patients (called them as high-risk group). The main findings of this study were as follows: the plasma level of S100A12 was significantly lower in the new cases of untreated RRMS (P ≤ 0.05; 0.045) and high-risk (P ≤ 0.05; 0.001) groups. Although the plasma protein level of Apo-A1 was reduced significantly in the high-risk group (P < 0.05, P = 0.003) as compared to the healthy control group, there was no significant difference in the untreated RRMS patients (P = 0.379). The plasma level of vitamin D3 in both RRMS patients and high-risk groups displayed significance reduction, although, there was no significant association between vitamin D and S100A12 & Apo-A1 levels. Given the role of S100A12 and Apo-A1 in the inflammatory process performed in the first-degree family members of the RRMS patients, which revealed a significant decrease in this group, we concluded that they can be considered as one of the contributing factors in the pathogenesis of MS, though more research is needed before assuming them as predictive biomarkers.

Economic burden of multiple sclerosis: a cross-sectional study in Iran

BACKGROUND

Multiple Sclerosis (MS) is a chronic debilitating disease that imposes a heavy socioeconomic burden on societies. This study aimed to determine the economic burden of MS on patients using the first (CinnoVex and ReciGen) and second (Fingolimod and Natalizumab) drug therapy lines.

METHODS

This cost of illness study was an economic evaluation carried out as cross-sectional research in 2019 in southern Iran. A total of 259 patients were enrolled in two lines of drug therapy (178 patients in the first line and 81 ones in the second). The prevalence-based approach and the bottom-up approach were used to collect cost information and to calculate the costs from the societal perspective, respectively. The human capital approach was applied to calculate indirect costs. To collect the required data a researcher-made data collection form was utilized. The data were obtained using the information available in the patients' medical records and insurance invoices as well as their self-reports or that of their companions.

RESULTS

The results showed that the annual costs of MS in the first and second lines of drug therapy per patient were $ 1919 and $ 4082 purchasing power parity (PPP), respectively, and in total, $ 2721 PPP in 2019. The highest mean costs in both lines were those of direct medical costs, of which purchasing the main medicines in both lines accounted for the highest.

CONCLUSION

Considering the findings of this study and in order to reduce the burden of the disease, the following suggestions are presented: providing necessary facilities for the production of MS drugs in the country; proper and equitable distribution of neurologists; expanding the provision of home care services; and using the technologies related to the Internet, including WhatsApp, to follow up the MS patients' treatment.

Prevalence of Multiple sclerosis and its clinical and demographic characteristics in Kurdish populations in western Iran (2020)

BACKGROUND

Multiple Sclerosis (MS) is a costly burdensome nervous system disorder leading several disabilities in young and middle-aged people. Knowing MS clinical, epidemiologic and demographic characteristics may help to estimate and predict the required health services and medication facilities for the affected people. This study was aimed to determine the prevalence of MS and its demographic characteristic in about 2 million Kurdish populations in western Iran in 2020.

METHODS

This cross-sectional study was conducted in 2020 on MS patients with Kurdish Ethnicity living in Kermanshah /western Iran which is a Mountainous area in. MS patients were registered and recruited to this study from several centers. The settings have been approved by the nationwide MS registry of Iran (NMSRI). Using two questioners, a questionnaire included sex, age, the age in which the MS symptoms onset, the age of diagnosis, family history of MS, and type of MS, and second one was the Expanded Disability Status Scale (EDSS) checklist. The demographic information of Kermanshah province was adopted from the Statistical Center of Iran. In addition to descriptive statistics, U-Mann-Whitney and Chi-square tests were also used.

RESULTS

A total of 1557 MS patients with a mean age (±SD) of 38.66 ± 9.9 years were recruited in this study. Of them, 1216 (78.1%) were female. The majority of patients, 300 patients (19.3%), were in the age range 35-39 years, and the highest prevalence (184.82 per 100,000 populations) was observed in the age range 40-44 years. The prevalence of MS in Kermanshah province is estimated 79.50 per 100,000 people, 125.71 per 100,000 in female and 34.41 per 100,000 in male. This prevalence was higher in female (female to male was 3.65 to 1). The EDSS score was significantly higher in male than in female (3.06 ± 2.2 in male versus 2.42 ± 1.8 in female) (p = 0.001). The type of MS was significantly different between male and female, so that SPMS and PPMS were more common in male (31(10.3%), 22(7.3%)) than female (81(7.5%), 39(3.6%)) (p = 0.012). A positive family history of MS was found in 12.6% of patients.

CONCLUSION

Given the information about prevalence of MS in Kermanshah (in 2012), the prevalence of MS in Kermanshah has increased during last decade. MS disabilities were more extensive in male rather than female.

Characteristics of COVID-19 in patients with multiple sclerosis

Background

Regarding the high prevalence of multiple sclerosis (MS) and COVID-19 in Iran, a multicenter study of COVID-19 in Iranian MS patients with is carried out to address the concerns of this population.

Methods

Data on MS patients with COVID-19 from nine provinces of Iran were entered in a web-based registry system, between July 2020 and March 2021. Among the COVID-19 symptoms, dyspnea, altered mental status, or those resulting in hospital admission were considered severe.

Results

A total of 397 eligible patients were identified. In addition, 310 (78%) were female. The mean age was 36.5 ± 9.5. 294 (74%) patients had relapsing- remitting form. Also, four patients (1%) expired due to COVID-19 infection. The mean duration of admission in hospitalized patients was 9 (± 5.3) days. MRI was performed on 111 (28%) patients after developing COVID-19. MRI changes were observed in 27 (24%) of these cases. MS drug was changed in 26 (6%) patients. Steroid use in the past three months (OR: 2.43, 95% CI: 1.003–5.88) (p value: 0.049) and antiCD20s (OR: 4.03, 95% CI: 2.41–6.68) (p value < 0.001) showed significant association with severe COVID-19 symptoms.

Conclusion

The death rate of COVID-19 among MS patients (1%) is lower than the overall death rate of the pandemic in Iran (3%). Those who received steroid in the past three months may be at increased risk of more severe forms of COVID-19. There are still doubts about the effect of anti CD20s on COVID-19 severity.

Prevalence of multiple sclerosis (MS) in Iran: a systematic review and meta-analysis

BACKGROUND

Prevalence of multiple sclerosis (MS) is increasing world-wide. Iran is not exception. As the prevalence reported differently in various provinces, we designed this systematic review and meta-analysis to estimate pooled prevalence of MS in Iran.

METHODS

Two researchers systematically searched Scientific Information Database (SID), PubMed, Scopus, EMBASE, Web of Science, and google scholar. They also searched references of the included studies, and conference abstracts which were published up to April 2021. The search strategy included the MeSH and text words as ((((Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Dis-seminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating)) AND (prevalence OR prevalences OR period prevalence OR prevalence, period OR point prevalence OR point prevalences OR prevalence, point) AND (Iran OR Islamic Republic of Iran)))).

RESULTS

The literature search revealed 2817 articles, after deleting duplicates 2184 remained. For the systematic review, 34 studies were included. The prevalence is highest in Tehran and lowest in Khuzestan and Sistan-Baluchestan provinces. The pooled prevalence was 0.001 (95% CI: 0.000-0.001) (I²=0, P<0.001).

CONCLUSION

The results of this study show that the pooled prevalence of MS in Iran is 100 in 100,000 which is high. The prevalence in provinces increases dramatically.

The contribution of self-disclosure to the prediction of mood symptoms in patients with multiple sclerosis

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.

MRI but not demographic or clinical characteristics differ between familial and sporadic MS cases

BACKGROUND

Multiple sclerosis (MS) is a chronic immune-mediated demyelinating disease. The prevalence and incidence of MS in Iran is high and is rising over time. This study was conducted to compare the demographic, clinical features and MRI findings of MS patients with history of the disease in the first-degree family members (fMS) with sporadic MS patients (sMS) to determine the importance of genetic or non-genetic factors in the development of the disease and its effect in diagnostic and therapeutic modalities.

METHODS

Among the 185 patients admitted to the study, 62 were fMS patients and 123 were sMS patients. All patients underwent clinical examination and data was gathered on age, sex, age of onset, symptoms, number of attacks, disease course, family history, disease-modifying drugs, and other accompanying diseases as well as MRI findings and EDSS scores.

RESULTS

In this study, we demonstrated that the frequency of plaques in the periventricular area was significantly higher in sMS patients (97.56% vs 88.71%, p = 0.01) while the callosal plaques were more common in fMS patients (62.9% vs 47.97%, p = 0.05) which was statistically borderline and nonsignificant. In other evaluated parameters, no significant difference was observed.

CONCLUSION

In our study, no significant difference was observed between the demographic and clinical characteristics of fMS and sMS patients, while there was a significant difference between the two groups in MRI findings.

Assessing multiple sclerosis-related quality of life among Iranian patients using the MSQOL-54 tool: a cross-sectional study

BACKGROUND

Multiple sclerosis (MS) is a chronic autoimmune disease and is one of the most costly medical conditions that imposed families with catastrophic health expenditures. There is an increasing trend in using alternative medicines including, dietary supplements, herbs, vitamins, and minerals. To date, the association between dietary as well as herbal supplements and QoL in MS patients is under researched; thus, this study aimed to assess the association between the self-reported supplement used and QoL between MS patients.

METHODS

This cross-sectional study was conducted on patients with MS referring to Shahid Kazemi Pharmacy, based in the city of Tehran, Iran, as a national pharmacy providing specialized pharmaceutical products and pharmaceutical care to patients. The Multiple Sclerosis Quality of Life-54 (MSQoL-54) tools was performed to evaluate MS patients QoL.

RESULTS

A total number of 382 patients with MS participated in this study. They include 89 (23.3%) men and 293 (76.7%) women, aged 40 ± 10.9 years old. The overall score of the MSQoL-54 questionnaire was 41.58 out of 100. Physical health composite (PHC) and mental health composite (MHC) were 69.60 and 62.99 from 100, respectively. This study revealed that 76.4% of patients used at least one vitamin daily; 92.4% of patients do not receive any herbal product. Vitamin D is the most widely used supplement, followed by calcium, while vitamin C is the least consumed. No correlation was observed regarding supplement use and overall QoL, PHC, or MHC. There were no significant differences between QoL's dimensions score in patients who used supplements. The results showed that increasing the number of supplements used did not relate to overall QoL, PHC, or MHC. In addition, there was not any correlation between the duration used of supplements and QoL's dimensions score in MS patients (p-value> 0.05).

CONCLUSIONS

The dietary supplement appears to be popular among MS patients. The study results showed that the number of supplementations and their long-term use in patients with MS were not associated with higher QoL. Similarly, the herbal supplements have failed to improve QoL.

Epidemiology of multiple sclerosis in Iraq: retrospective review of 4355 cases and literature review

OBJECTIVES

Multiple sclerosis (MS) is a progressive demyelinating and degenerative disease of the CNS, which is highly variable geographically. The objectives are to establish comprehensive nationwide MS epidemiological data and compare it with similar studies conducted in regional and international communities. To the best of our knowledge, this is the first nationwide comprehensive epidemiological study conducted in Iraq.

METHODS

This retrospective study is including 4355 MS cases from the 10 officially authorized MS clinics in Iraq from January 2000 to December 2018. All cases were diagnosed according to McDonald's criteria 2010, new cases diagnosed according to the new criteria of McDonald's criteria 2018. All patients' records were reviewed by the scientific committee.

RESULTS

Our study found that 68.51% of MS were females with female-to-male ratio 2.18:1 and 4.07% of patients were diagnosed before they reached 18 years of age. The mean age was 32.3 ± 9.8. The prevalence was found to be 11.73/100,000; it was 16.2/100,000 among females and 7.3/100,000 among males. The incidence was 0.05 in the year 2000 and 1.5 in the year 2017. Initial symptoms were visual 32.06%, motor 28.11%, and 25.58% were sensory symptoms, and 89.97% of the clinical form was relapsing/remitting MS (RRMS) and 81.65% of patients were on first-line treatment. Meanwhile, 66.97% of cases were diagnosed within weeks or months from symptom onset. Summer had the most frequencies regarding birth season.

CONCLUSIONS

MS has a significantly increased incidence in Iraq, while prevalence is low compared to neighboring countries. RRMS was the most common clinical form and visual symptoms showed the highest frequency of the first presenting symptoms.

Retinopathy prematurity: a systematic review and meta-analysis study based on neonatal and maternal risk factors

BACKGROUND

Retinopathy of prematurity is the abnormal development of retinal arteries in preterm neonates less than 32 weeks and weighing 1500 g, and less, which can lead to visual impairment during life and blindness. This study aims to investigate the relationship between some clinical characteristics of neonates and mothers with Retinopathy of prematurity in the world via a systematic review and meta-analysis.

MATERIALS AND METHODS

The present study is a systematic review and meta-analysis on the relationship between maternal and neonatal clinical variables with Retinopathy of prematurity in the world from the beginning of 2000 to the end of 2020. Accordingly, all English articles published on the topic were searched in scientific databases of Web of Science, PubMed, Google Scholar, Science Direct, and Scopus. The articles were searched independently by two researchers. Statistical analysis of data was performed using fixed and random effects model statistical tests in the meta-analysis, Cochran, meta-regression, I² index, Funnel plot, and Begg's by STATA software program, version 14.

RESULT

A total of 191 studies with a sample size of 140,921 persons were including in the meta-analysis. Accordingly, Preterm delivery ≤28 weeks (OR:6.3, 95% CI:4.9-8.1), Birth Weight ≤1000 g (OR:5.8, 95% CI:4.8-6.8), Birth Weight ≤1500 g (OR:4.8, 95% CI:3.8-6.1), PROM (OR:1.2, 95% CI:1.0-1.4), induced fertility (OR:1.9, 95% CI:1.1-3.0) and Chorioamnionitis (OR:1.5, 95% CI:1.0-2.2) There was a statistically significant association with retinopathy.

CONCLUSION

Based on the results of the present meta-analysis, the risk of retinopathy of prematurity in neonates born at 28 weeks and less, LBW (weight 1500 g and less), neonatal hypotension, chorioamnionitis, and induced fertility increases.

A focus on allogeneic mesenchymal stromal cells as a versatile therapeutic tool for treating multiple sclerosis

Multiple sclerosis (MS) is a central nervous system (CNS) chronic illness with autoimmune, inflammatory, and neurodegenerative effects characterized by neurological disorder and axonal loss signs due to myelin sheath autoimmune T cell attacks. Existing drugs, including disease-modifying drugs (DMD), help decrease the intensity and frequency of MS attacks, inflammatory conditions, and CNS protection from axonal damage. As they cannot improve axonal repair and show side effects, new therapeutic options are required. In this regard, due to their neuroprotection properties, immunomodulatory effects, and the ability to differentiate into neurons, the transplantation of mesenchymal stromal cells (MSCs) can be used for MS therapy. The use of adipose-derived MSCs (AdMSCs) or autologous bone marrow MSCs (BMSCs) has demonstrated unexpected effects including the invasive and painful isolation method, inadequate amounts of bone marrow (BM) stem cells, the anti-inflammatory impact reduction of AdMSCs that are isolated from fat patients, and the cell number and differentiation potential decrease with an increase in the age of BMSCs donor. Researchers have been trying to search for alternate tissue sources for MSCs, especially fetal annexes, which could offer a novel therapeutic choice for MS therapy due to the limitation of low cell yield and invasive collection methods of autologous MSCs. The transplantation of MSCs for MS treatment is discussed in this review. Finally, it is suggested that allogeneic sources of MSCs are an appealing alternative to autologous MSCs and could hence be a potential novel solution to MS therapy.

Cladribine tablets are a cost-effective strategy in high-disease activity relapsing multiple sclerosis patients in Iran

Background: Cladribine tablets are the foremost oral immune-reconstitution therapy for high disease activity relapsing multiple sclerosis (HDA-RMS). We aimed to assess the cost-effectiveness of cladribine tablets compared to natalizumab in patients with HDA-RMS in Iran. Methods: A 5-year cohort-based Markov model was developed with 11 expanded disability status score (EDSS) health states, including patients with HDA-RMS as on and off-treatment. All costs were identified from the literature and expert opinion and were measured in Iranian Rial rates, changed to the 2020 USD rate and were discounted by 7.2%. Quality adjusted life years (QALY), discounted by 3.5%, and life years gained (LYG) were adopted to measure efficacy. The final results were presented as incremental cost-effectiveness ratio that was compared to a national willingness to pay (WTP) threshold of 1 to 3 gross domestic product (GDP) per capita. Deterministic and probabilistic sensitivity analyses (D/PSA) were employed to evaluate uncertainty. Results: Cladribine tablets dominated natalizumab and yielded 6,607 USD cost-saving and 0.003 additional QALYs per patient. LYG was comparable. The main cost component was drug acquisition cost in both arms. DSA indicated the sensitivity of the results to the cost discount rates and also the patients' body weight; while they were less sensitive to the main clinical variables. PSA indicated that cladribine tablets were cost-effective in Iran, with a probability of 57.5% and 58.6% at lower and higher limits of threshold, respectively. Conclusion: Cladribine tablets yielded higher QALYs and lower costs compared to natalizumab, in patients with HDA-RMS in Iran.

Multiple sclerosis projection in Tehran, Iran using Bayesian structural time series

BACKGROUND

The prevalence of Multiple Sclerosis (MS) has been increasing worldwide and the highest prevalence ratio among Asian countries was reported in Iran. This study aims to estimate the increase in MS occurrence during more than three decades in Tehran and forecast the future condition of the disease using time series approaches for the next ten years.

METHODS

The cross-sectional study was conducted from 1999 to 2019 based on records of MS cases from Iranian MS Society (IMSS) registry system. The prevalence was estimated using population data presented by the Statistical Centre of Iran. Through Bayesian Structural Time Series (BSTS) model, we want to predict the prevalence of familial and sporadic MS in the next ten years. .

RESULTS

Among 22,421 cases with MS, 16,831 (75.1 %) were female and 5589 (24.9 %) were male. Female to male ratio was 3.0:1 and the number of familial MS cases were 2982 (13.3 %) of subjects. Female gender was less responsible for higher rate of MS in familial definition (beta = 0.020) in comparison to sporadic cases (beta = 0.034). Forecasting by BSTS revealed an increase in MS prevalence for the next ten years so that the prevalence rate for total, familial and sporadic MS respectively begins with 189.50 (183.94-195.14), 25.69 (24.97-26.45) and 163.74(159.06-168.57) in 2020 and ends with 220.84 (171.48-266.92), 30.79 (24.16-37.15), and 189.33(146.97-230.19) in 2029.

CONCLUSIONS

According to the findings, MS prevalence increased during three decades and it will increase over the next ten years. Tehran province is one of the regions with highest MS prevalence in Asia. The results of present study indicated that females are at higher risk for MS than males in both sporadic and familial MS.

Self-Care Practices and Related Factors in Patients with Multiple Sclerosis (MS) Based on the Health Belief Model

Introduction: Self-care programs can raise health in patients with Multiple Sclerosis (MS). This study aimed to identify the self-care behaviors and determinants in patients with MS according to the Health Belief Model (HBM). Methods: In this cross-sectional study, we included 280 MS patients through convenience sampling method. The collection tool was a self-administered questionnaire based on HBM. The participants were the members of MS society in Kerman, Iran. The data were analyzed using descriptive statistics, path analysis, and multivariable linear regression in SPSS software Version 22. Results: The mean (SD) score for self-care practices was 2.86 (0.64), and medication adherence was the most conducted practice. The perceived benefits and cues to action exerted positive influence on self-care practices. The most frequent symptoms experienced by the participants were fatigue (82.5%), visual impairment (76.4%), headaches (72.1%), and muscle weakness (71.4%). The most important cues to action for self-care behavior were the physician (77%), media (52%), and other MS patients (32%). Conclusion: The quality of life (QOL) of MS patients is heavily influenced by self-care behaviors. In this study, only about half of the patients accomplished self-care behaviors, which seems to be insufficient. Since the perceived benefits and cues to action are the main predictors of self-care practices, intervention based on these two constructs can be utilized to promote self-care programs and QOL in MS patients. Health-care providers should pay more attention to these factors for promoting self-care behaviors.

Epidemiology of multiple sclerosis in the Sultanate of Oman: A hospital based study

BACKGROUND

The prevalence of multiple sclerosis (MS) has been changing not only globally but also in individual countries. We aim to estimate the prevalence of MS in the Omani population over the period from 2006-2019 as well as the incidence between 2015-2018.

METHODS

This is a retrospective observational hospital-based study. All MS patients diagnosed, as per the revised McDonald criteria, over the period from June 2006 and until May 2019, had their information reviewed for age at disease onset, gender and year of diagnosis. We obtained the population of Oman from the national census data.

RESULTS

A total of 422 patients were diagnosed with MS during the study period and the population of Oman as per the 2019 census data was 2,652,199. The estimated crude prevalence was 15.9 (95% confidence interval: 14.4 - 17.5) per 100,000 and the female to male ratio was 2.17:1. The mean age at disease onset was 27.3 ± 7.7 (range: 9 - 59) years in which 83% of the patients had the first clinical manifestation at the age of 19 - 40 years, while only 9% had a disease onset at <19 years. The annual incidence increased from 1.00 case per 100,000 in 2015 to 1.38 cases per 100,000 in 2018.

CONCLUSION

The prevalence of MS in the Omani population is 15.9 per 100,000 placing Oman as a medium risk zone.

Explaining the facilitators of quality of life in patients with multiple sclerosis: a qualitative study

Background

In patients with multiple sclerosis (MS), the disease’s complications and manifestations affect a person’s ability to function normally and leads to further disruptions in their education, family life, job opportunities, and daily life activities, thereby reduce their quality of life. Different factors as facilitators or inhibitors affect the quality of life in patients with MS. This study aimed to explain the facilitators of quality of life in patients with MS.

Methods

This research applied qualitative methodology, utilizing semi-structured interviews with individuals with MS and their family members/caregivers. Purposeful sampling was done among people who referred to Isfahan MS Association. Participants were selected with a maximum variation in terms of gender, age, education, occupation and marital status. Interviews were continued to reach data saturation. The gathered data were concurrently analyzed by the content analysis technique. MAXQDA software version 10 was used for data management.

Results

Saturation was reached after eighteen interviews. A total of three main categories and 8 sub-categories were extracted from the data. The identified facilitators were: personal facilitators (leisure time and coping strategies), interpersonal facilitators (exercise therapy, social support and social organizations) and needs and suggestions for improvement (family therapy, adopting urban architecture and facilities, and supportive systems).

Conclusions

Based on these findings, in order to improve the quality of life in patients with MS, we should pay attention to factors such as leisure time, spirituality and positive thinking, exercise, social support and social organizations. Health professionals, the government, community and families could help to improve patients’ quality of life through adapting urban architecture, holding family therapy sessions and providing supportive systems.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-021-02213-9.

18-year temporal trend of multiple sclerosis in southern Iran

BACKGROUND

Multiple Sclerosis (MS) imposes significant burdens on patients, their families, and national healthcare systems particularly when there is a resource constraint. Proper prioritization and resource allocation are therefore essential for any effective disease management. Accordingly, we sought to assess the temporal profile of MS incidence over the past two decades in southeast Iran.

METHODS

A longitudinal design was employed using data from the Iranian multiple sclerosis registry system from March 2001 to March 2019 (n=6034). Annual age-standardized incidence rates of MS (cases of clinically isolated syndrome were also included) were calculated and the trend of incidence from 2001 to 2018 was analyzed.

RESULTS

The age-adjusted incidence rate of MS raised from 1.72/100,000 in 2001 to 11.29/100,000 in 2018 (average of 18-year incidence rate was 6.30/100,000), indicating a notable rise in the incidence of MS (P-Value<0.001). However, the female to male ratio of 3.62 remained relatively stable during the study period.

CONCLUSION

Our study suggests that, in Fars province, the incidence of MS has been remarkably rising over the past two decades. We recommend further studies to better understand the determinants of this pattern. Implementing effective policies in lowering the burden of MS is another important step in this regard.

Temporal trends of incidence and prevalence of multiple sclerosis in Razavi Khorasan Province, Northeast Iran

OBJECTIVES

The prevalence of multiple sclerosis (MS) in the Persian Gulf countries has been significantly increasing during the past decades. This study was conducted for investigating the prevalence and incidence of MS in Northeast Iran (Khorasan Razavi province).

METHODS

This cross-sectional study was conducted during 1 January 1988 and 23 September 2018. All patients with a clinically definite diagnosis of MS according to the McDonald criteria (2005) and MRI along with the medical diagnosis, recorded in the Khorasan MS society, were considered for calculation of crude and age-standardized prevalence, and incidence rates of MS. The periodic incidence rates were calculated based on the year of onset of MS. Also, we calculated gender ratios for prevalence and incidence rates.

RESULTS

The mean age-standardized prevalence and incidence rates of MS in the Khorasan Razavi were 8.69 (95% CI 8.05-9.41) per 100,000 (3.99 (95% CI 3.39-4.74) for males, 13.49 (95% CI 12.37-14.76) for females). Age-standardized prevalence was 48.87 (95% CI 48.37-49.35) per 100,000 (22.47 (95% CI 22.01-22.93) for males, 75.65 (95% CI 74.80-76.51) for females). Also, the mean incidence and prevalence for Mashhad County as capital of province were 11.38 and 59.09 per 100,000 populations, respectively. The female/male ratio was 3.33 for all age groups.

CONCLUSION

Our results showed that this region is a high-risk area for MS like central region of Iran. Our results revealed that the prevalence and incidence of MS in the study area have increased during the recent decades with a sharp slope.

Downregulation of miR-125a-5p and miR-218-5p in Peripheral Blood Mononuclear Cells of Patients with Relapsing-Remitting Multiple Sclerosis

Multiple sclerosis (MS) is a chronic neuroinflammatory disease of the brain and spinal cord. Evidences have demonstrated that microRNAs (miRNAs) are involved in the pathological process of MS that may confer a valuable diagnostic biomarker for disease diagnosis, prognosis, and treatment. Hence, we assessed the expression pattern of miR-125a-5p and miR-218-5p in the peripheral blood mononuclear cells (PBMCs) of subjects with relapsing-remitting multiple sclerosis (RRMS). We recruited 50 RRMS patients and 50 age- and sex-matched healthy control subjects. PBMCs were isolated from the peripheral blood samples, RNA content was extracted, cDNA was synthesized, and finally expression level of miRNAs was determined using quantitative real-time PCR. Our data indicate significant downregulation of both miR-125a-5p and miR-218-5p in RRMS patients compared to healthy controls (P< .0001). The levels of both miRNAs were significantly downregulated in an age-dependent manner compared with consistent healthy control groups (30-40 years old P< .0001). Expression level of miR-218-5p was significantly changed in only female patients (Female group P< .0001; Male group P= .12). Receiver operating characteristic (ROC) curve data indicated that the expression levels of both miRNAs were able to discriminate RRMS patients from healthy subjects (P< .05). Moreover, bioinformatic enrichment analysis revealed that the target genes of these miRNAs had cardinal roles in the regulation of key biological pathways involved in the clinical course and pathogenesis of MS. Collectively, our results suggested that miR-125a-5p and miR-218-5p play a role in RRMS pathogenesis and have an age- and sex-dependent expression pattern in these patients.

Medical history risk factors in primary progressive multiple sclerosis: A case-control study

Background: The association between medical 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.

Effectiveness of massage therapy on fatigue and pain in patients with multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

Fatigue and pain are prevalent symptoms of multiple sclerosis (MS) and frequent complaint in MS patients, which reduce their quality of life. This study aimed to assess the effect of massage therapy on pain and fatigue in MS Patients.

METHOD

The original and Persian databases were searched included PubMed, web of science, embase, ovid, scopus, and the Cochrane Library, SID, and Iranedex from inception to November 2020. Studies that reported the effect of massage on fatigue and pain were included. Two investigators extracted all relevant data, independently. For deriving analysis, mean difference (MD) and standardized mean difference (SMD) were used.

RESULT

Ten studies were eligible acoording criteria. The effect of massage on fatigue showed significant improvement (-1.62; 95% CL -2.40, -0.83; p < .00001), also results of the systematic review showed a significant reduction in pain severity.

CONCLUSION

Massage as a complementary and non-pharmacological therapy might have been associated with alleviating fatigue and pain in M.S. patients. Based on the current study, massage intervention for MS patients could have possible clinical value for palliating pain and fatigue and improving quality of life; however, this matter needs further and more significant trial studies.

Multiple sclerosis in Iran: An epidemiological update with focus on air pollution debate

BACKGROUND

Multiple sclerosis (MS), as the most common neurologic disorder of the central nervous system, with growing incidence and prevalence worldwide and in the Middle East. This article aimed to find out the potential relationship between MS and air pollution in Iran.

METHODS

By assessing the published articles on MS and air pollution in Iran, the situation of MS as well as air/soil pollution in Iran was clarified. Then, studies on air pollution and its potential effect on Iranian MS patients were checked until 2020.

RESULTS

The MS prevalence is distributed across Iran Provinces with highest rates in Isfahan, located in the center of Iran. The higher rates of MS in Isfahan and Tehran (the Metropolitan) might be due to industrial pollution of these cities, but this hypothesis is not true for non-industrial provinces. Based on the published atlas of MS in Iran, it seems that there is a high-risk "belt" from northwest to southeast.

CONCLUSION

There are many risk factors of MS in Iran including age, gender, Vitamin D deficiency, smoking, and air pollution. The potential main risk factor of MS might be air pollution considering Isfahan and Tehran provinces. However, Chahar Mahal and Bakhtiary Province, with non-industrial nature, has the second highest MS rates which does not follow this hypothesis.

RELEVANCE FOR PATIENTS

By finding the air pollution as the main potential risk factor of MS in big provinces including Isfahan and Tehran, its effect of this factor can also be considered during diagnosis and treatment.