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Zemorshidi F, Töpf A, Claeys KG, McFarlane A, Patton A, Nafissi S, Straub V. Novel OBSCN variants associated with a risk to exercise-intolerance and rhabdomyolysis. Neuromuscul Disord 2024; 34:83-88. [PMID: 38159459 DOI: 10.1016/j.nmd.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 01/03/2024]
Abstract
Obscurin, encoded by the OBSCN gene, is a muscle protein consisting of three main splice isoforms, obscurin-A, obscurin-B, and obscurin kinase-only protein (also known as KIAA1639 or Obsc-kin). Obscurin is located at the M-band and Z-disks and interacts with titin and myomesin. It plays an important role in the stability and maintenance of the A- and M-bands and the subsarcolemmal organization of the microtubule network. Furthermore, obscurin is involved in Ca2+ regulation and sarcoplasmic reticulum function and is connected to several other muscle proteins. OBSCN gene variants have been reported to be relatively common in inherited cardiomyopathies. Here we reported two young patients with a history of cramps, myalgia, exercise intolerance, rhabdomyolysis, and myoglobinuria without any evidence of concomitant cardiomyopathy in association with novel OBSCN variants (c.24822C>A and c.2653+1G>C). Obscurin-deficient muscle fibers seem to have increased susceptibility to damage triggered by exercise that may lead to rhabdomyolysis. More studies are needed to clarify the diverse clinical phenotypes and the pathophysiology of OBSCN gene variants.
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Affiliation(s)
- Fariba Zemorshidi
- Neuromuscular Research Center, Tehran University of Medical Sciences, Iran; Department of Neurology, Shariati Hospital,Tehran University of Medical Sciences, Tehran, Iran; Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ana Töpf
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kristl G Claeys
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium; Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, KU Leuven, and Leuven Brain Institute (LBI), Leuven, Belgium
| | - Adam McFarlane
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Annabel Patton
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Shahriar Nafissi
- Neuromuscular Research Center, Tehran University of Medical Sciences, Iran; Department of Neurology, Shariati Hospital,Tehran University of Medical Sciences, Tehran, Iran.
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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Kamrani M, Saryazdi S, Zemorshidi F, Khadem-Rezaiyan M, Behravan G. Cognitive deficits in HTLV-1 patients. J Neurovirol 2023; 29:416-424. [PMID: 37204651 DOI: 10.1007/s13365-023-01139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 10/31/2022] [Accepted: 04/12/2023] [Indexed: 05/20/2023]
Abstract
Human T-cell lymphotropic virus type 1 (HTLV-1) is a retrovirus known to be associated with adult T-cell lymphoma and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Previous researches and brain imaging techniques have suggested cognitive abnormalities as well as brain damage in individuals infected with this virus. Given the insufficient amount of studies on how this virus can impact the affected person's cognition, we aimed to assess and compare the cognitive abnormalities of HAM/TSP patients, asymptomatic HTLV-1 carriers, and healthy controls. This cross-sectional study was conducted on 51 patients divided into 3 groups; a group of HAM/TSP patients, a group of asymptomatic HTLV-1 carriers, and an uninfected control group. Each group contained 17 members. The cognitive state of the studied population was assessed using the Mini-Mental State Exam (MMSE), Symbol Digit Modalities Test (SDMT), Rey-Osterrieth complex figure test (ROCF), the "Verbal Fluency Test" and the "Trail Making Test" (TMT) components of the Delis-Kaplan executive function system (D-KEFS) test, the Rey Auditory Verbal Learning Test (RAVLT), and digit span memory test. Patients diagnosed with HAM/TSP received significantly lower scores on the SDMT, ROCF, TMT, RAVLT, digit span memory test, and the orientation, calculation, and recall component of the MMSE assessment (p-value < 0.001). In addition, the asymptomatic HTLV-1 carriers obtained lower scores on the SDMT, ROCF, digit span memory test, and the orientation, calculation, and recall component of the MMSE assessment compared to the control group (p-value < 0.001). Overall, the findings suggest that HAM/TSP, or an asymptomatic infection with HTLV-1 could lead to cognitive deficits in the affected individuals. This can further emphasize the importance of assessing the cognitive function and psychiatric abnormalities of those infected with this virus.
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Affiliation(s)
- Maedeh Kamrani
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sima Saryazdi
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariba Zemorshidi
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghazal Behravan
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Zemorshidi F, Nafissi S, Boostani R, Karimiani EG, Ashtiani BH, Karimzadeh P, Miryounesi M, Tonekaboni SH, Nilipour Y. Megaconial congenital muscular dystrophy due to CHKB gene variants, the first report of thirteen Iranian patients. Neuromuscul Disord 2023; 33:589-595. [PMID: 37393748 DOI: 10.1016/j.nmd.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
Megaconial congenital muscular dystrophy (OMIM: 602,541) related to CHKB gene mutation is a newly defined rare autosomal recessive disorder, with multisystem involvement presenting from the neonatal period to adolescence. Choline kinase beta, lipid transport enzyme, catalyzes the biosynthesis of phosphatidylcholine and phosphatidylethanolamine, two major components of the mitochondrial membrane, on which respiratory enzyme activities are dependent. CHKB gene variants lead to loss-of-function of choline kinase b and lipid metabolism defects and mitochondrial structural changes. To date, many megaconial congenital muscular dystrophy cases due to CHKB gene variants have been reported worldwide. We describe thirteen Iranian megaconial congenital muscular dystrophy cases related to CHKB gene variants, including clinical presentations, laboratory and muscle biopsy findings, and novel CHKB gene variants. The most common symptoms and signs included intellectual disability, delayed gross-motor developmental milestones, language skills problems, muscle weakness, as well as autistic features, and behavioral problems. Muscle biopsy examination showed the striking finding of peripheral arrangements of large mitochondria in muscle fibers and central sarcoplasmic areas devoid of mitochondria. Eleven different CHKB gene variants including six novel variants were found in our patients. Despite the rarity of this disorder, recognition of the multisystem clinical presentations combined with characteristic findings of muscle histology can properly guide to genetic evaluation of CHKB gene.
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Affiliation(s)
- Fariba Zemorshidi
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahriar Nafissi
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Boostani
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Ghayoor Karimiani
- Molecular and Clinical Sciences Institute, St. George's, University of London, Cranmer Terrace, London SW170RE, United Kingdom; Department of Medical Genetics, Next Generation Genetic Polyclinic, Mashhad, Iran
| | | | - Parvaneh Karimzadeh
- Pediatric Neurology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Pediatric Neurology Department, Mofid Children's Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Miryounesi
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hassan Tonekaboni
- Pediatric Neurology Department, Mofid Children's Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yalda Nilipour
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran; Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Manzarinejad M, Vahidi Z, Boostani R, Khadem-Rezaiyan M, Rafatpanah H, Zemorshidi F. Pentraxin 3, a serum biomarker in human T-cell lymphotropic virus type-1-associated myelopathy patients and asymptomatic carriers. Med Microbiol Immunol 2023:10.1007/s00430-023-00770-z. [PMID: 37278849 DOI: 10.1007/s00430-023-00770-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/27/2023] [Indexed: 06/07/2023]
Abstract
Human T-cell lymphotropic virus type 1 (HTLV-1) can induce a neuroinflammatory condition that leads to myelopathy. Pentraxin 3 (PTX3) is an acute-phase protein that its plasma concentration increases during inflammation. We aimed to determine whether PTX3 serum level is elevated in HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients and HTLV-1 asymptomatic carriers (ACs) and evaluate its association with proviral load and clinical features. The serum level of PTX3 was measured using an enzyme-linked immunosorbent assay in 30 HAM patients, 30 HTLV-1 ACs, and 30 healthy controls. Also, the HTLV-1 proviral load was determined via real-time PCR technique. The findings showed that PTX3 serum level was significantly higher in HAM patients than in both asymptomatic carriers and healthy controls (p values < 0.0001). No correlation between PTX3 and the proviral load was observed in HAM patients and asymptomatic carriers (r = - 0.238, p = 0.205 and r = - 0.078, p = 0.681, respectively). The findings showed that there was no significant correlation between PTX3 and motor disability grading (MDG) (r = - 0.155, p = 0.41) nor urinary disturbance score (UDS) (r = - 0.238, p = 0.20). Higher levels of PTX3 are associated with HTLV-1-associated myelopathy compared to asymptomatic carriers. This finding may support the idea that PTX3 has the potential as a diagnostic biomarker.
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Affiliation(s)
| | - Zohreh Vahidi
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Boostani
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Houshang Rafatpanah
- Rheumatic Disease Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariba Zemorshidi
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.
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Kamrani M, Rad NN, Zemorshidi F, Khadem-Rezaiyan M. Prevalence of sexual dysfunction in HTLV-1 patients without spastic paraparesis and the association with psychiatric symptoms. Indian J Psychiatry 2023; 65:565-571. [PMID: 37397840 PMCID: PMC10309255 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_388_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/31/2023] [Accepted: 04/09/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The findings of previous studies are inconclusive in terms of psychological abnormalities and sexual function in asymptomatic human lymphotropic virus type 1 (HTLV-1) carriers. Aim This study aimed to evaluate the prevalence of sexual dysfunction and its relationship with psychological abnormalities in asymptomatic HTLV-1 carriers. Materials and Methods This cross-sectional study was conducted on asymptomatic HTLV-1 patients who were referred to the Neurology Clinic of a tertiary hospital in Mashhad, Iran. Patients with spastic paraparesis, leukemia, and uveitis, and those with an expanded disability status scale (EDSS) score higher than 2 were excluded. Sexual function in male and female subjects was evaluated using the brief male sexual function inventory (BMSFI) and female sexual dysfunction index (FSFI) questionnaires, respectively. The severity of psychological symptoms was evaluated in all patients using the symptom checklist-90-revised (SCL-90-R) questionnaire. Results A total of 117 patients (61 males and 56 females) with a mean age of 35.3 ± 6.3 years were evaluated. Overall, 50.9% of males had a high and 39.3% of females had a good sexual function. Both male and female patients with poor sexual function were older and had more children compared to those with good sexual function (P < 0.05). There was no significant difference in the distribution pattern of SCL-90 domains between patients with high and low to moderate sexual function among male patients (P > 0.05). Depression, hostility, interpersonal sensitivity, paranoid ideation, and psychological abnormality were significantly more prevalent in female patients with poor sexual function compared to those with good sexual function (P < 0.05). Conclusion The prevalence of psychological abnormalities was high in female with sexual dysfunction and these disorders might have a negative effect on various dimensions of sexual function.
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Affiliation(s)
- Maedeh Kamrani
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narges Niazi Rad
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariba Zemorshidi
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Hatatian N, Bosstani R, Mohammadi A, Mehraban S, Mahdifar M, Zemorshidi F, Mozhgani SH, Haji Ghadimi A, Foroughipour M, Rafatpanah H. Evaluation of interleukin-32 and cyclooxygenase-2 expression in HAM/TSP patients and HTLV-1 asymptomatic carriers. Iran J Basic Med Sci 2021; 24:992-996. [PMID: 34712431 PMCID: PMC8528256 DOI: 10.22038/ijbms.2021.50821.11569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 06/07/2021] [Indexed: 11/13/2022]
Abstract
Objective(s): HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a neuroinflammatory disorder associated with HTLV-1. Cytokines and inflammatory mediators have a major role in forming inflammation in HAM/TSP patients. This study aimed to measure the levels of IL-32, a proinflammatory cytokine associated with autoinflammatory disorders, and also cyclooxygenase -2 (COX-2) as a key mediator of inflammatory pathways in HAM/TSP patients and HTLV-1 asymptomatic carriers (ACs). Materials and Methods: Peripheral blood monocyte cells (PBMCs) were isolated from HAM/TSP patients, ACs, and healthy controls (HCs), and DNA and RNA were extracted to evaluate HTLV-1 proviral load (PVL) and expression of IL-32 and COX-2, using real-time PCR. Serum levels of IL-32 were determined by using an ELISA assay. Results: The expression level of IL-32 was significantly higher in ACs compared with HAM/TSP patients and HCs (P<0.0001 and P>0.05, respectively). There were no statistically significant differences in the expression levels of Cox-2 and protein levels of IL-32 between the study groups. HTLV-1 PVL was higher in HAM/TSP patients compared with ACs. Conclusion: Results showed increased mRNA levels of IL-32 in ACs. Since HTLV-1 PVL in ACs is lower than in HAM/TSP patients, it could be concluded that IL-32 might be an HTLV-1 inhibitor that seems to control virus replication. Despite the difference in IL-32 mRNA levels between study groups, no statistically significant differences were observed in IL-32 serum levels. Also, there were no significant differences in COX-2 expression.
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Affiliation(s)
- Niayesh Hatatian
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Bosstani
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asadollah Mohammadi
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Saeedeh Mehraban
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Mahdifar
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariba Zemorshidi
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sayed-Hamidreza Mozhgani
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Mohsen Foroughipour
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Houshang Rafatpanah
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Saghi E, Norouzy A, Nematy M, Jarahi L, Boostani R, Zemorshidi F, Vahidi Z, Rafatpanah H. Dietary Intake and Serum Selenium Levels Influence the Outcome of HTLV-1 Infection. Biol Trace Elem Res 2021; 199:3242-3252. [PMID: 33169347 DOI: 10.1007/s12011-020-02472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
Human T cell leukemia virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP), as the most common neurological emersion related to HTLV-1, is a debilitating and lifelong treating disease with no definitive treatment. Furthermore, it has been determined that dietary compositions (inflammatory and anti-inflammatory) and some micronutrients (such as vitamin D and selenium) have an effect on inflammatory and immune processes and with this background; the study was done to compare the nutritional status between age- and sex-matched with infected and non-infected HTLV-1. In a multi-center setting, 70 healthy controls (HCs), 35 asymptomatic carriers (ACs), and 35 HAM/TSP patients were recruited in the HTLV-1 Foundation, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Nutritional status including anthropometric indices, dietary (micro- and macronutrient) intake, and serum vitamin D, vitamin B12, zinc, and selenium were measured. In anthropometric indices, mean waist circumference (WC) in the carrier group was significantly higher than the patient and the control groups (p = 0.008). In the dietary intake, the patient group received less energy, protein, mono-unsaturated fatty acids (MUFA), and oleic, but more fat than the HTLV-1 carrier and control groups, and these differences were remarkable in three groups (p = 0.002, 0.005, 0.001, 0.01, and 0.001, respectively), whereas the carrier group received more saturated fatty acid and less poly-unsaturated fatty acids (PUFA), linoleic, and linolenic than patient and control groups with a different significant (p = 0.01, 0.007, 0.005, and 0.006, respectively) in three groups. In micronutrient intake, although selenium, zinc, and vitamins B12 and D were lower in the patient group than the carrier and control group, however, no significant differences were observed. In comparison with micronutrient serum concentrations, vitamins B12 and D and selenium in the patient group were lower than the carrier and control groups, but statistically, the considerable difference was found only in the selenium concentration (p = 0.001). The study showed that there were differences in dietary intake (including energy, macronutrients, and fatty acids), WC, and selenium serum levels between HAM/TSP patients and HTLV-1 carriers, suggesting that nutritional statues influence the inflammatory immune response in HTLV-1 infection.
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Affiliation(s)
- Effat Saghi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Abdolreza Norouzy
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran.
| | - Mohsen Nematy
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Lida Jarahi
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Boostani
- Department of Neurology, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariba Zemorshidi
- Department of Neurology, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zohreh Vahidi
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Medical School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Houshang Rafatpanah
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Medical School, Mashhad University of Medical Sciences, Mashhad, Iran.
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Rahimi H, Allahyari A, Ataei Azimi S, Kamandi M, Mozaheb Z, Zemorshidi F, Khadem-Rezaiyan M, Bary A, Seddigh-Shamsi M, Nodeh MM. Effect of hydroxychloroquine on COVID-19 prevention in cancer patients undergoing treatment: study protocol for a randomized controlled trial. Trials 2021; 22:349. [PMID: 34011413 PMCID: PMC8131879 DOI: 10.1186/s13063-021-05292-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/23/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES In this study, we will investigate the effect of hydroxychloroquine on the prevention of novel coronavirus disease (COVID-19) in cancer patients being treated. TRIAL DESIGN This is a two-arm, parallel-group, triple-blind, phase 2-3 randomized controlled trial. PARTICIPANTS All patients over the age of 15 years from 5 types of cancer will be included in the study. Patients with acute lymphoid and myeloid leukemias in the first line treated with curative intent, patients with high-grade non-Hodgkin's lymphoma treated with leukemia regimens, and patients with non-metastatic breast and colon cancer in the first line of treatment will enter the study. INTERVENTION AND COMPARATOR Patients are randomly assigned to two groups: one being given hydroxychloroquine and the other is given placebo. During 2 months of treatment, the two groups will be treated with hydroxychloroquine every other day with a single 200-mg tablet (Amin® Pharmaceutical Company, Isfahan, Iran) or placebo (identical in terms of shape, color, and smell). Patients will be monitored for COVID-19 symptoms during follow-up period. If any COVID-19-related signs or symptoms occur, they will be examined, thoroughly, investigated with a high resolution computerize tomography (CT) scan of the lungs and nasopharyngeal swab assessed by RT-PCR for SARS-CoV-2 virus. This study will be performed in five centers affiliated to Mashhad University of Medical Sciences, Mashhad, Iran. MAIN OUTCOMES The primary end point of this study is to investigate the incidence of COVID-19 in patients being treated for their cancer and receiving prophylactic Hydroxychloroquine. RANDOMIZATION Randomization will be performed using random permuted blocks. By using online website ( www.randomization.com ), the randomization sequence will be produced by quadruple blocks. The allocation ratio in intervention and control groups is 1:1. BLINDING (MASKING) Participants and caregivers do not know whether the patient is in the intervention or the control group. Those assessing the outcomes and data analyzer are also blinded to group assignment. SAMPLE SIZE The calculated total sample size is 60 patients, with 30 patients in each group.
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Affiliation(s)
- H Rahimi
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - A Allahyari
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - S Ataei Azimi
- Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - M Kamandi
- Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - Z Mozaheb
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - F Zemorshidi
- Department of Neurology, Faculty of Medicine, MUMS, Mashhad, Iran
| | - M Khadem-Rezaiyan
- Department of Community Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - A Bary
- Razavi Hospital, Mashhad, Iran
| | - M Seddigh-Shamsi
- Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - M Moeini Nodeh
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran.
- Current address: Hematology-Oncology Section, Internal Medicine Department, Ghaem Hospital, Ahmadabad Ave, Shariati Sq, Mashhad, Iran.
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Boostani R, Talab FR, Meibodi NT, Zemorshidi F. COVID-19 associated with sensorimotor polyradiculoneuropathy and skin lesions: A case report. J Neuroimmunol 2020; 350:577434. [PMID: 33197843 PMCID: PMC7647902 DOI: 10.1016/j.jneuroim.2020.577434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 12/29/2022]
Abstract
A novel betacoronavirus,SARS-CoV-2, causes Coronavirus disease 2019 typically presented with fever, myalgia and cough, but central and peripheral nervous system manifestations such as stroke, encephalitis and Guillain-Barre-Syndrome are being increasingly reported. Acute immune-mediated polyradiculoneuropathy (Guillain-Barre-Syndrome) mostly occurs after viral or bacterial infections, presenting with ascending flaccid tetraparesis, dysautonomia and respiratory failure. We reported a patient with COVID-19 (confirmed with Lung HRCT scan and positive SARS-CoV-2 PCR) who developed acute progressive flaccid tetraparesis and maculopapular pigmented plaques on the limbs, 2 weeks after respiratory symptoms. He was treated with IVIg as the Electrophysiologic study showed sensorimotor polyradiculoneuropathy with demyelinating features and skin biopsy showed interface dermatitis and vasculopathic reaction. The causal association between Guillen-Barre-Syndrome and COVID-19 is uncertain yet, but neurologists should be aware of early diagnosis and treatment of acute polyradiculoneuropathy which may cause fatal dysautonomia and respiratory failure in the context of COVID19 pandemic.
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Affiliation(s)
- Reza Boostani
- Department of Neurology, Mashhad university of medical science, Mashhad, Iran
| | | | - Naser Tayyebi Meibodi
- Cutaneous Leishmaniasis Research Center, Mashhad university of medical science, Mashhad, Iran
| | - Fariba Zemorshidi
- Department of Neurology, Mashhad university of medical science, Mashhad, Iran.
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Bigham B, Zamanpour SA, Zemorshidi F, Boroumand F, Zare H. Identification of Superficial White Matter Abnormalities in Alzheimer's Disease and Mild Cognitive Impairment Using Diffusion Tensor Imaging. J Alzheimers Dis Rep 2020; 4:49-59. [PMID: 32206757 PMCID: PMC7081087 DOI: 10.3233/adr-190149] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) estimates the microstructural alterations of the brain, as a magnetic resonance imaging (MRI)-based neuroimaging technique. Prior DTI studies reported decreased structural integrity of the superficial white matter (SWM) in the brain diseases. OBJECTIVE This study aimed to determine the diffusion characteristics of SWM in Alzheimer's disease (AD) and mild cognitive impairment (MCI) using tractography and region of interest (ROI) approaches. METHODS The diffusion MRI data were downloaded from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database on 24 patients with AD, 24 with MCI, and 24 normal control (NC) subjects. DTI processing was performed using DSI Studio software. First, for ROI-based analysis, The superficial white matter was divided into right and left frontal, parietal, temporal, insula, limbic and occipital regions by the Talairach Atlas, Then, for tractography-based analysis, the tractography of each of these regions was performed with 100000 seeds. Finally, the average diffusion values were extracted from voxels within the ROIs and tracts. RESULTS Both tractography and ROI analyses showed a significant difference in radial, axial and mean diffusivity values between the three groups (p < 0.05) across most of the SWM. Furthermore, The Mini-Mental State Examination was significantly correlated with radial, axial, and mean diffusivity values in parietal and temporal lobes SWM in the AD group (p < 0.05). CONCLUSION DTI provided information indicating microstructural changes in the SWM of patients with AD and MCI. Therefore, assessment of the SWM using DTI may be helpful for the clinical diagnosis of patients with AD and MCI.
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Affiliation(s)
- Bahare Bigham
- Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Amir Zamanpour
- Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariba Zemorshidi
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzaneh Boroumand
- Student Research Committee, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hoda Zare
- Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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