The prevalence and odds of bipolar disorder in women with polycystic ovary syndrome (PCO) disease: a systematic review and meta-analysis

BACKGROUND

Women with polycystic ovary syndrome (PCO) suffer from psychological difficulties like bipolar disorder. Various studies in the literature report several prevalence rates of bipolar disorder in women with PCO, while there is no systematic review in this field. So, we designed this systematic review and meta-analysis to estimate the pooled prevalence and odds of bipolar disorder in women with PCO disease.

METHOD

PubMed, Scopus, EMBASE, Web of Science, Google Scholar, and references of the references, conference abstracts were comprehensively searched by two independent researchers. The search was done on May 1st, 2023.

RESULTS

A literature search revealed 438 records, 35 full texts were evaluated, and finally, 11 studies remained for systematic review. Totally, 73,102 women with PCO and 340,724 controls were evaluated. Among cases, 1471 had bipolar diagnosis vs. 4321 controls. The prevalence of bipolar disorder in women with PCO ranged between 0 and 27%, and the pooled prevalence was estimated as 4% (95% CI, 2-5%; I2, 99.3%, p < 0.001). The odds of bipolar disorder in women with PCO ranged between 0.98 and 8.78, and the pooled estimate was 2.06 (95% CI, 1.61-2.63) (I2, 85.6%; p < 0.001).

CONCLUSIONS

This systematic review and meta-analysis show that the pooled prevalence of bipolar disorder in women with PCO is 4%, and women with PCO are at a 2-fold higher risk of bipolar disorder.

The Effects of Aquatic Therapy on Depression, Fatigue, and Balance in Patients with Multiple Sclerosis (MS): a Systematic Review and Meta-Analysis

Background: Fatigue, depression, and balance impairment are common in patients with multiple sclerosis (MS). Aquatic therapy is an exercise program which is effective in improving the well-being of patients with MS. So, we designed this systematic review to estimate the pooled effects of aquatic therapy on depression, fatigue and balance in subjects with MS. Methods:Two independent researchers did a systematic and comprehensive search of PubMed, Scopus, EMBASE, Web of Science, Google Scholar as well as gray literature, including references of the included studies, and conference abstracts. The search was done on October 31st 2022. We extracted data regarding the total number of participants, first author, publication year, country of origin, mean age, EDSS, and results of fatigue, depression and balance. Results:The first search identified 6403 studies. After deleting duplicates, 3347 studies remained, and 86 full texts were evaluated. Ten studies remained for meta-analysis. The pooled standardized mean difference (SMD) of BBS (after-before) was 0.67 (95% CI 0.19-1.16) (I²=11.6%, P=0.3). The pooled SMD of MFIS (after-before) was -0.4 (95% CI -0.71 to -0.09) (I2=21%, P=0.2). The pooled SMD of FSS (after-before) was -1.13 (95% CI -1.95 to -0.3) (I²=82.5%, P=0.003). The pooled SMD of BDI (after-before) was -1.83 (95% CI -2.31 to -1.35) (I²=30.1%, P=0.2). Conclusion:The results of the present systematic review and meta-analysis show that aquatic therapy is effective for depression, fatigue, and balance improvement in subjects with MS.

Association between demographics, socioeconomics, and disease-related factors and the perception of stigma in people with MS

BACKGROUND

Stigma is prevalent among individuals with chronic diseases, such as multiple sclerosis (MS) and those with comorbid mental health disorders, but its associated factors are poorly understood.

OBJECTIVE

To investigate the prevalence and correlates of stigma in people living with MS.

METHODS

We analyzed data from the MS Partners Advancing Technology and Health Solutions (MS PATHS) network, which collected patient information and outcomes during routine clinic visits. We used a multinomial logistic regression model to examine the cross-sectional association between stigma and demographic, socioeconomics, and MS-related factors.

RESULTS

We included 11,634 participants. The mean Neuro-QoL stigma T-score was 47.2 ± 8.6, and 17.7% of participants were classified as having moderate to severe stigma using established cutoffs. Multinomial logistic regression models suggest that higher disability levels, progressive form of the disease, shorter duration of the disease, and unemployment were associated with higher stigma while being male, married, undergoing treatment with high-efficacy disease-modifying therapies (DMTs), and being from European MS centers were associated with lower stigma perception. Disability levels, measured by Patient-Determined Disease Steps (PDDS), had the strongest independent association with stigma.

CONCLUSION

Stigma remains a relevant issue for people living with MS. Factors, such as physical and cognitive disability, DMT, and employment status may influence the severity of perceived stigma.

The Efficacy of Fingolimod and Interferons in Controlling Disability and Relapse Rate in Patients with Multiple Sclerosis: A Systematic Review and Meta-Analysis

Background

Fingolimod and interferons are used in the relapse form of multiple sclerosis (MS). The goal of this systematic review and meta-analysis was to evaluate the efficacy of fingolimod versus interferon in patients with MS. The systematic search was done in PubMed, Scopus, Embase, Web of Science, and Google Scholar.

Methods

The references of included studies as well as conference abstracts were searched up to July 2021. The literature search revealed 8211 articles, and after deleting duplicates 5594 remained. For the meta-analysis, four studies were included. The standardized mean difference (SMD) of the Expanded Disability Status Scale (EDSS) after treatment (interferon vs fingolimod) was -0.06 (95% CI: -0.28, 0.17) (I2 = 80.2%, P = 0.002).

Results

The SMD of the annual relapse rate (ARR) after treatment (interferon - fingolimod) was -0.08 (95% CI: -0.53, 0.36) (I2 = 95.5%, P < 0.001). The SMD of the ARR after treatment and before treatment in the interferon group was - 1.45, (95% CI: -1.55, -1.36) (I2 = 0, P = 0.3). The SMD of ARR after treatment and before treatment in the fingolimod group was - 1.3, (95% CI: -1.94, -0.65) (I2 = 97.4%, P < 0.001). Conclusions: The results of this systematic review show that efficacy of interferon and fingolimod in controlling relapse rate and disability is similar.

The prevalence of multiple sclerosis (MS) in Oceania, a systematic review, and meta-analysis

BACKGROUND

Oceania is a continent, covering more than 8 million km2, with a population of more than 44 million people. In different countries landing in Oceania, various prevalence of MS has been reported, so we designed this systematic review and meta-analysis to estimate the pooled prevalence of MS in Oceania.

METHODS

We systematically searched PubMed, Scopus, EMBASE, Web of Science, and Google Scholar. We also searched references of included studies, and conference abstracts. The search was done on January 1, 2023, by two independent researchers. We extracted the name of the first author, country, publication year, prevalence period, number of study participants, total female and male population, disease duration, type of MS, mean duration of the disease, mean age at disease onset, mean Expanded Disability Status Scale (EDSS), and total female and male patients with MS.

RESULTS

A literature search revealed 81,044 records; after deleting duplicates, 38,260 records remained. One hundred and six full texts were evaluated, and finally, seventeen studies remained for systematic review. Most studies were done in Newcastle; eight studies were done in 1961, 8 in 1981, 2 in 1996, and 2 in 2001. In all other years, only one study was done. The pooled prevalence of MS in 1961 in Oceania was estimated as 19.85/100,000 (I2=70.3%, p=0.001). The pooled prevalence of MS in 1981 in Oceania was estimated as 39.07/100,000 (I2 =88%, p=0.001).

CONCLUSIONS

The result of this systematic review and meta-analysis shows that the prevalence of MS has increased dramatically during the timespan in Oceania.

Stem Cell Treatment and Cerebral Palsy: A Systematic Review and Meta-Analysis

OBJECTIVE

We designed this systematic review and meta-analysis to estimate the pooled efficacy and safety profile of different types of stem cells in treating patients with cerebral palsy (CP).

METHODS

We systematically searched PubMed, Scopus, EMBASE, Web of Science, Google Scholar, and also gray literature, including references of the included studies which were published before November 2021. We extracted data regarding the total number of participants, first author, publication year, country of origin, mean age, cell type, cell dose, cell source, method of transplantation, duration of follow-up, Gross motor function, Ashworth scale, and adverse events.

RESULTS

We found 2073 articles by literature search; after deleting duplicates, 1194 remained. Nine articles remained for meta-analysis. The SMD of GMF-66 score (after-before) treatment was 1.5 (95% CI:0.7-2.3) (I2 = 89.9%, P < 0.001). The pooled incidence of Gastrointestinal (GI) complications after transplantation was 21% (95% CI:9-33%) (I2 = 56%, P = 0.08). The pooled incidence of fever after transplantation was 18 % (95% CI:6-30%) (I2 = 87.9%, P = 0.08 < 0.001) Conclusion: The result of this systematic review and meta-analysis show that stem cell therapy in cerebral palsy has neuroprotective properties from anti-inflammatory and anti-apoptotic activities. Stem cell therapy seems to be a promising adjunct to traditional therapies for cerebral palsy patients.

Microbiomes and Pediatric onset multiple sclerosis (MS): A systematic review

Background

Gut microbiomes play a role in developing and regulating autoimmune diseases such as multiple sclerosis (MS). We designed this systematic review to summarize the evidence of the effect of gut microbiota in developing pediatric-onset MS.

Methods

PubMed, Scopus, EMBASE, Web of Science, Google Scholar, references of the references and conference abstracts were comprehensively searched by two independent researchers. The search was done on January 1st, 2023. Data regarding the total number of patients, the name of the first author, publication year, country of origin, mean age, duration of the disease, body mass index (BMI), type of MS, Expanded Disability Status Scale (EDSS), age at disease onset and stool composition were extracted.

Results

A literature search revealed 4237 published studies. After removing duplicates, we had 2045 records for evaluation. Twenty-three full texts were evaluated, and four case-control studies remained for systematic review. Three studies were conducted in the United States and one in the Netherlands. The number of participants in included studies ranged between 24 and 68. The mean age of patients at the time of study varied between 11.9 and 17.9 years, and the mean age at the onset of the disease ranged between 11.5 and 14.3 years. Most included patients were female. The results show that median richness (the number of unique taxa identified, which was provided by two studies) was higher in controls, and also Margalef index, which was reported by one study was higher in control group than the case group. The results of two studies also demonstrated that median evenness indexes (taxon distribution, Shannon, Simpson) were higher in control groups, as well as PD index (Faith's phylogenic diversity metric).

Conclusion

The result of this systematic review (including four studies) showed disruption of the microbiota-immune balance in pediatric-onset MS cases.

Clinical determinants of sleep quality in patients with amyotrophic lateral sclerosis

OBJECTIVES

Poor sleep quality is more prevalent in patients with amyotrophic lateral sclerosis (ALS) than in healthy populations. The purpose of this study was to examine whether or not motor dysfunction at various distinct levels correlates with subjective sleep quality.

METHODS

Patients with ALS and controls were assessed using the Pittsburgh Sleep Quality Index (PSQI), ALS Functional Rating Scale Revised (ALSFRS-R), Beck Depression Inventory-II (BDI-II), and the Epworth Sleepiness Scale (ESS). The ALSFRS-R was used to obtain information on 12 different aspects of motor function in patients with ALS. We compared these data between the groups with poor and good sleep quality.

RESULTS

A total of 92 patients with ALS and 92 age- and sex-matched controls entered the study. The global PSQI score was significantly higher in patients with ALS than in healthy subjects (5.5 ± 4.2 vs. 4.0 ± 2.8) and 44% of the patients with ALS had poor sleep quality (PSQI score > 5). The sleep duration, sleep efficiency, and sleep disturbances components were significantly worse in patients with ALS. Sleep quality (PSQI) score correlated with ALSFRS-R score, BDI-II score, and ESS score. Of the 12 ALSFRS-R functions, swallowing significantly affected sleep quality. Orthopnea, speech, salivation, dyspnea, and walking had a medium effect. In addition, turning in bed, climbing stairs, and dressing and hygiene were found to have a small effect on sleep quality among patients with ALS.

CONCLUSIONS

Nearly half of our patients had poor sleep quality related to disease severity, depression, and daytime sleepiness. Bulbar muscle dysfunction may be associated with sleep disturbances in individuals with ALS, particularly when swallowing is impaired. In addition, patients suffering from axial or lower limb muscle disruptions are likely to have trouble sleeping.

Social support and anxiety correlation with resilience in patients with multiple sclerosis during COVID-19 pandemic

Background: Social support and anxiety are essential for patients with chronic diseases such as multiple sclerosis (MS). During coronavirus disease 2019 (COVID-19) pandemic, the psychological well-being of subjects with MS was an important issue, and we designed this study to assess anxiety, resilience, and social support in these patients during COVID-19 pandemic stage. Methods: We used convenience sampling for this study. Inclusion criteria were definite diagnosis of MS based on McDonald criteria and age more than 18 years. Two hundred patients with MS were enrolled. Subjects were asked to fill out valid and reliable Persian versions of Connor-Davidson Resilience Scale (CD-RISC), Beck Anxiety Inventory (BAI), and Perceived Social Support Scale. We also collected demographic data (age, sex, marital status, and occupation), disease duration, and disability level [Expanded Disability Status Scale (EDSS)]. Continuous variables were presented as mean ± standard deviation (SD) (except for EDSS, as its distribution was not normal), and categorical variables were presented as frequencies. Correlation coefficients were calculated. We did a subgroup analysis and compared patients with BAI less than 30 and more than 30 (severe anxiety). A P-value less than 0.05 was considered significant. Results: Mean age and mean duration of the disease were 36.5 ± 9.3 and 6.2 ± 5.4 years, respectively. Mean BAI, social support, and resilience scores were 33.8 ± 11.4, 65.7 ± 16.7, and 62.5 ± 19.4, respectively.There was a significant positive correlation between resilience and social support scales (r = 0.44, P < 0.001), and also a significant negative correlation between resilience and BAI (r = -0.31, P < 0.001). Patients with severe anxiety (BAI > 30) had lower social support scores and resilience (social support: 70.3 ± 13.1 vs. 61.5 ± 18.6, P < 0.001; resilience: 57.3 ± 17.0 vs. 68.2 ± 19.6, P < 0.001) compared to patients with BAI ≤ 30. By considering resilience score as the dependent variable and other variables as independent variables, we found that BAI and social support scores were independent predictors. Conclusion: Social support and anxiety are independent predictors of resilience during COVID-19 pandemic in patients with MS.

Olfactory dysfunction in patients with Parkinson's disease: A systematic review and meta-analysis

Background: Parkinson's disease (PD) is a progressive neuro-degenerative disease and olfactory dysfunction is considered as an important issue in these patients. The prevalence of olfactory dysfunction in patients with PD was reported variously in previous studies. Therefore, we designed this systematic review and meta-analysis to estimate the pooled prevalence of olfactory dysfunction in patients with PD. Methods: Two expert researchers systematically searched PubMed, Scopus, EMBASE, Web of Science, Google Scholar, references of the papers, and conference abstracts. The titles and abstracts of the potential studies were evaluated after deleting the duplicates. We extracted data regarding the total number of participants, first author, publication year, the country of origin, mean age, mean disease duration, female/male, number with olfactory dysfunction, and name of the test. We evaluated the risk of potential bias by the Newcastle-Ottawa Quality Assessment Scale (adapted for cross-sectional studies). All statistical analyses were done using Stata software. To determine heterogeneity between the findings of included studies, inconsistency (I2) was calculated. We applied random effect model when I2 was more than 50%. P-value less than 0.05 was considered significant. Results: The literature search revealed 1546 studies; after deleting duplicates, 894 remained. Finally, twelve studies remained for meta-analysis. Studies were published between years of 2009 to 2021, the sample size of studies ranged between 30 and 2097, and the mean age ranged between 61 and 70 years. The pooled prevalence of olfactory dysfunction in patients with PD was estimated as 64% [95% confidence interval (CI): 44-84, I2 = 99.7%, P < 0.001]. The pooled prevalence of olfactory dysfunction using Sniffin's test was 67% (95% CI: 51-83) and using other tests was 60% (95% CI: 28-92). Conclusion: The results of this systematic review and meta-analysis showed that the pooled prevalence of olfactory dysfunction in patients with PD was 64% which should be considered by physicians.

The Prevalence of Cancer in Patients with Multiple Sclerosis (MS) who were Under Treatment with Natalizumab (Tysabri): A Systematic Review and Meta-Analysis

Background

To determine the pooled prevalence of cancer in subjects with multiple sclerosis (MS) who received Natalizumab.

Methods

Two researchers systematically searched PubMed, Scopus, EMBASE, Web of Science, google scholar, and gray literature including references of the included studies. The search strategy which was used in PubMed was ("Disseminated Sclerosis" OR "multiple sclerosis" OR "MS" OR "Acute Fulminating") AND ("Cancer" OR "Neoplasia*" OR "Neoplasm*" OR "Tumor*" OR "Malignancy" OR "Benign Neoplasm" OR "Malignant neoplasm") AND ("Tysabri" OR "Antegren" OR "natalizumab" OR "Modifying Therapy"). Results: We found 1,993 articles by literature search, and 1,573 studies remained after removing duplicate studies. For metaanalysis, we used the extracted data of eight studies. The pooled prevalence of cancer in patients who received Natalizumab was 2% (95%CI: 1-3%; I2: 99.4%, P < 0.001). The pooled prevalence of basal cell carcinoma in patients with cancer was 12% (95%CI: 5-20%; I2:50.3%, P = 0.13).

Conclusions

The main finding of this systematic review and metaanalysis is that the pooled prevalence of cancer in subjects who suffer from MS and received natalizumab was 2%.

Impact of menopause on relapse rate and disability level in patients with multiple sclerosis (MS): a systematic review and meta-analysis

BACKGROUND

Menopause is a physiologic phase in women's lives. Findings regarding multiple sclerosis (MS) course through menopause are diverse. So, we designed this systematic review and meta-analysis to estimate the impact of menopause on relapse rate, and disability status in women with MS.

METHODS

PubMed, Scopus, EMBASE, Web of Science, and google scholar were systematically searched by two independent researchers on January 1st, 2023. They also evaluated conference abstracts, and references of the included studies. In addition, data regarding the total number of participants, name of the first author of the publication, publication year, country of origin, disease duration, disease type, annual relapse rate, and Expanded Disability Status Scale (EDSS) before and after menopause were recorded.

RESULTS

A literature search revealed 1024 records. Twenty-one full texts were evaluated, and finally, four studies were included for meta-analysis. Mean ARR before menopause ranged between 0.21 and 0.37, and after menopause ranged between 0.13 and 0.08. The SMD of mean ARR ranged between - 1.04, and - 0.29, while the pooled SMD was estimated as -0.52(95% CI: -0.88, -0.15) (I2 = 73.6%, P = 0.02). The mean EDSS before menopause ranged between 1.5 and 2, and after menopause ranged between 2 and 3.1. The SMD of EDSS ranged between 0.46, and 0.71. The pooled SMD of EDSS change (after menopause-before menopause) estimated as 0.56(95% CI: 0.38, 0.73)(I2 = 0, P = 0.4).

CONCLUSION

The result of this systematic review and meta-analysis show that menopause can be associated with relapse rate reduction, unlike increase in disease-related disability in women with MS.

Fampridine for gait imbalance in patients with multiple sclerosis (MS): a systematic review and meta-analysis

BACKGROUND

Gait imbalance is one of the frequent complications in subjects with multiple sclerosis (MS). Fampridine (4-aminopyridine) is a potassium-channel blocker that is administered for gait imbalance in MS. Different studies showed the effects of fampridine on gait status based on various tests in subjects with MS. Some showed significant improvement after treatment, and others did not. So, we designed this systematic review, and meta-analysis to estimate the pooled effects of fampridine on gait status in patients with MS.

METHODS

The main goal is the evaluation of times of different gait test pre and post fampridine treatment. Two independent expert researchers conducted a systematic and comprehensive search in PubMed, Scopus, EMBASE, Web of Science, and Google Scholar and also gray literature, including references of the references and conference abstracts. The search was done on September 16, 2022. Before-after studies trials reporting scores of the walking tests. We extracted data regarding the total number of participants, first author, publication year, country of origin, mean age, Expanded Disability Status Scale (EDSS), and the results of walking tests.

RESULTS

The literature search revealed 1963 studies; after deleting duplicates, 1098 studies remained. Seventy-seven full texts were evaluated. Finally, 18 studies were included for meta-analysis, while most of them were not placebo-controlled trials. The most frequent country of origin was Germany, and the mean age and EDSS ranged between 44 and 56 years and 4 and 6, respectively. The studies were published between 2013 and 2019. The pooled standardized mean difference (SMD) (after-before) of the MS Walking Scale (MSWS-12) was - 1.97 (95%CI: - 1.7, - 1.03) (I2 = 93.1%, P < 0.001). The pooled SMD (after-before) of the six-minute walk test (6MWT) was 0.49 (95%CI: 0.22, - 0.76) (I2 = 0%, P = 0.7). The pooled SMD (after-before) of T Timed 25-Foot Walk (T25FW) was - 0.99(95%CI: - 1.52, - 0.47) (I2 = 97.5%, P < 0.001).

CONCLUSION

This systematic review and meta-analysis show that fampridine improves gait imbalance in patients with MS.

Incidence of Bell's palsy after Coronavirus disease (COVID-19) vaccination: a systematic review and meta-analysis

OBJECTIVE

To estimate the pooled incidence of Bell's palsy after COVID-19 vaccination.

METHODS

PubMed, Scopus, EMBASE, Web of Science, and google scholar were searched by two independent researchers. We also searched gray literature including references of the references and conference abstracts. We extracted data regarding the total number of participants, first author, publication year, the country of origin, female/male, type of vaccines, and the number of patients who developed Bell's palsy after COVID-19 vaccination.

RESULTS

Literature search revealed 370 articles, subsequently deleting duplicates 227 remained. After careful evaluation of the full texts, twenty articles remained for meta-analysis. The most commonly administered vaccines were Pfizer followed by Moderna. In total, 4.54e+07 individuals received vaccines against COVID-19, and 1739 cases developed Bell's palsy. In nine studies, controls (individuals without vaccination) were enrolled. The total number of controls was 1809069, of whom, 203 developed Bell's palsy. The incidence of Bell's palsy after COVID-19 vaccines was ignorable. The odds of developing Bell's palsy after COVID-19 vaccines was 1.02 (95%CI: 0.79-1.32) (I2 = 74.8%, p < 0.001).

CONCLUSION

The results of this systematic review and meta-analysis show that the incidence of peripheral facial palsy after COVID-19 vaccination is ignorable and vaccination does not increase the risk of developing Bell's palsy. Maybe, Bell's palsy is a presenting symptom of a more severe form of COVID-19, so clinicians must be aware of this.

Prevalence and risk of developing sexual dysfunction in women with multiple sclerosis (MS): a systematic review and meta-analysis

OBJECTIVE

To estimate the pooled prevalence of sexual dysfunction (SD) in women with multiple sclerosis (MS).

METHODS

We systematically searched PubMed, Scopus, EMBASE, Web of Science, and google scholar and also gray literature up to October 2021. The search strategy includes: ("Multiple Sclerosis" OR "MS" OR "Disseminated Sclerosis" OR (Disseminated AND Sclerosis) OR (Sclerosis AND Multiple)) AND ("Sexual Dysfunction" OR (Sexual AND Dysfunction) OR (Sexual AND Dysfunctions) OR (Sexual AND Disorders) OR (Sexual AND Disorder) OR "Sexual Dysfunctions" OR "Sexual Disorders" OR "Sexual Disorder" OR "Psychosexual Dysfunctions" OR (Dysfunction AND Psychosexual) OR (Dysfunctions AND Psychosexual) OR "Psychosexual Dysfunction" OR "Psychosexual Disorders" OR (Disorder AND Psychosexual) OR (Disorders AND Psychosexual) OR "Psychosexual Disorder" OR "Hypoactive Sexual Desire Disorder" OR "Sexual Aversion Disorder" OR (Aversion Disorders AND Sexual) OR (Disorders AND Sexual Aversion) OR "Sexual Aversion Disorders" OR "Orgasmic Disorder" OR (Disorders AND Orgasmic) OR "Orgasmic Disorders" OR "Sexual Arousal Disorder" OR (Arousal Disorders AND Sexual) OR (Disorders AND Sexual Arousal) OR "Sexual Arousal Disorders" OR "Frigidity").

RESULTS

We found 2150 articles by literature search, after deleting duplicates 1760 remained. Fifty-six articles remained for meta-analysis. The pooled prevalence of SD in MS patients estimated as 61% (95%CI:56-67%) (I²:95.7%, P < 0.001). The pooled prevalence of Anorgasmia in MS patients estimated as 29% (95%CI:20-39%) (I²:85.3%, P < 0.001). The pooled odds of developing SD in MS women estimated as 3.05(95%CI: 1.74-5.35) (I²:78.3%, P < 0.001). The pooled prevalence of decreased vaginal lubrication in MS patients estimated as 32%(95%CI:27-37%) (I² = 94.2%, P < 0.001). The pooled prevalence of reduced libido was 48%(95%CI:36-61%) (I²:92.6%, P < 0.001). The pooled prevalence of arousal problems was 40%(95%CI: 26-54%) (I²:97.4%, P < 0.001). The pooled prevalence of intercourse satisfaction was 27% (95%CI: 8-46%) (I²:99%, P < 0.001).

CONCLUSION

The result of this systematic review and meta-analysis show that the pooled prevalence of SD in women with MS is 61% and the odds of developing SD in comparison with controls is 3.05.

The Prevalence of Inflammatory Bowel Disease (IBD) in Patients with Multiple Sclerosis (MS): A Systematic Review and Meta-Analysis

Background

This systematic review and meta-analysis aim to update the pooled prevalence of Inflammatory bowel disease (IBD) in patients with multiple sclerosis (MS).

Methods

Two researchers independently and systematically searched PubMed, Scopus, EMBASE, Web of Science, and google scholar. They also searched for references of the included studies, and conference abstracts that were published up to September 2021.

Results

The literature search revealed 5719 articles, after deleting duplicates 3616 remained. Finally, 17 studies were included. The pooled prevalence of IBD in MS was 1% (I2 = 96.3%, P < 0.001). The pooled odds ratio of developing IBD in MS cases was 1.36 (95% CI: 1.1-1.6) (I2 = 58.3, P = 0.01).

Conclusions

The results of this systematic review and meta-analysis show that the pooled prevalence of IBD in MS patients was 1% and the pooled odds ratio of developing IBD in MS cases was 1.36.

Depression, sexual function and sexual quality of life in women with polycystic ovary syndrome (PCOS) and healthy subjects

BACKGROUND

Women with polycystic ovary syndrome (PCOS) suffer from a wide range of psychological problems. The goal of this study is to assess depression, sexual dysfunction and sexual quality of life in women with PCO compared with healthy subjects.

METHODS

One hundred and six PCO cases and 106 healthy subjects enrolled. They were asked to fill out valid and reliable Persian versions of BDI (Beck depression inventory), FSFIS (Female Sexual Function Index), and sexual quality of life-Female (SQOL-F) questionnaires.

RESULTS

One hundred and six PCO cases and 106 healthy subjects enrolled. Mean BDI was significantly higher while FSFI and its subscales as well as SQOL-F were significantly lower in PCO group than controls. There were significant negative correlation between FSFO and BDI (r=-0.43, p < 0.001) and also positive correlation between FSFI and SQOL-F (r = 0.438, p < 0.001) in whole population of the study. In PCO group, 77 (72.6%) had FSFI less than 26.55 and 29 (27.4%) had score more than 26.55. mean BDI was significantly higher in the group with FSFI < = 26.55 than the other group (33 ± 14.4 vs. 12 ± 11.6, p < 0.001) while SLQL-F was significantly lower in the first group (57 ± 16 vs. 74.9 ± 17.6, p < 0.001). Linear regression analysis by considering SQOL-F as dependent and FSFI, age and BDI as independent variables showed that BDI and FSFI are independent predictors.

CONCLUSION

Women with PCO, suffer more from depression and sexual dysfunction than healthy subjects.

The Prevalence of Migraine in Inflammatory Bowel Disease, a Systematic Review and Meta-Analysis

Background

Patients with inflammatory bowel disease (IBD) suffer from a wide range of comorbidities such as migraine. In studies, the prevalence of migraine in cases with IBD was reported differently. The goal of this systematic review and meta-analysis was to estimate the pooled prevalence of migraine in IBD cases.

Methods

Two researchers independently and systematically searched PubMed, Scopus, EMBASE, Web of Science, and google scholar. They also searched the gray literature including references of the included studies and conference abstracts which were published up to May 2021. Cross-sectional studies were included.

Results

The literature search revealed 840 articles, and after deleting duplicates, 650 remained. For the meta-analysis, 10 studies were included. Totally, 62,554 patients were evaluated. The pooled prevalence of migraine in patients with IBD was 19% (95% CI: 15-22%). The pooled prevalence of migraine in ulcerative colitis (UC) was 10% (95% CI: 4-15%) (I² = 99.8%, P < 0.001). The pooled prevalence of migraine in the Crohn's disease (CD) group was 24% (95% CI: 17-30%) (I² = 98.8%, P < 0.001). The pooled odds of developing migraine in IBD cases was 1.51 (95% CI: 1-2.27) (I² = 90.8%, P < 0.001).

Conclusions

The result of this systematic review and meta-analysis showed that the pooled prevalence of migraine in patients with IBD was 19% (95% CI: 15-22%).

Alternate dosing of fingolimod in relapsing-remitting multiple sclerosis: A systematic review

Background: Fingolimod is approved in relapsing-remitting multiple sclerosis (RRMS) with the recommended dose of 0.5 mg daily. To tackle possible adverse events, some clinicians may reduce the dose of fingolimod, mainly in the alternate-day form. We systematically reviewed the literature for efficacy measures of this method. Methods: PubMed (Medline®), Web of Science, Embase, Scopus, and the Cochrane Library databases were searched until April 9, 2021. Clinical studies (other than case reports and case series), in English, were included. Then, publications concerning alternate dose fingolimod (including every other day, every two or three days) were selected. Those studies concerning reduced daily dose (any daily dose less than 0.5 mg/day) were excluded to focus on alternate dosing. Results: Four observational studies were included. Data on Ohtani et al. study were limited. Three other studies were of good quality based on the Newcastle-Ottawa Scale. A total of 296 patients on the standard dose were compared to 276 patients on the alternate dosage. The most common reason for switching to the alternate dose was lymphopenia, followed by elevated liver enzymes. Two studies concluded that the alternate dosing could be a safe, yet effective strategy in patients with intolerable adverse effects of daily dose. However, Zecca et al. warned about the high possibility of disease reactivation. Due to the differences in outcome measures of the studies, meta-analysis was not applicable. Conclusion: This systematic review highlights the ambiguity of evidence on safety and efficacy of alternate dosing of fingolimod, encouraging further research on the subject.

Fear of re-infection, relapse, and anxiety during COVID-19 pandemic in patients with multiple sclerosis: A multi-center study

Background: Fear of relapse and re-infection during the coronavirus disease 2019 (COVID-19) pandemic can affect people with chronic relapsing diseases, such as multiple sclerosis (MS). We evaluated fear of re-infection, anxiety, and relapse during the COVID-19 pandemic in Iranian people with MS. Methods: This multicenter, cross-sectional study was performed in the MS clinic of Sina Hospital, Tehran, Iran, and Hakim Private Hospital, Isfahan, Iran, between January and April 2022. We asked the participants to fill out validated Persian versions of Fear of Relapse Scale (FoR), and Beck Anxiety Inventory (BAI) questionnaires and answer a binary question about their fear of getting reinfected with COVID-19. Results were reported as mean ± standard deviation (SD) for continuous variables or frequencies for categorical variables. For continuous variables which did not have a normal distribution, we reported the median and interquartile range (IQR). Spearman correlation coefficient between anxiety score and FoR score was calculated. An independent samples t-test was used to compare continuous variables. Results: Three hundred and sixty-eight patients participated in this study. The median scores of FoR and BAI were 49.7 and 34.3, respectively. Fifty-three had new relapses in their last infection. Thirty-six percent of the patients had a fear of getting COVID-19 again, and 43% had a fear of relapse during infection. Three hundred and twenty-three had two doses of COVID-19 vaccine; the most frequent type of vaccine was Sinopharm. There was a significant difference between the median FoR scores among patients with and without relapse during the last COVID-19. There was also a significant positive correlation between anxiety score and FoR (r = 0.49, P < 0.001). Conclusion: More than one-third of enrolled cases had fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) re-infection. Patients who experienced exacerbation of symptoms even in the form of relapse or pseudo relapse (possible clinical relapse) had a higher fear of infection.

Adverse side effects of Glatiramer acetate and Interferon beta-1a in patients with multiple sclerosis: A systematic review of case reports

Background: Glatiramer acetate (GA) and Interferon (IFN) beta-1a are used as first-line disease-modifying treatments for multiple sclerosis (MS). In this systematic review, we summarized case reports and case series of adverse side effects of GA and IFN beta-1a in MS patients. Methods: Without any restrictions, PubMed, Scopus, Web of Sciences, and Embase databases, and gray literature were systemically searched until June 2022. Articles were screened and data were extracted based on a predefined table by two independent reviewers. The risk of bias was assessed using the Joanna Briggs Institute (JBI) tool. Results: We identified 2103 records from the preliminary search. After deduplication and screening, 172 articles were included in the systematic review. In total, 229 individuals (52 men, 173 women, and 4 unknown) were included in the study. The most common adverse events were cutaneous (32.75%), hepatic (13.54%), allergic (8.3%), and neurological (5.68%) side effects. Furthermore, most reported side effects were related to autoimmune diseases or hypersensitivity reactions. Conclusion: GA and IFN beta-1a are associated with several side effects which may be related to the immunomodulatory function of medication or other injection-related reactions.

Low-dose ketamine infusion for the treatment of multiple sclerosis fatigue (INKLING-MS): Study protocol for a randomized, double-blind, active placebo-controlled phase II trial

BACKGROUND

Fatigue is one of the most common symptoms of people with Multiple Sclerosis (MS). However, currently-used medications for the treatment of fatigue probably do not work better than a placebo. In a pilot trial, we showed that one infusion of low-dose ketamine significantly improved fatigue severity measured four weeks after the infusion.

METHODS

The proposed study is a single-center, phase II, randomized, double-blind, parallel-group, active-placebo-controlled trial of intravenous low-dose ketamine in patients with MS fatigue. Participants will be randomized 1:1:1 into three groups: receiving either one or two infusions of ketamine (0.5 mg/kg over 40 min) or zero to one infusion of the active placebo (midazolam, 0.05 mg/kg over 40 min). Eligibility criteria include adult patients diagnosed with MS based on the latest criteria, complaining of fatigue as one of the main symptoms, and having a screening MFIS score higher than a pre-specified threshold.

RESULTS

One hundred and ten participants will be randomized over 30 months at Johns Hopkins MS Center. Complete enrollment is expected by mid-2025. The study's primary outcome will be the MFIS score at the end of week 4, comparing two-thirds of the participants who received ketamine with one-third who received midazolam. The secondary and exploratory outcomes (measured four weeks after the second infusion) will show how long the effects of a single infusion last and if two infusions of ketamine are better than one in improving MS fatigue.

CONCLUSION

This study can show whether intervening in the glutamatergic pathways would improves MS fatigue.

The relationship between retinal layer thickness and cognition in patients with multiple sclerosis: A systematic review of current literature

Background: This study was conducted to evaluate the relationship between retinal layer thickness (RLT) and cognition in patients with multiple sclerosis (MS). Methods: We searched PubMed, Scopus, Embase, Web of Science, and Google Scholar. The search strategy included the MeSH and text words as ["ora serrata" OR "retina" OR ("coherence tomography" AND "optical") OR "OCT tomography" OR (tomography AND OCT) OR "optical coherence tomography" OR "OCT" OR "retinal thickness" OR "inner plexiform layer" OR "nerve fiber layer" OR "ganglion cell layer" OR "inner nuclear layer" OR "outer plexiform layer" OR "outer nuclear layer" OR "external limiting membrane" OR "inner segment layer" OR "outer segment layer" OR "retinal pigment epithelium"] AND ["cognition"* OR "cognitive function"* OR (function* AND cognitive)] AND [(sclerosis AND multiple) OR (sclerosis AND disseminated) OR "disseminated sclerosis" OR "multiple sclerosis" OR "acute fulminating"]. Results: The literature search revealed 1090 articles; after deleting duplicates, 980 remained. Finally, 14 studies were included. Totally, 1081 patients were evaluated. Mean age ranged from 31 to 55 years. In some studies, there was a correlation between cognition and retinal thickness, while others did not confirm this finding. Some authors found cognitive impairment (CI) in patients with MS with RLT. Conclusion: The results of this systematic review show that there are discrepancies between the results of studies regarding the relationship between RLT and cognition status in patients with MS. Further studies with more included original studies and meta-analysis are recommended.

Disease-Modifying Therapy in Multiple Sclerosis: Evaluation of Patients Satisfaction in Iranian Multiple Sclerosis Population

Background

Medication satisfaction is a patient-reported outcome which could show medication adherence. The aim of this study was to determine Iranian MS patients' satisfaction with Disease Modifying Therapies (DMTs).

Methods

A standardized questionnaire was developed using Treatment Satisfaction Questionnaire for Medication (TSQM). The online link was released on IMSS (Iranian Multiple Sclerosis Society) social media channel, accessible to 4272 MS patients totally.

Results

Three hundred and ninety-four patients participated in our survey with 324 females, 70 males and an F/M ratio of 4.6:1. The most frequent DMTs used were interferon-beta (IFNβ) followed by rituximab. The mean effectiveness and global satisfaction scores were significantly higher for injectable DMTs, while the convenience score was significantly higher for oral DMTs. Mean effectiveness and side-effect scores were significantly higher in the Tysabri group and convenience score was significantly higher in the fingolimod group while global satisfaction was higher in the IFNβ group.

Conclusion

The global satisfaction and effectiveness were significantly higher with injectable DMTs while the convenience score was significantly higher with oral DMTs.

Therapeutic Plasma Exchange (TPE) Complications in Patients With Multiple Sclerosis (MS) and Clinically Isolated Syndrome (CIS): A Report From a Tertiary Center

BACKGROUND

Therapeutic plasma exchange (TPE) is a conventional second-line treatment for patients with multiple sclerosis (MS) or clinically isolated syndrome with steroid-refractory relapses.

METHODS

MS and clinically isolated syndrome patients with a steroid-refractory relapse, who fulfilled the indications for TPE were enrolled in this study. An expert nurse recorded the data comprising age, sex, type of MS, disease modifying therapy, disease duration, relapse rate, vital signs at the beginning, during and at the end of each plasma exchange session, plasma exchange volume, normal saline volume, and TPE complications. Ultimately, the statistical association was estimated amongst the variables.

RESULTS

A total of 122 cases were assessed. Twelve cases (9.8%) received plasmapheresis for the second time. The mean age was 32.2±8.7 years and 107 (87.7%) were female. In total, 609 plasma exchange sessions were completed. Hypotension and skin reaction were the most clinical complications. Hemoglobin loss and hypokalemia were the most laboratory complications. Fifty-four cases (44.3%) had no complications, 40 (32.8%) had 1 complication, 21 (17.2%) 2 complications, 6 (4.9%) had 3 complications, and 1 (0.8%) disclosed 4 complications. The relapse rate in the past 12 months and the mean plasma volume exchange were significantly different between the groups.

CONCLUSIONS

We revealed that TPE could be considered as a safe second-line therapy in MS relapses. Hypotension, skin reaction, hemoglobin loss, and hypokalemia were the most complications of TPE in our patients.

Psychometric properties of the Persian version of emotions and attitudes towards MRI" (MRI-EMA)

Background

Patients with multiple sclerosis (MS) should have magnetic resonance imaging evaluation regularly. They will experience anxiety before this examination. We conducted this study to evaluate the validity and reliability of emotions and attitudes towards MRI" (MRI-EMA).

Methods

One hundred-nine patients with MS were asked to fill the valid and reliable Persian version of Beck Anxiety Inventory (BAI), and MRI-EMA, questionnaires. Two weeks later, twenty cases were asked to fill the questionnaire again to assess reliability. The intra-class correlation coefficient (ICC) and Cronbach's alpha analysis were used. The correlation coefficient between BAI and MRI-EMA was calculated. Five neurologists assessed content validity by content validity ratio (CVR) and content validity index (CVI).

Results

The mean age was 37.2±1.2 years and 77% were females. CVI and CVR for all questions were 100%. The correlation coefficient between BAI and MRI-EMA was r=0.1, P=0.1 and only fear of MRI subscale was significantly correlated with BAI. The ICC of all questions was between 0.79 and 0.98.

Conclusion

Patients with MS have to be routinely screened with MRI which provides anxiety for them. Considering MRI related anxiety is crucial for these cases. The Persian version of the MRI-EMA questionnaire is a valid and reliable instrument for measuring MRI related anxiety in patients with multiple sclerosis.

The prevalence of restless legs syndrome (RLS) in patients with multiple sclerosis (MS): a systematic review and meta-analysis-an update

INTRODUCTION

The prevalence of restless legs syndrome (RLS) is reported to vary in patients with multiple sclerosis (MS) in studies which are conducted in different populations. The goal of this systematic review and meta-analysis is to update the prevalence of RLS in MS cases.

METHODS

We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, Google Scholar, and gray literature including references from identified studies and conference abstracts which were published up to June 2021. Data on the total number of participants, first author, country, disease duration, number of controls, mean patient age, male and female numbers, mean EDSS, and number of cases and/or controls with RLS were extracted from the included studies.

RESULTS

The literature search revealed 855 articles; after deleting duplicates, 530 remained. For the meta-analysis, 75 studies were included (Fig. 1). In six articles, the authors did not differentiate between CIS and MS cases when reporting RLS cases. In total, 15,411 MS/CIS patients were evaluated and 4309 had RLS. The pooled prevalence of RLS was 28% (95% CI: 24-33%). The pooled prevalence of RLS in men was 22% (95% CI: 17-26%), and the pooled prevalence of RLS in women was 30% (95% CI: 25-35%). The pooled prevalence of RLS in controls was 8% (95% CI: 6-10%).

CONCLUSION

The results of this systematic review and meta-analysis show that the pooled prevalence of RLS is 28% in MS cases and 8%. The pooled prevalence is higher in women than men (30% vs 22%).

Psychometric assessment of the Persian version of the patient determined disease steps scale in patients with multiple sclerosis and neuromyelitis optica spectrum disorder

Background: The purpose of this study was to evaluate the validity and reliability of the Persian version of Patient Determined Disease Steps (PDDS) in both patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Methods: One hundred and forty-five patients were enrolled between May and September 2020 by consecutive sampling. Participants were asked to complete timed 25-foot walk (T25FW), 12-item Multiple Sclerosis Walking Scale (MSWS-12), and Multiple Sclerosis Quality of Life-54 (MSQOL-54). Patients also completed Timed Up and Go (TUG) and six-minute walk (6MW) tests. Construct validity was assessed by calculating correlation between PDDS and ambulatory and demographic items. The intra-class correlation coefficient (ICC) was used to evaluate reliability. Results: One hundred and eleven patients with MS and 34 with NMOSD with disease duration of 7.6 ± 5.8 years were enrolled. Twenty-seven percent were men and mean Expanded Disability Status Scale (EDSS) was 1.8 ± 1.8. There was a significant positive correlation between EDSS and PDSS (rho = 0.64, P < 0.001) which was evident in MS subgroups and NMOSD [secondary progressive MS (SPMS): rho = 0.64, P < 0.001; relapsing-remitting MS (RRMS): rho = 0.47, P < 0.001; NMOSD: rho = 0.52, P = 0.001]. PDDS had also significant positive correlation with TUG, T25FW, and MSWS-12. PDDS had also significant negative correlation with 6MW test. PDDS had weak correlation with demographic variables. The ICC was calculated as 0.99 for PDDS. Conclusion: The Persian version of PDDS provides valid and reliable instrument to assess MS/NMOSD-related disability.

The prevalence of cancer in patients with multiple sclerosis (MS) who received rituximab: a systematic review and meta-analysis

OBJECTIVE

To estimate the pooled prevalence of cancer in patients with multiple sclerosis (MS) cases who were under treatment with rituximab.

METHODS

We searched PubMed, Scopus, EMBASE, Web of Science, and google scholar along with gray literature up to April 2021. The search strategy included the MeSH and text words as (("CD20 Antibody" AND Rituximab) OR "Rituximab CD20 Antibody" OR Mabthera OR "IDEC-C2B8 Antibody" OR "IDEC C2B8 Antibody" OR IDEC-C2B8 OR "IDEC C2B8" OR GP2013 OR Rituxan OR rituximab) AND ((Sclerosis AND multiple) OR (sclerosis AND disseminated) OR "disseminated sclerosis" OR "multiple sclerosis" OR "acute fulminating").

RESULTS

The literature search revealed 3577 articles, after deleting duplicates 2066 remained. For the meta-analysis, 22 studies were included. Totally, 15599 patients were enrolled while 133 cancers were detected. The pooled prevalence of cancer in MS patients under treatment with rituximab is 1in 100,000 (I2 = 99.9%, p < 0.001).

CONCLUSION

The results of this systematic review and meta-analysis show that the pooled prevalence of cancer in MS patients who received rituximab is 1 in 100,000 cases.

The prevalence of sexual dysfunction and erectile dysfunction in men with multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

The prevalence of sexual dysfunction (SD) in men with multiple sclerosis (MS) is reported variously in different studies. The most common form of SD in these patients is erectile dysfunction (ED). The goal of this systematic review and meta-analysis is to determine the pooled prevalence of SD and ED in men suffering from MS.

METHODS

We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, and gray literature (references of references, and congress abstracts) up to 14th November 2020.

RESULTS

We found 3163 studies by primary search, 2246 were included after deletion of duplicates. Finally, 29 studies were included for meta-analysis. A total of 3349 patients were evaluated. The pooled prevalence of SD was 66% (95% CI: 64%-69%). The pooled prevalence of erectile dysfunction was 49% (95% CI: 47%-50%).

CONCLUSION

Sexual dysfunction is a prevalent complication of MS in male patients which should be considered by clinicians.

COVID-19 vaccines and patients with multiple sclerosis: willingness, unwillingness and hesitancy: a systematic review and meta-analysis

Objective

The purpose of this study was to determine the pooled prevalence of vaccination willingness, unwillingness, and hesitancy among patients with multiple sclerosis.

Methods

Databases including PubMed, Scopus, EMBASE, Web of Science, and Google Scholar were searched. by two expert researchers, as well as references in the included studies, which were published before October 2021.

Results

Three hundred eighty articles were found in four data bases. One hundred eighty-two studies remained following deleting duplicates. Finally, ten studies remained for the meta-analysis. Totally, 5983 patients with MS were assessed. The pooled prevalence of willingness to vaccination among patients with MS was 76% (95% CI: 67–85%) (I² = 98.4%, p < 0.001). Unwillingness pooled prevalence to vaccination among patients with MS was 2% (95% CI: 2–3%) (I² = 97.9%, p < 0.001). Hesitancy pooled prevalence to vaccination among patients with MS was 0% (I² = 98%, p < 0.001).

Conclusion

According to the findings of this systematic review and meta-analysis, more than two-thirds of patients with MS were willing to obtain COVID-19 vaccines.

Psychometric Properties of the Persian Version of the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ) Questionnaire

Background

Patients with multiple sclerosis (MS) suffer from a wide range of psychological and physical problems. Employment status is a crucial issue for patients with MS as unemployment while it is not completely evaluated in patients with MS.

Objectives

To assess psychometrical properties of the Persian version of the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ).

Methods

One hundred and sixty patients were enrolled. They were asked to fill valid and reliable Persian version of the Fatigue Severity Scale (FSS), social support scale, and Short Form Health Survey (SF-36) and translated version of the MSWDQ questionnaire. Twenty cases filed the questionnaire two weeks later to assess reliability. The intra-class correlation coefficient (ICC), Cronbach's alpha, correlation coefficients were used.

Results

Mean age and mean duration of the disease were 36.8 ± 9.1, and 7.5 ± 5.1, respectively. The Cronbach alpha for psychological/cognitive barriers subscale was 0.87, for Physical barriers was 0.83 and for external barriers was 0.86. The Cronbach α for the whole questionnaire was 0.89. There was a significant positive correlation between FSS and MSWDQ score, and a significant correlation with SF-36 and social support. The ICCs of all questions were acceptable.

Conclusions

Persian version of MSWDQ questionnaire is a valid and reliable instrument for evaluating work-related problems in patients with MS.

Pregnancy History, Oral Contraceptive Pills Consumption (OCPs), and Risk of Multiple Sclerosis: A Systematic Review and Meta-Analysis

Background

To estimate the pooled odds of oral contraceptive pills consumption (OCPs) use as well as pregnancy history and multiple sclerosis (MS) risk.

Methods

We systematically searched PubMed, Embase, Scopus, Web of Science, Google scholar, and gray literature including references of the references as well as conference papers. The search strategy in PubMed was ((Oral contraceptive pills) OR OCP) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating) AND (gravidity) OR (pregnancy).

Results

Four studies were included. The pooled odds of developing MS in women with pregnancy history compared with nulligravid women was 0.64 (95%CI = 0.53 - 0.78) (I ² = 0, P = 0.5), which means that pregnancy reduces the risk of MS by 36%. The pooled odds of OCP consumption and risk of MS were 1.09 (95% CI = 0.67 - 1.76). By comparing the pooled odds of OCP consumption and risk of MS according to the country of the origin, we found that the pooled odds in Iranian studies was 1.03 (95% CI = 0.31 - 3.45) and the pooled OR in studies that were conducted in the United States was 1.13 (95% CI = 0.65 - 1.98), which showed that the country of the origin was not the cause of heterogeneity.

Conclusions

The results of this systematic review show that pregnancy history is a protective factor for MS development, whereas OCP use has no significant effect.

Intratympanic corticosteroid injection as a first-line treatment of the patients with idiopathic sudden sensorineural hearing loss compared to systemic steroid: A systematic review and meta-analysis

OBJECTIVES

The current study aimed to investigate if there is a difference in the use of intratympanic steroid therapy (IST), compared to systemic steroid treatment (SST), as an initial treatment for patients with sudden sensorineural hearing loss (SSNHL) by a meta-analysis design performed on the mean pure-tone average (PTA) improvement and the complete recovery rate.

METHODS

A systematic literature review was performed on randomized controlled trials published from 1990 to August 2020 in some databases including PubMed/MEDLINE, Scopus, Embase, Web of Science, Cochrane library/CENTRAL, Ovid, ProQuest, Google Scholar, and clinical trials.gov. The primary outcomes of interest were pure-tone average improvement and complete recovery rates.

RESULTS

Six eligible studies with 496 patients (250 patients in the IST group and 246 subjects in the SST group) were included in this study. The pooled standardized mean difference of the PTAs was estimated as 0.07 (95% CI = -0.10 to 0.25; I² = 0.0%, P = 0.668), and the pooled odds ratio of complete recovery rate was obtained as 1.00 (95% CI = 0.66 to 0.151; I² = 31.6, P = 0.199). Moreover, the pooled standardized mean difference of pure-tone average for the intratympanic steroid treatment group compared to the patients with oral steroid treatment was 0.07 (95% CI = -0.12 to 0.26; I² = 0.0%, P = 0.526).

CONCLUSIONS

The current study demonstrated that the effect of intratympanic injection of corticosteroid, as a first-line treatment, is not statistically different from the systemic route in improving the hearing outcomes among patients with SSNHL.

Predictors of Catching COVID-19 Infection during Pandemic Stage in Patients with Multiple Sclerosis (MS)

Background:

Patients with multiple sclerosis (MS) are considered at higher risk of COVID-19 infection due to treatment with immune modulators and immune-suppressive agents. The exact risk factors are not clear. So, we aimed to conduct a study to determine the predictors of catching COVID-19 infection during the pandemic stage in patients with multiple sclerosis (MS).

Methods:

We conducted a multicenter screening study and developed an online questionnaire to collect patients’ self-reported demographic features along with MS-related and COVID-19–related information. The online questionnaire link was released by the Iran Multiple Sclerosis Society (IMSS) social media channel, accessible for 4160 MS patients totally and also was sent by WhatsApp for nonmember cases.

Results:

Totally, 1448 MS patients participated in our study. Twenty-five (1.7%) patients were diagnosed with COVID-19, from which 4 were hospitalized, 4 were treated with medical therapy, and 17 patients had home-quarantine. The patients with COVID-19 diagnosis were more frequently treated with rituximab (28% vs 24%, P = 0.001) than others, and cardiovascular comorbidity was more frequent in this group (8% vs 1.6%, P = 0.01). Regression analysis showed that cardiovascular disease was a significant positive predictor of COVID-19 infection (OR = 5.2, 95% CI: 1.1–23.7).

Conclusions:

Patients with MS who have cardiovascular disease should be more monitored for COVID-19 infection as they are at higher risk of infection.

Parkinson's disease and COVID-19: a systematic review and meta-analysis

BACKGROUND

Patients with Parkinson's disease (PD) are at higher risk of COVID-19 infection as most of them are at older age. The goal of this study is to update the pooled prevalence of COVID-19 infection in patients with PD.

METHODS

Two researchers systematically searched PubMed, Scopus, EMBASE, Web of Science, Google Scholar, and also gray literature including references of the included studies which were published before September 2021. We extracted data regarding the total number of participants, first author, publication year, the country of origin, mean age, number with COVID-19, symptoms, hospitalization, and death.

RESULTS

We found 1693 articles by literature search; after deleting duplicates, 798 remained. Thirty articles remained for meta-analysis. The pooled prevalence of COVID-19 infection in PD cases was 5% (95%CI: 4-6%) (I² = 98.1%, P < 0.001). The pooled prevalence of fever in cases with PD was 4% (95%CI: 2-6%) (I² = 96%, P < 0.001). The pooled prevalence of cough in cases with PD was 3% (95%CI: 2-4%) (I² = 95.9%, P < 0.001). The pooled prevalence of hospitalization in cases with COVID-19 infection was 49% (95%CI: 29-52%) (I²: 93.5%, P < 0.001). The pooled prevalence of mortality in COVID-19 cases was 12% (95%CI: 10-14%) (I² = 97.6%, P < 0.001).

CONCLUSION

The results of this systematic review and meta-analysis show that the pooled prevalence of COVID-19 infection in PD cases is 5% besides hospitalization and mortality rates which are 49% and 12%.

Effect of Two Different Doses of Vitamin D Supplementation on Uterine Myoma on South East Iranian Population; A Clinical Trial

Objective: Uterine myoma is the most common benign tumor however with significant distress and reduced quality of life in affected women. Besides, vitamin D deficiency may be a risk factor for uterine myoma. This study aimed to evaluate the effect of vitamin D supplements on the size of myoma in women with vitamin D insufficiency or deficiency.

Materials and methods: This clinical trial was conducted in a teaching hospital from 2019 to 2020. According to baseline vitamin D level, participants were assigned into two interventional equal groups (vitamin D deficiency or insufficiency) to receive either 1000 IU daily or 50000 IU weekly vitamin D for 12 weeks. The size and location of the uterine myoma were compared before and after the intervention.

Results: Totally, 137 women with uterine myoma were enrolled. Based on baseline vitamin D level, 52 cases had vitamin D insufficiency and 85 cases had vitamin D deficiency. No significant difference was observed in age and BMI in both groups. The location of the subserosal and intramural myoma did not differ, otherwise, the percent of the submucosal myomas were increased significantly (p=0.020) after the intervention. In both groups decreased myoma size otherwise not significant was seen after the intervention (p=0.148 and p=0.664 respectively).

Conclusion: Vitamin D supplementation may not be effective in women with vitamin D insufficiency or deficiency in the short term to reduce myoma size.

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.

Deep brain stimulation for multiple sclerosis tremor: A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aims to evaluate efficacy of deep brain stimulation (DBS) in treating MS-related tremor.

METHODS

We systematically searched PubMed, Web of Science, Embase, Scopus, Google Scholar, and gray literature using a search strategy including the MeSH and text words as (((Brain Stimulations) OR (Deep Brain Stimulations) OR (Deep Brain Stimulations) OR (Deep Brain Brain Stimulation) OR (Deep Electrical Stimulation of the Brain)) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating).

RESULTS

The literature search revealed 1663 articles, 1027 of which remained after removing duplicates. Seventeen articles, published between 1999-2018, were included for the meta-analysis, including overall 168 patients. Follow-up time ranged between 6-62 months. The pooled frequency of tremor improvement among the enrolled patients was 73%, (95% CI:64-83%) (I²=84.1%, p<0.001). The pooled standardized mean difference (SMD) (after -before) was -2.9, (95% CI:-4.8, -0.98) (I²=89.8%, p<0.001).

CONCLUSION

The results of this systematic review and meta-analysis demonstrate MS-related tremor improvement after DBS.

Psychometric Properties of the Persian Version of the PARADISE-24 Questionnaire

Background:

Patients with multiple sclerosis (MS) suffer from a wide range of psychological problems. Application of a valid and reliable tool for psychosocial assessment is required for Iranian patients. The aim of this study is to determine the psychometric properties of the Persian version of the PARADISE-24 questionnaire in Iranian patients with multiple sclerosis.

Methods:

One hundred and thirteen multiple sclerosis cases were enrolled in this study. Participants were asked to answer the valid and reliable Persian version of the fatigue severity scale, social support scale, Pittsburg sleep quality index, and hospital anxiety and depression scale and translated version of the PARADISE-24 questionnaire. Twenty cases filed the questionnaire 2 weeks later to assess reliability. The intraclass correlation coefficient, Cronbach's alpha, correlation coefficients, and multiple regression analysis were used.

Results:

Mean age and mean duration of the disease were 35.8 ± 9.9 and 8.7 ± 5.6 years, respectively. The intraclass correlation coefficients ranged from 0.8 to 0.94 and Cronbach's alpha values (Cronbach's alpha was calculated as 0.91 for the whole questionnaire) were also significant. There were significant correlations between PARADISE-24 score and expanded disability status scale (r = 0.42, P < 0.001), fatigue severity scale (r = 0.62, P < 0.001), anxiety (r = 0.43, P < 0.001) and Pittsburg sleep quality index scores (r = 0.46, P < 0.001). Regression analysis by considering PARADISE-24 as dependent and other variables as independent showed that expanded disability status scale, fatigue severity scale, anxiety score, and Pittsburg sleep quality index were positive predictors of PARADISE-24 score.

Conclusions:

Persian version of PARADISE-24 questionnaire is a valid and reliable instrument for evaluating psychosocial aspects in patients with multiple sclerosis.

The prevalence of COVID-19 infection in patients with multiple sclerosis (MS): a systematic review and meta-analysis

Background

The prevalence of COVID-19 is different in studies conducted in different countries. The aim of this systematic review and meta-analysis is to estimate the pooled prevalence of COVID-19 in patients with MS.

Methods

Two independent researchers independently searched PubMed, Scopus, EMBASE, Web of Science, and google scholar along with gray literature up to April 2021. The search strategy included the MeSH and text words as (((coronavirus OR Wuhan coronavirus OR novel coronavirus OR coronavirus disease OR COVID-19 OR 2019 novel coronavirus infection OR 2019-nCOV OR severe acute respiratory syndrome coronavirus 2 OR SARS-CoV-2) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating).

Results

We found 1466 articles by literature search, and after deleting duplicates, 1029 remained. Twelve articles remained for meta-analysis. Totally, 101,462 patients were evaluated and the total number of possible/confirmed cases was 1394. Mean age ranged from 35 to 54 years. Totally, 49 patients died. The pooled prevalence of suspected COVID-19 in MS patients was 4% (95% CI: 3–4%) (I² = 98.5%, P < 0.001). The pooled prevalence of hospitalization in infected cases was 10% (95% CI: 7–12%) (I² = 95.6%, P < 0.001). The pooled prevalence of death in hospitalized cases was 4% (95% CI: 1–6%) (I² = 82.4%, P < 0.001).

Conclusion

Hospitalization rate is higher among MS patients based on COVID-19 infection while the pooled infection rate is estimated as 4%.

Prevalence of Seizure/Epilepsy in Patients with Multiple Sclerosis: A Systematic Review and Meta-Analysis

Background

Seizure and epilepsy are among the initial symptoms of multiple sclerosis (MS), yet different prevalence rates are reported for them in the previous studies. The goal of this systematic review is to estimate the pooled prevalence of seizure and epilepsy in patients with MS.

Methods

We searched PubMed, Scopus, EMBASE, Web of Science, google scholar, and gray literature including references from identified studies and conference abstracts published up to October 2019. The search strategy included the MeSH terms and text words as ((Epilepsies OR Seizure Disorder OR Seizure Disorders OR Awakening Epilepsy OR Epilepsy, Awakening OR Epilepsy, Cryptogenic OR Cryptogenic Epilepsies OR Cryptogenic Epilepsy OR Epilepsies, Cryptogenic OR epilepsy OR seizure) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating).

Results

The literature review resulted in 4860 articles; 2593 articles remained after eliminating the duplicates. For the final analysis, 39 articles were included, 9 of which were conference abstracts. The pooled prevalence of seizure in MS cases was 2%, 95% confidence interval (CI)(1%-3%) (I² = 91.8%, P < 0.001). The pooled prevalence of epilepsy in MS cases was 3%, 95% CI (2%-4%) (I2 = 92.9%, P < 0.001). The pooled prevalence of epilepsy in Asia, Europe, and America was 6%, 3%, and 3%, respectively. The level of heterogeneity decreased after subgroup analysis in Asian and American subgroups. Meta-regression analysis showed continent is not a source of heterogeneity (coefficient = -0.007, P = 0.6).

Conclusions

The result of this systematic review shows that the pooled prevalence of seizure and epilepsy among MS patients is 2% and 3%, respectively.

Effect of Vitamin D Supplements on Relapse Rate and Expanded Disability Status Scale (EDSS) in Multiple Sclerosis (MS): A Systematic Review and Meta-Analysis

Background

Multiple sclerosis (MS) is an inflammatory disease while there are controversies regarding the role of vitamin D supplements in controlling relapse and disability improvement during treatment.

Objective

The goal of this systematic review and meta-analysis was to evaluate the effect of vitamin D supplements on MS-related relapse and the Expanded Disability Status Scale (EDSS).

Methods

We searched databases to include randomized clinical trials (RCTs) which were published up to October 2018. We included RCTs, being single-blinded or double-blinded or open-label trials in which one of the main outcomes was EDSS and/or relapse after vitamin D supplementation. All statistical analyses were performed using RevMan 5.3. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for relapse between treatment arms. The mean difference was calculated for EDSS comparisons.

Results

Nine articles were included for analysis. Of these nine studies, five compared vitamin D supplement groups with placebo (group 1 studies), and four compared high- and low-dose vitamin D groups. A total of 561 patients were analyzed. Being treated with vitamin D instead of placebo showed no effect on relapse rate (OR = 0.66, 95% CI = 0.28-1.54) as well as EDSS (mean difference = 0.06, 95%CI [-0.31, 0.42]). The results of studies comparing high- vs. low-dose vitamin D interventions showed no significant effect on relapse rate (OR = 1.08, 95%CI [0.29-4.08] as well as final EDSS (mean difference = 0.17, 95% CI = -0.73, 1.07).

Conclusions

Our findings show that vitamin D supplements (high or low dose) have no significant effect on relapse rate and disability during treatment in MS patients.

Fear of relapse, social support, and psychological well-being (depression, anxiety, and stress level) of patients with multiple sclerosis (MS) during the COVID-19 pandemic stage

Background

Psychological well-being assessment during the COVID-19 pandemic is essential for patients with multiple sclerosis (MS). The goal of this study is to evaluate fear of relapse, social support, and psychological well-being (depression, anxiety, and stress level) of Iranian patients with MS during the COVID-19 pandemic stage.

Methods

One hundred and sixty-five patients were enrolled. We asked all cases to fill valid and reliable Persian version of depression, anxiety, and stress scale (DASS-21), perceived social support, and fear of relapse scale questionnaires.

Results

One hundred and sixty-five patients were enrolled. Female to male ratio was (F/M) = 4.6. Mean age and mean duration of disease were 35.3±8.6 and 7.1±5 years, respectively. Mean scores of social support, DASS, and FoR questionnaires were 63.1±16.8, 16.4±13.4, and 51.4±17.3, respectively. There was a significant negative correlation between social support and FoR scores and also significant positive correlations between components of DASS and FoR. Linear regression analysis by considering FoR as dependent variable and age, sex, marital status, duration of the disease, and EDSS as dependent variables showed that sex was an independent predictor of FoR score.

Conclusion

Psychological well-being as well as fear of relapse should be considered in patients with MS during the COVID-19 pandemic stage.