mahsa ghajarzadeh

Cognitive impairment (CI) is one of the main features of multiple sclerosis (MS). Cognitive rehabilitation (CR) programs are crucial for improving cognition and computer-assisted cognitive rehabilitation is considered as an effective method for cognition rehabilitation. To assess the effects of computer-based cognitive rehabilitation program on cognition in patients with multiple sclerosis (MS).

We performed a comprehensive search in PubMed, Scopus, Web of Science, EMBASE, and Google Scholar databases along with gray literature up to September 2021. Randomized clinical trials, articles had been published in the English language. We evaluated the risk of potential bias via the Cochrane Collaboration's tool for assessing the risk of bias. Standardized mean difference (SMD) was calculated.

The preliminary search retrieved 2302 articles by literature search, after deleting duplicates 2248 remained.  Eight articles remained for meta-analysis. Totally, 235 patients in intervention group and 192 in control group were evaluated. Mean age ranged from 43.5-52 years. The SMD of PASAT (Paced Auditory Serial Addition Test) (Case-control) test was 0.35 (95%CI:0.1-0.66) (I2:24.4%, P=0.2). The SMD of SDMT (Case-control) test was 0.07 (95%CI:-0.18-0.33). The SMD of PASAT before and after intervention in case group was 0.68 (95%CI:0.45-0.91) (I2:40%, P=0.15). The SMD of SDMT before and after intervention in case group was 0.44 (95%CI:0.21-0.66) (I2:40%, P=0.15).

The results of this systematic and meta-analysis showed that computerized cognitive rehabilitation program is effective in improving PASAT score.

Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disorder that is diagnosed using clinical signs and symptoms and confirmed via nerve conduction studies (NCSs). While NCS is a semi-invasive procedure, magnetic resonance imaging (MRI) is a non-invasive diagnostic tool that detects macroscopic nerve abnormalities and evaluates a patient's surgical or medication treatment options. This study assessed magnetic resonance neurography (MRN)’s diagnostic and grading value by comparing it to electrodiagnostic studies in patients with CTS and healthy individuals. This was a cross-sectional study on 27 wrists with CTS and 27 healthy wrists. After history taking and physical examination, we employed an NCS to confirm and determine the severity of CTS, then MRN and diffusion tensor imaging (DTI) were used to calculate apparent diffusion coefficient (ADC), fractional anisotropy (FA), and cross-sectional area (CSA). 18 patients with CTS (27 median nerves) and 15 healthy controls (27 median nerves) were evaluated. The mean FA in the CTS group was significantly lower (0.38 ± 0.05 vs. 0.45 ± 0.06, P < 0.001). The mean CSA and ADC were higher in patients with CTS but not statistically significant. FA’s diagnostic cut-off was 0.42, with a sensitivity of 70.4% and a specificity of 63%. MRN with DTI can be an effective and non-invasive diagnostic technique for the detection of CTS. The FA measure demonstrated adequate sensitivity and specificity for differentiating patients with CTS from healthy individuals.

Rehabilitation plays an important role in improving symptoms in patients with multiple sclerosis (MS). There are studies evaluating the effects of robotic rehabilitation in patients with MS, but the results varied between the studies. So, we designed this systematic review and meta-analysis to estimate pooled effects of robotic rehabilitation on fatigue, disability, and quality of life in subjects with MS.

We systematically searched PubMed, Scopus, EMBASE, Web of Science, Google Scholar, and also gray literature including references of the included studies, and also conference abstracts on October 1th 2022. Data regarding the total number of participants, first author, publication year, country of origin, mean age, EDSS, and results of fatigue and quality of life were recorded.

The first literature search revealed 6878 results, after deleting duplicates, 5019 studies remained. Two researchers, evaluated the titles and abstracts, and finally 77 full texts were assessed. For meta-analysis, we included 11 studies. The pooled Standardized Mean Difference (SMD) of Kurtzke Expanded Disability Status Scale (EDSS) (after-before) estimated as -0.56 (95%CI: -0.89,-0.23). The pooled SMD of Fatigue Severity Scale (FSS) estimated as -0.54(95%CI: -1.06, -0.01) (I2=66.7%, P=0.01). The pooled SMD of physical health subscale of multiple sclerosis quality of life (MSQOL-54) estimated as 0.36(95%CI:-0.23, 0.96) (I2=51.4%, P=0.1). The pooled SMD of mental health subscale of MSQOL54 estimated as 0.48 (95%CI: 0.07, 0.88) (I2=0%, P=0.6).

The results of this systematic review and meta-analysis show that robotic rehabilitation has positive effects on fatigue, and disability in patients with MS.

Patients with myasthenia gravis (MG), an autoimmune disease affecting the neuromuscular junction, exhibits varying rates of COVID-19 infection across different studies. This systematic review and meta-analysis aim to estimate the pooled prevalence of COVID-19 infection in individuals with MG. 

We systematically searched PubMed, Scopus, EMBASE, Web of Science, Google Scholar, and gray literature, including references to the research published before October 2021. The total number of participants, the first author, the publication year, the country of origin, the number of MG patients, their symptoms, hospitalization rates, and deaths were all extracted as study data. 

Our literature search yielded 253 articles, of which 75 remained after removing duplicates. Finally, 18 articles were included in the meta-analysis. The pooled prevalence of COVID-19 infection in MG cases was found to be 2% (95% CI, 1%, 3%; I2=85%, P<0.001). Additionally, the pooled prevalence of hospitalization among those with COVID-19 infection was 43% (95% CI, 26%, 60%; I2=97.6%; P<0.001), and the pooled prevalence of MG exacerbation was 33% (95% CI, 20%, 46%; I2=92.6%; P<0.001). 

In summary, this systematic review and meta-analysis reveal that the pooled prevalence of COVID-19 infection in individuals with MG is 2%.

One of the complications of multiple sclerosis (MS) is cognitive impairment (CI). The prevalence of CI is reported variously in previous studies. The goal of this systematic review and meta-analysis to estimate pooled prevalence of CI in patients with MS and also the prevalence of CI based on the type of applied test.

Two independent researchers systematically searched PubMed, Scopus, EMBASE, Web of Science, and google scholar as well as gray literature (conference abstracts, references of the references) which were published before up January 2022.

We found 4089 articles by literature search, after deleting duplicates 3174 remained.  Ninety articles remained for meta-analysis. The pooled prevalence of CI using all types of tests was 41% (95% CI: 38-44%) (I2=91.7%, p<0.001). The pooled prevalence of CI using BRB test was 39% (95%CI: 36-42%) (I2=89%, p<0.001). The pooled prevalence of CI using BICAMS was 44% (95%CI: 37-51%, I2=95.4%, p<0.001). The pooled prevalence of CI using MACFIMS was 44% (95% CI: 36-53%)(I2=89.3%, p<0.001).

The pooled prevalence of cognitive impairment in patients with MS is estimated as 41%, so CI it should be considered by clinicians.

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.

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).

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).

The results of this systematic review show that efficacy of interferon and fingolimod in controlling relapse rate and disability is similar.

Sexual activity is a major determinant of health-related quality of life. The aim of this study was to investigate sexual activity in women with polycystic ovary syndrome.

A case control survey was conducted at a tertiary care university hospital (Yas Hospital Complex.). A total of 193 women were enrolled in this study. The Female Sexual Function Index (FSFI) questionnaire was used to assess the sexual dysfunction. In this study, 100 cases with PCOS and 93 healthy controls were studied.

The mean FSFI total score and all domains except orgasm were significantly lower in PCOS patients as compared to healthy controls. With an FSFI score of less than 26.55, sexual dysfunction was found in 62% of PCOS cases versus 18.2% of the control group. Multiple regression analysis showed that FSH and free testosterone were independent predictors of FSFI score. The result showed that more than sixty percent of PCOS women suffer from sexual dysfunction.

PCOS women need to be asked about and managed for sexual dysfunction more frequently than non-PCOS women.

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.

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. 

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).

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.

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. 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. 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. Social support and anxiety are independent predictors of resilience during COVID-19 pandemic in patients with MS.

Multiple sclerosis is an autoimmune disease of central nervous system (CNS). There are a few articles studying the risk factors of developing MS in men. Male infertility can stem from a range of etiological factors such as genetics or environment. In the context of MS, research suggests a potential link, possibly due to shared immunological and inflammatory mechanisms. Therefore, we designed this study to evaluate the relationship between male infertility and MS development.

We systematically searched PubMed, Embase, Scopus, web of science, Google scholar and gray literature including references of the references as well as conference papers which were published up to June 2021. The search strategy in PubMed was ("Infertility, Male"[Mesh] OR [Male Infertility] OR [Sterility, Male] OR [Male Sterility] OR [Subfertility, Male] OR [Male Subfertility] OR [Sub-Fertility, Male] OR [Male Sub-Fertility] OR [Sub Fertility, Male]) AND ("Multiple Sclerosis"[Mesh] OR [Sclerosis, Multiple] OR [Sclerosis, disseminated] OR [Disseminated Sclerosis] OR [MS] OR [Multiple Sclerosis, Acute Fulminating]) AND ("Testicular Diseases"[Mesh] OR [Disease, Testicular] OR [Diseases, Testicular] OR [Testicular Disease]) AND ("Multiple Sclerosis"[Mesh] OR [Sclerosis, Multiple] OR [Sclerosis, disseminated] OR [Disseminated Sclerosis] OR [Multiple Sclerosis, Acute Fulminating] OR [MS]).

The literature search revealed 197 articles, after deleting duplicates 109 remained. For the meta-analysis, 3 studies were included. Totally, 2090 MS cases as well as 3895562 healthy subjects were enrolled. One hundred and fourteen infertile men were in MS group and 139716 infertile men were in controls. The pooled OR for male factor infertility and odds of developing MS was1.87 (95% CI: 0.89-3.94) (I2=86.1%, P=0.001).

The results of this systematic review and meta-analysis show that there is no relationship between male factor infertility and risk of MS.

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

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”).

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%; I 2: 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).

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%.

Context: 

Nowadays, botulinum toxin is used for migraine prophylaxis, and a wide range of adverse effects (AEs) are reported after administration.

The present study was conducted to evaluate the safety profile of botulinum toxin for migraine headache prophylaxis.

Migraine Disorder, Disorder AND Migraine, Headache AND Sick, Headache AND Migraine, Migraine, Migrainosus, Migraine Headache, Migraines, Sick Headaches, Botulinum, Toxins AND Botulinum, Botulinum AND Neurotoxins, Toxins AND Clostridium Botulinum Neurotoxins, Botulinum Toxin, Botulinum Neurotoxin, Clostridium Botulinum Toxins, and Botulin were searched in PubMed, Scopus, EMBASE, Web of Science, and Google Scholar databases, and gray literature, including references of the studies published before April 2023.

We found 3081 articles by literature search; after deleting duplicates, 1711 remained. Thirty-five articles remained for meta-analysis. The pooled prevalence of musculoskeletal weakness in the head and neck regions was 4% (95% CI: 2-5%) (I2 = 92.2%, P < 0.001). The pooled prevalence of neck pain was 6% (95% CI: 4-7%) (I2 = 95.8%, P < 0.001). The pooled prevalence of blepharoptosis was 2% (95% CI: 2-3%) (I2 = 91.1%, P < 0.001). The pooled prevalence of facial paralysis was 2% (95% CI: 1-4%) (I2 = 94.1%, P < 0.001). The pooled prevalence of injection site pain was 4% (95% CI: 2-5%) (I2 = 93.5%, P < 0.001).

The results of this systematic review and meta-analysis show that the most common AEs following botulinum toxin injection for migraine headache prophylaxis are neck pain, followed by musculoskeletal weakness and injection site pain.

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.

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.

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.

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 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.

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.

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).

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.

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.

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.

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.

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.

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

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.

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).

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.

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.

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.

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).

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%).

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).

 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).

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.

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.

This study was conducted to evaluate the relationship between retinal layer thickness (RLT) and cognition in patients with multiple sclerosis (MS).

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"].

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.

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.

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). 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. 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. The Persian version of PDDS provides valid and reliable instrument to assess MS/NMOSD-related disability.

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).

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.

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.

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

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).

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.

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).

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

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.

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

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.

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.

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

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

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).

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) (I2 = 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.

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

The recent surge in coronavirus disease 2019 (COVID-19) cases has exposed health care workers (HCWs) to a wide range of psychological stressors and predisposed them to anxiety-related disorders. In this study, we observed the anxiety level in this population.

This multicenter, cross-sectional study was performed on 1,038 HCWs in 14 hospitals of Tehran during the COVID-19 pandemic. In May 2020, Beck Anxiety Inventory (BAI) was used to measure the level of anxiety in this population.

The mean±SD age of participants was 36.30±8.23 years old. Most participants were 31 to 40 years old (43.2), female (87.6%), and nurses (49.5%). The BAI scores of the participants were in a positive skew distribution, with a score range of 0-63, a median of 12, and a mean value of 15.30±11.43. Out of 1,038 hospital staff, 411 (39.6%) had moderate to severe anxiety. The anxiety level was significantly higher in HCWs ≤40 years old, women, and nurses. However, there was no significant relationship between stress levels among frontline workers compared to second-line workers (P=0.82).

It seems that HCWs experienced a high level of anxiety in the COVID-19 outbreak. One of the critical measures in every epidemic is to provide supportive care to maintain the mental well-being of HCWs, especially in high-risk groups, including younger HCWs, women, and nurses.