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Background: It seems that patients with multiple sclerosis (MS) are at a higher risk for coronavirus disease 2019 (COVID-19) implications due to being subjected to immunomodulatory or immunosuppressive treatments. Besides, obesity as a risk factor may lead to more adverse consequences. The relationship between obesity and COVID-19 morbidity and outcomes in Iranian patients with MS still remains unclear. Methods: A cross-sectional study was conducted in Sina Hospital, Tehran, Iran. Patients with MS were asked to complete an online questionnaire in the Google Form format. Demographic information, clinical information including MS disease-related factors, COVID-19-related factors, and anthropometric information were recorded. Totally, 492 patients filled the questionnaire during two weeks in November 2021, by the response rate of 21.6%. Body mass index (BMI) was categorized based on the standard classification of the World Health Organization (WHO). The logistic regression was used to examine the risk of morbidity and chi-square test/one-way analysis of variance (ANOVA) was employed to determine the difference regarding severity and symptoms among groups. Results: In the fully adjusted model, the odds ratio (OR) of COVID-19 morbidity in class II obese participants was significantly 5.41 times higher than that in the normal BMI group [OR: 5.41, 95% confidence interval (CI): 1.00-29.09]. COVID-19 severity was significantly different among BMI groups (P = 0.024). Respiratory symptoms (P = 0.05) as well as gastrointestinal (GI) symptoms (P < 0.01) of COVID-19 were more prevalent among class I and class II obese patients compared with overweight, normal weight, and underweight groups. groups reported COVID-19 morbidity without any symptoms (P = 0.04). Conclusion: The results of the current study support the view that obesity could play a key role in susceptibility to COVID-19 morbidity and severity of the symptoms in patients with MS. The findings recommended that neurologists pay more attention to patients' BMI during this pandemic.

IntroductionDepression, fatigue, and anxiety are three common clinical comorbidities of multiple sclerosis (MS). We investigated the role of physical activity (PA) level and body mass index (BMI) as modifiable lifestyle factors in these three comorbidities.MethodsA cross-sectional study was conducted in the MS specialist clinic of Sina Hospital, Tehran, Iran. Demographic and clinical data were collected. BMI was categorized in accordance with the WHO’s standard classification. Physical activity (PA) level and sitting time per day were obtained using the short form of the International Physical Activity Questionnaire (IPAQ-SF). Fatigue, anxiety, and depression scores were measured using the Persian version of the Fatigue Severity Scale (FSS), Beck Anxiety Inventory (BAI), and Beck’s Depression Inventory II (BDI-II) questionnaires, respectively. The correlation between the metabolic equivalent of tasks (MET), BMI, and daily sitting hours with depression, anxiety, and fatigue were checked using the linear regression test. The normal BMI group was considered a reference, and the difference in quantitative variables between the reference and the other groups was assessed using an independent sample t-test. Physical activity was classified with tertiles, and the difference in depression, anxiety, and fatigue between the PA groups was evaluated by a one-way ANOVA test.ResultsIn total, 85 MS patients were recruited for the study. The mean ± SD age of the participants was 39.07 ± 8.84 years, and 72.9% (n: 62) of them were female. The fatigue score was directly correlated with BMI (P: 0.03; r: 0.23) and sitting hours per day (P: 0.01; r: 0.26) and indirectly correlated with PA level (P < 0.01; r: −0.33). Higher depression scores were significantly correlated with elevated daily sitting hours (P: 0.01; r: 0.27). However, the correlation between depression with PA and BMI was not meaningful (p > 0.05). Higher anxiety scores were correlated with BMI (P: 0.01; r: 0.27) and lower PA (P: 0.01; r: −0.26). The correlation between anxiety and sitting hours per day was not significant (p > 0.05). Patients in the type I obesity group had significantly higher depression scores than the normal weight group (23.67 ± 2.30 vs. 14.05 ± 9.12; P: 0.001). Fatigue (32.61 ± 14.18 vs. 52.40 ± 12.42; P: P: 0.01) scores were significantly greater among participants in the type II obesity group in comparison with the normal weight group. Fatigue (P: 0.01) and anxiety (P: 0.03) scores were significantly different in the three levels of PA, but no significant difference was found in the depression score (P: 0.17).ConclusionOur data suggest that a physically active lifestyle and being in the normal weight category are possible factors that lead to lower depression, fatigue, and anxiety in patients with MS.

Background: Coronavirus Disease 2019 (COVID-19) is a highly contagious disease that resulted in 4533645 deaths until September first, 2021. Multiple Sclerosis (MS) patients receive immunosuppressive drugs. Thus, there is a concern that these drugs will reduce the patient’s immune system resistance against COVID19. Objectives: This study aimed to evaluate the epidemiology of COVID19 and its impact on MS patients in our university hospital in Tehran City, Iran. Materials & Methods: A cross-sectional study was conducted based on hospital-based registry data from May 2020 to March 2021. Among more than 500 registered MS patients in Imam Khomeini Hospital in Tehran City, Iran, referring within our study period, 84 patients reported SARS-COV2 infection. The diagnosis of MS was confirmed by the McDonald criteria. Moreover, the diagnosis of COVID-19 in MS patients was established by the real-time-PCR technique and chest computed tomography. Results: Out of 84 MS patients with SARS-COV2 infection, 55(65.5%) were women, and their mean age was 37.48 years. The most commonly used medications by MS patients were Rituximab 20 (26.3%) and Dimethyl Fumarate 14(18.4%). Totally, 9(10.8%) of the patients needed to be hospitalized due to COVID-19, with a mean hospitalization duration of 5.88 days. A total of 1 (1.2%) death was reported. Conclusion: Compared to the healthy population, COVID-19 is not more serious in MS patients. Most MS patients with COVID-19 infection were not hospitalized and continued their medication during the infection.

The Mediterranean Dietary Approaches to the Stop Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND) diet has been shown to have beneficial neuroprotective effects. The purpose of this research was to evaluate the link between the MIND diet adherence and multiple sclerosis (MS), a degenerative neurological illness.In a hospital-based case-control setting, 77 patients with relapsing-remitting multiple sclerosis (RRMS) and 148 healthy individuals were recruited. A validated 168-item semi-quantitative food frequency questionnaire was used to assess participants' dietary intakes and the MIND diet score. A logistic regression model was used to evaluate the association between MIND diet adherence and MS.There was significant difference between RRMS and control groups in the median (Q1-Q3) of age (years, P value 0.001), body mass index (BMI) (kg/mThe MIND diet and its components, including green leafy vegetables, other vegetables, and beans, seem to decrease the odds of MS; besides butter and stick margarine, the MIND diet's unhealthy components seem to have the same protective effects, while pastries and sweets, cheese, poultry, and fried/fast foods have an inverse effect.

Background: Cognitive impairments in patients with multiple sclerosis (MS) are suggested as a prognostic factor for disease development, and consequently higher disability and more deficits in daily and social activities. In this regard, we aimed to investigate the association between quality of life (QOL) and cognitive function in patients with MS. Methods: We conducted a cross-sectional study on patients with relapsing-remitting MS (RRMS). General characteristic variables were carried out, and then all patients underwent assessments such as Multiple Sclerosis Quality of Life-54 (MSQOL-54), Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS), Expanded Disability Status Scale (EDSS), Beck Depression Inventory-II (BDI-II), and North American Adult Reading Test (NAART). Results: In the present study, a total of 92 patients, including 76 women with a mean disease duration of 6.82 ± 4.80 years were involved. Results of simple Pearson correlation revealed a significant positive relation between California Verbal Learning Test (CVLT) total learning with MSQOL mental health (r = 0.267, P = 0.017) and physical health (r = 0.299, P = 0.007). After adjusting for potential confounders, there was a negative correlation between MSQOL mental health with Delis-Kaplan Executive Function System (D-KEFS) (r = -0.303, P = 0.015) and Judgment of Line Orientation (JLO) (r = -0.310, P = 0.013). Besides, MSQOL physical health was negatively associated with Brief Visuospatial Memory Test-Revised (BVMT-R) in the adjusted model (r = -0.270, P = 0.031). Conclusion: There is a statistically significant association between specific aspects of cognitive decline and QOL. Therefore, more attention should be paid to cognitive impairment in patients with MS as based on our findings, it is significantly associated with QOL.

Background: Cognitive dysfunction is one of the problems that patients with neuromyelitis optica spectrum disorder (NMOSD) suffer from. We aimed to assess the association between demographic and clinical features as well as body mass index (BMI) and cognitive function in patients with NMOSD. Methods: A cross-sectional study was performed on 41 patients with definite diagnosis of NMOSD. Serum status of neuromyelitis optica immunoglobulin G (NMO-IgG) was determined using enzyme-linked immunosorbent assay (ELISA) method. Cognitive function was assessed by Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery which is validated for Persian people before and North American Adult Reading Test (NAART). Results: The mean score of NAART test was higher in participants with normal weight compared with overweight patients (40.47 ± 3.51 vs. 36.00 ± 5.74, P = 0.02). Current age was negatively correlated with Delis-Kaplan Executive Function System (D-KEFS)-Sorting (P = 0.05, r = -0.30). The correlation of duration of disease and cognitive performance was not significant (P > 0.05). Higher physical disability based on Expanded Disability Status Scale (EDSS) was correlated with lower results in Brief Visuospatial Memory Test-Revised (BVMT-R) (P < 0.01, r = -0.50), California Verbal Learning Test-second edition (CVLT-II)-Delayed Recall (P = 0.02, r = -0.35), and Symbol Digit Modalities Test (SDMT) (P = 0.03, r = -0.33) subtests of MACFIMS. Annual relapse rate was indirectly correlated with CVLT-II (P = 0.03, r = -0.34) and CVLT-II-Delayed Recall (P = 0.01, r = -0.38). Male participants obtained better scores in Paced Auditory Serial Addition Test (PASAT) subtest (P = 0.05). NMO-IgG seropositive patients had poorer performance in terms of CVLT-II-Delayed Recall, Controlled Oral Word Association Test (COWAT), and D-KEFS-Descriptive (P < 0.05). Participants with bachelor and master education degrees showed significantly better results compared to those with high school degree (P < 0.05). Conclusion: Investigating the clinical and demographic factors affecting cognitive impairment can increase the awareness of health care providers for early diagnosis of cognitive impairment in patients with NMOSD and increase the quality of health services.

Background : Regarding the high prevalence of multiple sclerosis (MS) and COVID-19 in Iran, a multicenter study of COVID-19 in Iranian MS patients with is carried out to address the concerns of this population. Methods : Data on MS patients with COVID-19 from nine provinces of Iran were entered in a web-based registry system, between July 2020 and March 2021. Among the COVID-19 symptoms, dyspnea, altered mental status, or those resulting in hospital admission were considered severe. Results : A total of 397 eligible patients were identified. In addition, 310 (78%) were female. The mean age was 36.5 ± 9.5. 294 (74%) patients had relapsing- remitting form. Also, four patients (1%) expired due to COVID-19 infection. The mean duration of admission in hospitalized patients was 9 (± 5.3) days. MRI was performed on 111 (28%) patients after developing COVID-19. MRI changes were observed in 27 (24%) of these cases. MS drug was changed in 26 (6%) patients. Steroid use in the past three months (OR: 2.43, 95% CI: 1.003- 5.88) (p value: 0.049) and antiCD20s (OR: 4.03, 95% CI: 2.41- 6.68) (p value < 0.001) showed significant association with severe COVID-19 symptoms. Conclusion : The death rate of COVID-19 among MS patients (1%) is lower than the overall death rate of the pandemic in Iran (3%). Those who received steroid in the past three months may be at increased risk of more severe forms of COVID-19. There are still doubts about the effect of anti CD20s on COVID-19 severity.

The onset and presentation of primary progressive multiple sclerosis (PPMS) like any other autoimmune diseases can be triggered by unexpected lifetime stressful events, which require to be assessed in order to minimize our exposure to such events as much as possible.The aim of the present study was to determine the possible role of socioeconomic status (SES) and stressful events in PPMS development METHODS: The present population-based case-control study recruited PPMS cases and healthy controls from the general population during 2019-2020 in Tehran, Iran. Clinical diagnosis of cases was based on the 2017 McDonald criteria and confirmed by a neurologist. The selection of sex-matched controls from the same source population of cases was performed using the standard method of Random Digit Dialing (RDD). The study questionnaire was filled out over telephone interviews. Matched logistic regression was administered to estimate the adjusted and unadjusted odds ratio (OR) at 95% confidence intervals (CIs) adjusted for sex, age, and marital status using SPSS 23.This study examined 146 PPMS cases and 294 controls. Mean ages (SD) for cases and controls were 46.97 (9.4) and 37.67 (6.12), respectively (P0.001). No stressful events over five years prior to the disease onset were associated with an increased risk of PPMS. Marriage (OR: 0.04; 95% CI (0.01- 0.37), P = 0.004), close family members' serious disease (OR: 0.10; 95% CI (0.02-0.60), P = 0.01), and being in debt (OR: 0.03; 95% CI (0-0.37), P = 0.006) were found to have a negative association with the risk of disease occurrence. Death of a loved one, family disruption, jail term, homelessness period, Conquer(national university entrance exam), death of spouse, getting fired from a job, joblessness, divorce, migration, close family members' suicide, and retirement were not associated with the risk of PPMS (P0.05). History of depression before the PPMS presentation was considerably associated with the incidence of PPMS (P0.001). Self-rated health status was scored noticeably lower by cases as compared with controls (P0.001). Participants with the paternal educational degree of guidance school showed a higher risk of PPMS by 2.83 time (OR: 2.83; 95% CI (1.02 - 7.80), P = 0.04) than participants with university educated fathers. In total, SES during adolescence did not indicate any association with the risk of PPMS (with the exception of levels 2 (P = 0.02) and 7 (P = 0.05)).No stressful life events were identified as possible increasing risk factors for PPMS. Marriage, close family members' serious disease, and being in debt had a negative association with the disease risk. The history of depression may elevate the risk of PPMS. While the highest and lowest SES levels in adolescence were not remarkable determiners for PPMS, levels 2 and 7 had a positive association with the risk of PPMS. The maternal educational level was not an important factor; however, the paternal educational degree of guidance school as compared to university degree made individuals more susceptible to PPMS. Self-rated health status score was higher in controls.

Neuromyelitis optica spectrum disorder (NMOSD) is a multifactorial autoimmune disease caused by genetic susceptibility and exposure to environmental factors. There is not sufficient evidence to estimate potential environmental risk factors for NMOSD; therefore, many predisposing factors may remain unknown.The present study assessed the possible associations of ethnicity, socioeconomic status (SES), and stressful life events with NMOSD risk after adjustment for sex and age in an Iranian population.This population-based case-control study included NMOSD cases and healthy controls in Tehran, Iran. Diagnosis of disease was confirmed by neurologists based on the 2015 International Consensus Criteria (ICC). Controls were sex-matched with cases and had no history of any neurological disorders. The telephone interviews were administered to gather pertinent data. Matched logistic regression was used to estimate unadjusted and adjusted odds ratio (ORs) and 95% confidence intervals (CIs) using SPSS.This study recruited 153 NMOSD cases and 400 controls with the case-control ratio of 1: 2.61 and mean ages (SD) of 37.11 (10.90) and 33.67 (8.37) years, respectively (p0.001). Depression history (OR = 3.79; 95% CI (1.50 - 9.58), p = 0.01) and stressful life events including death of first-degree relatives (OR = 5.10; 95% CI (1.78 - 14.61), p0.01), family disruption (OR = 12.68; 95% CI) 3.53 - 45.46), p0.001), homelessness periods(OR = 4.35; 95% CI (1.18 - 14.74), p = 0.02), joblessness (OR = 4.24; 95% CI (1.91 - 5.15), p = 0.01), and divorce (OR = 14.18; 95% CI (1.91 - 23.15), p = 0.01) were more common among NMOSD cases than matched controls and may play a role in increasing risk of disease occurrence. Marriage (OR = 0.10; 95% CI (0.03 - 0.35), p0.001) and Conquer (Iranian national exam for university entrance) (OR = 0.31; 95% CI (0.11 - 0.88), p = 0.02) had a negative association with NMOSD risk. Other stressful life events including jail term, close family members' serious disease or suicide, death of spouse, being in debt, getting fired from work, migration, and retirement had no relation with NMOSD risk (P0.05). The total stress number and load were not significantly associated with the risk of NMOSD (P0.05). Self-rated health status was significantly higher in controls (p0.001). Socioeconomic status (SES), parental ethnicity, and parental educational level during subjects' adolescence were not among the significant predictors of NMOSD risk (P0.05).No association was identified between ethnicity, SES, and parental educational levels as risk factors for developing NMOSD in an Iranian population. The obtained evidence showed the association of some individual stressful life events like death of first-degree relatives, family disruption, homelessness periods, joblessness, and divorce with the risk of developing NMOSD while marriage had a negative association. Depression history was more common among cases than healthy controls and may play a role in increasing risk of NMOSD.

Highlights • 90% of MS patients knew that COVID-19 is in a pandemic stage • 73% followed quarantine guidelines completely • All participants believed high person-to-person transmission rate of COVID-19

Introduction To assess the opinion of patients with Multiple Sclerosis (MS) on the outcomes of COVID-19 (coronavirus disease 2019) and its effects on MS symptoms if they catch coronavirus. A cross-sectional study was performed. Methods Considering the study objectives, a questionnaire was designed and prepared as a Google Form for MS patients for one week. Results A total of 148 MS patients with an average age of 35.73 years completed the questionnaire. The most important concern of the participants was "a high prevalence of COVID-19" following by the "MS symptoms worsening". Many participants (35%) believed that, if they catch COVID-19 they will be cured. However, the treatment will take more time for them in comparison with the general population. About 39.8% of the patients stated that COVID-19 infection does not affect the MS symptom, but others noted that, it can cause relapse (30.8%) or worsen MS symptoms (29.3%). Conclusion This study revealed that MS patients are more anxious about the effects of COVID-19 on their underlying disease rather than the infection itself.

Introduction Given some evidence on the effects of vitamin B6 on cognitive function and the high prevalence of cognitive impairment in patients with Neuromyelitis Optica Spectrum Disorder (NMOSD), we conducted the present study to evaluate the correlation between dietary vitamin B6 intake and cognitive function among NMOSD patients. Method A cross-sectional study was designed on 24 definite NMOSD patients in Sina hospital, Tehran, Iran. A validated 168-item food frequency questionnaire was used to obtain the participants’ routine dietary habits. For the cognitive function assessment, Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery was administered. Vitamin B6 intake per day was calculated, and the correlation between vitamin B6 and the results of MACFIMS subtests was examined. Results The results revealed a positive correlation between dietary vitamin B6 intake and cognitive function in all subtests of MACFIMS. This direct correlation was significant in case of verbal and learning memory according to CVLT-II subtest (p-value:0.02; r:0.45) as well as speed of information processing and working memory according to SDMT subtest (p-value:0.04; r:0.43). The results from linear regression analysis adjusted for carbohydrate intake and disease duration indicated a significant ascending trend for the score of CVLT-II, SDMT, CVLT-II-delayed recall, and Brief Visuospatial Memory Test-Revised (BVMT-R) subtests through the quartiles of vitamin B6 intakes. Conclusion Our finding indicated a positive correlation between higher dietary intake of vitamin B6 and cognitive function of NMOSD patients. Based on high prevalence of cognitive malfunction in NMOSD patients, these results are promising.

Background Neuromyelitis optica spectrum disorder (NMOSD) is an uncommon autoimmune disease of the central nerves system (CNS) by inflammatory nature. The effects of high dietary sugar intake on inflammation and dysbiosis have been received more attention in recent years. The aim of the present study was to investigate the association between various types of dietary sugar intake and NMOSD odds and clinical features. Method The current case–control study was conducted among 70 patients with definite NMOSD diagnosis based on 2015 international consensus criteria and 164 hospital-based controls. Demographic and anthropometric information in all participants and disease characteristics just in case group were obtained. Dietary data during the past year of study attendance was collected by a validated 168-item food frequency questionnaire. Participants were stratified into 3 tertiles according to each type of sugar intake and the third tertile considered as reference in multivariate regression models. The correlation between dietary sugar and disease features were analyzed using Pearson correlation test. Results The mean ± SD of total sugar intake increased from 80.73 ± 17.71 to 208.71 ± 57.93 g/day across tertiles of total sugar intake. In fully adjusted model, lower intake of sugar was associates with decreased odds of NMOSD in the first tertile vs third tertile by ORs of: 0.02(CI:0.00–0.08; p-for-trend:0.00), 0.02(CI:0.00–0.10; p-for-trend:0.00), 0.23(CI:0.08–0.61; p-for-trend:0.00), 0.19(CI:0.06–0.58; p-for-trend:0.00) and 0.16(CI:0.05–0.51; p-for-trend:0.00) for glucose, fructose, galactose, lactose and sucrose, respectively. The odds of NMOSD had a 1.72-fold (CI: 1.43–2.03; p-for-trend:0.00) significant raise per every 10 g increase for total sugar intake. There was no significant correlation between various types of dietary sugar intakes and relapse rate or patients’ disability. Conclusion The present study proposes a possible direct association between high intake of various sugar types and odds of suffering from NMOSD. More investigations are needed to prove this results.

Background A large number of multiple sclerosis [MS] patients suffer from cognitive dysfunction affecting their routine life in family and society. Investigating modifiable factors for cognition decline and controlling them, could improve the quality of life in MS patients. Therefore, the present study was aimed to evaluate the association between lipid profile components and cognition in MS patients. Methods A cross-sectional study was conducted on 50 Relapsing-Remitting MS (RRMS) patients referred to Sina hospital, Tehran, Iran. The definite diagnosis of MS was done based on the revised McDonald criteria. Data on demographic and clinical data of patients were obtained. 5 cc blood samples were taken from all subjects after 10-hour night fasting, and lipid profile components including LDL, HDL, triglyceride, and total cholesterol were evaluated. The Persian version of the Minimal Assessment of Cognitive Functions in MS [MACFIMS] battery was administered to assess the cognitive function. Spearman and Pearson correlation tests were applied to investigate the correlation between lipid profile components and MACFIMS subtests or clinical features of MS patients. Results The mean age of subjects was equal to 32.26 years old, and 85% of them were women. There was no significant correlation between MACFIMS subtests results with disease duration, patient's disability according to Expanded Disability Status Scale (EDSS), annual attack rate, and disease-modifying drug onset year (P value >0.05). A significant inverse correlation was found between greater serum total cholesterol and lower scores of Symbol Digit Modalities subtest [SDMT] (P value 0.02; r: −0.31), the Delis–Kaplan Executive Function System [DKEFS] sorting (P value 0.01; r: −0.34) and DKEFS-descriptive (P value 0.04; r: −0.28) subtests. This significant inverse correlation was also found in terms of the correlation between higher serum LDL and impairment in the case of DKEFS-sorting score (P value 0.05; r: −0.27), and DKEFS-descriptive score (P value 0.05; r: −0.27). No significant correlation was found in case of serum HDL or triglyceride and MACFIMS subtests (P value >0.05). Discussion Our findings proposed a possible correlation between the increased serum LDL cholesterol, serum total cholesterol and cognitive dysfunction among MS patients.