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Background: The accuracy of current laboratory and imaging studies for diagnosis and monitoring of Parkinson’s disease (PD) severity is low and diagnosis is mainly dependent on clinical examination. Proton magnetic resonance spectroscopy (MRS) is a non-invasive technique that can assess the chemical profile of the brain. In this study, we evaluated the utility of proton MRS in diagnosis of PD and determination of its severity. Methods: Patients with PD and healthy age-matched controls were studied using proton MRS. The level of N-acetylaspartate (NAA), total creatine (Cr), and total choline (Cho), and their ratios were calculated in substantia nigra (SN), putamen (Pu), and motor cortex. PD severity was assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Hoehn and Yahr scale. Results: Compared to 25 healthy controls (18 men, age: 59.00 ± 8.39 years), our 30 patients with PD (24 men, age: 63.80 ± 12.00 years, 29 under treatment) showed no significant difference in the metabolite ratios in SN, Pu, and motor cortex. Nigral level of NAA/Cr was significantly correlated with total UPDRS score in patients with PD (r = -0.35, P = 0.08). Moreover, patients with PD with Hoehn and Yahr scale score ≥ 2 had a lower NAA/Cr level in SN compared to patients with a lower stage. Conclusion: This study shows that 1.5 tesla proton MRS is unable to detect metabolite abnormalities in patients with PD who are under treatment. However, the NAA/Cr ratio in the SN might be a useful imaging biomarker for evaluation of disease severity in these patients.

Background: The COVID-19 pandemic and the concomitant quarantine have significantly reduced old adults’ independence in doing daily or functional activities. Thus, they require more support and help at home. Because of the effect of the disease’s progression and the adverse effects of quarantine on patients’ functional status, old adults’ caregivers might have been affected too. Objectives: The present research aimed to explore the role of the caregiving burden in the relationship between old adults’ functional status and caregivers’ mental health. Methods: The research population comprised caregiver families of old adults afflicted with chronic nervous diseases during the pandemic. To this aim, a sample of 249 caregiver families of old adults suffering from Alzheimer’s disease, Parkinson’s disease, or stroke participated in this study. Data were collected using three online questionnaires of Lawton’s instrumental activities of daily living scale (IADL), Novak’s caregiver burden inventory, and Goldberg’s mental health questionnaire. Data analysis was administered by Pearson’s correlation coefficient and structural equation modeling (SEM). Results: Correlation analysis and SEM results showed that the patients’ functional status and caregivers’ mental health had a significant, positive correlation, which was mediated by the caregiving burden variable. Conclusions: It can be concluded that better functional status of old adults can lead to a lower caregiving burden. Also, it can significantly improve caregivers’ mental health and increase the old adults’ and caregivers’ quality of life.

Background: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran. Methods: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients’ conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2). Results: A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation. Conclusion: Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system.

Despite the serious consequences of sleep apnea, some patients do not follow their physicians’ advice to undergo a sleep study. The present study aimed to determine the rate of adherence and influencing factors in conducting a polysomnography test in patients suspected of obstructive sleep apnea. This qualitative and quantitative analysis was conducted between July 2017 and November 2019 on patients suspected of sleep apnea. The quantitative analysis aimed at determining the rate of adherence through a retrospective cross-sectional study. The qualitative content analysis was conducted on purposefully selected subgroup of patients suspected of obstructive sleep apnea who were referred for polysomnography. The required data were collected through the semi-structured in-depth interviews and then recorded, transcribed, and analyzed using SPSS.22 and MAXQDA10. Quantitative part: Of 311 patients (mean age: 47.6 ± 13.1 years) referred for polysomnography, 283 patients (91%) were at a high risk of developing obstructive sleep apnea. Among those referred for polysomnography, 31% (n = 95) adhered to recommendations for a sleep study. Qualitative part: Factors affecting adherence to polysomnography were categorized as “barriers” and “triggers.” Barriers included inadequate knowledge, psychological factors, cost, and the service system. Triggers included adequate knowledge and tangible experience of consequences of the illness. The majority of patients at risk of developing obstructive sleep apnea did not follow the recommendation for polysomnography, indicating a need for systematic interventions. Among the identified barriers, knowledge and psychological factors are modifiable ones that can be addressed with the patient. We theorize that raising awareness among patients by providing additional information and eliminating concerns may help to increase the rate of adherence. Insurance coverage or subsidy to reduce the sleep study costs may also be an effective strategy to increase adherence to recommendations for polysomnography.

To investigate the incidence of coronavirus disease 2019 (COVID-19) cases, hospitalizations and deaths in Iranians vaccinated with either AZD1222 Vaxzevria, CovIran® vaccine, SARS-CoV-2 Vaccine (Vero Cell), Inactivated (lnCoV) or Sputnik V.We enrolled individuals 18 years or older receiving their first COVID-19 vaccine dose between April 2021 and January 2022 in seven Iranian cities. Participants completed weekly follow-up surveys for 17 weeks (25 weeks for AZD1222) to report their COVID-19 status and hospitalization. We used Cox regression models to assess risk factors for contracting COVID-19, hospitalization and death.Of 89 783 participants enrolled, incidence rates per 1 000 000 person-days were: 528.2 (95% confidence interval, CI: 514.0-542.7) for contracting COVID-19; 55.8 (95% CI: 51.4-60.5) for hospitalization; and 4.1 (95% CI: 3.0-5.5) for death. Compared with SARS-CoV-2 Vaccine (Vero Cell), hazard ratios (HR) for contracting COVID-19 were: 0.70 (95% CI: 0.61-0.80) with AZD1222; 0.73 (95% CI: 0.62-0.86) with Sputnik V; and 0.73 (95% CI: 0.63-0.86) with CovIran®. For hospitalization and death, all vaccines provided similar protection 14 days after the second dose. History of COVID-19 protected against contracting COVID-19 again (HR: 0.76; 95% CI: 0.69-0.84). Diabetes and respiratory, cardiac and renal disease were associated with higher risks of contracting COVID-19 after vaccination.The rates of contracting COVID-19 after vaccination were relatively high. SARS-CoV-2 Vaccine (Vero Cell) provided lower protection against COVID-19 than other vaccines. People with comorbidities had higher risks of contracting COVID-19 and hospitalization and should be prioritized for preventive interventions.Analyser l'incidence des cas, hospitalisations et décès liés à la maladie à coronavirus 2019 (COVID-19) chez les Iraniens vaccinés avec Vaxzevria AZD1222, CovIran®, le vaccin contre le SARS-CoV-2 (cellule Vero), le vaccin inactivé (lnCoV) ou Spoutnik V.Nous avons recruté des individus de minimum 18 ans ayant reçu leur première dose de vaccin contre la COVID-19 entre avril 2021 et janvier 2022 dans sept villes iraniennes. Les participants ont rempli des enquêtes de suivi hebdomadaires pendant 17 semaines (25 semaines pour AZD1222) afin de communiquer sur leur statut COVID-19 et leur hospitalisation. Nous avons utilisé des modèles de régression de Cox pour évaluer les facteurs augmentant les risques de contracter la COVID-19, d'être hospitalisé et de mourir.Sur 89 783 participants recrutés, le taux d'incidence pour 1 000 000 jours-personnes était de 528,2 (intervalle de confiance de 95%, IC: 514,0–542,7) en termes d'infection à la COVID-19; de 55,8 (IC de 95%: 51,4–60,5) en termes d'hospitalisation; et de 4,1 (IC de 95%: 3,0–5,5) en termes de décès. Comparé au vaccin contre le SARS-CoV-2 (cellule Vero), le rapport de risque (RR) de contracter la COVID-19 s'élevait à 0,70 (IC de 95%: 0,61−0,80) avec AZD1222; à 0,73 (IC de 95%: 0,62–0,86) avec Spoutnik V; et à 0,73 (IC de 95%: 0,63–0,86) avec CovIran®. Concernant l'hospitalisation et le décès, tous les vaccins offraient un niveau de protection similaire 14 jours après la seconde dose. Avoir contracté la COVID-19 par le passé prémunissait contre une réinfection (RR: 0,76; IC de 95%: 0,69–0,84). Le diabète et les maladies respiratoires, cardiaques et rénales entraînaient un risque accru de contracter la COVID-19 après la vaccination.Le taux d'infection à la COVID-19 après la vaccination était relativement élevé. D'autre part, le vaccin contre le SARS-CoV-2 (cellule Vero) s'est révélé moins efficace que les autres vaccins. Enfin, les personnes souffrant de comorbidités avaient plus de risques de contracter la COVID-19 et d'être hospitalisées; elles devraient donc être prioritaires lors des interventions préventives.Analizar la incidencia de los casos, hospitalizaciones y muertes a causa de la enfermedad por coronavirus de 2019 (COVID-19) en los iraníes vacunados con Vaxzevria AZD1222, la vacuna CovIran®, la vacuna contra el SARS-CoV-2 (célula Vero), la vacuna inactivada (lnCoV) o la Sputnik V.Se inscribieron personas de 18 años o más que recibieron su primera dosis de la vacuna contra la COVID-19 entre abril de 2021 y enero de 2022 en siete ciudades iraníes. Los participantes completaron encuestas de seguimiento semanales durante 17 semanas (25 semanas para AZD1222) para informar sobre su estado de la COVID-19 y la hospitalización. Se utilizaron modelos de regresión de Cox para valorar los factores de riesgo de contraer la COVID-19, de ser hospitalizado y de morir.De los 89 783 participantes inscritos, las tasas de incidencia por 1 000 000 de días-persona fueron 528,2 (intervalo de confianza del 95 %, IC: 514,0-542,7) en el caso de contraer la COVID-19; 55,8 (IC del 95 %: 51,4-60,5) en el caso de hospitalización; y 4,1 (IC del 95 %: 3,0-5,5) en el caso de muerte. En comparación con la vacuna contra el SARS-CoV-2 (célula Vero), los cocientes de riesgos instantáneos (CRI) de contraer la COVID-19 fueron 0,70 (IC 95 %: 0,61-0,80) con AZD1222; 0,73 (IC 95 %: 0,62-0,86) con Sputnik V; y 0,73 (IC 95 %: 0,63-0,86) con CovIran®. En cuanto a la hospitalización y la muerte, todas las vacunas proporcionaron una protección similar 14 días después de la segunda dosis. Los antecedentes de la COVID-19 protegieron contra la contracción de la COVID-19 de nuevo (CRI: 0,76; IC 95 %: 0,69-0,84). La diabetes y las enfermedades respiratorias, cardíacas y renales se asociaron a un mayor riesgo de contraer la COVID-19 después de la vacunación.Las tasas de contraer la COVID-19 después de la vacunación fueron relativamente altas. La vacuna contra el SARS-CoV-2 (célula Vero) proporcionó una menor protección contra la COVID-19 que otras vacunas. Las personas con comorbilidades tenían un mayor riesgo de contraer la COVID-19 y de ser hospitalizadas, por lo que deberían ser prioritarias para las intervenciones preventivas.التحقيق في حالات الإصابة بمرض فيروس كورونا 2019 (كوفيد 19)، وحالات الاستشفاء والوفيات بين الإيرانيين الذين تم تطعيمهم إما باستخدام لقاح AZD1222 Vaxzevria، أو لقاح CovIran®‎، أو لقاح SARS-CoV-2 )Vero Cell)، أو لقاحي (lnCoV) أو Sputnik V غير النشطين.قمنا بتسجيل الأفراد الذين تبلغ أعمارهم 18 عامًا أو أكثر، والذين تلقوا أول جرعة لقاح لكوفيد 19 بين أبريل/نيسان 2021 ويناير/كانون الثاني 2022، في سبع مدن إيرانية. أكمل المشاركون استطلاعات المتابعة الأسبوعية لمدة 17 أسبوعًا (25 أسبوعًا بالنسبة للقاح AZD1222) للإبلاغ عن تطور حالة كوفيد 19 والاستشفاء. استخدمنا نماذج التحوف كوكس (Cox) لتقييم عوامل الخطر للإصابة بكوفيد 19، والاستشفاء والوفاة.من إجمالي 89783 مشاركًا تم تسجيلهم، فإن معدلات حدوث الإصابة لكل 1000000 شخص-يوم، كانت: 528.2 (بفاصل ثقة مقداره %95: 514.0 إلى 542.7) للإصابة بكوفيد 19؛ و55.8 (بفاصل ثقة مقداره %95: 51.4 إلى 60.5) لحالات الاستشفاء؛ و4.1 (بفاصل ثقة مقداره %95: 3.0 إلى 5.5) للوفيات. بالمقارنة مع لقاح SARS-CoV-2 Vaccine )Vero Cell)، كانت نسب المخاطرة (HR) للإصابة بكوفيد 19: 0.70 (بفاصل ثقة مقداره %95: 0.61 إلى 0.80) مع AZD1222؛ و0.73 (بفاصل ثقة مقداره%95: 0.62 إلى 0.86) مع Sputnik V؛ و0.73 (بفاصل ثقة مقداره %95: 0.63 إلى 0.86) مع CovIran®‎. بالنسبة لحالات الاستشفاء والوفيات، فقد قدمت جميع اللقاحات حماية مماثلة بعد 14 يومًا من الجرعة الثانية. تاريخ الحماية من كوفيد 19 في مقابل الإصابة بكوفيد 19 مرة أخرى (نسب المخاطرة: 0.76؛ ‏بفاصل ثقة مقداره %95: 0.69 إلى 0.84). ارتبط مرض السكري، وأمراض الجهاز التنفسي، والقلب، والكلى بمخاطر أعلى للإصابة بكوفيد 19 بعد التطعيم.كانت معدلات الإصابة بكوفيد 19 بعد التطعيم مرتفعة نسبيًا. وفّر لقاح SARS-CoV-2 )Vero Cell) حماية أقل ضد الإصابة بكوفيد 19 مقارنةً بالتطعيمات الأخرى. عاني الأشخاص المصابون بأمراض مشتركة من مخاطر أعلى للإصابة بكوفيد 19 والاستشفاء، ويجب أن يحصلوا على الأولوية في التدخلات الوقائية.调查接种 AZD1222 Vaxzevria、CovIran® 疫苗、SARS-CoV-2 疫苗（Vero Cell）、灭活疫苗（lnCoV）或 Sputnik V 疫苗的伊朗人感染新型冠状病毒肺炎 (COVID-19) 的情况及其住院率和死亡率。.我们在七个伊朗城市招募了 2021 年 4 月至 2022 年 1 月之间接种第一剂新冠疫苗的 18 岁或以上的人员。参与者完成了为期 17 周（AZD1222 为 25 周）的每周跟进调查，报告他们的新冠肺炎状况和住院情况。我们使用 Cox 回归模型来评估感染新冠肺炎、住院和死亡的风险因子。.在招募的 89,783 名参与者中，每百万人每天感染新冠肺炎的比例为：528.2（95％ 置信区间，CI: 514.0-542.7)；住院比例为 55.8 (95% CI：51.4-60.5）；死亡比例为 4.1 (95% CI: 3.0–5.5)。与 SARS-CoV-2 疫苗（Vero Cell）相比，接种 AZD1222 疫苗后感染新冠肺炎的风险比（HR）为：0.70 (95% CI：0.61-0.80)；接种 Sputnik V 疫苗后感染的风险比为 0.73 (95% CI：0.62-0.86）；接种 CovIran® 疫苗后感染的风险比为 0.73 (95% CI: 0.63–0.86)。对于住院和死亡病例，所有疫苗在接种第二剂后的 14 天内均提供相同程度的保护力。感染过新冠肺炎可以避免再次感染（HR：0.76；95% CI：0.69-0.84)。患有糖尿病、呼吸系统、心脏和肾脏疾病的人群在接种疫苗后感染新冠肺炎的风险更高。.接种疫苗后感染新冠肺炎的比例较高。与其他疫苗相比，SARS-CoV-2 疫苗（Vero Cell）防止感染新冠肺炎的效果较低。并存其它疾病的患者感染新冠肺炎和住院的风险较高，应优先采取预防性干预措施。.Изучить уровень заболеваемости коронавирусной инфекцией 2019 года (COVID-19), случаи госпитализации и смерти среди иранцев, вакцинированных вакциной AZD1222 Vaxzevria, CovIran®, SARS-CoV-2 (Vero Cell), инактивированной вакциной (lnCoV) или вакциной Sputnik V.Авторы включили в исследование участников в возрасте от 18 лет, получивших первую дозу вакцины против COVID-19 в период с апреля 2021 г. по январь 2022 г. в семи иранских городах. Участники проходили еженедельные последующие обследования в течение 17 недель (25 недель для AZD1222) и сообщали о своем состоянии COVID-19 и госпитализации. Авторы использовали модели регрессии Кокса для оценки факторов риска заражения COVID-19, госпитализации и смерти.Из 89 783 включенных участников показатели заболеваемости на 1 000 000 человеко-дней составили: 528,2 (95%-й ДИ: 514,0–542,7) для случаев заражения COVID-19; 55,8 (95%-й ДИ: 51,4–60,5) для случаев госпитализации; 4,1 (95%-й ДИ: 3,0–5,5) для случаев смерти. По сравнению с вакциной SARS-CoV-2 (Vero Cell) коэффициенты риска (HR) для заражения COVID-19 были следующими: 0,70 (95%-й ДИ: 0,61–0,80) для AZD1222; 0,73 (95%-й ДИ: 0,62–0,86) для Sputnik V; 0,73 (95%-й ДИ: 0,63–0,86) для CovIran®. В отношении случаев госпитализации и смертей все вакцины обеспечивали одинаковую защиту через 14 дней после введения второй дозы. Наличие вакцины против COVID-19 защищает от повторного заражения COVID-19 (HR: 0,76; 95%-й ДИ: 0,69–0,84). Диабет, а также респираторные, сердечные и почечные заболевания были связаны с более высоким риском заражения COVID-19 после вакцинации.Уровень заражения COVID-19 после вакцинации был относительно высоким. Вакцина против SARS-CoV-2 (Vero Cell) обеспечивает более низкую защиту от COVID-19, чем другие вакцины. Люди с сопутствующими заболеваниями имели более высокий риск заражения COVID-19 и госпитализации, поэтому профилактические вмешательства для них следует осуществлять в приоритетном порядке.

Objectives Evaluate the effect of functional endoscopic sinus surgery (FESS) for nasal polyposis on sleep efficiency and polysomnographic parameters. Subjects and methods This clinical trial was conducted on 15 patients with bilateral massive sinonasal polyposis who underwent FESS between August 2012 and September 2013. All participants were evaluated subjectively by employing the Pittsburgh Sleep Quality Index (PSQI) questionnaire and objectively (provided by polysomnographic parameters) before and 2 months after surgery. Results The evaluation of subjective criteria of sleep quality assessed by PSQI showed significant improvement, particularly in nocturnal awakening (P = 0.002). However, Apnea Hypopnea Index (AHI) was not reduced significantly after surgery (P = 0.233). Among patients who had suffered from obstructive sleep apnea, AHI was improved in 7 patients, deteriorated in 3 patients, and did not change in 1 patient. Although the mean duration of REM sleep stage increased from 15.2 ± 10.7 to 18.9 ± 7.9, this change was not statistically significant. Furthermore, arousal index decreased dramatically from 31.6 to 17.1 (P = 0.02) and sleep efficiency index was improved after the surgery (P = 0.008). Conclusions This study documented the effect of resuming nasal cavity patency on improvement of sleep efficiency after FESS. In spite of insignificant effect of FESS on apnea index, alteration of other sleep parameters like arousal index following surgery may have a positive effect on sleep quality.

Objective: Vitamin D may be associated to the modulation of signaling cascade in the central nervous system. We aimed to evaluate the effect of high dose vitamin D supplementation on neuropsychological function in female adolescents. Methods: We evaluated the effects of 9 weeks of vitamin D supplementation [50000 IU of vitamin D3 (cholecalciferol)/weekly] on cognitive ability and sleep disorders among 940 adolescent girls. Results: Oral vitamin D supplementation upgraded cognitive abilities tasks including memory, inhibitory control and selective attention, decision making, planning, sustained attention and cognitive flexibility in healthy adolescent girls (p

Background: Inflammatory processes have been proposed in the pathophysiology of ischemic stroke. The present study was designed to evaluate the relationship between tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), IL 1 beta (IL-1β), and high sensitivity C-reactive protein (hsCRP) with the prognosis and functional outcome in patients with less severe ischemic stroke. Methods: We measured the level of IL-1β, IL-6, hsCRP, and TNF-α on days 1 and 5 after stroke onset by enzyme-linked immunosorbent assay (ELISA). The infarct volume was assessed using Alberta Stroke Program Early CT Score (ASPECTS) and posterior circulation ASPECTS (pcASPECTS) score in brain computed tomography (CT) scan and magnetic resonance imaging (MRI). The severity of stroke was assessed by applying the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) in 24 hours on day 5 and after 3 months from stroke onset. Good outcome was defined as the third month MRS ≤ 2. The association of inflammatory markers and the course of stroke symptoms over time was examined. Results: Forty-four first-ever stroke patients without concurrent inflammatory diseases with a mean age of 65 years were included. The mean NIHSS and MRS in admission time were 6.5 ± 3.5 and 3.07, respectively. The day 1 and the day 5 levels of IL-1β, IL-6, hsCRP, and TNF-α were not significantly different in good and poor outcome groups (all P-values > 0.05). In addition, they were not significantly associated with the ASPECTS, pcASPECTS, and changes of NIHSS and MRS over time. Conclusion: The levels of hsCRP, IL-1β, IL-6, and TNF-α are not reliable predictors of functional outcomes in patients with less severe acute ischemic stroke (AIS).

Abstinence-based treatment of opioid use disorder has always been faced with the probability of an increase in craving, which potentially results in relapse. Moreover, sleep problems are predominant among patients with abstinence treatment. A sample of twenty-six male subjects with opioid use disorder were selected from a residential treatment center for substance use disorders in 2017 in Mashhad, Iran. Opioid craving was evaluated using obsessive-compulsive drug use scale (OCDUS) at four-time points (days 1, 10, 20, and 30) during abstinence. Also, they were asked to report their total sleep time. The participants with an average age of 32.5 ± 8.0 years reported the use of opium and heroin to be as high as 2.0 ± 1.2 g per day and 1.5 ± 0.9 g per day, respectively. Abstinence induced a non-significant gradual decrease in self-reported craving during one month (p > 0.05). Also, they experienced significant declines in total sleep time over the first ten days (p = 0.008). The univariate analysis of variance showed no significant changes in craving after adjustment for total sleep time (p > 0.05). Insignificant reductions in opioid craving after detoxification persisted throughout the 30 days of abstinence.

Background: Daily naps are a common habit in many Middle Eastern and Asian countries; however, little is known about the association between daily naps and other health consequences, including the presence of metabolic syndrome (MetS). Methods: Participants were recruited from the Mashhad stroke and heart atherosclerotic disorders study. We defined MetS according to International Diabetes Federation criteria. Nighttime sleeping hours were categorized into three categories: 8 hours. Using logistic regression models, we analyzed the association between the duration of night-time sleep and daily naps with MetS and its different components. Results: A total of 9652 individuals were included in the study: 3859 with MetS (40%) and 5793 without MetS (60%), as the control group. Of all, 72% participants had a regular daily nap. Those with daily naps had a higher odd of MetS [Odds ratio:1.19, confidence interval: (1.08–1.33); P

Background and objectives Systemic lupus erythematosus (SLE) is reportedly associated with sleep disorders. Thus, the present study aimed to investigate sleep disorders in newly diagnosed SLE patients. Materials and methods This study was conducted on patients with newly diagnosed SLE (ie, case group) and a control group. The case and control groups were matched in terms of gender, age, socioeconomic status, and educational level. Venous blood samples were obtained from the participants to measure prolactin and melatonin levels. Furthermore, they were subjected to polysomnography. The data were analysed by SPSS (version 16) at a significance level of 0.05. Results A total of 28 women were enrolled in this study (ie, 14 individuals in each group). The frequencies of sleep disorder in the case and control groups were obtained as 64.3% and 50%, respectively (P=0.4). These two groups had the mean sleep onset times of 10.76±10.64 and 8.67±7.12 min (P=0.5) and the respiratory disturbance indices of 9.20±10.23 and 8.44±9.27, respectively (P=0.8). The frequency of sleep apnoea was obtained at 50% for both case and control groups (P=1). There was no significant difference between these groups in terms of the mean serum prolactin and melatonin levels (P=0.3 and P=0.2, respectively). Serum melatonin level showed a direct correlation with sleep latency to N1 (i.e., the first part of non-rapid eye movement in sleep) and spontaneous arousal index in the case group (P=0.02, r=0.602 and P=0.04, r=0.544, respectively). Conclusion According to the findings, there was no significant difference in the frequency of sleep disorders between the healthy subjects and patients at the onset of lupus. Additionally, melatonin and prolactin levels showed no significant difference between the groups. Our results are inconsistent with previous studies, due to the difference in disease duration probably. It seems that the chronicity and complications of the disease, as well as the adoption of glucocorticoid therapy for the chronic disease affect sleep quality in SLE patients more than disease duration.

This study was designed to evaluate whether severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can directly target the central nervous system (CNS). We present four patients suffering from the loss of consciousness and seizure during the clinical course of COVID-19 infection. In addition to positive nasopharyngeal swab tests, SARS-CoV-2 has been detected in their cerebrospinal fluid. This report indicates the neuroinvasive potential of SARS-CoV-2, suggesting the ability of this virus to spread from the respiratory tract to the CNS. Supplementary information The online version contains supplementary material available at 10.1007/s13365-020-00938-w.

Despite the serious consequences of sleep apnea, some patients do not follow their physicians' advice to undergo a sleep study. The present study aimed to determine the rate of adherence and influencing factors in conducting a polysomnography test in patients suspected of obstructive sleep apnea.This qualitative and quantitative analysis was conducted between July 2017 and November 2019 on patients suspected of sleep apnea. The quantitative analysis aimed at determining the rate of adherence through a retrospective cross-sectional study. The qualitative content analysis was conducted on purposefully selected subgroup of patients suspected of obstructive sleep apnea who were referred for polysomnography. The required data were collected through the semi-structured in-depth interviews and then recorded, transcribed, and analyzed using SPSS.22 and MAXQDA10.Quantitative part: Of 311 patients (mean age: 47.6 ± 13.1 years) referred for polysomnography, 283 patients (91%) were at a high risk of developing obstructive sleep apnea. Among those referred for polysomnography, 31% (n = 95) adhered to recommendations for a sleep study. Qualitative part: Factors affecting adherence to polysomnography were categorized as "barriers" and "triggers." Barriers included inadequate knowledge, psychological factors, cost, and the service system. Triggers included adequate knowledge and tangible experience of consequences of the illness.The majority of patients at risk of developing obstructive sleep apnea did not follow the recommendation for polysomnography, indicating a need for systematic interventions. Among the identified barriers, knowledge and psychological factors are modifiable ones that can be addressed with the patient. We theorize that raising awareness among patients by providing additional information and eliminating concerns may help to increase the rate of adherence. Insurance coverage or subsidy to reduce the sleep study costs may also be an effective strategy to increase adherence to recommendations for polysomnography.

Background: Stroke is the most common debilitating neurological disease in adults. Therefore, rehabilitation is a major consideration to reduce costs and relief disabilities. Biofeedback, a newly recommended method is claimed to be able to improve the consequences following stroke by enhancement the understanding of the psychological functions of the body. Objectives: The purpose of this study was to investigate the effect of biofeedback on the motor– muscular situation in rehabilitation of stroke patients Methods: The present study was a randomized clinical trial that was started in May 2016 and completed in September 2016. The sample of this study included all the patients with stroke attending the physiotherapy center of Imam Raza hospital in Mashhad, Iran. The participants were randomly divided into 2 groups (case and control group) after considering the inclusion and exclusion criteria. In the intervention group, biofeedback (2 times a week for 15 sessions, each session lasting 20 minutes) was performed.Before the intervention demographic information questionnaire was complete by all participants. Then a check list of main variables such as hands muscle strength, muscle stiffness (spasticity), balance and ability to walk was complete by a physician. In the 7th session of the exercise and in the end of intervention (14th session), again, the main variables of the check list were reassessed by the researcher. The statistical analysis was done by Statistical Package for the Social Sciences (SPSS) software version 16. Results: the mean score of balance evaluation in pre-intervention had not any significant differences (p=0.503), but in post intervention evaluation, this score in intervention group versus control group showed significant differences (p=0.014).the mean score of muscle strength,Results showed that by eliminating the effects of muscular strength before the intervention, this variable in both intervention and control groups after the intervention, had improvement and significant difference (p=0.005).Comparison the average spasticity, showed that spasticity evaluation score before and after intervention had no significant difference between the two groups (p=1.00) Conclusion: Considering the findings of this study, the biofeedback therapy is a promising treatment modality in improvement the motor– muscular condition following stroke.

Violet oil is an ancient herbal drug which has been extensively used to treat insomnia in traditional Iranian Medicine clinics. Violet oil is an almond or sesame oil-based extract of Viola odorata, which is administered as nasal drops. This study aimed to evaluate the efficacy of Violet oil in the treatment of insomnia.This study was conducted as a 3-arm double-blind randomized trial. A total of 75 patients with chronic insomnia were enrolled and randomly assigned to three groups in Traditional Iranian Medicine Clinic of Mashhad University of Medical Sciences, Mashhad, Iran. The treatment consisted of intranasal dropping of Violet oil, Almond oil or placebo (1% solution of Carboxymethyl cellulose) in each nostril every night before sleep for 30 days, i.e. three drops of the drug (including either Violet oil or Almond oil) or the placebo was used every night before the sleep. All the patients were asked to complete Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) questionnaires before and after the intervention.There were no significant differences between patients in the three groups before the intervention (P0.05). However, there were significant differences between the three groups after the intervention in ISI scores (P0.002) and PSQI scores (p0.001). When comparing the pre- and post-treatment data, the ISI and PSQI scores improved significantly in all the three groups as follows: Violet oil (P0.001), Almond oil (P0.001) and placebo (P0.001). The results also showed that the Violet oil had the most effect among the three groups. In addition, it was more effective on sleep quality than sleep quantity.Considering the effects of natural nasal drug on the improvement of sleep quality in insomniac patients, this study has proposed the use of Violet oil as a natural and herbal drug in a non-oral method without serious side effects for treatment of insomnia.

Sleep apnea is a relatively prevalent breathing disorder characterized by temporary interruptions in airflow during sleep. There are 2 major types of sleep apnea. Obstructive sleep apnea occurs when air cannot flow through the upper airway despite efforts to breathe. Central sleep apnea occurs when the brain fails to signal to the muscles to maintain breathing. The standard diagnostic test is polysomnography, which is expensive and time consuming. The aim of this study was to design an automatic diagnostic and classifying algorithm for sleep apneas employing thoracic respiratory effort and oximetric signals. This algorithm was trained and tested applying a database of 54 subjects who had undergone polysomnography. A feature extraction stage was conducted to compute features. An optimal genetic algorithm was applied to select optimal features of these 2 kinds of signals. The classification technique was based on the support vector machine classifier to classify the selected features in 3 classes as healthy, obstructive, and central sleep apnea events. The results show that our automated classification algorithm can diagnose sleep apnea and its types with an average accuracy level of 90.2% (87.5-95.8) in the test set and 90.9% in the validation set with high acceptable accuracy.

Pompe disease, also termed glycogen storage disease type II or acid maltase deficiency, caused by deficient activity of acid alpha-glucosidase (GAA), the glycogen degrading lysosomal enzyme. As a result, massive lysosomal glycogen deposits in the numerous organs including the muscles. In Pompe disease weakness of truncal muscles is a prominent presentation which results in respiratory failure as a main clinical presentation in the early stages of the disease. Even sleep may be affected by nocturnal respiratory disturbances. Specific treatment with enzyme replacement (human recombinant GAA) is available. Here we present a case of progressive muscular weakness which had been misdiagnosed with limb girdle muscular dystrophy. A history of severe morning headaches led authors to think about sleep apnea, which was confirmed by polysomnography and therefore provided a clue for appropriate diagnosis of Pompe disease. As a conclusion, Morning headaches and sleep insufficiency in any stage of a progressive muscular disorder can lead us to think about respiratory muscle involvement, which is more prominent in Pompe disease.

Traditional Persian Medicine (TPM) has been established as a valuable source of medicinal plants for the treatment of insomnia for thousands of years. Accordingly, oil extracts from plants' parts have been widely used to alleviate central nervous system (CNS) ailments including sleep disorders. A number of preparations have been recommended by TPM for the treatment of insomnia. Among them, an intranasal formulation containing oily macerates of Viola odorata L., Crocus sativus L. and Lactuca sativa L. stands out.In the present double-dummy, double-blind placebo controlled clinical trial, we aim to evaluate the effectiveness of a combination of violet oil, saffron oil, and lettuce seeds oil nasal drop compared with the placebo (sesame oil).Fifty patients with primary chronic insomnia were randomly assigned in TPM-treatment or placebo groups, received either two drops of the herbal oil or placebo into each nostril every noon and evening for 8 weeks. Before the study commencement and after 1, 4 and 8 weeks of treatment, Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) questionnaires were completed by all patients. The primary outcome measure was considered as any changes in ISI scores between the first visit and after 8 weeks. Changes in PSQI scores during the study and possible side effects were also assessed. The multicompound herbal oil was standardized using HPLC analysis and contained 0.02 mg/mL crocin and 4 μg/mL isoquercitrin.Our study revealed a significant reduction in the ISI and PSQI scores from baseline by the study endpoint (P ≤ 0.01). The mean ISI scores in week 8 decreased significantly for the intervention group (P = 0.001) and also the placebo group (P 0.01) when compared with baseline. Moreover, the use of hypnotic drugs in the intervention group was significantly reduced (P 0.001), while in the control group was maintained at baseline level.It seems that intranasal use of the multi-herbal preparation can be used to improve chronic insomnia and to reduce the dose of conventional hypnotic medications in insomniac patients.