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Background: Multiple sclerosis (MS) predominantly affects women of childbearing age, significantly impacting their quality of life (QOL). The diagnosis of MS can influence pregnancy intention, and the level of disability associated with MS may change before and after pregnancy. This study aims to analyze the reproductive characteristics of Iranian female patients with MS (PwMS) and their association with the Expanded Disability Status Scale (EDSS) and pregnancy tendency, providing valuable insights into disease progression and the development of tailored treatments. Methods: A cross-sectional study was conducted using data from the nationwide MS registry of Iran (NMSRI) from 2018 to 2021. Patients without a documented history of pregnancy, MS type, or EDSS score were excluded from the study. Various statistical methods, including nonparametric tests, the generalized estimating equation (GEE) model, and multiple logistic regression, were employed to analyze the data. Results: The study included 1120 PwMS with a median diagnostic age of 31 and a disease duration of 6 years. The majority had relapsing-remitting MS (RRMS) and the mean EDSS score at bassline was 1.5 ± 1.4. A history of pregnancy or abortion was associated with higher EDSS scores. Multiparity before MS diagnosis was linked to EDSS score ≥ 5, while this EDSS range was associated with decreased parity after MS diagnosis (all P-values < 0.05). Conclusion: Pregnancy and parity can affect the disability in female PwMS irrespective of clinical symptoms, diagnosis age, and MS type. Moreover, the chance of parity may be affected by a higher disability score, which should be considered in the clinical setting. [ABSTRACT FROM AUTHOR]

Fingolimod has been approved as a disease‑modifying drug in multiple sclerosis since 2010. There are a few reports of melanoma as a side effect of Fingolimod in the literature. Herein we aim to report a known case of multiple sclerosis under Fingolimod presenting with persistent nasal congestion who was eventually diagnosed with soft palate malignant melanoma. [ABSTRACT FROM AUTHOR]

People living with MS confront a variety of changes and challenges that need to cope with. The aim of this study was to explore the coping patterns related to the impact of MS on people's lives including; daily, family, and social functions. A constructivist grounded theory approach was taken. A purposive sample of 16 women living with MS were recruited from a MS clinic at a teaching hospital in the north of Iran. Participants completed 22 semi-structured interviews. The interviews were digitally recorded, transcribed and analyzed using initial, focused and theoretical coding. Participants described coping with a certain pattern that reflected direction and orientation of coping. Anticipating outcomes related to disease, self or others led the participants to plan ahead to deal with the challenges of living with MS. Indeed, they develop and employed anticipatory coping in disease-directed, self-directed and other-directed. Then they focused on the orientation of coping patterns, which involved actions, reactions, and interactions in order to manage anticipated outcomes. The majority of participants used coping pattern that were anticipatory rather than a reactionary to past or present challenges. The results highlight the value of engaging with people with MS in order to identify ways that they cope with the impact of this condition. This is an important distinction and one that health professionals not only need to be aware of but highlights the value of engaging with people with MS in this frame to develop informed and positive approaches to anticipated outcomes and in responding to anticipated changes and challenges. People develop the pattern of anticipatory coping in order to deal with issues related to the disease, self and others that they anticipate will happen in order to manage potential dysfunctions related to living with multiple sclerosis. People living with MS employ anticipatory coping based on existing and anticipated abilities and disabilities in order to maintain normality for as long as possible in daily, family and social activities. Proactive approaches to dealing with MS can be promoted in a number of ways, for example through support groups, social media or the development of networks with the aim of providing peer support and education. Developing rehabilitation programmes that reflect individual responses to living with MS would improve the ability of healthcare systems to meet clients' needs related to adjusting to living with a chronic condition. [ABSTRACT FROM AUTHOR]

Background: Stroke is a widespread chronic disease which remains a serious problem for public health and is the cause of major disability and death in adults. Despite valuable efforts, these patients still need new care programs for recovery and rehabilitation. Aim: The aim of this study is to determine the effect of the partnership care model (PCM) on quality of life (QOL) and activities of daily living (ADL) in stroke participants. Method: The study is a randomized clinical trial carried out in an educational and therapeutic center in 2019. Sixty‐seven participants (allocated randomly in intervention and control groups) with cerebrovascular accident who had hospitalization histories were selected. Data collection instruments were the Stroke‐Specific QOL scale and Lawton questionnaires. The care plan was developed and implemented for the intervention group after evaluating and recording basic information including demographic variables, care needs, and problems identified in the first PCM‐based stage. Ethics approval was obtained from the University / Regional Research Ethics Committee (IR.NIMAD.REC.1397.236). Results: The results show that the mean scores of the QOL significantly increased after the intervention in the intervention group (before = 130.80; 3 months = 172.19; 6 months = 205.29) compared to the control group (before = 150; 3 months = 144.86; 6 months = 160.66). Also, the mean scores of the ADL significantly increased after the intervention in the intervention group (before = 1.96; 3 months = 3.64; 6 months = 4.87) compared to the control group (p <.05). The effect size is equal to 0.501 and 0.245 for QOL and ADL, respectively. Conclusion: The findings show that the care program based on a PCM recovered the QOL and ADL of stroke participants more than other interventions. [ABSTRACT FROM AUTHOR]

Background: Cerebrovascular diseases are the second common cause of mortality worldwide. The onset of reperfusion in the first 3-4.5 hours is a predictive factor of treatment. Objective: The present study investigated barriers to receiving tissue plasminogen activator in patients with ischemic stroke. Methods: This cross-sectional study examined 191 patients with first-ever stroke referring to the emergency department of the Persian Gulf Martyrs Hospital of Bushehr City, Iran, in 2016. One checklist was completed which included demographic data, history of diseases, knowledge of stroke symptoms, and intervals regarding the onset of symptoms to informing emergency, informing emergency on arrival at the emergency department of the hospital, and making the diagnosis for the patients. The obtained data were analyzed in SPSS v. 19. Results: Mean±SD age of the patients was 65.92±12.48 years. The majority of patients under investigation (55.5%) were female, 63.4% were married, 56% were illiterate and 72.3% resided in other districts of Bushehr province. Mean duration between onset of symptoms and arrival at emergency department, onset of symptoms and call the emergency service, time of arrival at emergency department to perform brain Computer Tomography (CT) scan and also to be counseled by a neurologist were 699.66, 195.51, 45.11 and 423.62 minutes, respectively. Finally 14.6 percent of patients were qualified to be treated with tPA. Conclusion: The main barrier to timely therapy is a delay in golden time. Therefore, public education to promote public awareness could be of great benefit in reducing the referral delay time. [ABSTRACT FROM AUTHOR]

Guillain--Barré syndrome (GBS) is a neurological disorder accompanied by several neurological signs and symptoms including progressive weakness and diminished or decreased reflexes. GBS was reported as one of the several neurological complications in MERS-CoV and SARS-CoV outbreaks. Several studies have reported GBS as a neurological complication in recent COVID-19 outbreak. We report on the case of a 55-years -old female who was hospitalized with dyspnea, dry cough, and myalgia. She developed Acute Motor & Sensory Axonal Neuropathy (AMSAN), a rare variant of GBS signs and symptoms including decreased muscle strength and pinprick sensation in both lower extremities during her hospitalization. [ABSTRACT FROM AUTHOR]

Objectives: Intellectual disability (ID) represents a significant health challenge due to its diverse and intricate nature. A multitude of genes play a role in brain development and function, with defects in these genes potentially leading to ID. Considering that many of these genes have yet to be identified, and those identified have only been found in a small number of patients, no complete description of the phenotype created by these genes is available. CC2D1A is one of the genes whose loss-of-function mutation leads to a rare form of non-syndromic ID-3(OMIM*610055), and four pathogenic variants have been reported in this gene so far., Materials & Methods: n the current study, two affected females were included with an initial diagnosis of ID who were from an Iranian family with consanguineous marriage. Whole-exome sequencing was used to identify the probable genetic defects. The Genotypic and phenotypic characteristics of the patients were compared with a mutation in the CC2D1A gene, and then the structure of the gene and its reported variants were investigated., Results: The patients carried a novel homozygous splicing variant (NM&#95;017721, c.1641+1G>A) in intron 14, which is pathogenic according to the ACMG guideline. Loss-of-function mutations in CC2D1A have severe phenotypic consequences such as ID, autism spectrum disorder (ASD), and seizures. However, missense mutations lead to ASD with or without ID, and in some patients, they cause ciliopathy., Conclusion: This study reports the fifth novel, probably pathogenic variant in the CC2D1A gene. Comparing the clinical and molecular genetic features of the patients with loss-of-function mutation helped to describe the phenotype caused by this gene more precisely. Investigating the  CC2D1A  gene's mutations and structure revealed that it performs multiple functions. The DM14 domain appears more pivotal in triggering severe clinical symptoms, including ID, than the C2 domain., Competing Interests: The authors have no conflicts of interest to declare., (© 2023 The Authors.)

Ischemic stroke has been increasingly reported as a consequence of COVID-19 infection. However, the underlying etiology is not well determined. The objective of this study is to discuss association of juvenile stroke with COVID-19 infection. We analyzed 5 COVID-19 positive and stroke patients with a mean age of 41.2 years-old. Three patients developed large vessel occlusion, one small vessel occlusion and one PRES with superimposed lobar ICH, respectively. The mean initial NIHSS of our patients was 11.6. Except the one with massive cerebellar infarct, a desirable outcome occurred with a mean mRS 2.6 at discharge. The mean ESR and CRP level was elevated to 30.4 ml and 32 mg/dl. The severity of COVID-19 infection was considered mainly as mild. COVID-19 infection has the potential to induce hypercoagulability state contributing to stroke development even in the mild form of disease. Keywords: Cerebrovascular Accident, CVA, Stroke, COVID-19, Novel Coronavirus Acta.

Objective: To determine the impact of pneumonia on length of hospital stay in cases of acute stroke., Methods: This was a retrospective cross-sectional study on 368 stroke patients admitted with a diagnosis of stroke at the Avicenna Hospital, Qazvin, Iran between January 2010 and March 2011. By reviewing the hospital patient records, the demographic characteristics, stroke characteristics, and complications of stroke in these patients were determined during their hospital stay. In surviving patients, the impact of each variable on length of hospital stay was calculated by logistic regression analysis and the Log-Rank test., Results: Patients with pneumonia during the post stroke period had an increased length of hospital stay (11.5+/-6.4 days), compared with other patients (7.2+/-4.1 days), (p=0.0005). Multiple logistic regression analysis showed a significant association between length of hospital stay and urinary tract infection (p=0.001), steroid consumption (p=0.028), index of stroke severity (p=0.039), pneumonia (p=0.042), and swallowing disorder (p=0.048)., Conclusion: Considering the impact of pneumonia on the length of hospital stay and its consequences, prophylactic activities, rapid diagnosis, and treatment of pneumonia may improve outcome and reduce costs in stroke patients.