High Prevalence Of Multiple Sclerosis Research Articles

Epidemiologic and clinical characteristics of neuromyelitis optica spectrum disorder patients, A seven years follow-up study from Iran.

Neuromyelitis Optica Spectrum Disorder (NMOSD) is a rare neuroinflammatory disease characterized by recurrent relapses. The most common signs are myelitis and optic neuritis. It can also present by cerebral or brain stem syndromes. There are still many challenges in its diagnosis and treatment, and long-term follow-up studies are needed to see the disease course over time. We established an electronic registration system of NMOSD patients starting from October 2015 in Kashani hospital, Isfahan, Iran. Every suspected patient was documented and included in the follow-up system to survey their disease course. Anti-aquaporine 4 (AQP4) antibody checked for all by cell-based assay method. All information such as demographic and clinical data and laboratory and MRI findings were documented. Participants were followed up for any relapses, new paraclinical tests and drug changes. This study is based on the definite NMOSD cases (according to the 2015 criteria) characteristics and clinical course during 7 years of registration. The study included 173 NMOSD cases and 56 ones were seropositive for AQP4 Ab. Their mean age was 40.02±11.11 years (45.78 in the seropositive group). The mean age at disease onset was about 30.16 years. The mean time of follow-up by our registration system is 55.84±18.94 months (54.82 months in seropositive ones). The annual relapse rate is estimated as 0.47±0.36. Long extended transvers myelitis (LETM) was present in the baseline MRI of 77 patients (44.5%), while 32 of them did not show any related clinical symptoms. 124 patients revealed an abnormality in the first brain MRI. 27 individuals suffer hypothyroidism as the most common comorbid disease. The disease seems to be more prevalent in the west and southwest areas of Isfahan province. The mean age of onset is higher than Multiple Sclerosis (MS) patients, but there are notable pediatric cases too. It should also be noticed that cervical LETM can be asymptomatic at first. Brain MRI abnormalities are frequently observed. The disease is more prevalent in the geographical areas where showing high MS prevalence.

Awareness of the Saudi community toward multiple sclerosis in Al-Madinah Al- Munawarrah, Saudi Arabia

Background: Multiple sclerosis (MS) is an inflammatory neurodegenerative disease affecting the central nervous system (CNS); pathophysiological concepts revealed that exposure to some infectious agents during childhood and genetics involvement played a role. Data reported that females were more affected by MS than males due to genetic predisposition. Recent epidemiological data indicated a higher prevalence of MS in the Arabian Gulf region, with increasing incidence in the Kingdom of Saudi Arabia (KSA). Knowledge about MS shall aid in better management, diagnosis and treatment. This study aimed to assess the level of awareness about MS among participants in Al Madinah Al Munawarrah, KSA. Methods: This was a cross-sectional non-interventional observational survey questionnaire among 381 participants in Al Madinah. Results: The majority of participants were female aged more than 20 years old and high graded; 66.4% of the participants reported good awareness about MS, and 68% reported that MS impact the central nervous system, causing more illness among females aged between 20-39 years. Regarding the risk factors towards MS, Family history of MS and personal history of autoimmune diseases were on top of the list among the participants in relation to risk factors MS, with 43.3% and 38.1%, respectively. Conclusions: In summary, our study shed light on the lack of knowledge about MS among the adult population in Al Madinah AL Munawarrah, KSA. A better understanding of MS shall contribute towards better diagnosing and management.

Population-Based Estimates for the Prevalence of Multiple Sclerosis in the United States by Race, Ethnicity, Age, Sex, and Geographic Region

Racial, ethnic, and geographic differences in multiple sclerosis (MS) are important factors to assess when determining the disease burden and allocating health care resources. To calculate the US prevalence of MS in Hispanic, non-Hispanic Black (hereafter referred to as Black), and non-Hispanic White individuals (hereafter referred to as White) stratified by age, sex, and region. A validated algorithm was applied to private, military, and public (Medicaid and Medicare) administrative health claims data sets to identify adult cases of MS between 2008 and 2010. Data analysis took place between 2019 and 2022. The 3-year cumulative prevalence overall was determined in each data set and stratified by age, sex, race, ethnicity, and geography. The insurance pools included 96 million persons from 2008 to 2010. Insurance and stratum-specific estimates were applied to the 2010 US Census data and the findings combined to calculate the 2010 prevalence of MS cumulated over 10 years. No exclusions were made if a person met the algorithm criteria. Prevalence of MS per 100 000 US adults stratified by demographic group and geography. The 95% CIs were approximated using a binomial distribution. A total of 744 781 persons 18 years and older were identified with MS with 564 426 cases (76%) in females and 180 355 (24%) in males. The median age group was 45 to 54 years, which included 229 216 individuals (31%), with 101 271 aged 18 to 24 years (14%), 158 997 aged 35 to 44 years (21%), 186 758 aged 55 to 64 years (25%), and 68 539 individuals (9%) who were 65 years or older. White individuals were the largest group, comprising 577 725 cases (77%), with 80 276 Black individuals (10%), 53 456 Hispanic individuals (7%), and 33 324 individuals (4%) in the non-Hispanic other category. The estimated 2010 prevalence of MS per 100 000 US adults cumulated over 10 years was 161.2 (95% CI, 159.8-162.5) for Hispanic individuals (regardless of race), 298.4 (95% CI, 296.4-300.5) for Black individuals, 374.8 (95% CI, 373.8-375.8) for White individuals, and 197.7 (95% CI, 195.6-199.9) for individuals from non-Hispanic other racial and ethnic groups. During the same time period, the female to male ratio was 2.9 overall. Age stratification in each of the racial and ethnic groups revealed the highest prevalence of MS in the 45- to 64-year-old age group, regardless of racial and ethnic classification. With each degree of latitude, MS prevalence increased by 16.3 cases per 100 000 (95% CI, 12.7-19.8; P < .001) in the unadjusted prevalence estimates, and 11.7 cases per 100 000 (95% CI, 7.4-16.1; P < .001) in the direct adjusted estimates. The association of latitude with prevalence was strongest in women, Black individuals, and older individuals. This study found that White individuals had the highest MS prevalence followed by Black individuals, individuals from other non-Hispanic racial and ethnic groups, and Hispanic individuals. Inconsistent racial and ethnic classifications created heterogeneity within groups. In the United States, MS affects diverse racial and ethnic groups. Prevalence of MS increases significantly and nonuniformly with latitude in the United States, even when adjusted for race, ethnicity, age, and sex. These findings are important for clinicians, researchers, and policy makers.

Common pathogenetic mechanisms in affective disorders and multiple sclerosis: role of interleukin imbalance in the progression of comorbid pathology

Relevance. Among many comorbid pathologies, it is of considerable interest to study and compare the pathogenetic mechanisms of neurological and mental disorders that combine the clinical manifestations of multiple sclerosis (MS) and affective disorders. The high MS prevalence, economic and social significance of the disease, heterogeneity of clinical symptoms, an unfavorable progressive course, as well as the frequent combination of this pathology with various forms of hypothymic disorders determine the relevance of studying the common pathogenetic mechanisms for the development of this comorbid pathology, which is necessary for the development of effective and safe preventive medical activities. The purpose of the review is to determine the common immunopathological mechanisms of affective disorders and multiple sclerosis, to analyze the role of cytokine status imbalance in the mutual increase in the severity of clinical symptoms in comorbid pathology, and to identify prognostic markers of disease progression. Materials and methods. On the basis of electronic Russian and foreign databases for the period 2017–2022, a theoretical analysis of the pathophysiological mechanisms of autoimmune CNS damage in MS and affective disorders was carried out. In order to search for literary sources, the following resources were used: https://elibrary.ru/, https://www.ncbi.nlm.nih.gov/pubmed/, https://cyberleninka.ru/. 10 Russian and 25 foreign sources were cited. Results. The mechanisms of development of mental affective disorders and multiple sclerosis have common pathogenetic features and are characterized by a violation of pro-inflammatory cytokine reactions and autoimmune nature of changes in the structures of the central nervous system (CNS). The similarity of immunological disorders underlying the pathogenesis of various forms of multiple sclerosis and affective disorders is of undoubted interest in terms of developing common approaches to the prevention and treatment of detectable interleukin status imbalance in neurological and mental diseases. Conclusion. Identification of mutually reinforcing changes in interleukin status and determination of the features of the course of immune imbalance in multiple sclerosis and hypothymic disorders in various pathologies of the mental sphere are necessary for a deeper understanding of neuroimmune interactions.

Temporal Incidence and Prevalence Trends of Multiple Sclerosis in Markazi Province, Iran

BackgroundThe epidemiology of multiple sclerosis (MS) exhibits significant variability all over the world. Additionally, the incidence and prevalence of the disease are geographically diverse in the different provinces of Iran. ObjectivesDue to the lack of a research about the epidemiology of MS in the Markazi province of Iran, the present study aimed to estimate its prevalence and incidence in this province. MethodsThis cross-sectional register study was conducted according to the data related to the MS Society of Markazi province. The inclusion criteria were definite MS during 2010–2019, residence in Markazi province, and membership in the MS society of Markazi province. The annual incidence and prevalence of MS (per 100,000 person-years) were computed by sex and age groups. Further, age-standardized prevalence and incidence rates were calculated based on the Iranian population. A gamma regression model with log link was utilized for comparing the rates over time statistically. The prevalence and incidence rates were computed by using Excel, and R 4.0.5 was applied to fit the gamma model. ResultsIn the study, the total number of MS cases was 1,391, among whom 1,098 (78.9%) and 293 (21.1%) were females and males, respectively. The onset of MS occurred at the mean (S.D) age of 31.76 (8.98) years with a female/male ratio of 3.75. During the study period (2010–2019), the incidence rate of the disease was on the decline, while the prevalence rate elevated, by indicating a rising trend in MS prevalence in both sexes. ConclusionThe results represented the decreasing and increasing trend of the incidence and prevalence of MS in Markazi province over the recent years. The province is one of the regions with a high prevalence and incidence rate of MS compared to the national and global statistical data.

Dietary habits, nutritional status and risk of a first demyelinating event: an incident case-control study in a southern European cohort.

The relationship between dietary habits and multiple sclerosis (MS) risk is still controversial. Most studies have involved populations from Scandinavia, North America, and Australia. Data on populations from southern Europe (an area of high MS prevalence) are scarce. To examine the association between dietary habits/nutritional status and risk of a first demyelinating event, in a southern European incident cohort. In this incident case-control study, a detailed nutritional assessment was performed by a registered dietitian in patients with a first demyelinating event, and in age-/sex-matched controls. Body composition analysis, anthropometric evaluation, and blood tests for nutritional status were also performed. Eighty-three patients with a first demyelinating event were prospectively recruited over a 1-year period. Low intake of fibers (OR 0.846, p = 0.014), vitamin D (OR 0.730, p < 0.0001), and alpha-linolenic acid (OR 0.283, p = 0.014), high BMI (OR 1.132, p = 0.028), and ever smoker status (OR 4.472, p = 0.003) were all independently associated with risk of a first demyelinating event. Higher intake of rapid absorption carbohydrates, lower intake of vegetal proteins, and higher intake of animal proteins were observed in patients with a first demyelinating event. Significant differences between patients and controls are observed in the dietary habits at the time of a first demyelinating event, suggesting low intake of fibers, vitamin D and alpha-linolenic acid as the main dietary risk factors. Furthermore, high cardiovascular risk dietary habits are frequent at the time of MS onset, suggesting the usefulness of nutritional intervention as part of the activities of MS centers.

Multiple sclerosis and inflammatory bowel disease: Asystematic review and meta-analysis.

BackgroundMultiple sclerosis (MS) and inflammatory bowel disease (IBD) are two autoimmune diseases that seriously affect patients' quality of life. Previous studies have established an association between MS and IBD, including Crohn's disease (CD) and ulcerative colitis (UC), but the results were inconsistent. The aim of this study was to quantify the prevalences of and the association between MS and IBD.MethodsThe PubMed, Web of Science, and Embase databases were searched through November 2020 for studies reporting data on MS among patients with IBD and vice versa. The main outcomes were the proportion of MS in patients with IBD and vice versa, as well as the association (risk ratio [RR]) of IBD in MS and that of MS in IBD.ResultsBased on the analysis of 17 studies, the prevalence of MS in patients with IBD was 0.2% (95% CI 0.1–0.4%), while the prevalence of IBD in patients with MS was 0.6% (95% CI 0.4–0.9%). Patients with MS had a higher prevalence of IBD than controls (RR = 1.53, 95% CI 1.38–1.70, p < 0.00001). There was a similarly high risk of developing CD (RR 1.41, 95% CI 1.14–1.74, p = 0.001) or UC (RR 1.42, 95% CI 1.17–1.71, p = 0.0003) in patients with MS (p for subgroup differences: 0.97). Patients with IBD had a higher prevalence of MS than controls (RR = 1.91, 95% CI 1.06–3.45, p = 0.03).ConclusionsClinicians should be aware of the increased risk of IBD or MS comorbidity during the diagnostic process. Systematic diagnosis and management at an earlier stage are suggested.

Suppressive Effect of Fruiting Bodies of Medicinal Mushrooms on Demyelination and Motor Dysfunction in a Cuprizone-Induced Multiple Sclerosis Mouse Model.

Epidemiologic studies have shown a high prevalence of multiple sclerosis (MS) in Europe and North America, and a low prevalence in East Asia. Mushrooms contain various biological response modifiers (BRMs) and are widely used in traditional Chinese medicine in East Asian countries. To investigate whether mushrooms have potential beneficial effects on MS, we administered mushrooms to cuprizone (bis-cyclohexanone-oxalyldihydrazone, CPZ)-induced MS model mice. This model is used to study the processes of demyelination in the CNS. The CPZ-induced demyelination is involved in the apoptotic death of mature oligodendrocytes, neuroinflammation, and motor dysfunction. Mice were fed a powdered diet containing 5% each mushroom and CPZ diet for 5 weeks, which coincides with peak demyelination. We measured the body weight of the mice, evaluated their motor function using a rotarod, and quantified the myelin levels using Black-Gold II staining. Ganoderma lucidum and Hericium erinaceus treatments showed recovery from weight loss. Pleurotus eryngii, G. lucidum, and Flammulina velutipes treatments significantly improved CPZ-induced motor dysfunction. P. eryngii, G. lucidum, F. velutipes, and H. erinaceus treatments effectively suppressed CPZ-induced demyelination. The four medicinal mushrooms may be promising BRMs for prevention and alleviation of the symptoms of MS.

Characteristics of COVID-19 in patients with multiple sclerosis

BackgroundRegarding 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. MethodsData 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. ResultsA 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. ConclusionThe 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.

Comparison of Spinal Cord Injury Patient Characteristics in Male and Female Veterans

<h3>Research Objectives</h3> To expand the understanding of gender differences in the spinal cord injury and disorders (SCI/D) population served by a local Veterans Affairs rehabilitation hospital <h3>Design</h3> Retrospective comparative analysis. <h3>Setting</h3> The Veterans Affairs Palo Alto Health Care System (VAPAHCS) Spinal Cord Injuries & Disorders (SCI/D) System of Care, which provides inpatient and outpatient SCI/D-related care for veterans. <h3>Participants</h3> 1617 (6% female; 67% white) veterans who were treated at the VAPAHCS SCI/D since 2013, 816 of whom have annual exams and are considered active patients. <h3>Interventions</h3> No intervention was involved as part of this study. <h3>Main Outcome Measures</h3> Patient's care encounters as measured by annual visits, demographics, diagnoses, level of injury, functional control, ASIA Impairment Scale (AIS) Score, etiology of SCI/D. <h3>Results</h3> Of all 1617 seen by VAPAHCS for SCI/D, 816 have returned for annual visits (50.4%; 50.2% among males; 53.8% among females). Among all SCI/D patients, women were younger, more likely to live out of state, and were less likely to have passed away (11% vs. 32%; p = .04). Among active SCI/D patients, women were more likely to be treated for non-traumatic SCI/D (66% vs. 35%; p < .001) and had a higher prevalence of multiple sclerosis (42% vs. 10%; p < .001). Missing data rates were greater for women for level of functionality (48% vs. 16%; p < .001) and neurological level of injury (48% vs. 6%; p < .001). <h3>Conclusions</h3> This analysis highlights several gender differences in SCI/D patients in a rehabilitation Veterans Affairs Hospital in age, residence, vital status, and SCI etiology. Higher missing data rates in female patients may lead to an incomplete understanding of the clinical characteristics and needs of female patients, resulting in complications in resources and funding. <h3>Author(s) Disclosures</h3> No author disclosures to declare.

Multiple sclerosis projection in Tehran, Iran using Bayesian structural time series

BackgroundThe prevalence of Multiple Sclerosis (MS) has been increasing worldwide and the highest prevalence ratio among Asian countries was reported in Iran. This study aims to estimate the increase in MS occurrence during more than three decades in Tehran and forecast the future condition of the disease using time series approaches for the next ten years.MethodsThe cross-sectional study was conducted from 1999 to 2019 based on records of MS cases from Iranian MS Society (IMSS) registry system. The prevalence was estimated using population data presented by the Statistical Centre of Iran. Through Bayesian Structural Time Series (BSTS) model, we want to predict the prevalence of familial and sporadic MS in the next ten years. .ResultsAmong 22,421 cases with MS, 16,831 (75.1 %) were female and 5589 (24.9 %) were male. Female to male ratio was 3.0:1 and the number of familial MS cases were 2982 (13.3 %) of subjects. Female gender was less responsible for higher rate of MS in familial definition (beta = 0.020) in comparison to sporadic cases (beta = 0.034). Forecasting by BSTS revealed an increase in MS prevalence for the next ten years so that the prevalence rate for total, familial and sporadic MS respectively begins with 189.50 (183.94-195.14), 25.69 (24.97–26.45) and 163.74(159.06-168.57) in 2020 and ends with 220.84 (171.48-266.92), 30.79 (24.16–37.15), and 189.33(146.97-230.19) in 2029.ConclusionsAccording to the findings, MS prevalence increased during three decades and it will increase over the next ten years. Tehran province is one of the regions with highest MS prevalence in Asia. The results of present study indicated that females are at higher risk for MS than males in both sporadic and familial MS.

Multiple Sclerosis Clinic Utilization is Associated with Fewer Emergency Department Visits.

Alberta is a Canadian province with a high prevalence of multiple sclerosis (MS). In this ecological study, we examined group differences in health care utilization among persons with MS (pwMS) living within different regions of the province. pwMS were identified from provincial administrative databases spanning 2002-2011. Utilization of health care services was determined for a 2-year period (April 2010-March 2012). Residential postal codes placed patients into their provincial health care zones. As data were provided to the investigators in an aggregated form, tests of statistical significance and confounding were not performed. In total, 11,721 pwMS were identified. During the 2-year observation period, 96.2% of pwMS accessed a family physician and 57.1% accessed a neurologist. Nearly all (99.0%) pwMS who received neurologist care in Calgary visited an MS clinic, in contrast to Edmonton where a larger proportion (34.8%) received solely community neurologist care. More pwMS living in Edmonton accessed the ED (41.1%) compared to Calgary (35.7%), and the rate of visits per pwMS was higher in Edmonton (1.07/pwMS) than in Calgary (0.81/pwMS). The frequency of inpatient admissions was similar. Over 2 years, most pwMS accessed primary care and over half saw a neurologist. Despite a similar frequency of inpatient admissions, the frequency of ED visits by pwMS was higher in Edmonton compared to Calgary, where more patients received MS clinic care. Although this exploratory study is subject to several limitations, our findings suggest that specialized MS clinics may reduce costly ED visits.

Prevalence and Incidence of Multiple Sclerosis (MS) in Guilan Province

Introduction: The aim of this study was to investigate the prevalence and incidence of multiple sclerosis (MS) in Guilan Province) and to compare the standardized prevalence by the factor of age in this province. Methods: The study was a cross-sectional design that was conducted in 2018 at the Guilan MS Society (GMSS) on people with multiple sclerosis and examined the 654 people with multiple sclerosis case. In this study, the trend of MS disease was examined from 2009 to 2019 and in order to investigate the rate of cumulative incidence of the disease, new cases were defined based on the date of diagnosis of the disease from the beginning of 2018. Data collection was performed using a checklist that was collected during the GMSS registration by a registrar in the form of a structured interview. Prevalence rate was compared between different subgroups using Chi-Square and Fisher's exact tests. Field characteristics were described by using absolute and relative frequency indices or mean and standard deviation using Stata 13 and SPSS 19 statistical software. Results: The results showed that 71.4% of all patients were female. The mean age of the patients was 36.5 years and the highest frequency of MS was observed in the age group of 30-40. The MS patients lived in the urban were 81%. The highest initial manifestations of people with multiple sclerosis were reported in numbness or tingling, vision problems, weakness, other symptoms, and walking (Gait) difficulties, respectively. The highest prevalence of MS was in Lahijan and then Rasht and Astaneh-ye Ashrafiyeh citie.. Conclusion: From the results of this study, it is concluded that there is no significant difference between the prevalence rate in Guilan Province and the standardized rate with the age adjustment based on the WHO standard population, although no analytical comparison has been performed in this study.

Multiple sclerosis and pregnancy. Impact of multiple sclerosis disease-modifying therapy on the health of newborns

Background. Due to the high prevalence of multiple sclerosis (MS) among women of reproductive age, special attention is paid to the management of pregnancy in them. The problem concerning the health of infants born to mothers with MS receiving disease-modifying therapy has not yet been addressed. It is necessary to identify the timing of cessation of drugs changing the course of MS, as well as to find the possibility of mitigating exacerbations during pregnancy using corticosteroid therapy.Objective: to analyze the effects of causal therapy for MS on the health of newborns.Materials and methods. This study included 154 women with MS residing in Moscow region and receiving disease-modifying therapy. We evaluated the course of pregnancy, delivery, and the condition of infants born to these mothers.Results and conclusions. Our findings are consistent with the earlier published data in the general cohort of pregnant women and allowed us to conclude that the presence of MS and history of immunomodulatory therapy do not significantly affect the outcome of pregnancy. The incidence and severity of disorders in infants born to MS mothers did not significantly differ from those in the general population. Prolongation of therapy with drugs that change the course of MS up to pregnancy is most appropriate, since it stabilizes the condition of women in the perinatal period, without causing significant harm to the health of newborns. Immunosuppressive therapy increases the risk of various disorders in infants (such as multiple malformations, low birth weight, prematurity). If a woman develops an exacerbation of MS during pregnancy, it is possible to prescribe a short course of pulse therapy with methylprednisolone.

Can pulse steroid therapy increase the risk of infection by COVID-19 in patients with multiple sclerosis?

BackgroundIran is one of the countries with a high prevalence of multiple sclerosis (MS) and COVID-19.MS patients receiving the immunomodulatory or immunosuppressive therapy have a higher risk of infection. Due to the significance of determining the risk factors for getting COVID-19 among MS patients, the present study was designed to assess the risk of infection following the pulse steroid therapy. MethodsThis cross-sectional study included all MS patients that received corticosteroids in Tehran from December 2019 to August 2020 during the COVID-19 pandemic spread. The subjects’ clinical records including their sex, age, the type of MS, the type of medication, the number of days using corticosteroids, the status of prednisolone intake, and the number of days receiving prednisolone after the corticosteroid therapy were obtained. Moreover, main outcomes such as COVID-19 infection and the occurrence of death were recorded by patient’s visits and follow-up phone calls. COVID-19 infection was confirmed by physicians according to the clinical performance of RT-PCR, chest CT scan, and antibody tests. ResultsTotally, 133 MS cases participated in the study, and the pulse therapy was completed for 104 (78.2%) patients up to 5−7 days. 89 (66.9%) cases used the prednisolone tablet following the pulse therapy. Overall, the infection by Covid-19 was observed in 8 (6%) cases, among whom 5 (71.4%) cases received the pulse therapy for 5−7 days and 4 (57.1%) cases had a history of taking the prednisolone tablet. The age of less than 40 years (OR = 1.03; 95% CI (0.23−4.51)), male sex (OR = 0.35; 95% CI (0.03−3.34)), and the RRMS type (OR = 2.87; 95% CI (0.52−15.72)) had no effect on the risk of Covid-19 infection.In addition, there was not statistically significant difference between subjects with the short-term pulse therapy duration (3−4 days) (OR 0.68 (0.12–3.74) and those with the long-term pulse therapy duration (5−7 days). Similarly, no statistically significant difference was observed between subjects taking prednisolone (OR = 1.62 (0.34–7.61) and those not taking prednisolone. Furthermore, there was no significant association between different medication groups and the risk of Covid-19 infection (p < 0.05). No death occurred due to Covid-19 infection among the subjects. ConclusionCOVID-19 infection was more common among female and younger patients as well as patients with a longer duration of the pulse therapy and prednisolone intake. There was no significant association between the pulse steroid therapy in MS patients and the risk of infection by COVID-19 in the Iranian population.

Age and sex adjusted prevalence and annual incidence of multiple sclerosis in East-Azerbaijan, Iran

BackgroundIncidence and prevalence of multiple sclerosis (MS) is postulated to be rising in recent decades. Therefore, updating and completing the information of patients is essential, especially in high population areas. East-Azerbaijan is the largest and most populous province in the northwest of Iran. This study aimed to determine the prevalence and annual incidence of MS from 2008 to 2017 in East-Azerbaijan. MethodsWe evaluated the data of all patients who had registered at the MS center in the university hospital. The data include nearly all MS patients in the East-Azerbaijan region, because it is the only referral site in the area. All of the reported rates were calculated in 100,000 of the total population. ResultsBy the end of 2017, the number of MS patients was 2995 (residing in the, with 769 (25.67%) men and 2226 (74.32%) women. The prevalence rate was 75.72/100,000 (95 % CI: 73.06-78.48), 38.2 in men (95% CI: 35.5-41.0), and 114.61 for women (95% CI: 109.9-119.4), with a female to male (F/M) ratio of 3:1. The mean annual incidence rate was 7.63/100,000 (95% CI: 5.6-9.3), and this rate was higher in women than men. During the nine years, the incidence rate increased. The patients' mean age was 32.33 ± 8.92, with a peak prevalence in 25-29 years for both genders. In this study, 13.9% of patients had a positive MS family history. ConclusionsThis study showed a high prevalence of MS in the region. There is a significant increase in the incidence of MS during the nine years in East-Azerbaijan. The increment of incidence was more prominent in women. Also, considering the increasing incidence rate, it is concluded that the risk of MS is increasing in this region.

Does the multiple sclerosis (MS) map need to change again? An update of MS prevalence in Mazandaran province of Iran in 2018

BackgroundInformation of Previous studies on the prevalence of MS, including our study conducted 12 years ago, used to shape global prevalence map of MS. According to those results, Iran placed in medium-prevalence MS region in the world Atlas of MS 2013.This study aimed to investigate the prevalence of MS in Mazandaran province after 12 years and the need for possible changes in the global map of the prevalence of MS.MethodsWe included all MS patients living in Mazandaran province in 2018 in this descriptive cross-sectional study. We updated our pre-existing registration questionnaires which included demographic information and medical data of MS patients by interview. We obtained the demographic profile of Mazandaran province from the most recent census in 2016 and the National Civil Registry of the Mazandaran province for calculating prevalence of MS.ResultsThe total number of MS patients in Mazandaran was 2418 (25.8% male and 74.2% female) with a female to male ratio of 2.9. Based on the local population of 3,332,556, (50.4% male and 49.6% female), this study showed a prevalence of 72.5 per 100,000 for MS in this region. The prevalence of this disease by gender was 37.1 per 100,000 for men and 108.5 per 100,000 for women. The mean (SD) age of the patients at the time of the study was 38.5 (10.1) years with a minimum of 15 and a maximum of 75 years. The most common type of MS was Relapsing-Remitting MS with 86%.ConclusionsAll recent studies showed significant upward trend in the prevalence of MS around the world. Based on the results of our study and many other studies in Iran, the Atlas of MS prevalence map needs to be update. Iran’s status should be changed to the high-prevalence of MS in the new Atlas. Due to the increasing prevalence of MS, we suggest an adjustment in the Global MS Prevalence Scale.

Epidemiology of MS in Tehran Province, Iran: A Population- Based Study

There is a significant increase of Multiple Sclerosis (MS) in Asia, special in Iran. Familial recurrence studies in MS are useful to identify the correlated effects in etiology of the disease. This is a cross-sectional study based on Iranian MS Society data from 1999 to 2018 with the aim of estimating incidence, prevalence and assessing associations among most important variables related to familial MS (gender, age at disease onset, types of MS and familial history). Multiple regressions were used to indicate the predictors of MS via SPSS. Among 21580 MS subjects, the crude incidence and prevalence rate was 6.93 and 151.3 per 100000 populations in 2018 respectively. Completely 16187 (75%) were female and female to male ratio was 3:1.Mean age at disease onset was 28.82 years old, 9.7% of the population had early onset MS (<=18 years old). Female gender was a strong significant predictor for onset age (p<0.001). 749 (14.4%) of male patients and 2066 (13.1%) of female patients had a history of familial MS which was significantly different between them, p value=0.017, (OR=1.11; 95% CI=1.02, 1.22). Crude odds ratio for familial recurrence of MS in first degree of relatives was significantly different among genders (OR=1.30; 95% CI=1.12, 1.5). The age standardized prevalence rate of MS was estimated 54.1 (95%CI: 53.6-54.6) among males and 174.5 (95%CI: 173.6-175.4) per 100,000 among females. Totally, 75.7% were relapsing remitting MS, 16.4% were primary progressive MS and 7.9% were secondary progressive MS. MS incidence and prevalence in Tehran has increased with a decreased female to male ratio. Despite the higher prevalence of MS amongst females, the familial recurrence was higher among males except in first degree of relatives.

Pregnancy and Motherhood Concerns Surrounding Women with Multiple Sclerosis: A Qualitative Content Analysis.

ABSTRACTBackground: There is a high prevalence of multiple sclerosis (MS) among Iranian women of reproductive age. However, very few studies have been conducted in Iran to assess the experiences with and concerns about pregnancy and motherhood of such patients. The present study was conducted to better understand the experiences and concerns of women with MS about pregnancy and motherhoodMethods: The present qualitative study was conducted from August 2016 to January 2017 among Iranian women with MS visiting the Iran MS Society in Tehran, Iran. The purposive sampling method was used to recruit the participants and the sampling was continued until data saturation. Based on the inclusion criteria, a total of 25 women with MS were recruited in the study. The data were collected by in-depth semi-structured face-to-face interviews and analyzed using the MAXQDA 10 softwareResults: The analysis of the interview data resulted in four main categories, namely “Pregnancy concerns”, “Fear of failing as a parent”, “Feeling of threatened fertility”, and “Lack of social support”. The results showed that Iranian women with MS avoided pregnancy due to the negative effects of the disease on their physical abilities and on life in general. They were also concerned about possible infertility, the effect of MS medications on their menstrual cycle, and the limitations of infertility treatments due to the presence of MS. These concerns led them to postpone pregnancy and lose time or opt for voluntary childlessness and consequently miss out on the experience of motherhoodConclusion: MS poses a serious challenge to women who consider getting pregnant and wish to experience motherhood. Health care professionals should support such patients to overcome their concerns and indecisiveness by providing appropriate information and counseling

Do socioeconomic factors affect the prevalence of multiple sclerosis in Iran?

A rising trend for incidence of multiple sclerosis (MS) has been observed during the recent years in Iran. Several factors have been investigated as the reason, but socioeconomic determinants have been neglected. The present study aimed to investigate the relationship between Human Development Index (HDI), income and education and MS prevalence in the provinces of Iran. The data used in this study were obtained from three sources: (a) National Registry of MS for MS prevalence data from 2006 to 2013, (b) Statistical Centre of Iran for demographic, income, and percentage of educated people data, and (c) some previous studies for HDI data. The findings showed high prevalence of MS in the provinces of Iran. Most patients were residents of provinces with a higher socioeconomic level. Significant relationships were found between the prevalence of MS and HDI, income and educational level (P=.002, P=.006, and P=.001, respectively). Socioeconomic determinants in Iran are different from those in many other countries. It seems that Iranian provinces with a higher socioeconomic level have higher prevalence of MS. Further studies in smaller scale are needed to better understand the relationship between socioeconomic determinants and MS prevalence in the provinces of Iran.