Sclerosis In Isfahan Research Articles

General knowledge and Attitudes Toward Multiple Sclerosis: A Cross-Sectional Study

Introduction: Multiple sclerosis is an inflammatory and chronic disease of the central nervous system. Lack of knowledge about the disease and its symptoms may delay early diagnosis and control of the disease. The present study aimed to investigate the general knowledge and attitude towards multiple sclerosis in Isfahan.
 Methods: This was a cross-sectional (descriptive-analytical) study conducted in 2021 in Isfahan. A researcher-made questionnaire with 22 questions was created and distributed online through social networks. Data were analyzed using independent t-test and one-way analysis of variance with SPSS software (v.24).
 Results: A total number of 480 people participated in this study. The mean scores of knowledge and attitude were 4.77±1.86 and 54±6.24, respectively. T-test results indicated that there is a significant difference between participants' knowledge and attitude scores in terms of gender and history of multiple sclerosis in those around them. Analysis of variance results also showed that there is a significant difference in the mean scores of participants' knowledge and attitude according to their education level and job status. But there was no difference in the participants' attitudes toward multiple sclerosis and patients with multiple sclerosis according to their marital status.
 Conclusion: Based on the present study findings, participants' knowledge about multiple sclerosis was moderate. Therefore, Measures must be taken in order to increase the public awareness through the mass media and health centers. It can help to early diagnose and control of the disease and correcting the people's misconceptions about patients with multiple sclerosis.

Cost of Illness of Multiple Sclerosis in Isfahan, Iran, From a Social Perspective: A Comparison of the Human-Capital and Friction-Cost Methods

ObjectivesMultiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that is characterized by demyelination and neurodegenerative changes and associated with high levels of disability. This study aimed to investigate direct and indirect costs of illness of patients with MS in Isfahan using and comparing human-capital and friction-cost methods from a societal perspective. MethodsA total of 300 patients with MS of 2 main centers of the disease in Isfahan, the MS center of Ayatollah Kashani hospital and Isfahan MS center, were included. Patient’s demographic characteristics, disease information, and annual social costs (2018-2019) were collected using data collection form. Both the human-capital and friction-cost methods were applied and compared with value indirect costs because of loss of productivity. ResultsFrom the social perspective, the average annual total cost of MS disease was estimated to be 1 441 163 710 rials (34 313 US dollar [USD]) per patient using the human-capital approach and 1 434 832 004 rials (34 162 USD) with the use of friction-cost method, from which 1 428 668 396 rials (34 016 USD) was related to direct costs. The main direct costs were related to disease-modifying therapies and referring to other physicians and hospitals. The cost of loss of production was greater with human-capital approach in comparison with friction-cost method. ConclusionsThe most prominent cost in MS disease is related to drug costs. The indirect costs were sensitive to the methods, applied in the study.

An 8-year study of people with multiple sclerosis in Isfahan, Iran: Association between environmental air pollutants and severity of disease

The evidence for an impact of ambient air pollution on the incidence and severity of multiple sclerosis (MS) is still limited. In the present study, we assessed the association between daily air pollution levels and MS prevalence and severity in Isfahan city, Iran. Data related to MS patients has been collected from 2008 to 2016 in a referral university clinic. The air quality index (AQI) data, were collected from 6 monitoring stations of Isfahan department of environment. The distribution map presenting the sites of air pollution monitoring stations as well as the residential address of MS patients was plotted on geographical information system (GIS).An increase in AQI level in four areas of the city (north, west, east and south) was associated with higher expanded disability status scale (EDSS) of MS patients[logistic regression odds ratio = 1.01 (95% CI = 1.008,1.012)]. Moreover, significant inverse association between the complete remission after the first attack with AQI level in total areas [logistic regression odds ratio = 0.987 (95% CI = 0.977, 0.997)] was found in crude model. However, after adjustment for confounding variables through multivariate logistic regression, AQI level was associated with degree of complete remission after first attack 1.005 (95% CI = 1.004, 1.006). The results of our study suggest that air pollution could play a role in the severity and remission of MS disease. However, more detailed studies with considering the complex involvement of different environmental factors including sunlight exposure, diet, depression and vitamin D are needed to determine the outcome of MS.

The Effectiveness of Dohsa Psycho-Motor Rehabilitation Method on Fatigue Severity, Sleep Quality, and Resilience Promotion of Patients with Multiple Sclerosis (MS)

<p>Because of multiple psychological-physical symptoms and failure to accept the reality, multiple sclerosis (MS), patients are suffering from negative mood disorders and fatigue which affects their life quality negatively. Therefore this study has been conducted to determine the effect of Dohsa Psycho-Motor Rehabilitation Method on fatigue severity, sleep quality, and Resilience promotion of Patients with Multiple Sclerosis in Isfahan, Iran. A quasi-experimental study with pre-test, post-test and follow up was administered on both the experimental and control groups. The population consisted of all patients diagnosed with multiple sclerosis in Isfahan with clinical and MS society records. By purposive sampling 30 patients were selected for the experimental (n=15) and control (n=15) groups. Patients completed fatigue (FSS), Scale of sleep quality (PSQI) and Resilience Scale (CD-RISC) questionnaire before the beginning of the treatment (pretest) and also later for post-test. Dohsa treatment duration was ten sessions, three sessions per week and their post test was administered 30 days later. Finally, data were analyzed using SPSS18. The results of the multivariable covariance analysis showed that Dohsa Psycho-Motor Rehabilitation Method decreases fatigue severity, increases quality of sleep, and resilience of patients with Multiple Sclerosis (p<0.001). Since MS disease has led to widespread symptoms and different clinical signs, MS patients may need psychological rehabilitation in the future, therefore Dohsa Psycho-Motor Rehabilitation Method is an effective treatment for reducing fatigue, improving sleep quality and increasing the resilience of multiple sclerosis patients.</p>

Early-Onset Multiple Sclerosis in Isfahan, Iran: Report of the Demographic and Clinical Features of 221 Patients.

It is estimated that early-onset multiple sclerosis multiple sclerosis (early-onset multiple sclerosis) approximately incorporates 3-5% of the multiple sclerosis population. In this report on early-onset multiple sclerosis, the authors aimed to define demographic, clinical and imaging features in a case-series of true-childhood multiple sclerosis and to compare its characteristics with juvenile multiple sclerosis. The authors inspected the records of multiple sclerosis patients who were registered by Isfahan MS Society. Clinical and demographic data of children with less than 16 years of age were reviewed retrospectively. Out of 4536 multiple sclerosis patients referred to the authors' center, 221 patients (4.8%) had multiple sclerosis starting at the age of 16 or less (11 true-childhood multiple sclerosis vs 210 juvenile-onset multiple sclerosis); the female to male ratio was 4.81:1. In the mean follow-up period of 6.2 years, 22 patients (10.5%) had positive family history of multiple sclerosis, 196 (88.6%) patients were classified as relapsing-remitting multiple sclerosis, the mean (± SD Expanded Disability Status Scale) was 1.5 ± 1.1 at the last evaluation. The most common initial presentation was optic nerve involvement (36.1%) and cerebellar sign and symptoms (14.6%). In all, 13 patients (5.8%) had experienced seizure in the course of multiple sclerosis. This study indicated that early-onset multiple sclerosis is not rare condition and overwhelmingly affects girls even at prepubertal onset. Physicians should consider multiple sclerosis in suspicious pediatric cases.

Soil heavy metals are associated with the distribution of multiple sclerosis in Isfahan, Iran.

Few epidemiological studies have explored the effects of soil pollution on multiple sclerosis (MS) risk in Asia. Based on catchment areas, Isfahan province is divided into five regions (Central, North, East, West, and South), and Soil sampling performed in catchment area with the highest range of MS prevalence and incidence. Samples were analyzed for cobalt (Co), lead (Pb), cadmium (Cd), copper (Cu), zinc (Zn), and absorbable forms of Pb, Cd, and Co. Linear regression is used to examine the association of soil heavy metals with prevalence of MS in central part of Isfahan province. Multiple sclerosis prevalence ranged from 5.62 to 156.65 in different townships. Based on regression analysis, in case of considering fixed amounts for the rest of elements, a one (SD) increase of absorbable Pb and absorbable Cd are associated with 0.385 (SD) (P<0.0001) increase and 0.209 (SD) (P<0.007) decrease in MS prevalence, respectively. This study documented a significant association between exposure to absorbable Pb and Cd in soil with prevalence of MS in Isfahan. Further work is warranted to confirm this association and if validated, to understand the mechanisms behind the association.

Preliminary Study of Differences Between Prevalence of Multiple Sclerosis in Isfahan and its’ Rural Provinces

Background:: Previous publications categorized Isfahan as a high-risk area with regard to the prevalence and incidence of multiple sclerosis (MS). Objectives:: Till to date, there have been no studies differentiating between the prevalence of MS in Isfahan and its rural provinces. Patients and Methods:: A retrospective study of 4,209 patients with MS was conducted and recorded by the deputy of health at the Isfahan university of medical sciences in 2013. Demographic variables and place of birth were recorded in Excel. Descriptive and comparative analyses were conducted using SPSS. Results:: For Isfahan and its rural provinces, the calculated prevalence of MS could be referred as P = 84.14. The calculated prevalence of MS for Isfahan was as P = 27.61. It seems that the highest MS populations are located in the Isfahan rural southwest provinces. The place of birth in 52% was Isfahan. The number of women (78%) was higher than that of men (22%), and 90% of the population was young (range: 20 - 50 years old). Conclusions:: The outcome of this preliminary study suggested that Isfahan and its rural provinces might be categorized as two distinct regions for epidemiology of MS. Medium-risk areas included Isfahan, and high-risk areas included the Isfahan rural southwest provinces. Further advanced studies in this direction are recommended.

Association of SNP rs6897932 on CD127 gene in Relapsing Remitting Multiple Sclerosis (RRMS) patients compared to control group

Association of SNP rs6897932 on CD127 gene in Relapsing Remitting Multiple Sclerosis (RRMS) patients compared to control group

Late-onset multiple sclerosis in Isfahan, Iran.

Multiple sclerosis (MS) typically affects young adults; however, the first symptoms can occur after age 50 and is classified as late-onset MS (LOMS). In this retrospective study, we extracted the records of 3522 MS patients (2716 females and 806 males) registered in the Isfahan MS Society (IMSS) from 2003 to 2010. Next, we searched for LOMS cases. We aimed to compare these cases with 1698 non-LOMS subjects also extracted from the IMSS database. We found 48 LOMS patients (28 females and 20 males), which gave a crude frequency of 1.36%. The frequency by sex of LOMS in males (2.4%) was significantly greater than in females (1.0%, P = 0.002). The mean age at onset was 55.1 ± 4.3 years. The female to male ratio of 1.4:1 in these patients was significantly lower than in non-LOMS subjects (3.37:1, P = 0.003). The leading pattern of MS was relapsing-remitting (RR) in 62.5%, followed by primary progressive (PP) in 27.1%, and secondary progressive (SP) in 10.4%. Predominant presenting symptoms and signs were motor disturbances (35.4%), followed by brainstem (25%), optic neuritis (22.9%), and sensory related deficits (18.7%). The mean progression index (PI) in LOMS patients (0.88 ± 0.48) was significantly higher than in non-LOMS cases, 0.37 ± 0.17 (P < 0.0001). In comparing LOMS patients with the non-LOMS cohort, there was a higher frequency of the PP pattern and a higher PI in the LOMS group. In comparing other high-risk populations with the Isfahan cohort, LOMS formed a lower percentage of the total Isfahan MS population.

Serum Mercury Level and Multiple Sclerosis

Exposure to heavy metals has been associated to a higher incidence of multiple sclerosis. In this work, we present a possible relationship between serum mercury levels and development of multiple sclerosis in Isfahan, the third largest city in Iran. Seventy-four patients affected by multiple sclerosis were retrieved from multiple sclerosis (MS) clinic in Isfahan, Iran. By matching sex and age, 74 healthy volunteers were chosen as control group. Blood samples were collected and serum mercury content was determined. Serum mercury level in MS patients was significantly higher than controls (9.6 ± 10.17 vs. 5.7 ± 8.6, P = 0.037). Concerning all MS patients, serum mercury value was significantly higher than the mercury concentration founded in control subjects {odd ratio: 2.39 (CI, 1.96-2.94), P = 0.00}. Serum mercury level is higher in MS patients with odd ratio equal to 2.39 compared with healthy individuals. It may reveal that high mercury levels in serum might help MS development in susceptible individuals. More studies with larger sample size are needed to confirm this hypothesis.

Fatigue, depression, and health‐related quality of life in patients with multiple sclerosis in Isfahan, Iran

Quality of life (QoL) of patients with multiple sclerosis (MS) is worse than that of other chronic diseases. There is a need to examine the impact of fatigue and depression on the QoL independent of level of physical disability in MS. The aim of this study is to explore physical, psychological, and social aspects of health-related QoL (HRQoL) of MS patients in association with physical disability, fatigue, and depression. In a cross-sectional study, 281 (63.4% women, 36.6% men) patients with MS participated in the study. The HRQoL was assessed by the Persian version of the multiple sclerosis quality of life (MSQoL-54) questionnaires. Other covariates included in the study were disease type, physical disability, fatigue, disease impact, and depression. In univariate analysis disease type, physical disability, fatigue, disease impact, and depression were significantly associated with both physical and mental health composite summaries of MSQoL-54. In multivariate regression analysis, patients' physical disability remained significantly associated with both components of MSQoL-54, whilst fatigue and depression were associated with physical and mental composite summaries, respectively. Our findings suggest that MS-related physical disability, fatigue, and depression affect the HRQoL of MS patients, independently of each other and other potential confounding factors. Effective interventions that target fatigue and depression may help improve the QoL of patients, regardless of their disease type and level of disability.

Sharp increase in the incidence and prevalence of multiple sclerosis in Isfahan, Iran

Background: The epidemiology of multiple sclerosis (MS) has changed in recent decades. Objectives: This study aimed to give an update on the prevalence and incidence of MS in Isfahan, Iran. Methods: The study population was all residents of Isfahan province during the period from April 2003 to July 2010. In April 2003, a registry of MS patients was created at the Isfahan MS Society (IMSS), which is the only referral center for MS patients in the province. Nearly all MS patients in Isfahan province are now registered with IMSS and were included in the analysis. Results: Among the 3522 registered patients, 2716 were female and 806 were male (sex ratio: 3.37 : 1), and 431 were diagnosed in 2009. This results in a prevalence figure of 73.3 (95% CI: 70.9–75.8) and an incidence of 9.1 (95% CI: 8.3–10.0) per 100,000. Conclusion: The reported prevalence and incidence figures in our study were higher than in our previous report of 2007, in which the prevalence and incidence of MS were reported to be 43.8 and 3.64 per 100,000, respectively. This dramatic increase in the prevalence of MS puts Isfahan amongst the regions with the highest prevalence of MS in Asia and Oceania and is mostly due to changing environmental factors, amongst which vitamin D deficiency seems an important factor in our population.

Epidemiology of amyotrophic lateral sclerosis in Isfahan, Iran

Few studies are carried out on the epidemiology of amyotrophic lateral sclerosis (ALS) in Middle East with no reports from Iran. To determine the epidemiological and clinical features of ALS amongst the Iranian population living in Isfahan, Iran. Medical records of all hospitals with a neurology department and outpatient neurology clinics in Isfahan province from 2002 to 2006 were reviewed, and all patients with the diagnosis of ALS according to El Escorial diagnostic criteria were extracted and related demographic and clinical data were gathered and analyzed. We found 98 new patients (66 men and 32 women) with definite, probable, or possible ALS. The average annual incidence was 0.42/100,000, with the highest incidence rate amongst those aged 70-74. On 21 March 2006, the crude prevalence was 1.57/100,000. Median survival from onset was 48 months (95% confidence interval 34-61) and survival rates for 1, 3,and 5 years after the onset were 94%, 66%, and 32%, respectively. The incidence and prevalence of ALS in the Iranian population seems to be lower compared to other populations and the survival of patients was longer than previously reported.

Childhood-onset multiple sclerosis: report of 82 patients from Isfahan, Iran.

Although multiple sclerosis is considered as an inflammatory demyelinating disease of young adults, nearly 3% of patients manifest it under the age of 16 years. The aim of this study was to highlight the clinical and demographic features of early-onset multiple sclerosis in Isfahan, Iran. This prospective study concerned multiple sclerosis patients in whom the disease started before the age of 16 years and who were referred to the only clinic of multiple sclerosis in Isfahan from October 1997 through February 2003. All early-onset multiple sclerosis patients underwent magnetic resonance imaging. Magnetic resonance imaging findings were analyzed according to the Barkhof's criteria. All early-onset multiple sclerosis patients were followed for a mean period of 4.7 years. Among 1,238 multiple sclerosis patients, 82 early-onset multiple sclerosis patients were identified. The female to male ratio was 4.5:1. The mean age of onset was 14.1 (range: 5 to 16) years. In 53 (65%) patients, the onset was monosymptomatic; in the remaining 29 (35%), it was polysymptomatic. Sixty-four (78%) patients presented a relapsing-remitting course, 14 (17%) had a secondary-progressive and 4 (5%) had a primary-progressive course. At the last evaluation, the expanded disability status scale score was > or =6 in only 8 (10%) patients. According to Barkhof's criteria, the characteristic magnetic resonance imaging findings were observed in 80 (98%) of early-onset multiple sclerosis patients. In our study, a high rate of childhood multiple sclerosis was observed that may be because of geographical or ethnic differences. Our study also showed that Barkhof's criteria, which is mostly used in adult patients, could be also applied to early-onset multiple sclerosis cases.

Clinical and demographical characteristics of primary progressive multiple sclerosis in Isfahan, Iran

Primary progressive multiple sclerosis (PPMS) is an uncommon form of multiple sclerosis (MS) in which the course of disease is progressive from onset. In a retrospective study amongst 1606 MS patients registered in Isfahan MS Society (IMSS) from April 2003 to 31 December 2005, 92 PPMS cases were identified. That means, the frequency of PPMS amongst all included MS patients would be 5.7% (95% CI: 6.7% and 4.7%). The mean expanded disability status scale (EDSS) for the group was 5.09 +/- 1.3. The commonest mode of presentation was motor disturbance in 55 (59.8%), other modes of presentation were, vertigo in 15 (16.3%), visual problems in 12 (13%), sensory disturbances in six (6.5%), and diplopia in four (4.3%). The current [corrected] existing symptoms were motor problems in all 92 (100%), cerebellar symptoms in 46 (50%), and cognitive impairment in only 6[corrected](6.5%). Interestingly, two (2%) were affected by poliomyelitis during childhood and presenting symptom in both was limb weakness. Primary progressive form of MS is less common in Persian population and some of the rates observed in PPMS patients differ from those in other regions, these differences may be due to different ethnicity of Persian patients or to geographical differences.

Prevalence of Multiple Sclerosis in Isfahan, Iran

Background: The prevalence of multiple sclerosis (MS) shows considerable variability all over the world. According to Kurtzke, Iran is considered to have a low prevalence. Objective: To estimate the period prevalence and risk factors of MS in Isfahan, central part of Iran. Methods: A cross-sectional case register study conducted between 2004 and 2005. In the province of Isfahan, Iran, all patients known to have definite MS during 2004 and 2005, being alive and resident within Isfahan as well as being a member of the Isfahan MS Association were included in the study. Demographic and case-related information was recorded. 1,391 definite MS patients (308 men and 1,083 women) from the Isfahan MS Association, Iran, have been identified. The disease was confirmed using clinical information and MRI findings by a neurologist and radiologist. The patients were evaluated by interview and a questionnaire. Population data were obtained from the year 1999 Iran Census. The mean (SD) age of the participants was 32.5 (9.3) years with a mean (SD) duration of the disease of 6.4 (5.1) years for men and 6.9 (5.3) years for women. Results: The period prevalence of MS was 35.5 per 100,000 [95% confidence interval (CI) 33.6–37.3] in a population of 3,923,255, with a higher rate in women than men [54.5 (95% CI: 51.1–57.8) for women and 14.9 (95% CI: 13.3–16.6) for men]. The female/male ratio was 3.6 (95% CI: 3.2–4.1). The direct age-adjusted period prevalence was 59.5 per 100,000 (95% CI: 44.8–75.2) for women and 17.0 per 100,000 (95% CI: 8.9–25.1) for men. MS rates were highest among 30- to 39-year-olds and decreased with increasing age. Sensory and visual disturbances were the most common initial presentations with a prevalence of 51.1% (95% CI: 48.4–53.7) and 47.0% (95% CI: 44.4–49.7), respectively. Conclusion: Isfahan could be considered as an area with a medium to high risk of MS. This is in sharp contrast with the gradient hypothesis.