Impact of menopause on relapse rate and disability level in patients with multiple sclerosis (MS): a systematic review and meta-analysis

BACKGROUND

Menopause is a physiologic phase in women's lives. Findings regarding multiple sclerosis (MS) course through menopause are diverse. So, we designed this systematic review and meta-analysis to estimate the impact of menopause on relapse rate, and disability status in women with MS.

METHODS

PubMed, Scopus, EMBASE, Web of Science, and google scholar were systematically searched by two independent researchers on January 1st, 2023. They also evaluated conference abstracts, and references of the included studies. In addition, data regarding the total number of participants, name of the first author of the publication, publication year, country of origin, disease duration, disease type, annual relapse rate, and Expanded Disability Status Scale (EDSS) before and after menopause were recorded.

RESULTS

A literature search revealed 1024 records. Twenty-one full texts were evaluated, and finally, four studies were included for meta-analysis. Mean ARR before menopause ranged between 0.21 and 0.37, and after menopause ranged between 0.13 and 0.08. The SMD of mean ARR ranged between - 1.04, and - 0.29, while the pooled SMD was estimated as -0.52(95% CI: -0.88, -0.15) (I2 = 73.6%, P = 0.02). The mean EDSS before menopause ranged between 1.5 and 2, and after menopause ranged between 2 and 3.1. The SMD of EDSS ranged between 0.46, and 0.71. The pooled SMD of EDSS change (after menopause-before menopause) estimated as 0.56(95% CI: 0.38, 0.73)(I2 = 0, P = 0.4).

CONCLUSION

The result of this systematic review and meta-analysis show that menopause can be associated with relapse rate reduction, unlike increase in disease-related disability in women with MS.

Pregnancy History, Oral Contraceptive Pills Consumption (OCPs), and Risk of Multiple Sclerosis: A Systematic Review and Meta-Analysis

Background

To estimate the pooled odds of oral contraceptive pills consumption (OCPs) use as well as pregnancy history and multiple sclerosis (MS) risk.

Methods

We systematically searched PubMed, Embase, Scopus, Web of Science, Google scholar, and gray literature including references of the references as well as conference papers. The search strategy in PubMed was ((Oral contraceptive pills) OR OCP) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating) AND (gravidity) OR (pregnancy).

Results

Four studies were included. The pooled odds of developing MS in women with pregnancy history compared with nulligravid women was 0.64 (95%CI = 0.53 - 0.78) (I ² = 0, P = 0.5), which means that pregnancy reduces the risk of MS by 36%. The pooled odds of OCP consumption and risk of MS were 1.09 (95% CI = 0.67 - 1.76). By comparing the pooled odds of OCP consumption and risk of MS according to the country of the origin, we found that the pooled odds in Iranian studies was 1.03 (95% CI = 0.31 - 3.45) and the pooled OR in studies that were conducted in the United States was 1.13 (95% CI = 0.65 - 1.98), which showed that the country of the origin was not the cause of heterogeneity.

Conclusions

The results of this systematic review show that pregnancy history is a protective factor for MS development, whereas OCP use has no significant effect.

Effect of Vitamin D Supplements on Relapse Rate and Expanded Disability Status Scale (EDSS) in Multiple Sclerosis (MS): A Systematic Review and Meta-Analysis

Background

Multiple sclerosis (MS) is an inflammatory disease while there are controversies regarding the role of vitamin D supplements in controlling relapse and disability improvement during treatment.

Objective

The goal of this systematic review and meta-analysis was to evaluate the effect of vitamin D supplements on MS-related relapse and the Expanded Disability Status Scale (EDSS).

Methods

We searched databases to include randomized clinical trials (RCTs) which were published up to October 2018. We included RCTs, being single-blinded or double-blinded or open-label trials in which one of the main outcomes was EDSS and/or relapse after vitamin D supplementation. All statistical analyses were performed using RevMan 5.3. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for relapse between treatment arms. The mean difference was calculated for EDSS comparisons.

Results

Nine articles were included for analysis. Of these nine studies, five compared vitamin D supplement groups with placebo (group 1 studies), and four compared high- and low-dose vitamin D groups. A total of 561 patients were analyzed. Being treated with vitamin D instead of placebo showed no effect on relapse rate (OR = 0.66, 95% CI = 0.28-1.54) as well as EDSS (mean difference = 0.06, 95%CI [-0.31, 0.42]). The results of studies comparing high- vs. low-dose vitamin D interventions showed no significant effect on relapse rate (OR = 1.08, 95%CI [0.29-4.08] as well as final EDSS (mean difference = 0.17, 95% CI = -0.73, 1.07).

Conclusions

Our findings show that vitamin D supplements (high or low dose) have no significant effect on relapse rate and disability during treatment in MS patients.

Prevalence of Multiple Sclerosis (MS) in Zanjan Province of Iran

Background:

The prevalence of multiple sclerosis (MS) varies in different geographical regions and has dramatically increased in Iran. Revealing the high prevalence rate draws the attention of policymakers and helps them allocate necessary resources. The aim of this study is to determine the prevalence of MS in Zanjan province of Iran.

Methods:

We included all registered residents of Zanjan province with MS on the prevalence day (July 31, 2019). All cases met the McDonald criteria. All registered cases in Zanjan MS society were identified as index cases. Data regarding patient's national code, gender, age, age at the first symptom onset, city of residence, marital status, education level, occupation, ethnicity, family history of MS and the time span between symptom's onset and disease diagnosis were recorded.

Results:

We identified 758 patients, 551 of whom (72.7%) were female. The mean age at the first symptom onset was 28.9 ±8.7 years old. The crude prevalence was 71.6 per 100,000 population (95% CI 66.6–76.9). The disease was most prevalent in Zanjan city (100.5 per 100,000). The gender-specific prevalence per 100,000 population was 105.4 for women (95% CI: 96.8–114.6) and 38.7 for men (95% CI: 33.6–44.1), with female to male ratio of 2.6. The standardized mortality ratio (SMR) was calculated as expected/observed for both men and women as 2.3 (207/88.2) (551/234.1).

Conclusions:

Our data confirm that the MS prevalence rate is high in Zanjan province of Iran.

Prevalence of Anti-JC Virus Antibody Seropositivity in Patients with Multiple Sclerosis: A Systematic Review and Meta-Analysis

BACKGROUND

The John Cunningham virus (JCV) is the causative agent of progressive multifocal leukoencephalopathy. Anti-JCV antibody seropositivity is an important consideration in patients with multiple sclerosis (MS). The reported prevalence of JCV in MS patients has been conflicting.

OBJECTIVE

We aimed to conduct a systematic review and meta-analysis to estimate the pooled prevalence of anti-JCV antibody seropositivity in cases with MS.

METHODS

We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, Ovid, ProQuest, Google Scholar, and gray literature including reference of included studies, and conference abstracts which were published up to April 2019. Two independent researchers independently assessed the articles.

RESULTS

The literature search found 181 articles. After eliminating duplicates, reviews, case reports, and trials, 15 articles remained. Finally, 8 articles were included for the final analysis (from Asia, Europe, the USA, and Canada). In total, 16,041 MS cases were analyzed. The prevalence of anti-JCV antibody seropositivity varied between 40 and 80%, and the pooled estimate was calculated as 60% (95% CI: 56-64%), though with significant heterogeneity (I2 = 95%, p = 0.01).

CONCLUSION

The prevalence of anti-JCV antibody seropositivity is variable among MS patients in different countries, and the pooled estimate showed that this is 60% overall.

Effects of Vitamin D Supplements on IL-10 and INFγ Levels in Patients with Multiple Sclerosis: a Systematic Review and Meta-Analysis

Background:Vitamin D is one of the considerable environmental factors exhibiting immunomodulatory and anti-inflammatory effects. Objective: To conduct a systematic review and meta-analysis to estimate the effect of vitamin D supplements on IL-10 and INFγ levels in patients with multiple sclerosis. Methods: We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, Ovid, The Cochrane Library and gray literature, including references of selected studies, conference abstracts which were published up to May 2019. We included single- or double-blinded RCTs or open-label trials in which one of the main outcomes was INFγ and/ or IL-10 levels after vitamin D supplementation. Only articles that had been published in English were included. Results: The literature search yielded 369 articles, that were monitored by us. After eliminating duplicates, 128 studies remained; from these, we excluded observational studies, reviews, case reports and non-randomized trials, and 33 studies remained. Finally, only three articles were included. The mean difference for INFγ was 268.4 and 95 % CI 200.6-336.1. There was no significant heterogeneity (I ² = 0 %, Chi ² = 0.1, p = 0.7). The mean difference for IL-10 was 398.3 and 95% CI -528.05-1324.8). There was significant heterogeneity (I2 = 94 %, Chi2 = 31.1 p < 0.001). Conclusion: The results of this systematic review were not satisfactory. More clinical trials are further needed to evaluate the effects of vitamin D supplements on IL-10 and INFγ levels in patients with multiple sclerosis.

Age at menarche and risk of multiple sclerosis (MS): a systematic review and meta-analysis

BACKGROUND

Some studies have looked at the age at menarche and risk of Multiple Sclerosis (MS).We aimed to conduct a systematic review and meta-analysis to estimate a pooled odds ratio of developing MS by increasing age at menarche.

METHODS

We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, Ovid, google scholar and gray literature (references of references, congress abstracts) up to 10th April 2019.

RESULTS

The literature search found 312 articles. After eliminating duplicates, reviews, case reports and trials, 18 articles remained. Three articles were ultimately included in the final analysis. Two studies were from Iran, and one from Canada. The pooled odds ratio (OR) for increasing 1 year of age at menarche was 0.88 (95% CI:0.82-0.94), with no significant heterogeneity (I2 = 49%, p = 0.1). Mean age at menarche was significantly different between case and control groups (mean difference = - 0.22, 95% CI = -0.42,-0.02).

CONCLUSION

The result of this systematic review showed that the risk of MS decreases by increasing age at menarche.

Incidence of seroconversion and sero-reversion in patients with multiple sclerosis (MS) who had been treated with natalizumab: A systematic review and meta-analysis

BACKGROUND

Natalizumab is a medication of choice for some patients with relapsing remitting (RR) form of multiple sclerosis (MS). John Cunningham virus (JCV) antibody status is important in cases who are treating with natalizumab. Different studies reported various rates of seroconversion and sero-reversion in patients who had been treated with natalizumab. As there is no systematic review reporting incidence of seroconversion and seroreversion in MS cases who were treated with natalizumab, we aimed to conduct this systematic review and meta-analysis to find pooled incidence of seroconversion and seroreversion in MS cases who were treated with natalizumab.

METHODS

PubMed, Scopus, EMBASE, CINAHL, Web of Science, Ovid, and google scholar were systematically searched. We also searched the gray literature including references from included studies, and conference abstracts which were published up to April 2019.

RESULTS

The incidence of seroconversion was reported between 6% and 41% and the incidence of seroreversion was reported between 1% and 11%. The pooled estimate of seroconversion incidence was 19% (95% CI: 13%-25%) (I² = 96.8%, P < 0.001) and the pooled estimate of seroreversion incidence was 5% (95% CI: 3%-8%) (I² = 72.2%, P < 0.001). Subgroup analysis by considering the country of the origin showed that the pooled incidence of seroconversion incidence during the studies was 6% in Asian countries and 21% in European/American countries. The incidence difference between subgroups was significant (p < 0.001).

CONCLUSION

Incidence of seroconversion in MS patients who had been treated with natalizumab is higher in European/American countries than Asian countries.

The Effect of Vitamin D Supplements on Clinical and Para-Clinical Outcomes in Patients With Multiple Sclerosis: Protocol for a Systematic Review

Background

Multiple sclerosis (MS) is an inflammatory disease, which has a wide range of effects on patients. There are controversies regarding the role of vitamin D in clinical and laboratory improvements in MS patients.

Objective

The aim of this systematic review protocol is to evaluate the efficacy of vitamin D supplements on relapse rate, gadolinium-enhancing lesions of magnetic resonance imaging (MRI), and cytokine profiles.

Methods

We will search PubMed, Scopus, EMBASE, CINAHL, Web of Science, Ovid, ProQuest, American College of Physicians Journal Club database, Health Technology Assessment Database (The Cochrane Collaboration), and National Health System Economic Evaluation Database (The Cochrane Collaboration) and gray literature including reference of included studies and conference abstracts. Clinical trials reporting the effect of any doses of vitamin D on relapse rate, gadolinium-enhancing lesions of MRI, and cytokine profiles will be included. In total, 2 independent researchers will independently assess the studies, extract data, and evaluate the quality of primary studies.

Results

This systematic review was started in September 2017 and the process is continuing. The included articles are evaluated and researchers are going to extract the data.

Conclusions

To our knowledge, this will be the first comprehensive systematic review aiming to assess the effect of vitamin D supplements on clinical and para-clinical outcomes in patients with multiple sclerosis.

International Registered Report Identifier (IRRID)

DERR1-10.2196/12045

Comparison of Sexual Dysfunction in Women with Migraine and Multiple Sclerosis (MS)

Migraine and multiple sclerosis (MS) are two neurologic disorders that influence different aspects of women who are affected. Sexual function is one of the co-morbidities that are not considered well in such cases. The goal of this study to evaluate sexual function in women experiencing either migraine or MS. Eighty six married migraineus patients and 86 age- matched married MS cases were asked to fill out valid and reliable Beck depression inventory (BDI) and FSFI (Female Sexual Function Index ) questionnaires. BDI score was higher in women with migraine than MS cases and BDI scores in both groups were high in cases with sexual dysfunction. BDI score was significantly correlated with total FSFI and its subscales in both groups. Multiple linear regression analysis between the FSFI as a dependent variable and age, BDI and education level as independent variables showed that age and BDI are independent predictors of FSFI in both groups. Sexual dysfunction should be considered in women with either MS or migraine.

Validity and Reliability of the Persian Version of the PERception de la Scle'rose En Plaques et de ses Pousse'es Questionnaire Evaluating Multiple Sclerosis-related Quality of Life

BACKGROUND

Multiple sclerosis (MS) affects all aspects of patients. Recently, the "PERception de la Scle'rose En Plaques et de ses Pousse'es" (PERSEPP) scale was designed to assess MS-related relapse on quality of life (QoL). The aim of this study was to evaluate validity and reliability of Persian version of PERSEPP scale in Iranian patients with MS.

METHODS

Two-hundred eleven patients with relapsing-remitting form of the disease asked to fill the PERSEPP scale, MSQOL-54, and SF-36 questionnaires. Fifty cases filed the questionnaire 2 weeks later to assess reliability. The intraclass correlation coefficient (ICC) and Cronbach's alpha analysis were used.

RESULTS

Mean age and mean duration of disease were 32.2 ± 8.4 years and 6.5 ± 2.5 years, respectively. One hundred sixty-seven (79.1%) were female and 44 (20.9%) were male. Forty-one (19.4%) were in relapse phase of the disease. ICC score of all items was above 0.8. Cronbach's alpha of all items was above 0.8. The results show that the mean scores of four items (relationship difficulties, time perspective, and symptoms) were significantly different between cases in relapse and none relapse. Coping and relationship difficulties scores were significantly different between different expanded disability status scale groups. Pearson correlation score for QoL 54 and PERSEP calculated as r = 0.44, P < 0.001 and r = 0.66, P < 0.001 between SF36 and PERSEP.

CONCLUSIONS

Persian version of PERCEPP questionnaire provides valid and reliable instrument to assess MS-related QoL.

Sexual function in women with multiple sclerosis

Multiple sclerosis (MS) is an inflammatory disease of central nervous system (CNS) and sexual dysfunction (SD) is one of the most common disabilities of MS women. The aim of this study was to determine sexual function of women with MS (multiple sclerosis). One hundred definite MS patients MS patients and fifty age-matched healthy controls were enrolled. Demographic data (sex, age), duration of the disease and disease pattern extracted from patient's  files and Kurtzke Expanded Disability Status Scale (EDSS) recorded for each patient by an expert neurologist. Participants were asked to answer the valid and reliable Persian version of Beck depression inventory (BDI) and Female Sexual Function Index (FSFI) questionnaires. The total FSFI score and subscale scores differed significantly between the MS patients and the controls. There was a significant negative correlation between EDSS and FSFI scores (rho=-0.44, P<0.001) and significant positive correlation between EDSS and BDI (rho=0.36, P<0.001) in patients. Mean BDI and all subscales of FSFI differed significantly between patients with total FSFI score higher and lower than 26.55. Sexual dysfunction should be considered in women with multiple sclerosis.

Anxiety in patients with multiple sclerosis: association with disability, depression, disease type and sex

The aim of the current study was to evaluate anxiety in patients with multiple sclerosis (MS) and factors which are associated with this symptom. Eighty totals of 180 patients with MS were enrolled in this cross-sectional study. They were asked to answer the valid and reliable Persian version of the Beck depression inventory (BDI) and Beck anxiety inventory (BAI) questionnaires. Demographic characteristics (sex and age), duration of the disease, disease course and Kurtzke Expanded Disability Status Scale (EDSS) were recorded for all participants. Mean BDI was 17.5 ± 11.4 in patients while mean BAI was17.7 ± 12.5 in all participants, respectively. Mean BDI and BAI were not statistically different between male and female participants. Patients with higher levels of disability (higher EDSS) had significant higher BDI and BAI scores and there was significant positive correlation between EDSS and BDI and BAI scores (rho=0.42, P<0.001, rho=0.35, P<0.001). Patients with SP (Secondary progressive) type of disease had significant higher BDI and BAI score. Multiple linear regression analysis showed that depression and disability level were independent predictors of anxiety in patients. Anxiety and factors which are related with this symptom should be considered in MS patients.

Mean right and left carotid intima-media thickness measures in cases with/without coronary artery disease

One of the important factors which should be considered in (Coronary artery disease) CAD cases is increased carotid intima-media thickness (IMT) which has been considered to be associated with coronary artery disease severity and cardiovascular events. The goal of this study was to compare risk factors and carotid IMT in cases with CAD and healthy subjects and to determine the association between severity of CAD and IMT. In this case-control study, 250 proved CAD cases and 250 healthy ones were enrolled. Ultrasound evaluation of carotid IMT Ultrasound quantification of the right and left carotid IMTs was obtained. Demographic characteristics (age and sex), risk factors (presence of diabetes, hyperlipidemia (HLP), hypertension (HTN) and smoking) were recorded for all participants. Presence of diabetes, HTN, HLP and mean age was significantly higher in patients than controls. There was positive correlation between IMTs and advancing CAD (for right IMT, rho=0.34, P<0.001, for IMT rho=0.47, P<0.001). Sex, HTN, HLP, right and left IMT measures were independent predictors of CAD. The best cutoff point for right IMT to differentiate patients from controls was 0.82 with sensitivity and specificity of 70% and 50% (AUC=0.70, P<0.001). The best cutoff point for left IMT to differentiate patients from controls was 0.85 with sensitivity and specificity of 80% and 55% (AUC=0.70, P<0.001). Carotid IMT increase should be considered as a surrogate factor for CAD.

Fatigue in multiple sclerosis: relationship with disease duration, physical disability, disease pattern, age and sex

To evaluate the relationship between disease duration, disability, disease pattern, age and sex with fatigue in MS patients. One hundred and seventy-three clinically definite MS patients and 87 age-matched healthy controls enrolled in this cross sectional study. Demographic data (sex, age), duration of the disease and disease pattern extracted from patient's files and Kurtzke Expanded Disability Status Scale (EDSS) were recorded for each patient by an expert neurologist. Participants were asked to answer the validated and reliable Persian version of beck depression inventory (BDI) and FSS (fatigue severity score) questionnaires. Mean FSS and BDI scores were significantly different between patients and controls (p < 0.001). Patients with longer disease duration, higher EDSS and progressive type of disease had significantly higher FSS and BDI scores. Although men had higher EDSS, FSS and BDI scores were similar in both sex groups. FSS was significantly correlated with age, disease duration, BDI and EDSS. The analysis of covariance revealed that there is no difference in the covariance-adjusted means for fatigue among two disease groups (relapsing remitting and secondary progressive) except for EDSS. MS patients with longer disease duration, higher EDSS and progressive type of disease suffer from fatigue more than cases with lower EDSS, duration of disease and relapsing type of the disease.

Successful catheter-directed venous thrombolysis in an ankylosing spondylitis patient with phlegmasia cerulea dolens

Ankylosing spondylitis (AS) is an inflammatory rheumatic disease. Phlegmasia cerulea dolens is a severe form of deep vein thrombosis characterized by swelling, pain, and bluish discoloration. Treatment delay may cause venous gangrene, tissue ischemia, limb loss or death. Here, we present an AS case who presented with phlegmasia cerulea dolens and treated by catheter-directed thrombolysis.

Emotional intelligence of medical residents of Tehran University of Medical Sciences

Nowadays, educators pay attention to emotional intelligence which is defined as the ability to monitor and explain one's own and other's emotional experience and feelings to differentiate between them as well as applying necessary information for determining thoughts and actions. The goal of this study was to determine emotional intelligence of medical residents of Tehran University of Medical Sciences. By means of two stage cluster sampling, 98 medical residents of Tehran University of Medical Sciences were selected. Participants were asked to fill valid and reliable Persian version of Emotional Quotient inventory (EQ-i) questionnaire which had been developed due to Bar-On model. Seventy two filled-up questionnaires were returned (RR=73%). Mean EI score of all participants was 319.94 ± 32.4. Mean EI score was not significantly different between male and female also, single and married participants. EI did not differ significantly in residents in respect to their discipline. Mean responsibility subscale differ significantly between male and female participants (P=0.008). Multiple regression analysis showed that happiness subscale is a predictive factor for total EI score (B=-0.32, P=0.009). Responsibility subscale differed significantly between men and women participants and happiness subscale was a good predictor for emotional intelligence score. These factors should be considered in education of medical residents.

The Role of Multidetector CT in the Diagnosis of Retroperitoneal Fibrosis: Report of a Case

Herein, we report a 40-year old man who presented with flank and abdominal pain with dilatation of the bilateral pyelocalyceal system detected in ultrasonography. Computed Tomography (CT) scan showed a soft tissue mass at the level of the fourth and fifth lumbar vertebrae in the retroperitoneal region. There were no blood flow signals in 64-slice multidetector CT (MDCT) which confirms the Retroperitoneal Fibrosis (RPF). Pathological examination showed infiltration of plasma cells, macrophages, lymphocytes and eosinophils accompanied by fibrosis, which is consistent with idiopathic RPF. In conclusion, 64-slice MDCT imaging is useful in the diagnosis of RPF.

Hydatid cyst of the knee: a case report

Hydatid disease is a parasitic infection which occurs in specific geographical areas such as the Mediterranean region. We report a case of hydatid cyst of the knee in a 34-year-old man who was admitted with inability to walk and a painful knee. He had a past history of liver infection nine years ago. Laboratory findings were negative. According to the high prevalence of hydatid disease in Iran, it should be considered as a differential diagnosis of Baker's cyst, synovial cyst and lipoma.