Sleep Disorder as a Triggering Factor for Relapse in Multiple Sclerosis.

BACKGROUND/AIMS: To determine the effect of sleep disturbances on predisposing multiple sclerosis (MS) patients for acute relapse. METHODS: This case-control study was conducted on 80 MS patients including 40 patients in the remission phase and 40 in the relapse phase. Patients were asked to fill in the Pittsburgh Sleep Quality Index to determine their sleep quality during the previous month. Individuals with scores of 5 or less were considered having normal sleep quality. RESULTS: Mean ± SD ages were 32.5 ± 7.7 and 30.2 ± 7.2 years among patients with and without acute relapses, respectively (p > 0.05). The mean disease duration and disease severity (according to Expanded Disability Status Scale [EDSS]) were comparable across the groups (p > 0.05). Among those with and without acute exacerbations, 87.5 and 50% had poor sleep quality, respectively (p = 0.0001), with OR of 1.75 (95% CI 1.25-2.43). The age, gender, EDSS, and disease duration did not associate with sleep quality in either groups (p > 0.05). CONCLUSIONS: This study showed that sleep disturbance might be a trigger for an acute MS exacerbation. Increasing the awareness of specialists and routine screening of sleep disorders in MS patients are warranted, as treatment of these disorders might decrease the likelihood of acute relapses.

Effect of scuba-diving on optic nerve and sheath diameters.

BACKGROUND: There is not any data available about the effect of high bar pressure condition on intracranial pressure. In this study, the effect of diving on the optic nerve and sheath diameters as non-invasive markers of intracranial pressure has been investigated. METHODS: Twenty professional male divers from twenty one volunteers were chosen for this cross-sectional study. Only one person who had a history of barotraumas was excluded. Each diver then completed a questionnaire on demographic data, medical and diving history. Nineteen other volunteers were selected to represent a control group. A 10-MHz linear ultrasonic probe was used to measure the optic nerve sheath diameters of both eyes in closed and supine position and its relationship with diving history of divers was determined. RESULTS: It was found that divers have a higher mean optic nerve sheath diameter compared to the normal population as previously reported by other studies. The mean diameter of the left and right optic nerve sheaths were 6.4±0.7, 6.5±0.9 mm respectively and a significant relationship between optic nerve sheath diameter and diving history was found. CONCLUSION: RESULTS showed that divers have a higher optic nerve diameter than the general population. However, our result cannot yet be considered as a marker of intracranial pressure in divers as it was conducted on an limited number of subjects and so a bigger study should be undertaken for this purpose.

Translation, Cultural Adaptation and Validation of the Qualiveen-30 Questionnaire in Persian for Patients with Spinal Cord Injury and Multiple Sclerosis.

OBJECTIVES: This study aimed to cross-culturally translate the Qualiveen-30 into Persian and validate it in Iranian patients with spinal cord injury (SCI) and multiple sclerosis (MS). METHODS: This was a cross-sectional prospective validation study. The translation and cross-cultural adaptation of the original questionnaire was performed in accordance with published guidelines. A total of 154 patients with SCI or MS who suffered from lower urinary symptoms for at least 6 months were asked to complete the questionnaire in the first visit to the clinic and after 3 weeks. To assess reliability, the internal consistency was assessed by Cronbach's alpha coefficient, and validity was assessed using convergent and discriminant validities. RESULTS: The Cronbach's alpha coefficients for the Qualiveen-30 at two assessments ranged from 0.82 to 0.95, indicating a good internal consistency for the questionnaire. There were high amounts of test-retest reliability for the Qualiveen questionnaire and each of its domains (ICC > 0.90). Also, Qualiveen and its domains had a moderate to high correlation with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) (0.36 < r < 0.57) and SF-12 MCS (-0.51 < r < -0.11) and SF-12 PCS (-0.29 < r < -0.19), indicating good convergent validity. Comparison of Qualiveen in groups of income, education and manner of voiding revealed the high discriminative power of this instrument. The hypothesized four factor structure was approved using confirmatory factor analysis (CFA). CONCLUSIONS: In general, the Persian version of Qualiveen-30 performed is a reliable and valid measure for the evaluation of the quality of life related to lower urinary symptoms in patients with SCI or MS.

Increased carotid intima-media thickness in scuba divers.

BACKGROUND: Scuba divers work in high pressure conditions which may cause some changes in physiological status to adapt to this situation. In this study, the carotid intima-media thickness (CIMT) was assessed in divers as a risk factor of cerebrovascular and cardiovascular disorders. METHODS: This historical cohort study was performed on 16 male professional scuba divers as case group and 30 healthy people as controls with age range of 26-66 years. CIMT of both carotids of supine participants was measured by a 10 MHz linear ultrasonic probe quantitatively. Relationship between experience of diving and carotid IMT was evaluated. RESULTS: All the participants were males (mean age 42.9 ± 10.58. and for the control group was (47.05 ± 12.31 years). The mean right CIMT in divers and control group was 524.31 ± 149.40 and 443.66 ± 59.62 micrometer, respectively. Furthermore, the mean left CIMT in divers and control group was 624.57 ± 116.15 and 458.44 ± 49.56 micrometer, respectively. CONCLUSION: The findings demonstrated that long-term occupational diving leads to increased intima-media thickness in scuba divers.

Effect of Air Pollutant Markers on Multiple Sclerosis Relapses.

BACKGROUND: Multiple Sclerosis (MS) is one of the autoimmune diseases with an unknown cause. The aim of this study was to explore the link between air quality and MS relapses in patients who suffer from MS. METHODS: This time-series study was conducted on patients registered at the Iranian Multiple Sclerosis Society in 2011-2012. They were randomly selected from patients lived in Tehran in the last five years, and had at least one relapse in the last three years. The link between monthly mean air pollutant levels and the relapses of MS in the participants was studied. RESULTS: Among the registered 160 participants, at least 150 had one attack during 2009 and 2012. Most air pollutants such as NO2, NO and CO are in high levels in the rainy season. Others like Pm10 and Nox are in high levels in the dry season. The correlation between NO2 levels of all markers of air quality and MS relapses (P=0.03, r=0.27) is weak. Best ARIMA model (p,d,q; 1,0,1) was determined between number of monthly relapses and living place, although this model was not significant (P=0.3) (AR; P=0.000, MA;P=0.4). CONCLUSIONS: Air pollutants might be regarded as a risk factor for MS relapse.

Epidemiology of multiple sclerosis in Qom: Demographic study in Iran.

BACKGROUND: Recent studies have demonstrated controversial results and somewhat increased frequency of multiple sclerosis (MS). We reevaluated the files of MS patients from Qom Province of Iran in order to investigate the epidemiology of the disease. METHODS: Demographic and clinical records of 592 MS patients were reviewed, which included; age, sex, date of birth, marital and occupation status, presenting symptoms, time of onset, type and family history of MS, and history of autoimmune or other diseases. RESULTS: At the time of our study, 11 patients had died, and 581 were alive with a total female-to-male ratio of 3.4. The mean age of onset of the disease was 34.25 ± 9.01 for all the patients. 11.2% of patients had positive family history of MS. The majority of patients (80.1%) showed relapsing-remitting (RR) pattern. The prevalence of MS was calculated as 50.4/100000 for Qom. CONCLUSION: Qom is located within a high risk zone of MS. Although we found evidences about the role of environmental factors, geographical distribution, and etcetera, many more studies need to be performed in this respect.