Depression, anxiety, and fear of COVID-19 in patients with multiple sclerosis in pandemic era: a cross-sectional study.

BACKGROUND: Depression and anxiety are the two important factors determining quality of life of patients with multiple sclerosis (PWMS). In COVID-19 pandemic era, several factors can provoke mental issues of people and patients. In this cross-sectional study, we aim to estimate the new prevalence of anxious and depressive symptoms and their relating factors in PWMS. METHODS: In this cross-sectional study, we include PWMS who are recruited in the MS clinic of Sina Hospital, Tehran, and are joined in our channel of Telegram media. A self-designed online questionnaire consisted of 4 parts handed out between patients: demographic and clinical data, Beck depression inventory, Beck anxiety inventory, and Fear of COVID-19 Scale. Univariate and multiple logistic regression analyses were performed to find the relating factors of expression of depressive and anxious symptoms in PWMS. RESULTS: Of a total of 282 participants with the mean age of 35.66 (30.75-40) years, had been suffering from multiple sclerosis for 7.36 (3-10) years, 81.7% were women and 69.1% classified as relapsing-remitting MS. Mean score of BDI was 17.13 ± 11.51 which is classified as minimal-moderate depressive symptoms. 48.6% of patients did not express depressive symptoms (BDI-II ≤ 14) and the others reported some degrees of depression. In the univariate analysis employment (p = 0.015), marital status (p = 0.022), level of education (p = 0.004), number of hospitalization due to MS attacks (p = 0.048), and fear of COVID-19 (p ≤ 0.0001) associated significantly with presence of depressive symptoms. After entering these factors in a binary logistic regression model, level of education (p = 0.019), marital status (p = 0.044), number of hospital admissions due to MS relapses (ß = 1.10, p = 0.02), and fear of COVID-19 (ß = 1.07, p ≤ 0001) remained significant as relating factors. Mean score of the anxiety calculated 14.54 ± 9.75 and just 3.2% of patients had severe anxiety. Employment (p = 0.045), EDSS score (p = 0.004), and fear of COVID-19 (p ≤ 0.0001) reported relating to anxious symptoms significantly in the univariate analysis. After entering in the logistic regression analysis, EDSS (ß = 1.30, p = 0.001) and fear of COVID-19 (ß = 1.13, p ≤ 0.0001) remained as significant relating factors of anxious symptoms. CONCLUSION: The overall prevalence of depressive symptoms in PWMS in our MS clinic is 51.4% which is obviously higher than other world's centers which could be due to fear of COVID-19. In addition to fear of COVID-19, presence of depressive symptoms in PWMS is related significantly with level of education, number of hospital admissions due to MS relapses, and marital status. Other side, the patients classified as suffering from anxious symptoms had more severe problems on fear of COVID-19. But it is recommended for future studies to compare patients score in the COVID-19 era with their score before this pandemic.

Early and mid-term outcomes of off-pump versus on-pump coronary artery bypass surgery in patients with triple-vessel coronary artery disease: a randomized controlled trial.

BACKGROUND AND AIM OF THE STUDY: Several studies have compared early and late outcomes of on-pump coronary artery bypass grafting (CABG) and off-pump CABG. However, there is still an ongoing debate on this matter, especially in patients with triple-vessel coronary artery disease (3VD). METHODS: We randomly assigned 274 consecutive patients with 3VD to two equal groups to undergo on-pump CABG or off-pump CABG. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, acute coronary syndrome, stroke or transient ischemic attack, and the need for repeat revascularization. The secondary outcomes were postoperative infection, ventilation time, ICU admission duration, hospital stay length, and renal failure after surgery. RESULTS: The median follow-up duration was 31.2 months (range 24.6-35.2 months). The mean age of patients was 61.4 ± 9.3 years (range: 38-86), and 207 (78.7%) were men. There were 15 (11.2%) and 9 (7.0%) MACCE occurrences in on-pump and off-pump groups, respectively (P value = 0.23). MACCE components including all-cause death, non-fatal MI, CVA, and revascularization did not significantly differ between on-pump and off-pump groups. We observed no difference in the occurrence of MACCE between off-pump and on-pump groups in multivariable regression analysis (HR = 0.57; 95% CI 0.24-1.32; P value = 0.192). There were no statistical differences in postoperative outcomes between the off-pump and on-pump CABG groups. CONCLUSIONS: Off-pump CABG is an equal option to on-pump CABG for 3VD patients with similar rates of MACCE and postoperative complications incidence when surgery is performed in the same setting by an expert surgeon in both methods. (IRCT20190120042428N1).

Comparison of effects of Empagliflozin and Linagliptin on renal function and glycaemic control: a double-blind, randomized clinical trial.

BACKGROUND: This study aimed to compare the effects of Linagliptin and Empagliflozin on renal function and glycaemic control in patients with type 2 diabetes mellitus (DM). METHOD: We conducted a randomized, double-blind, parallel trial on patients aged 30 to 80 years with type 2 DM and HbA1c ≤ 9%, regardless of background medical therapy, to compare the effects of Empagliflozin and Linagliptin on albuminuria, FBS, HbA1c, and eGFR. Participants were given the mentioned drugs for 12 weeks. Statistical analysis was performed using appropriate tests in IBM™SPSS® statistics software for windows version 24. RESULTS: In total, 60 patients participated in the study, thirty patients in each group. The mean age of participants was 56.8 (SD = 8.15) in the Empagliflozin group and 60.9 (SD = 7.22) in the Linagliptin group. Before the intervention, FBS, HbA1C, and albuminuria values were significantly higher in the Empagliflozin group than those in the Linagliptin group (P < 0.05), but there was no significant difference between groups regarding eGFR (P = 0.271). Changes in the FBS, HbA1C, and eGFR were not significantly different between groups (P > 0.05), but there was more decrease in albuminuria in the Empagliflozin group compared to the Linagliptin group (P = 0.001, Cohen's d = 0.98). CONCLUSIONS: Regardless of baseline albuminuria, eGFR, or HbA1c, Empagliflozin 10 mg daily significantly reduced albuminuria at 12 weeks compared to Linagliptin 5 mg daily in patients with type 2 diabetes. TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT20200722048176N1 . Registered 3 August 2020.

Sleep characteristics of Iranian people and their effects on daytime functioning: a population-based study.

Sleep characteristics vary between populations. Detrimental sleep habits have cognitive consequences leading to daytime functioning debilitation. Until now no study has been done to investigate sleep characteristics in Iran thoroughly. In this study, we aimed to evaluate Iranians' sleep characteristics and their association with daytime functioning. We conducted a population-based study from January 2017 to May 2019 on people more than 18 years old who lived in 11 urban destricts and 3 rural areas of Tehran, Iran. We randomly selected the participants using a multistage random stratified clustered sampling method. We obtained the participants' demographic and anthropometric characteristics and details of bedtime, sleep duration, sleep onset latency, wake-up time and sleep impact on daytime functioning. Logistic regression model was used to assess the relationship between sleep characteristics) and daytime functioning. In total, 1830 people with a mean age of 40.83 years participated in the study. The gender distribution of the participants was even, and 70.98% of them were married. After adjusting for age and sex, the following three factors had a significant impact on daytime functioning: bedtime, sleep onset latency, and sleep duration. (OR = 1.12, P < 0.038, OR = 1.01, P < 0.011, and OR = 0.99, P = 0.01, respectively). We also found that longer sleep onset latency (P = 0.004) and shorter sleep durations (P = 0.029) significantly interfere with daytime functioning. Iranians' sleep characteristics, especially their sleep duration and sleep onset latency, are associated with their daytime function. Interventions on people's sleep hygiene are warranted to promote healthier sleep behaviors among Iranians, considering the high impact of current sleep characteristics on their daily lives.

The Outcome of COVID-19 in Patients with a History of Taking Rituximab: A Narrative Review.

Coronavirus disease 2019 (COVID-19) is a recently emerging disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Notably, the safety of immunosuppressive medications is a major concern during an infectious disease pandemic. Rituximab (RTX), as a monoclonal antibody against CD20 molecule, is widely used for the treatment of various diseases, mostly autoimmune diseases and some malignancies. Previous studies indicated that RTX, as an immunosuppressive medication, may be associated with the increased risk of infections. Moreover, given the wide use of RTX, a necessity of determining the different aspects of RTX use in the COVID-19 era is strongly felt. We reviewed current studies on the clinical courses of patients with SARS-CoV-2 infection. It appears that the use of RTX does not increase morbidity and mortality in most patients. However, underlying diseases and other concomitant medications may play a role in the disease course, while the concerns of vaccine efficacy in patients receiving RTX still need to be addressed. Therefore, more controlled studies are needed for a better conclusion.

Increased Intracranial Pressure on a Patient with Neuromyelitis Optica Spectrum Disorder.

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathic disease affecting central nervous system (CNS). CSF pressure in these patients is usually normal. CASE PRESENTATION: A 30-year-old woman was admitted with complaints of headache and lower limbs paresis. Lumbar puncture (LP) and magnetic resonance imaging were performed for the patient. Opening pressure was 42 cm H2O in the first LP. According to the clinical evidences, imaging, and the patient's positive aquaporin-4 antibody, the diagnosis of NMOSD was established. CONCLUSION: High intracranial pressure headache; however rare, may be the first sign of the onset of the acute exacerbation phase of NMOSD.

Demographic features, behavioral measures, and clinical factors as predictors of cognitive function in patients with multiple sclerosis.

BACKGROUND: One of the most concerning features that involves 40-70% of patients with multiple sclerosis (MS) is cognitive impairment. Moreover, it affects various aspects of patients' life. In this regard, this study was conducted to find independent predictors of cognitive function. METHOD: We performed a cross-sectional analysis on 92 patients chosen from MS clinic of Sina hospital, Iran. After completing a general questionnaire of demographic and various clinical features, the included participants (patients with RRMS) underwent neuropsychological assessment using Minimal Assessment of Cognitive function in Multiple Sclerosis (MACFIMS), Expanded disability Status Scale (EDSS), Beck Depression Inventory II (BDI-II), and National American Adult Reading Test (NAART). An un-weighted average of MACFIMS subscales z-scores was reported as cognitive index. In order to find the association between CI and different factors, each variable was entered in a simple regression model first. Then, a univariate multiple regression model was invoked to evaluate the predictors of cognitive index in patients. RESULTS: Simple regression for cognitive index of 92 patients (86% female) with a mean age of 33.4±7.6 years old suffering of RRMS for 6.8±4.8 years revealed patients with history of former smoking (p=0.001), sole visual symptoms as the presentation sign of the study (ß=-0.341, p=0.001), lower EDSS score (ß=-0.299, p=0.005), higher NAART score (ß=0.416, p≤0.0001), and college education (p=0.001), had better cognitive function in our study population. Such factors including age, educational status, BDI-II score, EDSS score, and disease duration were fixed and the other significant factors entered once separately and then simultaneously in the univariate multiple linear regression model. It was revealed that former smoking (ß=-0.372, p≤0.0001), NAART (ß=0.304, p=0.002), and EDSS (ß= -0.185, P=0.045) are associated significantly with the cognitive function of patients with multiple sclerosis. CONCLUSION: This study demonstrated NAART, as a proxy of premorbid intelligence, history of former smoking, and EDSS score may have effects on cognitive function in MS. Future studies need to be invoked for the evaluation of the causality relation of these factors.

Premature Coronary Artery Disease Is More Prevalent in People Who Go to Bed Late.

BACKGROUND: Little is known regarding the impact of quantity and quality of sleep on the incidence of cardiovascular disease. The aim of this study was to investigate the possible independent association of late bedtime and premature coronary artery disease (PCAD). METHODS: Between October 2016 and November 2019, we conducted a cross-sectional population-based study on 30101 participants aged 20-65 years in Khuzestan Comprehensive Health Study (KCHS). Data on major risk factors of cardiovascular disease, habit history, physical activity, and sleep behavior was gathered and participants underwent blood pressure, anthropometric, and serum lipid and glucose profile measurements. PCAD was defined as documented history of developing obstructive coronary artery disease before 45 years in men and before 55 years in women. RESULTS: Of a total of 30101 participants (64.1% female, mean age: 41.7±11.7 years) included in this study, 1602 (5.3%, 95% confidence interval: 5.1%-5.6%) had PCAD. Late bedtime was reported in 7613 participants (25.3%, 95% confidence interval: 24.9%-25.8%). Age-sex standardized prevalence for PCAD and late bedtime were 3.62 (3.43-3.82) and 27.8 (27.2-28.4), respectively. There was no significant difference (P=0.558) regarding prevalence of PCAD between those with late bedtime (5.5%, 95% CI: 4.9%-6.0%) and those with early bedtime (5.3%, 95% CI: 5.0%-5.6%). However, after adjustment for potential confounders, late bedtime was independently associated with PCAD (OR=1.136, 95% CI=1.002-1.288, P=0.046). CONCLUSION: In this study, late bedtime was significantly associated with presence of PCAD. Future prospective studies should elucidate the exact role of late bedtime in developing coronary atherosclerosis prematurely.

Evaluation of emotional intelligence (EI) in neuromyelitis optica spectrum disorder (NMOSD) patients compared to healthy individuals.

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is known as an autoimmune astrocytopathic disorder involving central nervous system (CNS). The aim of this study was to compare Emotional Intelligence (EI) score between NMOSD patients and healthy individuals, and to find out the possible effect of this disease on EI. METHODS: A total of 45 NMOSD participants and 48 healthy individuals were enrolled in this study. Demographic information (e.g., gender and age) of all participants as well as their level of education, and data on the patients' duration of disease were collected. EI of each participant was assessed using Persian version of Emotional Quotient inventory (EQ-i) questionnaire. RESULTS: The mean total EI score was significantly different between the participants and controls (322±36.7 vs 338±31.5, p value<0.03). Compared to controls, patients had a poor performance in 4 of 15 EI subscales including emotional self-awareness (21.29±3.6 vs 22.85±3, p value<0.03), optimism (22.4±4 vs 24.1±3.1, p value<0.03), self-regard (22.7±4.6 vs 24.5±3.4, p value<0.04), and impulse control (16.9±6.5 vs 19.5±5.5, p value<0.05). No difference was found between anti-aquaporin-4 antibody (AQP4-IgG) positive and AQP4-IgG negative patients regarding EI score or its subscale scores, except for self-actualization (p value<0.05). CONCLUSION: Our study showed that EI could be regarded as a tool for understanding emotions, thoughts, and behavior of NMOSD patients. It was implied that taking therapeutic steps could improve the performance of NMOSD patients with EI impairment in social life.