Adjuvant Vitamin D Injection in Elderly Patients Before Intertrochanteric Fracture Surgery: A Randomised Controlled Trial.

Background: There are multiple recommended protocols for Vitamin D (VitD) supplementation in elderly; however, only a few studies achieved to examine the role of VitD supplements before intertrochanteric fracture surgery on mortality and complications after surgery. Methods: This single-center block-randomized double-blinded trial was conducted on 80 patients with intertrochanteric fractures and a sufficient level of 25 (OH) VitD. The intervention group received an intramuscular 300,000 IU VitD ampule before surgery. The primary outcome was a 6-month mortality rate, and the secondary outcomes were 1- and 2-year mortality rates and Harris Hip Score (HHS) in 6, 12, and 24 months after surgery. Chi-square, t-test, repeated measure ANOVA, and Cox regression survival model was used for statistical analysis. Results: 40 patients were allocated to each group. Demographic, clinical characteristics, and preoperative evaluations were not significantly different between the groups. Mortality rate 6-month after the surgery was 7.5% and 10% for the intervention and placebo groups respectively (P value = .71), 15% and 12.5% at 1-year (P value = .83), and 25% and 27.5% at 2-year (P value = .98). Based on the Cox regression model, only age was significantly associated with mortality (HR = 1.229, P value <.001). Significant HHS changes from baseline through 24 months after surgery were observed within both groups; however, mean differences were not significantly different between groups. Conclusions: A single preoperative 300,000 IU VitD did not significantly impact 2-year survival and HHS in patients with intertrochanteric fractures and sufficient serum VitD level.

Multiple sclerosis and personality traits: associations with depression and anxiety.

BACKGROUND: Depression and anxiety are commonly observed in people with multiple sclerosis (pwMS). There is a growing body of literature supporting the hypothesis that personality traits can influence the mood disorders. This study aimed to investigate the personality traits and their relationships with depression and anxiety among pwMS. METHODS: 234 pwMS were involved in this cross-sectional study. Personality traits, depression, and anxiety were assessed using the NEO Five-Factor Inventory (NEO-FFI) and Hospital Anxiety and Depression Scale (HADS), respectively. Pearson's correlation coefficient and generalized linear model were employed to evaluate the relationships between demographic and clinical characteristics, NEO-FFI, and HADS subscales. RESULTS: In pwMS, longer disease duration was significantly associated with lower level of conscientiousness (ß = - 0.23, p = 0.008) and agreeableness (ß = - 0.2, p = 0.01). Moreover, higher expanded disability status scale (EDSS) of pwMS had a significant relationship with higher level of neuroticism (ß = 0.89, p = 0.01). Increased level of neuroticism was significantly correlated with lower level of extraversion (r = - 0.28, p < 0.001), openness (r = - 0.37, p < 0.001), agreeableness (r = - 0.31, p < 0.001), and conscientiousness (r = - 0.45, p < 0.001). PwMS with higher level of conscientiousness showed more extraversion (r = 0.23, p < 0.001), openness (r = 0.61, p < 0.001), and agreeableness (r = 0.41, p < 0.001). Elevated level of neuroticism was significantly associated with higher level of anxiety (ß = 0.47, p < 0.001) and depression (ß = 0.11, p < 0.001) among pwMS. CONCLUSION: The co-occurrence of depression and anxiety is probably associated with neuroticism among pwMS. Additionally, the impact of personality traits extends to influencing key disease aspects such as physical disability and disease duration in MS.

Prevalence and incidence of multiple sclerosis in Isfahan, Iran between 1996 and 2021: A population-based study.

BACKGROUND: There has been no recent comprehensive epidemiological study on a large and stable population of multiple sclerosis (MS) in Isfahan. Therefore, we conducted this study to estimate the incidence and prevalence of MS in Isfahan province from 1996 to 2021. METHOD: In this population-based study, we utilized the dataset from the Vice-Chancellor's Office of Isfahan University of Medical Sciences, which registers all people diagnosed with MS (PDWM) in Isfahan province, excluding those residing in Kashan city. We measured crude incidence and prevalence of MS, separated by sex, and based on age of MS onset, as well as changes in age of MS onset during observation. RESULTS: A total of 9,909 PDWM were included in our study. The incidence during the time period of 1996-2000 was 5.4/100,000 (1.1/100,000 per year), which subsequently increased to 14.1 (2.8/100,000 per years) and 31.1 per 100,000 (6.2/100,000 per year) during 2001-2005 and 2006-2010, respectively. There was a further increase to 70.9/100,000 (14.2/100,000 per year) in 2011-2015, but it remained stable at 71.8/100,000 (12/100,000 per year) during the period of 2016-2021. In 2016, the age-standardized incidence rates of pediatric-onset, adult-onset, and late-onset MS were 1.8/100,000, 31.4/100,000, and 17.5/100,000, respectively. The prevalence of MS in 2021 was 183.9/100,000. The female/male new case ratio was 4.5 during 1996-2000, decreasing to 4.0, 3.9, 3.9, and 2.9 in the subsequent four five-year periods. The mean age of RRMS onset was 26.3 ± 8.1 between 1990 and 1999, 28.5 ± 8.3 during 2000-2009, and increased to 32.8 ± 9.6 in 2010-2019. CONCLUSION: This study shows that Isfahan has one of the highest incidence rate and prevalence ratio of MS in the region. We observed an increase in the incidence rate during the first decade, followed by stability in the last two five- and six-year periods. Further studies are needed to identify the reasons behind the change in incidence of MS in Iran.

Demographic and Clinical Characteristics of Familial and Sporadic Multiple Sclerosis Patients.

Background: Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating, immune-mediated disease of the central nervous system. It is still unestablished whether heredity correlates with the disease's progression and severity. Methods: This study includes the patients with MS seen in the MS clinic of Kashani Hospital, affiliated with Isfahan University of Medical Sciences, from January 2019 to January 2020. We gathered data regarding the demographic and clinical characteristics, such as type of disease and family history of MS. Patients were grouped based on having relatives with MS. We compared demographic and clinical characteristics between those with a family history of MS (familial MS: FMS) and those without a family history of MS (sporadic MS: SMS). Results: We included 2,929 MS patients, 523 (17.2%) with FMS and 2,406 (82.8%) with SMS. Patients with FMS were found to have active lesions in the thoracic spine more frequently than those with SMS (P = 0.022). We also found differences in the distribution of gender (P = 0.036) and the frequency of having active brain lesions (P = .024) among patients with FMS and SMS. No difference was found between the demographic/clinical characteristics and the number of affected relatives in the family. Conclusions: Significant differences were found among different groups of patients in terms of demographical and clinical characteristics.

Assessment of Hip Range of Motion Limitations in Cases with Low Back Pain Based on the Classified Movement System Impairment.

Background: The hip joint's limitation causes lumbopelvic compensatory motions, accumulating tissue stress on the lumbar spines. It is essential and valuable to evaluate hip rotation range of motion (ROM) in different low back pain (LBP) classifications to understand them and plan the best exercise program. This study aimed to compare hip rotation ROM between subjects with and without LBP classified in movement system impairment (MSI). Materials and Methods: In this cross-sectional study, 100 subjects with LBP were classified into different MSI subgroups (mean age of 41.66 ± 7.82 years), and 100 healthy subjects (mean age of 38.96 ± 8.84 years) participated. Passive and active hip medial and lateral rotations ROM in prone and supine positions for dominant and non-dominant lower limbs were measured. Results: Generally, in the LBP group, minimal lateral rotation as compared to controls in movement tests measuring hip rotation ROM actively and passively, in prone and sitting positions, and for dominant and non-dominant limbs (P < 0.05). There were no significant differences among the LBP subgroups (P > 0.05). Conclusions: Due to LBP, regardless of the MSI categories, remarkably restricted hip lateral rotation ROM.

Multiple sclerosis and the incidence of venous thromboembolism: a systematic review and meta-analysis.

A number of studies have suggested that multiple sclerosis (MS) can be associated with serious vascular complications, for which pulmonary thromboembolism (PTE) is a potentially lethal complication. The purpose of this study is to establish a current literature-based estimate of the incidence of venous thromboembolism (VTE), deep vein thrombosis (DVT), and PTE in patients with MS (pwMS) due to the lack of systematic reviews and meta-analyses on this topic. In this systematic review and meta-analysis, studies were assessed regarding the association between MS and the incidence of VTE. The studies were identified through a systematic search of major electronic databases spanning the period from 1950 to February 2022. A random-effects analysis was conducted to calculate the pooled effect size (ES) and 95% confidence intervals (CI) using STATA software. Nine out of 4605 studies were included in the meta-analysis, with an overall sample size of 158,546 individuals. Meta-analysis revealed that the pooled incidence of VTE was 1.8% (95% CI 1.4-2.3) among pwMS. Also, there was an incidence of 0.9% (95% CI 0.4-1.4) and 1.5% (95% CI 1-2.2) for PTE and DVT, respectively in pwMS. Analysis showed MS would be significantly associated with a twofold increased risk of VTE [risk ratios (RR) = 2.12 (95% CI 1.53-2.93)]. Although MS is not typically considered a major risk factor for VTE, the meta-analysis of cohort studies shows that MS has a relative association with an increased incidence of VTE. Future research should focus on the investigation of the effects of MS and its treatments on VTE risk, and also a full range of confounding adjustments will be needed.

Worldwide prevalence of neuromyelitis optica spectrum disorder (NMOSD) and neuromyelitis optica (NMO): a systematic review and meta-analysis.

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is a progressive demyelinating disease of the central nervous system that has overlapping symptoms with multiple sclerosis (MS) but differs from it in a variety of ways. Previous studies have reported conflicting results trying to estimate the number of individuals affected by them which is why we designed this systematic review and meta-analysis to estimate the worldwide prevalence and incidence of NMOSD/NMO based on current evidence. METHODS: We searched PubMed, Scopus, EMBASE, Web of Science, and gray literature including references from the identified studies, review studies, and conference abstracts which were published up to February 1, 2022. We used all MeSH terms pertaining to "NMOSD," "NMO," and all the terms on "prevalence," "incidence," and "epidemiology" to identify the search components. Pooled effect sizes were measured using random-effect model by DerSimonian-Laird. RESULTS: The prevalence and incidence rates of NMOSD/NMO ranged from 0.07 to 10 and 0.029 to 0.880 per 100,000 population, respectively. The overall pooled prevalence of NMO per 100,000 population was 1.54 (I2: 98.4%, 95% CI: 1.13-1.96, P< 0.001) based on the 2006 criteria, 1.51 (I2: 99.4%, 95% CI: 1.21-1.81, P < 0.001) based on the 2015 criteria and 2.16 (I2: 89.4%, 95% CI: 1.46-2.86, P < 0.001) based on the 2006/2015 criteria. The overall annual incidence of NMO per 100,000 population was 0.155 (I2: 95%, 95% CI: 0.115-0.195, P < 0.001) based on the 2006 criteria and 0.278 (I2: 100%, 95% CI: 0.135-0.420, P < 0.001) based on the 2015 criteria. The prevalence rates were highest in French West Indies and South Korea, and lowest in Cuba and Australia, based on the 2006 and 2015 criteria, respectively. Also, the highest annual incidence rates were obtained for Sweden and Slovak republic and the lowest for Cuba and Australia based on the 2006 and 2015 criteria, respectively. All estimated rates were higher among females compared to males. CONCLUSION: Although rare, NMOSD/NMO impact affected individuals in devastating ways. Several large-scale prospective studies are required to reach a comprehension of the epidemiological aspects of these notorious demyelinating conditions.

Effectiveness of BBIBP-CorV vaccine in preventing SARS-CoV2 infection and severe outcomes in people living with multiple sclerosis: A population-based study.

BACKGROUND: The objective of the present study was to estimate the effectiveness of the BBIBP-CorV vaccine (VE) in preventing SARS-CoV-2 infection, related hospitalization, and death among people living with multiple sclerosis (PLWMS). METHODS: In this population-based retrospective observational study, data on all PLWMS, vaccination, SARS-CoV-2 tests, hospitalization, and deaths were collected in Isfahan, Iran between February 9, 2021, and November 4, 2021. We estimated the hazard ratio between vaccinated (partially and fully) and unvaccinated groups using the Andersen-Gill extension of the Cox proportional hazards model. We also performed Cox proportional hazards analysis to identify risk factors for breakthrough infection and COVID-19-related hospitalization in fully-immunized group. RESULTS: Of the 9869 PLWMS, 1368 were in partially-vaccinated group, 4107 were in the fully-vaccinated group, and 3794 were in the unvaccinated group. In the partially-vaccinated group, the estimated VE against COVID-19 infection was 39.3% (16%, 56.1%), hospitalization was 64.9% (1.3%, 87.5%), and mortality was 92.7% (88.8%, 100%). The respective results for the fully-vaccinated group were 63.9% (56%, 70.3%), 75.7% (57.5%, 86.1%), and 100%. Progressive MS was independently associated with a greater risk of breakthrough infection (HR=1.952, 95%CI: 1.174-3.246, p = 0.010). Older adults (≥50 years vs. 18-49 years, HR=3.115, 95%CI: 1.145-8.470, p = 0.026) and those on rituximab (HR=7.584; 95% CI: 1.864-30.854; p = 0.005) were at an increased risk of COVID-19-related hospitalization. CONCLUSION: This study showed that two doses of the BBIBP-CorV vaccine can effectively prevent COVID-19 infection and hospitalization among PLWMS. Old PLWMS and those who treating with rituximab are at increased risk of hospitalization after receiving two doses of the vaccine.

Assessment of intelligence quotient in patients with neuromyelitis optica spectrum disease and multiple sclerosis.

BACKGROUND: Cognitive impairment is common in people living with neuromyelitis optica spectrum disease (NMOSD) and multiple sclerosis (MS). However, there is little published data on intelligence quotient (IQ) in NMOSD patients. Therefore, we performed the present study to compare IQ scores across NMOSD, MS, and control groups. METHOD: In this cross-sectional study, 49 NMOSD (30 with positive aquaporin4 antibody), 41 MS, and 20 control individuals were recruited. The IQ score for each person was measured using Wechsler Adult Intelligence Scale-Revised (WAIS-R). Participants were reported on eleven scores of subsets, verbal IQ (VIQ), performance IQ (PIQ), and full score IQ (FSIQ). RESULT: The scores of FSIQ, VIQ, PIQ, vocabulary, similarities, and digit-symbol in NMOSD and MS individuals were lower than the control group. Relative to control, NMOSD patients reported a lower score of information. We found no difference between NMOSD and MS groups, except in vocabulary and similarities. No significant difference between seropositive and seronegative NMOSD groups was observed except for the information and block design. In NMOSD group, a greater EDSS score was associated with decreased scores of FSIQ, VIQ, and PIQ. Being employed and being married were associated with greater scores of VIQ and PIQ, respectively. In both NMOSD and MS groups, advanced education was associated with increased scores of FSIQ and VIQ. CONCLUSION: Our study showed decreased IQ scores in NMOSD and MS. Further studies are required to examine intellectual quotient in people with NMOSD and MS.

Prevalence of dysphagia in patients with multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND: Dysphagia is a major disorder observed in patients with multiple sclerosis (MS), yet different prevalence rates are reported for it. Therefore, we designed this study to estimate the pooled prevalence of dysphagia in patients with MS. METHOD: We searched PubMed, Scopus, EMBASE, Web of Science, and gray literature including references from the identified studies, reviews studies, and conference abstracts which were published up to May 2022. Articles that were relevant to our topic and could provide information regarding the prevalence of dysphagia among MS patients were included; however, articles with self-report screening strategies were excluded. RESULTS: The literature search found 997 articles. After eliminating duplicates, 672 articles remained. Two conference abstracts were included for final analysis. A total of 11,266 MS cases and 5047 MS patients with dysphagia were included in the meta-analysis. The overall prevalence of dysphagia across all 54 studies was 44.8 % (95 % CI: [40.4 %-49.2 %]), with a high level of heterogeneity between countries (Q=; I2 = 94.96 %; p < 0.001). CONCLUSION: The results of this systematic review shows that the prevalence of dysphagia in MS patients is 45% which is greatly higher compared to the general population.

Association of Disease-Modifying Therapies with COVID-19 Susceptibility and Severity in Patients with Multiple Sclerosis: A Systematic Review and Network Meta-Analysis.

Background: We conducted this study to assess the effect of disease-modifying therapies (DMTs) on coronavirus disease (COVID-19) susceptibility and severity in people with multiple sclerosis (MS). Methods: Available studies from PubMed, Scopus, EMBASE, Web of Science, and gray literature, including reference lists and conference abstracts, were searched from December 1, 2019, to July 26, 2021. We included cross-sectional, case-control, and cohort studies assessing the association of DMTs with risk of contracting COVID-19 or its outcomes in MS patients on univariate or multivariate regression analyses. We conducted a network meta-analysis (NMA) to compare the risk of COVID-19 and developing severe infection across DMTs. Results: Out of the initial 3893 records and 1883 conference abstracts, a total of 10 studies were included. Pairwise comparisons showed that none of the DMTs meaningfully affect the risk of acquiring infection. There was significant total heterogeneity and inconsistency across this NMA. In comparison with no DMT, dimethyl fumarate (0.62 (0.42, 0.93)), fingolimod (0.55 (0.32, 0.94)), natalizumab (0.50 (0.31, 0.81)), and interferon (0.42 (0.22, 0.79)) were associated with a decreased risk of severe COVID-19; but, rituximab was observed to increase the risk (1.94 (1.20, 3.12)). Compared to rituximab or ocrelizumab, all DMTs were associated with a decreased risk. Pairwise comparisons showed no differences across other DMTs. Interferon and rituximab were associated with the lowest and highest risks of severe COVID-19. Conclusion: Our study showed an increased risk of severe COVID-19 in patients on rituximab and ocrelizumab. No association with COVID-19 severity across other DMTs was observed.

Comparative Impact of Various Exercises on Circulating Irisin in Healthy Subjects: A Systematic Review and Network Meta-Analysis.

Irisin is a myokine that is secreted from skeletal muscle during exercise and increases lipid metabolism, converting white adipose tissue to brown adipose tissue. Recent studies have shown conflicting results in relation to chronic and acute exercise and irisin. The aim of this study was to evaluate the effects of chronic and acute exercise training on circulating (plasma/serum) irisin level in healthy subjects. We conducted a search of Cochrane Library, PubMed, ISI, Scopus, Embase, and Pedro up to September 2021. A random effects network meta-analysis was performed to calculate the pooled estimate of standardized mean difference (SMD) for acute and chronic exercise effects on irisin level, using Hedge's g statistic. Of the 16 studies included, six were acute exercise studies (175 participants). The aerobic (Hedge's g = 0.23; 95% CI: -0.58, 1.03) and the anaerobic exercises (Hedge's g = 0.12; 95% CI: -0.45, 0.70) were associated with the increased level of irisin, compared to the control. In the ten chronic exercise studies (433 participants), the resistance training was superior to anaerobic and aerobic training (P score = 0.632). However, comparing acute and chronic exercise studies, acute training showed the most excellent potential as the best treatment to improve the irisin level (P score = 0.721). This network meta-analysis showed that acute aerobic exercise has a more effect on irisin levels than acute anaerobic exercise. Also, chronic resistance training has the greatest additive effect on irisin levels compared to chronic aerobic and anaerobic training.

Hearing loss among patients with multiple sclerosis (PwMS): A systematic review and meta-analysis.

BACKGROUND: Multiple sclerosis (MS) is a kind of autoimmune disorder that has swept more than 2 million people worldwide and has caused multiple disabilities in the patients. Hearing loss(HL) is also one of the disabilities that numerous patients with multiple sclerosis (PwMS) experience. METHODS: We searched four databases: PubMed (Medline), Scopus, Web of Science, and Embase, from 1970 to July 2021. The gray literature containing the conference abstracts, review studies, and references of the articles was also investigated. We included any studies that reported PwMS with HL. RESULTS: Out of 1875 articles, 1042 articles remained following eliminating duplicates. Afterward, all articles were screened, and 953 were eliminated based on exclusion criteria. Full texts of 89 articles were collected. Finally, eight articles were selected based on inclusion and exclusion criteria. The pooled prevalence of HL in PwMS was 1.1% (95% CI: [0.2%, 2.4%]; I2=80.11%; p<0.001) among 5187 MS population. CONCLUSION: Our analysis suggests that MS might increase the risk of HL , and it might be an indicator for MS diagnosis. More research with larger sample sizes is required.

Olfactory dysfunction in patients with multiple sclerosis; A systematic review and meta-analysis.

BACKGROUND: The importance and prevalence of olfactory dysfunction is recently gaining attention in patients with multiple sclerosis (MS) as a result of their chronic inflammatory disease, yet different prevalence rates are reported for it. Therefore, we have designed this systematic review to estimate the pooled prevalence of olfactory dysfunction in patients with MS. To our knowledge, this is the first systematic review and meta-analysis on the prevalence of olfactory dysfunction in MS patients. METHODS: We searched PubMed, Scopus, EMBASE, Web of Science, ProQuest, and gray literature including references from the identified studies, review studies, and conference abstracts which were published up to January 2021. Articles that were relevant to our topic and could provide information regarding the prevalence of olfactory dysfunction, or the scores of smell threshold, discrimination, or identification (TDI) among MS patients and healthy individuals were included. The pooled prevalence was calculated using a random-effects model and a funnel plot and Egger's regression test were used to see publication bias. RESULTS: The literature search found 1630 articles. After eliminating duplicates, 897 articles remained. Two conference abstracts were included for final analysis. A total of 1099 MS cases and 299 MS patients with olfactory dysfunction were included in the analysis. The pooled prevalence of olfactory dysfunction in the included studies was 27.2%. Also, the overall TDI score in MS patients was lower than that in the control group, and the level of Threshold, Discrimination, and Identification per se were lower in MS compared with control respectively. CONCLUSION: The results of this systematic review show that the prevalence of olfactory dysfunction in MS patients is high and more attention needs to be drawn to this aspect of MS.

COVID-19 susceptibility and outcomes among patients with neuromyelitis optica spectrum disorder (NMOSD): A systematic review and meta-analysis.

BACKGROUND: We conducted this systematic review and meta-analysis to assess the risk of coronavirus disease (COVID-19), clinical features and outcome among patients with neuromyelitis optica spectrum disorder (NMOSD). METHODS: We systematically searched PubMed, Scopus, Web of Science, and Embase from December 1, 2019, to July 2, 2021. The gray literature including the references of original studies, review studies, conference abstracts, and WHO COVID-19 database was also searched. We included any type of studies that reported NMOSD patients with COVID-19, prevalence of COVID-19 among NMOSD patients or the infection outcome (hospitalization, intensive care unit [ICU] admission, or mortality). RESULTS: Out of 540 records, a total of 23 studies (19 published articles and 4 conference abstracts) including 112 NMOSD patients with COVID-19 met the inclusion criteria. Nine studies reporting risk of COVID-19 and nine studies on outcome were included in a quantitative synthesis. The pooled prevalence of COVID-19 was 1.2% (95% CI: 0.001%-0.030%; I2 = 92%, p< 0.001), with hospitalization of 33.7% (95% CI: 23.3-44.8%; I2 = 9.1%, p = 0.360) with 52.9% on rituximab treatment. ICU admission was 15.4% (95% CI: 7.6%-24.7%; I2 = 20.7%, p = 0.272) and mortality was 3.3% (95% CI: 0-9.7%; I2 = 21.3%, p = 0.253). Thirty-eight patients (48.7%) reported at least one comorbidity. The mean age of the included patients was 40.8 (10.63) years, female/male ratio was 3.35:1. The most common COVID-19 symptom was fever (54.5%), followed by fatigue/asthenia (42.9%), headache (41.6%), and cough (40.3%). Four patients developed neurological worsening. The Begg's and Egger's tests showed no evidence of publication bias. CONCLUSION: The analysis suggests that comorbidity and treatment with rituximab may be risk factors for COVID-19 infection in NMOSD patients.

Incidence, prevalence, and characteristics of heart failure among patients with multiple sclerosis: A systematic review and meta-analysis.

INTRODUCTION: Multiple sclerosis (MS) is the most common neurological autoimmune disease. Although it primarily harms the central nervous system, other organs are liable to be affected by it as well. There is a growing body of evidence suggesting that heart failure should be considered as a potential suspect for cardiac dysfunction and insufficiency among MS patients. As such, we designed this systematic review and meta-analysis to elaborate more on the incidence, prevalence, and characteristics of HF among MS patients. METHODS: We conducted a systematic computerized search using four data banks: PubMed (MEDLINE), Scopus, web of science, and Embase (via Elsevier). The literature search found 930 articles. After eliminating duplicates, 695 articles remained, from which 42 articles were assessed for inclusion eligibility, and eventually 8 full-text articles were included in the final data extraction table. RESULTS: The overall prevalence of heart failure was 1% (95% CI: 0.6%-1.5%), which ranged from 0.6% observed in UK to 1.8% for Taiwan study. The overall incidence of heart failure was also 0.7% (95% CI: 0.4%-1.2%), ranging from 0.2% observed in UK to 1.4% in USA. The pooled odds ratio for the association between heart failure and multiple sclerosis calculated based on 4 studies, using random effect model was 1.29 (95% CI: 0.74-2.26; I2=82.5%), but not significant. CONCLUSION: In conclusion, this study demonstrates that patients with MS are at an elevated risk of developing heart failure compared to the general population, which highlights the importance of regular and thorough checkups in PwMS in an effort to better detect any cardiovascular abnormality, dysfunction, or disease as soon as possible to help improve the prognosis.

Prevalence of trigeminal neuralgia in multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND: The prevalence of Trigeminal Neuralgia (TN) in patients diagnosed with multiple sclerosis (MS) is insufficiently understood and controversially reported. This study focused on providing a better understanding of the prevalence of TN in MS patients. METHOD: We systematically searched PubMed, Scopus, EMBASE, Web of Science, and Google Scholar to identify studies published from January 1, 1990, to December 30, 2020. We included studies reporting the TN prevalence among MS patients and exclude case reports/series and editorial studies, review studies, and non-English written articles. We used pooled prevalence estimates to determine the TN prevalence among MS patients. RESULTS: Pooled overall TN prevalence among 19 studies and 30,348 MS patients was estimated as 3.4% (95% CI: 1.5%-5.9%) with a high level of heterogeneity among studies (I2=98.92%; p<0.001). The pooled prevalence of TN in male and female patients across 9 surveys was 2.4% (95% CI: 0.5%-5.4%) and 3.8% (95% CI: 0.8%-8.7%), respectively. No heterogeneity between the two groups was observed (p = 0.558). A meta-regression was performed to explore the source of the heterogeneity. None of the candidate covariates, including the year of a study publication, the sample size, the average age of patients, and the disease duration, were significant in the model. CONCLUSION: Our results showed that TN is a common problem among patients with MS, predominantly male patients. Future studies should target the general prevalence of pain in MS patients.

Prevalence and Risk Factors of Dysphagia in Patients with Multiple Sclerosis.

Dysphagia is one of the most common symptoms in multiple sclerosis (MS) patients. It can reduce the quality of life and increase the risk of mortality by developing complications such as aspiration pneumonia. The present study was conducted to estimate the prevalence of dysphagia in MS patients and investigate the associations between dysphagia and disease characteristics. The Persian version of the DYMUS questionnaire was used to assess dysphagia in 865 patients with MS, including 738 (85.3%) relapsing-remitting MS (RRMS), 106 (12.3%) secondary progressive MS (SPMS), and 21 (2.4%) primary progressive MS (PPMS). Also, demographic and clinical data, including age, sex, smoking status, Expanded Disability Status Scale (EDSS) score, disease duration, disease-modifying therapies exposure, initial symptoms of MS, were recorded. The mean (SD) age was 37.95(9.25) years, and 83.1% of the participants were female. The prevalence of dysphagia was estimated to be 25.4% among all patients. According to the DYMUS questionnaire results, the prevalence of dysphagia in RRMS, SPMS, and PPMS patients was 22.2%, 44.3%, and 42.9%, respectively. After multivariate analysis the current EDSS score (OR = 1.197, CI: 1.062, 1.350, p = 0.003), cerebellar impairment (OR = 1.335, CI: 1.450, 4.716, p = 0.004) and motor dysfunction (OR = 1.651, CI: 1.004, 2.715, p = 0.048) emerged as the risk factors for dysphagia. Since dysphagia, as previously mentioned, is a common symptom in multiple sclerosis, particularly in SPMS and PPMS courses, active screening for this condition is recommended in all patients, particularly those with identified risk factors.

The prevalence of Myocardial Infarction among Multiple Sclerosis Patients: a Systematic Review and Meta-analysis.

BACKGROUND: People with multiple sclerosis (PwMS) are suggested to have a higher death rate compared to the overall population. Increased risk and incidence of cardiovascular diseases is a possible contributing factor here, as these patients are suggested to be more prone to early death due to myocardial infarction (MI). AIM: This systematic review aims to describe the prevalence of MI among PwMS in comparison to the non-MS population. METHOD: We thoroughly searched for publications reporting the prevalence of MI among PwMS in PubMed, Scopus, Embase, and Web of Science. We excluded studies focusing on the following conditions: ischemic heart disease only, autopsy of PwMS, MS patients with a previous history of cardiovascular diseases, and MS diagnosed after MI. Moreover, we excluded reviews, editorials, and commentaries. We used the random effect model to calculate the pooled prevalence. RESULTS: We included nineteen studies, comprising 44 to 66616 participants. The overall prevalence of MI was 1.7% among PwMS. The pooled odds ratio estimate for MI was 1.41 in PwMS compared to the MS-free population. CONCLUSIONS: Results of this systematic review confirms the increased risk of MI among PwMS. Consequently, cardiovascular diseases should be considered in the management of these patients.

Evaluation of Month of Birth in Neuromyelitis Optica Spectrum Disorders (NMSOD) and Multiple Sclerosis (MS).

INTRODUCTION: Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMO) are chronic immune-mediated diseases in the central nervous system (CNS). Environmental factors such as month of birth can be a trigger for these diseases. Therefore, we conducted this study to compare the months of birth in MS and NMOSD patients with the control group. METHODS: In this cross-sectional study, 2345 patients with MS, 220 NMOSD patients, and 2174 healthy subjects were enrolled. Demographic information such as age, sex, month of birth, and education in three groups was extracted from the database. The associations between month of birth and MS were studied by binary logistic regression with adjusting for the year of birth. RESULTS: There was a reduced birth rate in September-October in NMOSD (OR = 0.309, 95% CI: 0.150-0.636; p < 0.001) and MS patients (OR = 0.470, 95% CI: 0.374-0.591; p < 0.001) compared to the general population. The birth rate in March-April in MS was higher than the control group (OR = 1.613, 95% CI: 1.324-1.964; p < 0.001). There was no difference in the birth month distribution between the NMOSD and MS patients. No significant difference in MOB among different MS types was found. CONCLUSION: Our findings showed a decreasing risk of NMOSD and MS in individuals born in the autumn months and an increasing MS risk in spring. More studies are required to elucidate the association between the month of birth and risk of MS and NMOSD and the seasonality factors.