MRI features and disability in multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND: In this systematic review and meta-analysis, we aimed to investigate the correlation between disability in patients with Multiple sclerosis (MS) measured by the Expanded Disability Status Scale (EDSS) and brain Magnetic Resonance Imaging (MRI) features to provide reliable results on which characteristics in the MRI can predict disability and prognosis of the disease. METHODS: A systematic literature search was performed using three databases including PubMed, Scopus, and Web of Science. The selected peer-reviewed studies must report a correlation between EDSS scores and MRI features. The correlation coefficients of included studies were converted to the Fisher's z scale, and the results were pooled. RESULTS: Overall, 105 studies A total of 16,613 patients with MS entered our study. We found no significant correlation between total brain volume and EDSS assessment (95 % CI: -0.37 to 0.08; z-score: -0.15). We examined the potential correlation between the volume of T1 and T2 lesions and the level of disability. A positive significant correlation was found (95 % CI: 0.19 to 0.43; z-score: 0.31), (95 % CI: 0.17 to 0.33; z-score: 0.25). We observed a significant correlation between white matter volume and EDSS score in patients with MS (95 % CI: -0.37 to -0.03; z-score: -0.21). Moreover, there was a significant negative correlation between gray matter volume and disability (95 % CI: -0.025 to -0.07; z-score: -0.16). CONCLUSION: In conclusion, this systematic review and meta-analysis revealed that disability in patients with MS is linked to extensive changes in different brain regions, encompassing gray and white matter, as well as T1 and T2 weighted MRI lesions.

Efficacy and safety of rituximab in multiple sclerosis: a systematic review and meta-analysis.

OBJECTIVE: We aimed to synthesize all available observational studies and clinical trials of rituximab to estimate the safety and efficacy of this monoclonal antibody in people with multiple sclerosis (MS). METHODS: The four databases including PubMed, Scopus, Embase, and Web of Science were comprehensively searched in April 2022. We defined PICO as follows. Problem or study population (P): patients with MS; intervention (I): Rituximab; comparison (C): none; outcome (O): efficacy and safety. RESULTS: After two-step screening, a total of 27 studies entered into our qualitative and quantitative synthesis. Our analysis showed a significant decrease in EDSS score in all patients with MS after treatment (SMD: - 0.44, 95% CI - 0.85, - 0.03). In addition, the ARR was reduced after using rituximab compared to the pre-treatment period (SMD: - 0.65, 95% CI - 1.55, 0.24) but it was not significant. The most common side effect after rituximab with a pooled prevalence of 28.63% (95% CI 16.61%, 42.33%). Furthermore, the pooled prevalence of infection was 24% in patients with MS (95% CI 13%, 36%). In the end, the pooled prevalence of malignancies after rituximab treatment was 0.39% (95% CI 0.02%, 1.03%). CONCLUSION: Our findings illustrated an acceptable safety for this treatment. However, further studies with randomized design, long follow-up, and large sample sizes are needed to confirm the safety and efficacy of rituximab in patients with MS.

Ethnobotanical and ethnomedicinal studies in Baluchi tribes: A case study in Mt. Taftan, southeastern Iran.

ETHNOBOTANICAL RELEVANCE: From ancient times, the applied use of herbs has been common among indigenous people throughout the world. The present survey is a regional ethnobotanical study of Baluchi tribes living in the Mt. Taftan area, Sistan and Baluchistan Province, southeastern Iran. The aim of this study was to document all traditional knowledge and analyze the medicinal plants used in area and also to identify significant plant species for future pharmacological study. MATERIALS AND METHODS: Local knowledge was obtained through semi structured and open interviews, in which 51 informants were interviewed. Data were analyzed with Informant Agreement Relative (IAR) and Frequency of Citation (FC) indices. RESULTS: A total number of 106 taxa of medicinal plants were collected from ten villages from the surrounding plains and highlands of Mt. Taftan, out of 446 plant taxa collected or reported as native in the area. Most plants belong to the Irano-Turanian phytogeographical region in which Asteraceae (15%), Lamiaceae (11%), Fabaceae (8%), Rosaceae (7%), Apiaceae (7%) and Brassicaceae (5%) are those predominantly used. The regression analysis shows that families Apiaceae, Lamiaceae, Solanaceae and Rosaceae are more highly used as medicinal than species rich families such as Asteraceae and Fabaceae, which are the richest families in the Iranian flora. The highest FC was recorded for Artemisia spp. (41) and Berberis integerrima (40). The highest IAR Index was obtained for stings (0.86), followed by disorders in the circulatory system (0.7), dental problems (0.70) and injuries (0.69). Comparing our data with major ethnobotanical references in Iran revealed that medicinal applications of 34 taxa have not been cited, including Hyoscyamus malekianus, a local endemic plant using for ailments of toothache and worms. The toxicity of the endemic Semenovia suffruticosa is also reported. CONCLUSION: As a result of this study we conclude that Taftan area harbours many plant species for which indigenous knowledge provides a background of medicinal importance. The high percentage of medicinal plants proportional to the native flora is 23.8%, compared to the world percentage of 17.1%, is an indication of the rich knowledge and relationship of isolated Baluchi tribes living in Mt. Taftan to the local flora growing in their surroundings. This rich knowledge should be highly regarded as a cultural and ethnobotanical heritage. Furthermore, ethnobotanical results show some weak interrelation between Baluchi tribes living in Iran and Pakistan, probably because of a different flora and/or unfavourable environmental conditions and perhaps local conflicts which might have reduced active cultural exchange.