mahan shafie

Isaacs’ syndrome is a form of generalized peripheral nerve hyperexcitability (PNH) causing increased and continuous muscle activity characterized by muscle twitching, stiffness, cramps, myokymia, and pseudomyotonia. Herein, we aimed to review the clinical and paraclinical aspects of Isaacs’ syndrome in a number of cases. We reported a series of 12 patients with Isaacs’ syndrome, including their clinical features, electrophysiological findings, laboratory parameters, malignancy work-up, and therapeutic management. In all cases, clinical and electrodiagnostic assessment was suggestive of Isaacs’ syndrome. Of the 12 studied cases, 5 patients were positive for both leucine-rich glioma inactivated 1 (LGI1) and contactin-associated protein-like 2 (CASPR2) antibodies, 5 patients were CASPR2 positive and LGI1 negative, and 1 had borderline positive titers for CASPR2 with negative LGI1 antibody. The search for underlying malignancies was inconclusive in all subjects. After symptomatic treatment, mostly with carbamazepine or gabapentin, immunotherapies with double filtration plasmapheresis or Intravenous immunoglobulin (IVIG) provided favorable outcomes. Ultimately, all subjects fully recovered after 3-6 months of follow-up and all signs and symptoms resolved. Despite the rarity of the disease, our results provide valuable information for understanding the epidemiological, clinical, and paraclinical features of Isaacs’ syndrome.

Psychoses of epilepsy usually have an acute onset, accompanied by brief symptom duration and a risk of recurrence. Managing these conditions can be challenging due to the potential for seizures associated with certain antipsychotic medications, as well as exacerbating psychosis resulting from some antiepileptic medications. Our objective in this study was to assess the occurrence of psychosis among patients with epilepsy, as well as identify the factors linked to the presence and severity of psychosis in this population.

In this study, we included a total of 514 subjects diagnosed with epilepsy referring to our neuropsychiatry clinic affiliated with Tehran University of Medical Sciences from April 2011 to December 2021, among whom 57 patients showed psychotic presentations. We compared baseline and clinical characteristics between patients with psychosis of epilepsy and non-psychosis patients who also had epilepsy.

Marital status was the sole demographic factor that displayed a statistically significant difference between the psychosis and non-psychosis groups (P = 0.019). There was no significant difference observed between the two groups regarding family history of epilepsy and age at the onset of the epilepsy. Patients with psychosis experienced significantly more frequent seizures and generalized type (P < 0.001). Participants were matched for demographics and other clinical factors between the refractory and controlled psychosis groups, except for the psychosis frequency (P = 0.007). The type of epilepsy was significantly associated with psychosis when adjusted for the covariates (P < 0.001).

Patients with psychosis of epilepsy experienced more episodes of epilepsy than non-psychotics. We identified generalized epilepsy as an independent risk factor for the development of psychosis. Additional cohorts are warranted to explore the factors associated with epilepsy-related psychosis across diverse populations.

The COVID-19 pandemic restrictions may have significant implications for patients with multiple sclerosis (MS). The objective of this study is to explore the impact of the pandemic on physical activity levels and health outcomes among MS patients, as well as to examine potential associations between these factors. In this cross-sectional study, 197 patients with confirmed MS diagnosis were included. Physical activity and health status were assessed using international physical activity questionnaire-long form (IPAQ-LF) and short form 36 health survey questionnaire (SF-36) during the period of restrictions. The relationship between clinical characteristics, physical activity levels and health status parameters were examined. A total of 45 participants (22.8%) scored low, 73 (37.1%) scored moderate, and 79 (49.1%) achieved a high level of physical activity during the COVID-19 pandemic. We observed no significant association between total physical activity and any domains of SF-36 health status, except for pain. However, correlations were found between IPAQ and SF-36 domains. Specifically, walking showed positive correlations with physical functioning, physical limitation, general health, and physical component summary score. Vigorous activity demonstrated a negative correlation with social functioning, while moderate activity displayed a positive correlation with energy levels. Despite the challenges of home isolation and quarantine, most of our participants managed to achieve a moderate to high level of physical activity, while their overall health status was found to be moderate. Additionally, significant correlations were identified between the domains of health status and different types of physical activity, particularly walking. Further studies are warranted to optimize the care and support provided to patients with MS.

 Since the coronavirus disease 2019 (COVID-19) pandemic, the use of angiotensin II receptor blockers (ARBs) in hypertensive patients with COVID-19 has been controversial. Following our previous study, after one year, we intended to extend our sample size and results to investigate the effects of ARBs with both in-hospital outcomes and 7-month follow-up results in patients with COVID-19.

 Patients with a diagnosis of COVID-19 who were admitted to Sina Hospital, Tehran, Iran, from February to October 2020 participated in this follow-up cohort study. The COVID-19 diagnosis was based on a positive polymerase chain reaction test or chest computed tomography scan according to guidelines. Patients were followed for disease severity, incurring in-hospital mortality, complications, and 7-month all-cause mortality.

 We evaluated 1413 patients with COVID-19 in this study. After excluding 124 patients, 1289 including 561(43.5%) hypertensive patients, entered the analysis. During the study, 875(67.9%) severe disease, 227(17.6%) in-hospital mortality, and 307(23.8%) 7-month all-cause mortality were observed. After adjusting for possible confounders, ARB was not associated with severity, in-hospital and 7-month all-cause mortality, and in-hospital complications except for acute kidney injury. Discontinuation of ARBs was significantly associated with higher in-hospital mortality and 7-month all-cause mortality (both P values<0.006). We observed a better 7-month outcome in those who continued their ARBs after discharge.

 The results of this study, along with the previous studies, provide reassurance that taking ARBs is not associated with the risk of mortality, complications, and poorer outcomes in hypertensive COVID-19 patients after adjustment for possible confounders.

COVID-19 pandemic obligated applying population-level behavioral modifications to effectively prevent the spread of the disease. This necessitated investigating those measures that determine population behavior. Herein we have studied risk perception and information exposure that are among those determinants in Iran. 402 cases from medical sciences students were enrolled during the last week of September 2020. Using an online questionnaire, risk perception and sources of information about COVID-19 were investigated. Although most students considered COVID-19 preventable, merely a few considered the disease curable. A higher risk was perceived concerning the families compared to themselves. Moreover, most of them believed the prognosis good even in high-risk patients. Social media was the most informative source used; however, health professionals were considered the most reliable. The risk perception was equal between those diagnosed with COVID-19 or had a family member diagnosed compared to those without such exposure in most questions. Also, no significant difference was observed in risk perception between those students with serious underlying medical conditions and those without one regarding most items. Lastly, major and grade were the most significant demographic contributors to the risk perception. Moderate risk was perceived overall among the cases in which major and grade were the only remarkable demographic contributors. Unexpectedly, underlying medical history was not significantly correlated with the perceived risk. Lastly, previous COVID-19 exposure merely altered the curability and preventability perception.