فهرست مطالب seyed massood nabavi

Stroke, is accounting for more than 34% of total healthcare spending globally. Ischemic stroke (IS) accounts for 62.4% of incident stroke cases. IS-related direct medical expenditures place a considerable burden on healthcare system. The burden is more prominent in developing countries where limitations in insurance coverage is a big concern. It would be less challenging in developed countries, where costs are covered by third parties. After introduction of advanced therapeutic medicinal products (ATMPs), a new line of treatments is proposed. Although the high prices of these treatments may cause financial concerns, they have encouraged scientists and provided acceptable results in a way that makes investment in this area reasonable for health experts. All ATMP-based therapies used in clinical trials for the treatment of IS are stem-cell-based or stem-cell-derivatives. The cost of stem-cell-based therapies are considerable like other alternative medical settings, e.g., thrombolysis and thrombectomy. However, the considerable recovery after prescription of ATMPs is expected to be cost-effective. Furthermore, various gene therapy approaches for the treatment of IS have been proposed. However, none has been qualified for clinical studies yet. If such a procedure is introduced in near future, it does not necessarily guarantee that these innovative treatments would be offered to the patients.   Application of ATMPs have many challenges particularly in developing countries. This is primarily related to exorbitant expenditures. Despite these challenges, the insurance systems in developed-countries supports stem-cell therapies as novel treatments. Significant improvements in the insurance systems of both developing and developed countries are necessary.

Multiple sclerosis is the most common progressive neurological disease in young people and affects women several times more than men. Sexual problems are one of the most common symptoms in affected women, which have a great impact on the couple’s relationship and are often ignored. Therefore, the present study aimed to determine the effect of health-promoting multimedia education on sexual function in women with multiple sclerosis.

The present study is a randomized controlled trial of before and after with the control group. 116 women with multiple sclerosis, referredto Hazrat Rasool Akram Hospital and a private referral center for multiple sclerosis patients (from 21 September 2020 to 19 January 2021) were selected by continues sampling method to participate in the study. They were assigned as two groups, intervention and control ones, using the Sealed envelope randomized online site which randomly divided to single up to quintuple blocks, which allocated equally in intervention and control groups. Data collection tools were demographic profile form and intimacy and sexual activity questionnaire for multiple sclerosis patients (MSISQ-19). Data analysis is done by using descriptive statistical methods (mean, standard deviation, frequency and percentage) and with independent t-test, chi-square, analysis of covariance and analysis of variance with repeated measures RM using SPSS software v. 16.

Before the intervention, there was no significant difference between the two groups in terms of sexual function scores and all its dimensions (P=0.690). Mean sexual function in the intervention group at 4 weeks (P=0.014) and 12 weeks after the intervention (P=0.021) was significantly lower than before, but there was no statistically significant difference between the scores at 4 weeks and 12 weeks after the intervention (P<0.050).

Health-promoting lifestyle (HPL) training has an effect on sexual performance of women with multiple sclerosis and this training can be a good way to improve their sexual problems.

Coronavirus disease 2019 (COVID-19) is more common in patients with multiple sclerosis because of receiving immunosuppressive or immunomodulating disease-modifying therapies (DMTs). On the other hand, some of these drugs may interact on COVID-19 vaccines. In this commentary, first we introduce some available COVID-19 vaccines and then discuss the effect of different DMTs on immune responses after vaccination. We have not found a connection between vaccination and MS relapses, so we suggest that the benefit from the vaccine outweighs any potential risks in these patients.

Sexual dysfunction has many factors in multiple sclerosis, but there is no reliable treatment for this challenge.

Determining effective sexual function or dysfunction interventions in individuals with multiple sclerosis.

To find the relevant published interventional studies that at least had an English abstract or in Persian, we searched International Statistical Institute, PubMed, Scopus, Cochrane, Medline, PsycINFO, EMBASE, CINAHL, and Google Scholar from January 1990 to June 2021. The results were analyzed using RevMan 5.3 software. The p < 0.05 was considered significant.

Out of 568 articles, 41 were included after deleting the duplicate and irrelevant articles. Studies were divided into 2 groups of sexual function (n = 27) and dysfunction (n = 14). Interventions in each category have 4 subgroups: psychoeducational, exercise and rehabilitation, and medical and multi-type interventions. For improving sexual function, more than half of psychoeducational interventions showed a significant improvement after interventions (p = 0.0003). In sexual dysfunction studies, most of the interventions (n = 13/14) had improved at least one subscale of sexual dysfunction. Medical interventions were effective on men’s sexual dysfunction, and psychoeducational interventions had been more effective in women’s sexual dysfunction.

Psychoeducational and medical interventions are the commonest effective interventions. The psychoeducational studies conducted specifically on women had a positive impact, and only 4 articles with medical interventions were specifically targeted at men, which had a positive effect.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder with very limited treatment options. Stem cells have been raised as a new treatment modality for these patients. We have designed a single-center, prospective, open-label, and single arm clinical trial to assess the safety, feasibility, and rather efficacy of administrating allogeneic adipose-derived mesenchymal stromal cells (Ad-MSCs) in ALS patients. We enrolled 17 patients with confirmed ALS diagnosis with ALS Functional Rating Scale-Revised (ALSFRS-R) ≥24 and predicted forced vital capacity (FVC) ≥40%. Allogeneic Ad-MSCs were transplanted intravenously for all patients. Follow-ups were done at 24 hours, 2, 4, 6, and 12 months after cell infusion by checking adverse events, laboratory tests, and clinically by ALSFRS-R and FVC. Patients were also followed five years later and ALSFRS-R score was recorded in the survived individuals. There was no report of severe adverse events related to cell infusion. Two patients experienced dyspnea and chest pain 36 and 65 days after cell infusion due to pulmonary emboli. The progressive decrease in ALSFRS-R and FVC levels was recorded and three patients died in the first year. During five years follow up, despite a notable decrease in functional scores, 5 patients survived. Intravenous (IV) infusion of allogeneic Ad-MSCs in ALS patients is safe and feasible. The survival rate of the patients is more than IV autologous MSCs (Registration number: IRCT20080728001031N26).

Multiple sclerosis (MS) affects own physical function and body image. The aim of this study was to determine the effect of expressive writing on body image in women with MS.

In this randomized trial, the Solomon four-group design was employed. The study was carried out in 116 women attending an MS clinic in Tehran, Iran 2019. The participants were randomly assigned to two subgroups of control (A1 and A2) and two subgroups of intervention (B2 and B1). Pretest and posttest were done in A2 and B2 while for A1 and B1only posttest was performed. Expressive writing including morning pages, meeting the inner child, and creative assignments were carried out for six weeks. The control group received routine care. Fisher Body Focus Questionnaire was completed at pretest in A2 and B2 and at posttest in all groups (immediately after the intervention, and at weeks four and eight). Data analysis was done in SPSS V26.

The mean scores for body image in B2 were 145.65±19.89 at pretest, 156.89±9.54 immediately after the intervention, 158.16±8.92 at week four, and 153.96±8.27 at week eight. In A2, the mean score at these times were 144.96±7.17, 145.55±5.10, 145.28±7.84, 145.00±9.15, respectively. Expressive writing significantly improved body image in B2 at immediately and four weeks after the intervention compared to pretest (P˂0.001). There were significant differences between the control group and intervention group at immediately after (P=0.002) and four weeks (P=0.03) after the intervention.

Expressive writing could be effective in improving body image in women with MS.

Aerobic exercise has been shown to decrease the functional disorders related to multiple sclerosis (MS). Nevertheless, the effect of aerobic exercise training on the cytokines and neuroprotective mediators associated with the disease activity has remained relatively unknown.

The present research was conducted to evaluate the responses of the vascular endothelial growth factor (VEGF) and tumor necrosis factor-alpha (TNF-α) to single-bout and six-week aerobic exercise training in the patients with MS.

Totally, 20 subjects ((n = 10) patients with MS and (n = 10) controls) who were matched in terms of gender, weight, body mass, and age were included in the study. Participants received aerobic exercise training at approximately 60% of VO2max in 30-min sessions 3 times a week for six weeks. Serum concentrations of the VEGF and TNF-α were analyzed pre- and post-exercise training (in the first session and after 18 sessions of the study).

Serum concentration of the TNF-α decreased significantly after a single bout and 6-week aerobic exercise training (P = 0.002 and P = 0.005) in the intervention group. Serum concentration of the VEGF increased significantly only after exercise in the first and 18th sessions in the intervention group (P = 0.017 and P = 0.022).

Our results revealed that exercise may influence the VEGF regulation in patients with MS. Although, further research is needed to determine the effect of exercise on the immune variables in patients with MS.

There is a high prevalence of multiple sclerosis (MS) among Iranian women ofreproductive age. However, very few studies have been conducted in Iran to assess the experiences with and concerns about pregnancy and motherhood of such patients. The present study was conducted to better understand the experiences and concerns of women with MS about pregnancy and motherhood. The present qualitative study was conducted from August 2016 to January 2017 among Iranian women with MS visiting the Iran MS Society in Tehran, Iran. The purposive sampling method was used to recruit the participants and the sampling was continued until data saturation. Based on the inclusion criteria, a total of 25 women with MS were recruited in the study. The data were collected by in-depth semi-structured face-to-face interviews and analyzed using the MAXQDA 10 software. The analysis of the interview data resulted in four main categories, namely “Pregnancy concerns”, “Fear of failing as a parent”, “Feeling of threatened fertility”, and “Lack of social support”.The results showed that Iranian women with MS avoided pregnancy due to the negative effects of the disease on their physical abilities and on life in general. They were also concerned about possibleinfertility, the effect of MS medications on their menstrual cycle, and the limitations of infertilitytreatments due to the presence of MS. These concerns led them to postpone pregnancy and lose time or opt for voluntary childlessness and consequently miss out on the experience of motherhood. MS poses a serious challenge to women who consider getting pregnant and wish to experience motherhood. Health care professionals should support such patients to overcome their concerns and indecisiveness by providing appropriate information and counseling.

Sexual problems are prevalent in women with multiple sclerosis (MS), and sexual self-efficacy as an effective variable plays an important role in sexual health and sexual quality of life of these women. The aim of this study was to determine the predictors of sexual self-efficacy in women with multiple sclerosis. This descriptive analytical study was conducted in Tehran, Iran, with participation of 200 women with MS, who referred to the Iranian MS society, had Expanded Disability Status Scale (EDSS) ≥ 7, and met the inclusion criteria in year 2019; they were selected using convenience sampling method. For data collection and assess the predictor factors of sexual self-efficacy in women with MS, related standard questionnaires were used. Data were analyzed using Pearson correlation coefficient, t-test, one-way ANOVA, and multiple linear regression model via SPSS software. The mean age of participants was 36.33 ± 5.22 years, and the mean score of sexual self-efficacy was 16.54 ± 7.27. After entering the significant variables derived from measuring the relationship between each variable individually with the score of sexual self-efficacy in multiple linear regression model for controlling confounders, sexual dysfunction (P = 0.001), anxiety (P = 0.024), stress (P = 0.006), and the number of sexual intercourse (P < 0.013) were significantly predictor factors of sexual self-efficacy in women with MS. The sexual dysfunction, anxiety, stress, and the number of sexual intercourse significantly predicted sexual self-efficacy in women with MS. Therefore, considering these factors in the treatment process of these patients can help to promote sexual self-efficacy and empower them in sexual life.

We compared the efficacy and safety of a biosimilar form of beta-interferon-1a (Actovex) versus the reference product in the treatment of relapsing remitting multiple sclerosis (RRMS). In a double blind, randomized phase 3 clinical trial, we evaluated 138 patients with RRMS that were allocated to receive the biosimilar medication and the reference treatment (30 μg intramuscular, weekly for one year). We investigated changes in EDSS, relapse rate and MRI changes within one year. In sixty-nine patients who were allocated to each arm and analyzed mean age and its standard deviation was 32.4 ± 8.8 and 31.5 ± 8 for the biosimilar medication and the reference arm respectively. One-year follow-up revealed a mean difference of 0.084 in EDSS (95% CI: 0.069-0.237) between the two groups in favor of the biosimilar medication. This value did not exceed the predefined non-inferiority margin of 0.1. There were no statistically significant differences in relapse rate and systemic and local adverse events of the two groups. The results show that the biosimilar interferon 1-a is non-inferior to the reference product in terms of efficacy while it demonstrates comparable safety. In conclusion the biosimilar interferon 1-a can be considered as an effective and safe alternative to the reference product due to lower cost and more availability.

Sexual dysfunction is one of the most common symptoms in women with multiple sclerosis (MS), which has a great impact on the individuals’ quality of life, and is usually neglected. The present study was conducted with the aim of studying the prevalence of sexual dysfunction in Iranian women with MS. All Iranian articles published between 2000 and June 2018 in Persian and English were collected by using standard keywords in national and international databases. After evaluating articles based on inclusion/ exclusion criteria and quality assessment, related articles were selected. Heterogeneity of the studies was evaluated using the I2 index and the publication bias was assessed using the Egger and Begg tests. Data analysis was performed in STATA software version 11, 1 by using random effect model. Eight studies with a sample size of 1,301 people entered in this meta-analysis. The overall prevalence of sexual dysfunction in women with MS was 62% (CI: 95%, 51% - 73%). In addition, the prevalence of sexual dysfunction by using female sexual function index (FSFI) was 57% (CI: 95%, 46% - 68%) and by using multiple sclerosis intimacy and sexuality questionnaire-19 (MSISQ-19), was 73% (CI: 95%, 55% - 91%). The results of the present study were indicative of a prevalence of 62% for sexual dysfunction in Iranian women with MS. Considering the high prevalence of sexual dysfunction and its impact on the quality of life of these women, it seems essential for treatment teams to pay attention, plan, and design effective interventions in this regard.

Randomized clinical trials are considered the ideal source for generation of robust evidence for clinical and public health decision making. Estimation of treatment effect in observational studies is always subject to varying degrees of bias due to lack of random allocation, blindness, precise definition of intervention, as well as the existence of potential unknown and unmeasured confounding variables. Unlike other conventional methods, instrumental variable analysis (IVA), as a method for controlling confounding bias in non-randomized studies, attempts to estimate the treatment effect with the least bias even without knowing and measuring the potential confounders in the causal pathway. In this paper, after understanding the main concepts of this approach, it has been attempted to provide a method for analyzing and reporting the IVA for clinical researchers through a simplified example. The data used in this paper is derived from the clinical data of the follow-up of multiple sclerosis (MS) patients treated with two class of interferon.

Multiple sclerosis (MS) is a chronic disease of the central nervous system and one of the most common causes of neurological disability among those aged 20-40 years, particularly in women. Major histocompatibility complex (MHC) Class II genes are known to be involved in the development of MS. One of the important groups of this complex is the HSP gene family, especially HSP70, which is induced under stress conditions. The aim of the present case-control study was to determine the association between the heat shock protein 70 (HSP70) and risk of MS in Iranian patients by genotyping the rs1061581 gene polymorphism. A total of 50 relapsing-remitting MS (RRMS) patients and 50 healthy control subjects were considered for this study. Genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR- RFLP) method. PCR-RFLP results of twenty-five randomly selected samples were confirmed by DNA sequencing. Genotypic and allelic distributions were compared between the case and control groups. We observed no significant difference in the distribution of rs1061581 genotype and allele frequencies between RRMS patients and controls. In addition, there was no association between the HSP70 gene polymorphism and the clinical variables in the case group. Our data indicate that HSP70, in particular rs1061581, is unlikely to be involved in the susceptibility to or the severity of RRMS in Iranian patients. Further large prospective studies are required to confirm these findings.

Amyotrophic lateral sclerosis (ALS) is the most severe disorder within the spectrum of motor neuron diseases (MND) that has no effective treatment and a progressively fatal outcome. We have conducted two clinical trials to assess the safety and feasibility of intravenous (IV) and intrathecal (IT) injections of bone marrow derived mesenchymal stromal cells (BM-MSCs) in patients with ALS.
This is an interventional/experimental study. We enrolled 14 patients that met the following inclusion criteria: definitive diagnosis of sporadic ALS, ALS Functional Rating Scale (ALS-FRS) ≥24, and ≥40% predicted forced vital capacity (FVC). All patients underwent bone marrow (BM) aspiration to obtain an adequate sample for cell isolation and culture. Patients in group 1 (n=6) received an IV and patients in group 2 (n=8) received an IT injection of the cell suspension. All patients in both groups were followed at 24 hours and 2, 4, 6, and 12 months after the injection with ALS-FRS, FVC, laboratory tests, check list of side effects and brain/spinal cord magnetic resonance imaging (MRI). In each group, one patient was lost to follow up one month after cell injection and one patient from IV group died due to severe respiratory insufficiency and infection.
During the follow up there were no reports of adverse events in terms of clinical and laboratory assessments. In MRI, there was not any new abnormal finding. The ALS-FRS score and FVC percentage significantly reduced in all patients from both groups.
This study has shown that IV and IT transplantation of BM-derived stromal cells is safe and feasible (Registration numbers: NCT01759797 and NCT01771640).

Multiple sclerosis (MS) is the most common autoimmune disease that often affects women within the reproductive age. Among the common clinical complaints in these women is variety of menstrual disorders. Thus, we aimed to examine menstrual disordersand related factors in women with MS.
A descriptive cross-sectional study was performed among 172 women with MS who visited the Neurology Specialized Clinic in Tehran, Iran, during 2016-2017. The participants filled out a questionnaire consisting of demographic (e.g., age, educational level, economic status, disease duration, vitamin D consumption duration, and Expanded Disability Status Scale [EDSS]) and disease characteristics (age at menstruation, duration of each period, interval between two periods, the amount of bleeding, presence or lack of presence of pain, and menstruation pain score). Data were analyzed by using SPSS version 22 and multiple logistic regression model, Chi-square test, and Spearman correlation coefficient. P-value less than 0.05 was considered significant.
Overall, 88 patients (51.2%) experienced irregular menstruation patterns, and 116 patients (67.5%) had some forms of menstruation disorders. Multiple logistic regression reflected statistically significant correlations between disability score (β=0.702, P=0.001), moderate (β=2.561, P The results of the present study showed that menstrual disorders have high prevalence in women with MS. Our results also indicated that factors such as duration of vitamin D intake, menstrual bleeding, menarche, menstrual pattern, dysmenorrhea, and EDSS affect menstrual disorders.

Multiple sclerosis (MS) is the most common autoimmune disease of the central nervous system (CNS). The main cause of the MS is yet to be revealed, but the most probable theory is based on the molecular mimicry that concludes some infections in the activation of T cells against brain auto-antigens that initiate the disease cascade.
The Purpose of this research is the prediction of the auto-antigen potency of the myelin proteolipid protein (PLP) in multiple sclerosis.
As there wasn’t any tertiary structure of PLP available in the Protein Data Bank (PDB) and in order to characterize the structural properties of the protein, we modeled this protein using prediction servers. Meta prediction method, as a new perspective in silico, was performed to fi nd PLPs epitopes. For this purpose, several T cell epitope prediction web servers were used to predict PLPs epitopes against Human Leukocyte Antigens (HLA). The overlap regions, as were predicted by most web servers were selected as immunogenic epitopes and were subjected to the BLASTP against microorganisms.
Three common regions, AA58-74, AA161-177, and AA238-254 were detected as immunodominant regions through meta-prediction. Investigating peptides with more than 50% similarity to that of candidate epitope AA58-74 in bacteria showed a similar peptide in bacteria (mainly consistent with that of clostridium and mycobacterium) and spike protein of Alphacoronavirus 1, Canine coronavirus, and Feline coronavirus. These results suggest that cross reaction of the immune system to PLP may have originated from a bacteria or viral infection, and therefore molecular mimicry might have an important role in the progression of MS.
Through reliable and accurate prediction of the consensus epitopes, it is not necessary to synthesize all PLP fragments and examine their immunogenicity experimentally (in vitro). In this study, the best encephalitogenic antigens were predicted based on bioinformatics tools that may provide reliable results for researches in a shorter time and at a lower cost.

Many risk factors have been investigated in multiple sclerosis (MS); however, few studies have focused on the association between risk factors and the disease severity. The aim of our study was to evaluate the association between some of these risk factors and MS severity in a population sample of Iranian patients.
This cross-sectional study was conducted on 660 patients with MS. In addition to demographic variables, many potential risk factors were recorded. To compare the severity, progression index (PI) was calculated. This index is created by current Expanded Disability Status Scale (EDSS) /disease duration.
Univariate analysis revealed that active smoking status is related with MS severity. (P-value = 0.012). Furthermore, our findings demonstrated that age at the disease onset [P Due to high cost of MS care and its moderate to severe disability, identification of factors influencing the MS severity is important. Our results demonstrated that the major modifiable factors related with MS severity in Iranian population, some protective and some promotive, were smoking, education, marital status and occupation. Prospective studies on larger scale are needed for further proof of these results.

Multiple sclerosis (MS) is an autoimmune disease in which auto-reactive T cells react with self-antigens expressed in the central nervous system (CNS). The main cause of MS is unknown. Nonetheless, the most probable theory is based on molecular mimicry, which suggests that some infections can activate T cells against brain auto-antigens like myelin proteolipid protein (PLP) and initiate the disease cascade. This study is conducted to evaluate the activatory effects of PLP58-74 on T lymphocytes and humoral immunity. PLP58-74 was considered as an immunodominant epitope candidate of PLP using bioinformatics tools. Patients and healthy individuals’ peripheral blood mononuclear cells (PBMCs) were treated with PLP58-74 and its proliferative effects were evaluated through assessing proliferating cell nuclear antigen (PCNA) gene expression changes by real time PCR and immunocytochemistry assay. Finally, the rate of CD4 and CD8 T cells were assessed by flowcytometry. ELISA was also performed to measure anti PLP58-74 antibody in patients’ serum. PLP58-74 induced proliferation in patients’ PBMCs while it did not influence PBMCs of healthy individuals. CD4 T cells were the main activated cells in reaction to PLP58-74 which increased from 22% to 39.91%. In addition, immune assay showed threefold increase in specific anti PLP58-74 IgG in patients compared to healthy controls. Results showed that PLP58-74 can stimulate CD4 T cells and humoral immunity. Therefore it seems that the epitopes of some microorganisms mimicking PLP such as PLP58-74 might have a potential role in the initiation of MS.

Multiple sclerosis (MS) is a neurological disease with a variety of signs and symptoms. Exercise therapy has been shown to improve physical functions in MS. However, questions about an optimal exercise therapy remain. In this regard, we suggest a combined exercise therapy including aerobic and resistance exercises for MS patients. The study is designed to observe, test and compare the effects of proposed combined exercises on strength, balance, agility, fatigue, speed, and walking distance in people with mild to moderate MS [0 A total of 40 people with relapse-remitting MS (16 male, 0 For most tests, post-intervention values of the group 1, with 3-aerobic and 1-resistance exercises, were significantly higher compared to control group (P A combination of three aerobic exercises with one resistance exercise may result in improved balance, locomotion, and endurance in MS patients.

This study was designed to evaluate the psychometric features of the Persian version of the Fatigue Impact Scale (FIS-P) tool when used in Iranian MS patients. 140 MS patients and the equivalent number of healthy controls completed the following assessments: FIS-P, Fatigue Severity Scale (FSS), SF-36 questionnaire and the Mini Mental State Examination (MMSE). A significant inverse correlation between FIS and the quality of life (SF 36 assessment tool), as well as a positive and significant correlation with the FSS were noted. The Intraclass Correlation Coefficient (ICC) values for the inter-rater reliability for the physical, cognitive, and social sections and the whole questionnaire were 0.89, 0.86, 0.95 and 0.98, respectively. The FIS Persian version was shown to possess a high reliability (with a Cronbach’s alpha of 0.953). Likewise, the ICC values for the test-retest reliability were 0.86, 0.87, 0.92 and 0.93 for the physical, cognitive, social subscales and the whole questionnaire, respectively. This suggested a high reliability for the FIS-P. With a proper validity and reliability, the Persian-version of FIS retains the capability for being used in the assessment of fatigue and evaluation of the treatment and rehabilitation effects on fatigue-related symptoms among Persian-speaking patients with MS.

Multiple Sclerosis (MS) is the most common disabling neurological disease. Hand dysfunction is one of the main complaints of patients with MS. The present study aimed to compare hand dexterity of MS patients with low Expanded Disability Status Scale (EDSS) scores and healthy adults. It also sought to identify the predictors of disability status of patients with MS based on their manual dexterity and demographic characteristics. In this cross-sectional study, 60 (16 male/44 female) patients with MS and 60 (19 male/41 female) healthy people, who matched in terms of age and sex, were recruited. Their hand dexterity was evaluated by the Purdue Pegboard Test. The disability status of the MS group was determined by the Expanded Disability Status Scale. The data were analyzed using SPSS15. The hand dexterity in MS group even with low EDSS score (1.5 ± 1.07) was weaker than control group. Moreover, the dexterity of dominant hand and alternating two hands coordination subtests of the PPT was a good discriminator between two groups (p<0.001). The results of linear regression analysis suggested dominant hand dexterity and disease duration as predictors of disability status that predict 60.5 per cent of the variation in EDSS scores in patients with MS (p<0.001). Reduced dominant hand dexterity in patients with MS is a disabling factor. Further research is recommended to determine if early hand rehabilitation can reduce the severity of disability in Patients with MS.

The positive impacts of exercise therapy on patients’ cognitive problems still remain unknown. This study was a pilot intervention to examine the effects of combined exercise on the cognitive problems of patients with multiple sclerosis (MS) in Iranian MS Society over 201 to 2013. This quasi-experimental research was carried out in the form of a pretest/posttest study. Forty two patients with MS were selected from those visiting the rehabilitation center of Iranian MS Society, using non-probability convenience sampling. The Expanded Disability Status Scale (EDSS) of each patient was recorded before the intervention and Brief Repeatable Battery of Neuropsychological (BRB-N) test was administered before and after the intervention. The data were analyzed using the analytical tests such as Wilcoxon test. Of 21 participants, 17 subjects (82%, n=14) female with mean (±SD) age of 37 (±9.98) years and mean (±SD) EDSS of 2.35 (±0.90) completed all stages of the study. Changes in long-term storage and permanent long-term retrieval of information after the intervention were statistically significant (p<0.001). In addition, the change in the average of total delay after the intervention was also significant by 1.11 (p<0.001). Our study confirmed the possibility of change in the cognitive abilities of MS patients through physical interventions. This finding emphasizes the necessity of more clinical examinations and increases the hopes for new rehabilitation methods for the disorder.

The purpose of this study was the association between urinary disorder (UD), spastic hypertonia and assistive device with falling. In this analytical cross sectional study, 140 participants with Expanded Disability Status Scale (EDSS) score below 7; aged 20 to 55 years were divided into two groups according to their reports of falls in the past 6 months. Participants selected from Tehran outpatient clinics by convenient sampling. The presence or absence of UD, fall history and using assistive device was recorded by self-report. In addition, spastic hypertonia was assessed by Ashworth scale in knee extensors and ankle plantar flexors muscles for lower extremities. Finally, we used Mann whitney, chi-square test and Spearman correlation coefficient for analyzing. We found more UD, spastic hypertonia and using assistive device in MS with history of falling compared with MS without history of falls (P < 0.05). Additionally, the direct and significant relationship existed between UD, spastic hypertonia and using assistive device with falls. MS people with history of falls that have UD, spastic hypertonia and using assistive device are in risk of falling than MS patients without history of falling.

In this study, we aimed to assess the association between air pollution and cerebrovascular complications in Tehran, one of the most air-polluted cities in the world, among different subgroups of patients with stroke in 2004. In this ecologic study, we calculated the daily average levels of different air pollutants including CO, NOX, SO2, O3, and PM10 and also humidity and temperature on the day of stroke and 48 hours prior to stroke in 1 491 patients admitted with the diagnosis of stroke in eight referral hospitals in different areas of Tehran. Then, we evaluated the association between the rate of stroke admissions and the level of the selected pollutants, humidity, and temperature on the day of stroke and 48 hours prior to stroke among different subgroups of patients. There was no significant association between the sameday level of the pollutants and the rate of stroke admissions, but an association was seen for their level 48 hours before stroke. These associations differed among different subgroups of age, sex, history of underlying diseases, and type of stroke. Same-day temperature had a reverse association in patients with hemorrhagic stroke and in patients without a history of heart disease or previous stroke. A direct significant association was seen for humidity level 48 hours before stroke in patients with a history of heart disease. It is inferred that air pollution has a direct association with the incidence of stroke and these association differs among different subgroups of patients. The results of this study are not time-dependant and can be generalized to different times and regions. Moreover, these results may be useful for environmental health policy makers.