Aynaz Mohammadi

Brimonidine ingestion in young children can cause rapid, severe central nervous system (CNS) depression, including miosis and hypotonia. Clinicians should maintain a high index of suspicion in toddlers presenting with unexplained drowsiness following exposure. Prompt airway management and supportive care are critical, as naloxone may improve symptoms in these cases.

Background: Up to 80% of people with multiple sclerosis (PwMS) experience various visual symptoms. The MS Vision Questionnaire (MSVQ‐7) is a self‐report tool that assesses visual function in PwMS. This study is aimed at validating the MSVQ‐7 in Persian‐speaking PwMS and comparing its screening ability with the National Eye Institute Visual Function Questionnaire (NEI VFQ‐25). Materials and Methods: A total of 140 PwMS were enrolled in this study. All participants completed the MSVQ‐7 (higher scores indicate worse visual symptoms) and the NEI VFQ‐25 (lower scores indicate worse visual symptoms). Reliability was assessed using Cronbach′s alpha. Exploratory factor analysis (EFA) was used to evaluate the structural validity. To assess convergent validity, correlations between the MSVQ‐7 and the NEI VFQ‐25 were examined. Receiver operating characteristic (ROC) curve analysis was used to compare the MSVQ‐7 and NEI VFQ‐25 in classifying PwMS by optic neuritis (ON) history. Results: The Persian MSVQ‐7 demonstrated excellent reliability (Cronbach ^′ s alpha = 0.852). Test–retest reliability was excellent (ICC = 0.980; SEM = 0.65; MDC = 1.80), derived from the 63‐participant retest subsample. The EFA revealed a unidimensional structure for the Persian MSVQ‐7. There was a negative correlation between the MSVQ‐7 and the NEI VFQ‐25 ( r = −0.72, p < 0.001). The ROC curve analysis showed that the MSVQ‐7 (AUC = 0.901, sensitivity = 98.3 % , and specificity = 71.2 % ) had better screening ability than the NEI VFQ‐25 (AUC = 0.826, sensitivity = 68.8 % , and specificity = 83.3 % ) for classifying PwMS based on having ON history. Conclusion: MSVQ‐7 is a valid and reliable patient‐reported outcome measure in Persian PwMS. Its high sensitivity makes it an effective screening tool for assessment of visual function.

Background: Living with multiple sclerosis (MS) means facing significant obstacles in managing the unpredictable nature of this lifelong condition. Studies highlight a concerning connection between the disease and an elevated risk of suicide. In this study, we assessed the prevalence of suicide and suicide mortality risk in people with MS (PwMS). Methods: A comprehensive and systematic search of Medline, EMBASE, Scopus, and Web of Science databases was conducted. Studies of any design were included if they reported at least one of the following outcomes: (1) the prevalence of suicide ideation, suicide attempts, suicide deaths, and the proportion of suicide deaths among total deaths in MS populations (2) the risk of suicide mortality in PwMS compared to healthy controls. Results: The systematic review and meta‐analysis included 64 studies across 19 countries, predominantly from Europe and North America, encompassing over 200,000 PwMS. The pooled prevalence of suicide ideation was 22.6% (95% CI: 16.9–28.3). Suicide attempts were reported at 3.4% (95% CI: 1.6–5.2), while suicide mortality was 0.5% (95% CI: 0.3–0.7), accounting for 2.1% (95% CI: 1.5–2.7) of total mortality in PwMS. PwMS had a significantly higher suicide mortality risk compared to healthy controls (standardized mortality ratio [SMR] = 1.49, 95% CI: 1.08–2.05). Conclusion: This study highlights the elevated suicide mortality risk among PwMS, underscoring the urgent need for integrated mental health care in MS management. Future research should explore the impact of disease‐modifying therapies, protective factors, and standardized risk assessment tools to improve early intervention and reduce suicidal behavior in this vulnerable population.

Multiple sclerosis (MS) is a chronic autoimmune disorder affecting the central nervous system, leading to a range of symptoms that impact physical, psychiatric, and cognitive functions. Cognitive dysfunction is prevalent among patients with MS (pwMS), affecting at least 65% of patients, and includes deficits in processing speed, attention, learning, memory, and executive function. Despite the significant impact on daily life, cognitive impairment in MS patients is often underrecognized in clinical settings. This systematic review and meta-analysis aimed to evaluate cognitive function using the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery among pwMS patients and healthy controls (HCs). A comprehensive search of the Web of Science, PubMed, Scopus, and Cochrane Library databases was conducted on January 2024 following the PRISMA guidelines. Eligible studies included peer-reviewed research assessing the validity of the MACFIMS in adult MS patients. Data extraction and quality assessment were performed using standardized tools, and statistical analyses were conducted using R4.2.3. Eight studies met the inclusion criteria, including a total of 1,481 pwMS and 1,072 HCs. The meta-analysis revealed significant cognitive deficits in pwMS patients compared to HCs across all the MACFIMS subtests, including language, spatial processing, new learning and memory, processing speed, and executive function. Processing speed and working memory were the most affected domains, with 36% of pwMS showing impairment on the Symbol Digit Modalities Test (SDMT). Subgroup analyses indicated that the Expanded Disability Status Scale (EDSS) score significantly influenced cognitive impairment, while disease duration had a limited impact. The MACFIMS effectively discriminates between pwMS patients and HCs, demonstrating its validity as a comprehensive cognitive assessment tool for MS. Routine cognitive screening, particularly for processing speed and working memory, is crucial for early detection and intervention. Future research should focus on the sensitivity and specificity of the MACFIMS across diverse MS subtypes and cultural contexts to enhance its global applicability in clinical practice.

Objective Modic changes (MCs) in the cervical spine are common, but remain an under-researched phenomenon, particularly regarding their prevalence, natural history, risk factors, and implications for surgical outcomes. This systematic review and meta-analysis endeavors to elucidate the multifactorial dimensions and clinical significance of cervical MCs. Methods Following PRISMA guidelines, a comprehensive systematic search was performed using Medline (via PubMed), EMBASE, Scopus, and Web of Science databases from their dates of inceptions to September 4, 2023. All identified articles were meticulously screened based on their relevance to our investigative criteria. Bias was assessed using quality assessments tools, including Quality in Prognosis Studies (QUIPS) and Newcastle-Ottawa Scale (NOS). Diverse datasets encompassing MCs prevalence, demographic influences, risk factors, cervical sagittal parameters, and surgical outcomes were extracted. Meta-analysis using both random and common effects model was used to synthesis the metadata. Results From a total of 867 studies, 38 met inclusion criteria and underwent full-text assessment. The overall prevalence of cervical MCs was 26.0% (95% CI: 19.0%, 34.0%), with a predominance of type 2 MCs (15% ; 95% CI: 0.10%, 0.23%). There was no significant difference between MCs and non-MCs in terms of neck pain (OR:3.09; 95% CI: 0.81, 11.88) and radicular pain (OR: 1.44; 95% CI: 0.64, 3.25). The results indicated a significantly higher mean age in the MC group (MD: 1.69 years; 95% CI: 0.29 years, 3.08 years). Additionally, smokers had 1.21 times the odds (95% CI: 1.01, 1.45) of a higher risk of developing MCs compared to non-smokers. While most cervical sagittal parameters remained unaffected, the presence of MCs indicated no substantial variation in pain intensity. However, a significant finding was the lower Japanese Orthopaedic Association (JOA) scores observed in MC patients at the 3-month (MD: -0.34, 95% CI: -0.62, -0.07) and 6-month (MD: -0.40, 95% CI: -0.80, 0.00) postoperative periods, indicating a prolonged recovery phase. Conclusion This study found a predominant of type 2 MCs in the cervical spine. However, there was no significant mean difference between MCs and non-MC groups regarding neck pain and radicular pain. The results underscore the necessity for expansive, longitudinal research to elucidate the complexity of cervical MCs, particularly in surgical and postoperative contexts.

Key Clinical Message: This case highlights the challenges in diagnosing Bethlem myopathy, the need for a high index of suspicion, and the importance of recognizing the diverse clinical presentations of this rare condition. Enhanced understanding can aid in early diagnosis and tailored management. Bethlem myopathy (BM), a rare collagen VI‐related myopathy, is characterized by progressive muscle weakness and contractures, typically affecting the proximal muscles and joints. This case report presents a 15‐year‐old girl from Tehran, Iran, with a 5‐year history of severe limb pain and progressive weakness. Born to consanguineous parents, the patient displayed delayed walking milestones and significant hypotonia, leading to a waddling gait and lumbar hyperlordosis. Neurological examination revealed marked proximal lower limb weakness, a positive Gowers' sign, and absent myotatic reflexes. Elevated creatine phosphokinase (CPK) levels and electromyography (EMG) results indicated myopathy, while nerve conduction studies showed no neuropathy. Genetic testing revealed a novel homozygous variant of c.385C>T (p.Arg129Cys) in the COL6A2 gene, classified as a variant of uncertain significance (VUS) per American College of Medical Genetics and Genomics (ACMG) guidelines due to its rarity and specific phenotype association. Differential diagnosis is essential to distinguish it from other neuromuscular conditions. Management primarily focuses on symptom relief and enhancing patients' quality of life. This case highlights the challenges in diagnosing BM, the need for a high index of suspicion, and the importance of recognizing the diverse clinical presentations of this rare condition. Enhanced understanding can aid in early diagnosis and tailored management.

Background: The Neutrophil-to-Lymphocyte Ratio (NLR) is a clinical indicator of peripheral inflammation that is easily accessible. It is worth noting that the formation of amyloid-β (Aβ) plaques and neurofibrillary tangles has been linked to inflammation and immune dysregulation. The main objective of this systematic review and meta-analysis is to comprehensively evaluate the existing body of research concerning the NLR in the context of Alzheimer’s disease (AD) and mild cognitive impairment (MCI). Method: We conducted a comprehensive online search and included studies that evaluated the NLR in 1) patients with AD or MCI and 2) healthy control (HC) participants. We also pooled mean and standard deviation (SD) data for each group. Results: Ultimately, 12 studies encompassed 1,309 individuals diagnosed with AD with mean NLR levels of 2.68, 1,929 individuals with MCI with mean NLR levels of 2.42, and 2,064 HC with mean NLR levels of 2.06 were included in this systematic review and meta-analysis. The mean NLR was 0.59 higher in AD patients compared to HC participants (mean difference (MD) = 0.59 [0.38; 0.80]). Similarly, the mean NLR was higher in AD than MCI patients (MD = 0.23 [0.13; 0.33]). Additionally, the mean NLR was higher in individuals with MCI compared to HC participants (MD = 0.37 [0.22; 0.52]). In the subgroup meta-analysis based on the Mini-Mental State Examination (MMSE), AD patients with lower MMSE scores (using a cut-off of 20) exhibited significantly higher mean NLR (3.10 vs. 2.70, with a p-value for subgroup differences < 0.01). Conclusion: The NLR, which serves as a marker of peripheral inflammation, shows increased levels in individuals with AD and MCI compared to HC participants. Furthermore, our study indicates that NLR levels are significantly higher in AD than MCI. Additionally, our novel finding suggests significantly higher NLR levels among AD patients with more severe cognitive decline compared to AD patients with less severe cognitive decline. So, it can be concluded that the higher cognitive decline in humans is accompanied by higher NLR levels. Further longitudinal researches are needed to explore more details about the relationship between inflammation and dementia.

Although many frailty tools have been used to predict traumatic spinal injury (TSI) outcomes, identifying predictors of outcomes after TSI in the aged population is difficult. Frailty, age, and TSI association are interesting topics of discussion in geriatric literature. However, the association between these variables are yet to be clearly elucidated. We conducted a systematic review to investigate the association between frailty and TSI outcomes. The authors searched Medline, EMBASE, Scopus, and Web of Science for relevant studies. Studies with observational designs that assessed baseline frailty status in individuals suffering from TSI published from inception until 26th March 2023 were included. Length of hospital stay (LoS), adverse events (AEs), and mortality were the outcomes of interest. Of the 2425 citations, 16 studies involving 37,640 participants were included. The modified frailty index (mFI) was the most common tool used to assess frailty. Meta-analysis was employed only in studies that used mFI for measuring frailty. Frailty was significantly associated with increased in-hospital or 30-day mortality (pooled odds ratio [OR]: 1.93 [1.19; 3.11]), non-routine discharge (pooled OR: 2.44 [1.34; 4.44]), and AEs or complications (pooled OR: 2.00 [1.14; 3.50]). However, no significant relationship was found between frailty and LoS (pooled OR: 3.02 [0.86; 10.60]). Heterogeneity was observed across multiple factors, including age, injury level, frailty assessment tool, and spinal cord injury characteristics. In conclusion, although there is limited data concerning using frailty scales to predict short-term outcomes after TSI, the results showed that frailty status may be a predictor of in-hospital mortality, AEs, and unfavorable discharge destination.