Background: During the COVID-19 pandemic, besides the most prevalent respiratory and systemic symptoms, some neurological symptoms such as acute hemorrhagic necrotizing encephalopathy and myelitis associated with COVID-19 have been reported. It is suspected that COVID-19 involves different body systems via interaction with the ACE-2 (angiotensin-converting enzyme 2) receptor. As ACE2 is expressed on the surface of central nervous system cells, including the brain and spine, these kinds of manifestations are inevitable. Clinical Presentation and Intervention: Here we report a case of COVID-19 associated with acute myelitis in an infected patient in the north of Iran during the pandemic of COVID-19. He presented with paraparesis and urinary incontinence. Unfortunately, he did not respond to anti-inflammatory treatment. Conclusion: Para/Post Infectious myelitis could be a complication of COVID-19 infection.

Background: Multiple Sclerosis (MS) is a debilitating disease of the central nervous system. Usually, long-term MS medications are injected intramuscularly or subcutaneously, making them intolerable for many MS patients. Objectives:In the present study, the rate and the causes of non-adherence to MS disease-modifying drugs (DMDs) were assessed in patients with MS. Materials and Methods:Two hundred and three MS patients of Guilan MS Society were interviewed demographic and clinical data of the patients were collected. Results:Among the 203 patients, 73.9% were female. The mean±SD age of the patients was 32.47±9.15. Non-adherence to DMDs was due to side effects (21.7%) and requests of the families (21.7%) or ineffectiveness (17.4%). Significant association was seen between the non-adherence to DMDs and gender (p=0.015) and relapses (p=0.021). Conclusion:The evidence from the present study suggests that there is a high rate of non-adherence to DMDs in MS patients in Guilan. Keywords: Multiple Sclerosis; Medication Adherence Bullet points: Disease-modifying drugs are somehow intolerable for patients with MS. A high rate of nonadherence to DMDs in MS patients was demonstrated.

Introduction:Bacterial meningitis is an acute infectious inflammation of the protective membranes covering the brain. Its early diagnosis is vital because of its high morbidity and mortality. It is mostly diagnosed by a gold standard diagnostic tool i.e. Cerebrospinal Fluid (CSF) analysis. However, it is sometimes difficult and or impossible to do this procedure and an alternative diagnostic tool is needed. Contrast enhanced magnetic resonance imaging can detect the pus or other changes in subarachnoid space. But our optimal aim is to use an imaging method without using contrast to be useable and available in more specific condition.Methods:This study aimed to survey the role of non-contrast Magnetic Resonance Imaging (MRI) in the diagnosis of the bacterial meningitis. MEDLINE/PubMed Central, Web of Science and Scopus were searched without time period and language limitation until March 2017. We found 6410 papers in our initial search. After assessing the content of the papers based on Cochrane library guidelines and inclusion/exclusion criteria, 6 relevant studies were included in the systematic review. All of included studies were observational studies.Results:MRI studies demonstrated that Fluid Attenuation Inversion Recovery (FLAIR) and Diffusion-Weighted Image (DWI) MR imaging among all MRI modalities can detect some abnormalities compatible with bacterial meningitis. FLAIR and DWI-MR imaging are potentially useful to diagnose bacterial meningitis and can be used in emergent condition in which bacterial meningitis is highly suspicious and the other diagnostic tools are not available or feasible.

Background: Insulin serves an important role in brain metabolism, and insulin resistance and subsequent diabetes mellitus type 2 (DM2) can give rise to dysfunction of brain metabolism. This study aimed to test the hypothesis of association of late onset Alzheimer's disease (AD) with DM2 in an Iranian population. Methods: In this case-control study, 243 subjects including 81 patients with late onset AD and 162 healthy controls were recruited. The frequency of DM were compared in AD patients with non-AD counterparts. Results: The prevalence of diabetes in AD and control patients was 27% and 9%, respectively. (OR = 3.94, 95% confidence interval: 1.89-8.22). After adjustment for age and gender, there was a significant association between DM2 and AD (OR = 3.7, 95% confidence interval: 1.73-8.00). Conclusion:The evidence from the present study suggested that DM2 was associated with AD in an Iranian population. Further longitudinal studies are warranted to confirm this finding.

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Background: Patients with ischemic stroke and underlying Atrial Fibrillation (AF) have a high risk of recurrent embolic events. New Oral Anticoagulant (NOAC) is highly effective and reduces the risk of recurrence in AF-associated Ischemic Stroke (AFAIS). Objectives: This study aimed to determine the prescription pattern of NOAC and its determinant factors in patients with non-valvular AFAIS. Materials & Methods: This research was a cross-sectional descriptive study and the participants were referred to an academic hospital in the north of Iran from 2017 to 2018. The study variables included demographic variables such as the use of new anticoagulants, age, sex, place of residence, income level, education, the history of stroke and myocardial Infarction (MI), medication, and stroke severity based on The National Institutes of Health Stroke Scale criteria. The patient’s functional status based on the modified Rankin Scale (mRS) was extracted from the patients’ medical records. The data analysis was conducted by SPSS V. 19, using the Chi-square test and t-test, as well as the logistic regression model. Results: In this study, 363 patients with ischemic stroke with the origin of non-valvular AF and the mean age of 67.87 years were studied. Of them, 191 (52.6%) patients were women, and 30.6% were prescribed rivaroxaban at the time of discharge. The results showed that women were more likely to use rivaroxaban than men (P=0.001, OR=0.422). The history of stroke (P=0.004, OR=2.17) and the stroke severity (P=0.05, OR=2.19) was associated with an increase in NOAC prescription. Conclusion: The results of this study showed that the administration of NOAC in this population was low and associated with gender and the severity and the history of stroke.

Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. COVID-19 has presented a significant challenge to the care providers of patients with MS. Objectives: The present study aimed to investigate the frequency of COVID-19 infection and its seropositivity in MS patients in Guilan, Iran, in 2021. Materials & Methods: In this analytical-cross-sectional study, all patients with relapsing-remitting MS registered in the Guilan MS Association with an expanded disability status scale of less than 5 who were referred for evaluation participated in the study. Information related to the clinical and serological symptoms of COVID-19 infection, changes in drug use, and the occurrence of new attacks were collected. Serological results of COVID-19 (IgG) among them were registered. Results: In total, 260 patients with MS (78.8% women, and 21.2% men) with a Mean±SD age of 38.7±9.9 years, and a Mean±SD duration of MS of 8.9±4.9 years were investigated. The most commonly used drugs were Dimethyl fumarate, Interferon, and Rituximab, respectively. Thirty-three patients (12.6%) had a clinical COVID-19 infection, of which 32 people had a mild and only one had a critical infection. Eight patients (1.3%) had positive COVID-19 IgG tests. No significant relationship was found between the COVID-19 infection with the type of medication, medication change, clinical attack of MS, and co-morbidities (P>0.05). Conclusion: A few patients had positive COVID-19 IgG tests and clinical COVID-19 infection. The vast majority had mild disease, and the clinical attack was not related to COVID-19 infection.

Background: Alzheimer's disease (AD) is the most common type of dementia. The role of genetic factors in the development of AD has not been demonstrated yet. Objectives In this study, our aim was to investigate the association between one of the BIN1 gene’s single-nucleotide polymorphism (SNP( (rs744373) and late-onset Alzheimer's disease (LOAD) in an Iranian population in the Guilan province. Materials & Methods: In this case-control study, 110 patients with LOAD, and 110 unrelated healthy controls were recruited. Polymerase chain reaction-restriction length polymorphism (PCR-RFLP) was performed for genotyping BIN1 gene’s SNP (rs744373). Electrophoresis was there after carried out using agarose gel and DNA safe stain and the gels were visualized under an ultraviolet (UV) trans-illuminator. The allelic and genotypic frequencies were determined. Results: The frequency of allele T (Wild-type allele) in the control and the LOAD groups was 70.9% (n = 159) and 58.6% (n = 129), respectively (p = 0.007). The frequency of allele C in the LOAD group (41.4%) (n = 91) was significantly higher than that of the control group (29.1%) (n=64) (p=0.007). Frequency of homozygous genotype (CC) of BIN was significantly higher in the LOAD group than in the control group (p = 0.043). Conclusion: rs744373 SNP of BIN1 gene is significantly associated with the risk of developing AD in the studied population.