Highlights We described GBS symptoms in three infected patients with COVID-19. The severity and fast progression of GBS linked to COVID-19 seems considerable in mentioned cases. Acute motor and sensory axonal neuropathy (AMSAN) type of GBS was diagnosed according to electrodiagnostic findings in all three cases. GBS is suggested to be considered as a severe and rapid progressive profile in neurologic complications of COVID-19.

The new coronavirus virus 2019 (COVID-19) has affected many routine medical activities, including medical education and clinical activities. The social isolation has led to highlighting virtual learning and telemedicine. We present a report of our adoptive procedures taken during the outbreak of COVID-19 in our tertiary healthcare center and compare the current educational and clinical issues with these issues one month before the outbreak. Virtual learning is a useful replacement in this critical situation.

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Background: Considering the high prevalence of vitamin D deficiency worldwide and its relationship with immune response to viral infections, this study attempted to identify the predictive power of serum vitamin D for poor outcomes among the COVID-19 patients.Methods: This retrospective cohort study included all patients with confirmed COVID-19 hospitalized between 20 February 2020 and 20 April 2020 at a designated COVID-19 hospital, located in Tehran province, Iran. General characteristics, medical history, and clinical symptoms were recorded by trained physicians. Blood parameters including complete blood count, creatinine, lactate dehydrogenase, creatine phosphokinase, erythrocyte sedimentation rate, C-reactive protein, and vitamin D were tested. Results: This study included 290 hospitalized patients with COVID-19 (the mean age (SD): 61.6 (16.9), 56.6% males), of whom 142 had vitamin D concentrations less than 20 ng/ml, defined as vitamin D deficiency. COVID-19 patients with vitamin D deficiency were more likely to die (Crude OR (95% CI): 2.30 (1.25-4.26)), require ICU care (2.06 (1.22-3.46)) and invasive mechanical ventilation (2.03 (1.04-3.93)) based on univariate logistic regression results. However, after adjusting for potentials confounders such as gender and age, the association between vitamin D and need to invasive mechanical ventilation lost its significance.Conclusion: Vitamin D deficiency can be considered as a predictor of poor outcomes and mortality in COVID-19 patients. Therefore, checking serum 25 (OH) D on admission and taking vitamin D supplements according to the prophylactic or treatment protocols is recommended for all COVID-19 patients.

Background: One of the main parts of the early treatment of Acute Ischemic Stroke (AIS) is the attitude and knowledge of Emergency Medicine (EM) specialists. This study aimed to investigate the knowledge and attitude of emergency physicians working in Iran about the prescription of tissue Plasminogen Activator (tPA) in AIS. Methods: This was a cross-sectional questionnaire-based study including EM physicians working in different cities of Iran in 2020. A previously used English questionnaire was translated into Persian. After face validity and reliability assessment, the final questionnaire was designed as a Google form and sent to 400 EM professionals. Results: 128 physicians filled in the forms. 64.8% of participants had sufficient attitude and 68% had sufficient knowledge about tPA treatment in AIS. The knowledge regarding tPA treatment was higher in the age>40 years, male gender and physicians with up-to-date information (P<0.05), but no significant association was found for the attitude. Logistic regression analysis showed that the amount of information about tPA administration in AIS (OR=3.475, 95% CI =1.242-9.723, p=0.018) and age (OR=0.336, 95% CI = 0.130-0.865, p=0.024) had the greatest impact on the level of knowledge for tPA treatment. Conclusion: About two-thirds of EM professionals in Iran had sufficient knowledge and attitude about tPA administration in AIS. Having up-to-date information and age>40 years were the major predictors of higher knowledge of AIS treatment. Holding some training workshops together with strengthening infrastructures such as establishing intensive stroke units would help to increase the use of tPA in AIS in Iran.

Background: Post traumatic lumbosacral plexopathy (LSP) is a well-known condition following pelvic fracture or abdominal trauma and surgery. A rare condition of LSP has been reported in the literature following femoral shaft fractures. Case Report: Two cases of LSP after bilateral femoral shaft fracture presented to our center. In both cases, the mechanism of injury was a high energy trauma without any signs or symptoms of pelvic or spinal injury. Electrodiagnostic studies confirmed acute plexopathy and spontaneous recovery occurred in both. Conclusion: LSP can be seen in association with fractures or traumas far from anatomical location of the plexus. Multidisciplinary approach and complete accurate examination are mandatory for diagnosis management of the condition.

Background: Amyotrophic lateral sclerosis (ALS) is an adult-onset motor neuron disease which leads to limb and/or bulbar muscle degeneration with a poor prognosis. Several demographic and biological factors have prognostic importance, but little data exist on the relationship between clinical, electrodiagnostic, and laboratory markers as predictors of disease progression. We aimed to assess the relationships between different aspects of clinical, electrodiagnostic, and laboratory features of ALS patients with their level of functioning. Methods: We included 27 patients with ALS who were diagnosed within two years before enrolment. Clinical assessment and electrodiagnostic studies were done by a neurology resident. The motor unit number index (MUNIX) and compound motor action potential (CMAP) were used as measures of motor unit loss. Serum creatinine, urea, Albumin, and creatine kinase were measured as laboratory markers. We used the Persian version of ALS functional rating scale (ALS-FRS) as the main outcome measure. Data were analyzed using the SPSS software. Pearson's correlation coefficient was calculated to test for correlations. Results: None of the demographic or laboratory parameters correlated with ALS-FRS. Patients with the onset of disease in the limbs had a higher MUNIX score compared to patients with a bulbar onset. Also, increased body mass index was associated with lower CMAP and MUNIX scores (p-value:0.02). Higher serum creatinine levels were significantly associated with higher lower limb MUNIX (p value:0.04). Higher lower limb MUNIX was in turn associated with higher lower limb functional score (ALS-FRS). Conclusion: Decreased serum creatinine may possibly be an indicator of lower limb motor unit loss in patients with ALS. Also, MUNIX scores may be used as surrogates for ALS-FRS in ALS trials. Further research is needed to elucidate the clinical application of these findings.Methods: We included 27 patients with ALS who were diagnosed within two years before enrolment. Clinical assessment and electrodiagnostic studies were done by a neurology resident. The motor unit number index (MUNIX) and compound motor action potential (CMAP) were used as measures of motor unit loss. Serum creatinine, urea, Albumin, and creatine kinase were measured as laboratory markers. We used the Persian version of ALS functional rating scale (ALS-FRS) as the main outcome measure. Data were analyzed using the SPSS software. Pearson's correlation coefficient was calculated to test for correlations. Results: None of the demographic or laboratory parameters correlated with ALS-FRS. Patients with the onset of disease in the limbs had a higher MUNIX score compared to patients with a bulbar onset. Also, increased body mass index was associated with lower CMAP and MUNIX scores (p-value:0.02). Higher serum creatinine levels were significantly associated with higher lower limb MUNIX (p value:0.04). Higher lower limb MUNIX was in turn associated with higher lower limb functional score (ALS-FRS). Conclusion: Decreased serum creatinine may possibly be an indicator of lower limb motor unit loss in patients with ALS. Also, MUNIX scores may be used as surrogates for ALS-FRS in ALS trials. Further research is needed to elucidate the clinical application of these findings.

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