Neuromyelitis optica (NMO) is an autoimmune inflammatory disease of the central nervous system with preferential involvement in the optic nerve and spinal cord with a widespread spectrum of clinical features; multiple therapeutic agents have been used with different results. Recent evidence points to B-cell-mediated humoral immunity in the pathogenesis of NMO. Rituximab targets the CD20 antigen on B-cells. Treatment leads to profound B-cell depletion, principally over an antibody-dependent cell cytotoxicity mechanism. The aim of our study was to review clinical trials to elucidate the impact of rituximab on the relapse rate, Expanded Disability Status Scale (EDSS), and progression of disability in NMO. We performed a comprehensive review of all studies that evaluated clinical and paraclinical effects of rituximab on NMO. MEDLINE-PubMed, Web of Sciences, EMBASE, and Cochrane databases up to June 2016 included in our searches. In addition, reference lists from articles identified by search as well as a key review article to identify additional articles included in the study. Rituximab targets the CD20 antigen on B-cells and decreases attack frequency and severity in patients with NMO; however, it does not remove attacks, even when modifying treatment to achieve B-cell depletion. Most of the investigations revealed that EDSS significantly in all patients with rituximab treatment will be decreased after treatment with rituximab. No new or enlarged lesions or pathological gadolinium enhancement was observed in serial brain and spinal cord magnetic resonance imaging, except for those observed concomitantly with clinical relapses and the median length of spinal cord lesions was significantly reduced after therapy. Rituximab targets the CD20 antigen and decreases attack frequency and severity in patients with NMO.
Background With the onset and spread of the COVID‐19 pandemic, the hospitalization and treatment of noncovid patients were dramatically affected. The aim of this study is to evaluate the electrophysiology (EP) lab activity in a referral center in Iran during the COVID‐19 era. Methods A cross‐sectional descriptive survey was conducted on EP lab activity in Shahid Chamran Heart Center, Isfahan, Iran. Two periods of COVID‐19 occurrence peaks in Iran were compared with same date in 2019. Information was collected on number of diagnostic and therapeutic electrophysiology studies (EPSs) and implantation of intracardiac devices such as permanent pacemaker (PPM), implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy (CRT). Results In the first peak of COVID‐19 pandemic, both of EPSs and intracardiac device implantations decreased by 80% compared to the same period in 2019. The most common type of device implanted during this period was PPM (70%); however, at the time of control, the ICD (73%) was the most common. Paroxysmal supraventricular tachyarrhythmia (PSVT) was the best indication for diagnostic and therapeutic EPSs in covid and control periods. In the second peak of prevalence of COVID‐19 virus infection in Iran, 6% and 36% decreases in device implantations and EPSs were seen, respectively. During this period, the number of procedures increased, although it was still lower than in 2019. Conclusion A significant reduction in the EP lab activity has been observed during both the COVID‐19 pandemic peaks.
Aims Psychological factors are among the most suspected indicators which may cause atherosclerosis. Coping strategies modifying psychological stress may be significantly associated with health outcomes. However, little is known about the influence of adaptive and maladaptive coping strategies on major adverse cardiovascular disease (CVD) events. The purpose of this study is to examine this idea among a sample of adults. Design: cohort study. Methods and results The Isfahan cohort study (ICS) is a longitudinal population-based, prospective study. Participants (N=6323 individuals aged 35 years or greater at baseline) were selected by multistage random sampling with 6-year intervals (i.e. 2001: 6323 individuals, 2007: 3296 individuals, and 2013: 1706 individuals). Adaptive and maladaptive coping strategies were evaluated by a multicomponent self-administered stress management paper-based questionnaire. All CVD events were confirmed by a blinded panel of experts and a marginal cox regression model was used to model the survival data. Adaptive coping strategies could be protective against CVD events with hazard ratios (95% confidence interval) [0.97 (0.95–0.99)] and maladaptive coping strategies seem to be a risk factor, 1.02 (1.01–1.04) in the whole population. Individuals younger than 60 showed similar results, with 0.96 (0.93–0.98) and 1.04 (1.01–1.07) for adaptive and maladaptive coping strategies, respectively. However, these findings were not replicated among seniors older than age 60. Conclusion Based on our results, coping strategies have an important role in cardiovascular events, particularly among young adults. According to the results, informing patients about adaptive stress management may promote primary prevention of CVD events.
From the early stages of the pandemic, the development and mass production of a safe and effective vaccine seemed like the greatest tool, to win the fight against the virus. In the present study, we comprehensively conducted a systematic review of all current cases worldwide to better understand whether there is a link between COVID-19 vaccination and one of the most devastating complications, cardiac Inflammation. Our search retrieved over 250 results, of which 130 met the inclusion criteria, and their respective data were extracted. The results suggest that postvaccination myocarditis and pericarditis are more likely to be seen in male, younger, and mRNA-vaccinated individuals. Most affected patients experienced symptoms following the second shot, and complaint of chest pain was the most prevalent presentation. Currently, no direct link can be drawn between the vaccines and the risk of cardiac inflammation.
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