Letter to Editor

Review Article

The Anxiety Disorder Among the Healthcare Providers During The COVID-19 Infection Pandemic: A Systematic Review

Sepideh Paybast, Fatemeh Baghalha, Ali Emami, Mohsen Koosha

International Clinical Neuroscience Journal, Vol. 7 No. 3 (2020), 21 June 2020, Page 115-121

Background: The outbreak of the novel coronavirus disease (COVID-19) imposes a considerable psychological burden on the medical staff working in central hospitals for COVID-19. In this systematic review, we will discuss the prevalence and the risk factors of anxiety disorder among the frontline medical staff dealing with COVID-19 patients.

Methods: PubMed, Scopus, Embase, Web of Science data bases were systematically searched from December 01, 2019 to April 30, 2020 for related published articles. In all electronic databases, the following search strategy was implemented and these key words (in the title/abstract) were used: “COVID-19” OR “novel Coronavirus” AND “anxiety” OR “psychology” OR “psychiatry” OR “psychological distress” AND “nurses” or “clinicians”. We included only the cross sectional studies.

Results: Through the search strategy, we could identify eight related cross sectional articles about anxiety among the healthcare workers in central hospitals for COVID-19 infection. However, the authors scanned the reference lists of the included studies and identified multiple references. According to our findings, the frontline medical staff are at risk developing anxiety disorder which is mainly mild. Additionally, the female nurses are more susceptible to experience anxiety during the COVID-19 pandemic.

Conclusion: Regarding to the outbreak of COVID-19 worldwide and the workload of the frontline medical staff dealing with COVID-19 patients, a particular attention should be given on the mental health of the healthcare provides.

Original / Research Article

Investigating the Association Between Serum Vitamin D Deficiency and Idiopathic Benign Paroxysmal Positional Vertigo

Dhameliya Jignesh Dhirubhai, Umesh Kumar Chandra, Sumit Kumar Vishwakarma, Dattaprasad Ganganpalli, Archana Verma

International Clinical Neuroscience Journal, Vol. 7 No. 3 (2020), 21 June 2020, Page 122-126

Background: It is suggested that there is a positive association between vitamin D deficiency and benign paroxysmal positional vertigo (BPPV). We suggest, as a hypothesis, there is a positive association between vitamin D deficiency and BPPV. The current study aimed to investigate the association between vitamin D levels and BPPV.

Methods: The present observational case-control study was planned and conducted on 100 participants (50 cases and 50 controls) in the Department of Neurology, Choithram Hospital & Research Center (CHRC), Indore, MP, India, from January 2018 to December 2018. All consecutive patients with diagnosis of idiopathic BPPV who were above the age of 18 years with a negative neurological status were included. Analyses were performed using SPSS software version 10. Results: BPPV was more common among those aged 50 to 70 years (64%). Out of 100 participants, 72 (72%) had vitamin D deficiency, in which 40 (80%) were cases and 32 (64%) were controls. 32 (64%) patients had posterior canal involved, out of them 20 (40%) were females and 12 (24%) were males, and in both groups posterior canal was more involved. Canal involvement according to gender was not statistically significant (P value=0.45). Mean vitamin D level for cases and controls was 34.9 and 46.5 nmol/L, respectively, and this difference was statically very significant with a p-value of 0.01 (P value < 0.05).

Conclusion: According to the findings, there is a statistically significant association between vitamin D3 deficiency and Idiopathic BPPV. It can be noted that vitamin D3 deficiency may be a risk factor for the BPPV.

Effectiveness of Extremely Low Frequency Electromagnetic Field and Pulsed Low Level Laser Therapy in Acute Stroke Treatment

Farzad Ashrafi, Amir Rezaei, Arash Azhideh, Faraj Tabeie, Latif Gachkar, Mehran Arab Ahmadi, Maryam Yousefi-Asl, Alireza Zali, Reza Jalili Khoshnoud

International Clinical Neuroscience Journal, Vol. 7 No. 3 (2020), 21 June 2020, Page 127-131

Introduction: Stroke is one of the most devastating neurologic conditions in the world. Despite all the efforts that have been made for effective treatment, the prevalence of this medical condition is still high. One of the new methods in the treatment of patients is the use of low power laser and pulsed magnetic fields. The previous studies investigated the effectiveness of these methods individually. However, the present study aimed to investigate their effectiveness in combination.

Methods: We divided the patients into control (n = 26) and experimental (n=26) groups. The primary variables included the Mini-Mental State Examination (MMSE) and the National Institute of Health Stroke Scale (NIHSS). The experimental group received Extremely Low-Frequency Electromagnetic Field (EMF-ELF) treatment with 1 mT power and laser in rejection with a wavelength of 840 nm for 5 days and 45 minutes per day. 

Results: The variable measured during this study, in addition to comparing the results of the intervention between the control and experimental groups, showed a significant difference in all indicators before and after the intervention. The mean and standard deviations of the Modified Rankin Scale (mRS), functional status (Barthel’s index), and cognitive status (MMSE) (p<0.001) were signed between two groups.

Conclusion: Laser and magnetic field combination can be effective in the treatment of stroke. Further studies are recommended to ensure a better comparison.

Keywords:  Stroke; Low Level Light Therapy; Electromagnetic Field; Nonablative Laser Treatments

Expression of the Apoptotic Proteins in Glioblastoma U87-MG Cell Line Treated by Botulinum Toxin

Mona Farhadi, Samaneh Moniri, Melikasadat Jameie, Nasrin Hosseini, Manasadat Jameie, Seyed Behnamedin Jameie

International Clinical Neuroscience Journal, Vol. 7 No. 3 (2020), 21 June 2020, Page 132-137

Background: Glioblastoma multiforme (GBM) is the most type of brain malignancy in adults. Radical excision surgery, chemotherapy, and radiotherapy in some cases are still unsuccessful, and most patients with GBM die within three to six months following diagnosis. Botulinum toxin type A (BtxA) has cellular toxin effects and suppresses the cell division of certain types of cancer cell lines in vivo and in vitro study. The present study designed to evaluate the apoptotic effect of BtxA on the GBM cell line.

Material & methods: U87-MG GBM cell line cultured according to the routing protocols, divided into two groups including, trial (BtxA treated) and control groups. Cells of the trial group exposed to different doses of BtxA. The cell viability, cycle arrest, and pro-apoptotic proteins evaluated respectively by MTT assay, SubG1, and Western blotting.

Results: MTT assay showed that the viability of the BtxA treated cells at doses of 1.45 Unit and other doses after 24 to 48 hours, significantly decreased (p<0.001) compared to the control groups. Apoptosis percentage of the SubG1 test also indicated that 1.45 Unit dose significantly increased in the cells exposed to BtxA compared to the control group in 24 hours. The expression of P53 and Caspase 3 proteins indicated a significant increase.

Conclusion: BtxA induces apoptosis in U87- MG cell line via p53 and caspase three pathways and could have clinical applications. In vivo studies need to confirm the clinical application of the present findings.

Modelling and Control Human Arm with Fuzzy-Genetic Muscle Model Based on Reinforcement Learning: The Muscle Activation Method

Fereidoun Nowshiravan Rahatabad

International Clinical Neuroscience Journal, Vol. 7 No. 3 (2020), 21 June 2020, Page 138-146

Background: The central nervous system (CNS) is optimizing arm movements to reduce some kind of cost function. Simulating parts of the nervous system is one way of obtaining accurate information about the neurological and treatment of neuromuscular diseases. The main purpose of this paper is to model and control the human arm in a reaching movement based on reinforcement learning theory (RL).

Methods: First, Zajac’s muscle model is improved by a fuzzy system. Second, the proposed muscle model applied to the six muscles which are responsible for a two-link arm that move in the horizontal plane. Third, the model parameters are approximated based on genetic algorithm (GA). Experimental data recorded from normal subjects for assessing the approach. At last, reinforcement learning algorithm is utilized to guide the arm for reaching task.

Results: The results show that: 1) The proposed system is temporally similar to a real arm movement.  2) The reinforcement learning algorithm has the ability to generate the motor commands which are obtained from EMGs. 3) The similarity of obtained activation function from the system is compared with the real data activation function which may prove the possibility of reinforcement learning in the central nervous system (Basal Ganglia). Finally, in order to have a graphical and effective representation of the arm model, virtual reality environment of MATLAB has been used.

Conclusions:  Since reinforcement learning method is a representative of the brain's control function, it has some features, such as better settling time, not having any peek overshoot and robustness.

The Effective Brain Areas in Recognition of Dyslexia

Roya Kheyrkhah Shali, Seyed Kamaledin Setarehdan

International Clinical Neuroscience Journal, Vol. 7 No. 3 (2020), 21 June 2020, Page 147-152

Background: The brain has four lobes consist of frontal, parietal, occipital, and temporal. Most researchers have reported that the left occipitotemporal region of the brain, which is the combined region of the occipital and temporal lobes, is less active in children with dyslexia like Sklar, Glaburda, Ashkenazi and Leisman.
Methods: There are different methods and tools to investigate how the brain works, such as magnetic resonance imaging (MRI), positron emission tomography (PET), magneto-encephalography (MEG) and electroencephalography (EEG). Among these, EEG determines the electrical activity of the brain with the electrodes placed on the special areas on the scalp. In this research, we processed the EEG signals of dyslexic children and healthy ones to determine what the areas of the brain are most likely to cause the disease.
Results: For this purpose, we extracted 43 features, including relative spectral power (RSP) features, mean, standard deviation, skewness, kurtosis, Hjorth, and AR parameters. Then an SVM classifier is used to separate two classes. Finally, we show the particular brain activation pattern by calculating the correlation coefficients and co-occurrence matrices, which suggests the activation of the working memory region as an active area.
Conclusion: By identifying the brain areas involved in reading activity, it has expected that psychologists and physicians will be able to design the therapeutic exercises to activate this part of the brain.

Case Report

Co-Morbidity of Pituitary Adenoma and Frontal Convexity Meningioma: A Case Report and Review of the Literature

Hoai T P Dinh, Thi D Mai, Tri V Truong

International Clinical Neuroscience Journal, Vol. 7 No. 3 (2020), 21 June 2020, Page 153-155

Instruction: The current study reports a woman with pituitary adenoma and frontal convexity meningioma that was detected accidentially. To the best of our knowledge, this case is considered as a rare clinical scenario.

Case presentation: A 37 years old woman suffering from amenorrhea and galactorrhea had her detail investigation showed hyperprolactinemia. The patient was diagnosed with a prolactinoma, and a frontal convexity meningioma was discovered on MRI. The prolactinoma controlled with Bromocriptine therapy, while the meningioma monitored through medical observation. After two months of pharmaceutical medication, her symptoms improved with the decrease in serum prolactin.

Conclusion: Thanks to sophisticated MRI techniques, meningioma and prolactinoma were incidentally detected. It should be noted that co-morbidity of prolactinoma and meningioma is very rare. The mechanism of the association between these two familiar types of intracranial tumors has not yet been clarified, which indicates the need for further studies to offer possible targeted treatment for patients.

Keyword: Meningiomas; Prolactinomas; Pituitary adenomas.

Case Series

Guillain–Barré Syndrome as a Neurological Complication of COVID-19 Infection: A Case Series and Review of the Literature

Hossein Mozhdehipanah, Sepideh Paybast, Reza Gorji

International Clinical Neuroscience Journal, Vol. 7 No. 3 (2020), 21 June 2020, Page 156-161

Background: The novel coronavirus (COVID-19) is a global pandemic. Although the main clinical manifestations of the COVID-19 infection has confined to the respiratory system, there is some evidence suggesting the neuro-invasive potential of the COVID-19. There are limited reports of Guillain–Barré syndrome (GBS) as a peripheral nervous system complication of COVID-19 infection.

Methods and results: We described four patients with COVID-19 infection who developed acute polyneuropathy with a final diagnosis of Guillain–Barré syndrome.

Conclusion: COVID-19 may have the potential to invade the peripheral nervous system. GBS, as one of the critical neurological complications of COVID-19, could be considered as a post-infectious event.