Letter to Editor

The Mental Health of Pregnant Women During COVID-19

Poorya Davoodi, Meisam Akhlaghdoust

International Clinical Neuroscience Journal, Vol. 8 No. 3 (2021), , Page 103-104

Dear Editor,
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global health emergency since the end of 2019.1 It has been the cause of more than 2.06 million deaths around the world until now.2,3 As you know, this pandemic has caused many problems and has had damaging effects on various aspects of people’s lives. One of the essential issues to pay special attention to is women’s mental health during pregnancy. In this letter, we would like to explain the immediate need to focus on the psychological impact of the SARS-Cov-2 during pregnancy.
Several reports have shown that the rate of psychopathology (anxiety, depression, etc.) in pregnancy has increased significantly during pandemics. This increasing rate was related to fear of infection with the virus, reduce support services in hospitals and operating rooms, inadequate prenatal care, and social isolation from support networks.4
Mortazavi and colleagues published an article regarding pregnant women’s well-being and worry during the COVID-19 pandemic.5 The results of their study showed that the COVID-19 pandemic has had a harmful effect on pregnant women in terms of mental health. A little percentage of pregnant women have severe coronavirus infection, but this pandemic has psychological consequences for the neonate and the mother.
Perinatal support is a service for any woman with mental health problems, who are planning a pregnancy, are pregnant, or have a baby up to one year of age. There has been a significant decrease in prenatal care around the world, which could lead to increased rates of psychopathology problems which is in turn a risk factor for poor postpartum health and postnatal depression. Since the start of the pandemic, for the protection of pregnant women and their children, only one person is allowed to enter the delivery room and unnecessary visits are unacceptable.
Perinatal support leads to reduced pain during delivery, increases psychological health, and satisfaction during pregnancy, so it seems that these policies have some harmful effects, and they will show themselves in the near future.
Moreover, during the pandemic, violence against women has increased as a result of economic stress and financial instability. Domestic violence is closely related to psychopathology, especially increased rates of depression, anxiety, and suicide. During pregnancy, mental health disorders can have very serious consequences for both the mother and baby. For instance, increased perinatal psychopathology can result in the usage of drugs, alcohol, and future suicide. In addition, when the mother has stress, many problems can restrict fetal growth, lead to premature birth, and induce low birthweight.
According to all the explanations above, future research should aim to recognize women who are exposed to domestic violence, as well as the psychological effects of the pandemic on pregnant women and their children. To solve these problems, careful planning and management is needed and if not addressed, it can lead to irreversible outcomes in the future.
In order to have a healthy society in future, we also suggest that after the end of this pandemic we need to set up a screening and control program for women who have given birth during this pandemic to monitor and manage possible consequences.

Sleep Quality During Coronavirus-2019 Pandemic

Farzin Bagheri Sheykhangafshe, Mostafa Hojjat Shamami

International Clinical Neuroscience Journal, Vol. 8 No. 3 (2021), , Page 105-106

Dear Editor,
Since December 2019 and the coronavirus disease 2019 (COVID-19) in Wuhan, China, it has rapidly spread and attracted the World Health Organization’s attention and concern. COVID-19 is a new case of coronavirus that is closely related to severe acute respiratory syndrome (SARS), with a high transmission rate.1 The disease is usually accompanied by simple respiratory symptoms such as fever and dry cough, fatigue, and gastrointestinal symptoms. COVID-19 has specific characteristics that has led to increased anxiety in the society. Person-to-person transmission, high prevalence rates, treatment failure, rumors and misinformation about the origins and causes of the disease, emotional and exaggerated images and news, and the possibility of recurrence of the disease are among the factors causing significant anxiety compared with past pandemics.2 With the outbreak of COVID-19 and subsequent changes such as unemployment in high-risk jobs, providing an emergency level of public health, and home quarantine, social and occupational relations and people lifestyles were strongly influenced. The number of deaths increased and strict measures were taken to control the disease’s spread in different world areas. One of the measures taken to control COVID-19 was home quarantine, which in itself can have a variety of consequences, including increased anxiety, stress and reduced sleep quality for individuals.3 Patients with or suspected of COVID-19 often experience fear and anxiety about the consequences of the deadly virus. People in the quarantine may also experience fatigue, loneliness, depression, and anger. Furthermore, some common symptoms of this disease, such as fever, body aches, loss of taste and smell, hypoxia, cough and dry throat, reduce sleep quality.4
The relationship between sleep quality and physical and mental health is evident to all. Sleep quality is a relatively complex and subjective concept that cannot be measured in the laboratory, and factors affecting each person’s quality of sleep can be different. In general, sleep duration, delay in falling asleep, sleep efficiency, sleep disorders, sleeping pills, and impaired daily functioning are significant factors that play a role in sleep quality.5 COVID-19 is a global pandemic that can affect the physical and mental health of individuals. Previous studies evaluating pandemic and infectious diseases such as SARS and Ebola virus have shown that pandemic diseases lead to disorders and reduced sleep quality in individuals.6 Studies in previous pandemic conditions have shown that the mental health of non-infected individuals was more affected than that of infected individuals so that those who were afraid of developing the disease reported more psychological problems.

Review Article

Treatment Approaches Based on Neuroscientific Data in Patients With Obsessive-Compulsive Disorder

Mohammad Ansari Asl, Parviz Asgari, Zahra Bakhti

International Clinical Neuroscience Journal, Vol. 8 No. 3 (2021), , Page 107-117


 Background: Obsessive-compulsive disorder (OCD) is a severe psychological disorder that can be very disabling. Recent increasing neuroscientific data about OCD has provided important evidence that has started to change our knowledge about treatment. This paper offers an applied perspective of neuroscience on diagnosis and treatment preparation for people with OCD disease. The main aim is to enhance clinician-researcher communication to promote the conversion of developments in neuroscience research into better treatment for patients with OCD.

Methods: A PubMed search was performed using the keywords “obsessive-compulsive disorder”, “neuroimaging methods”, “neuroscience”, and “neurological treatment”. The search provided sufficient articles published in peer-reviewed journals from 1995 to 2021. The data were obtained from these various sources and were included in this review.

Results: The advancement of neurotherapeutic techniques targeting the cortico-striatal-thalamo-cortical (CSTC) circuit is the subject of a circuit dysregulation system. Also, according to neuroimaging studies, reductions in D2 receptors (about -18%), GABAA receptors (-15%), and cingulate 5-HT1A receptors (-18%) in patients with OCD were reported compared with healthy controls.

Conclusion: The result suggests that DA, 5-HT, and GABA have considerable roles in anxiety- and compulsion-related disorders such as OCD. For patients with OCD, these core neuroscience themes collectively guide formulation and clinical preparation.

Original/Research Article

Introduction of a Simple and Minimally Invasive Approach for Access to Epidural Space in Cat

Asma Asadian, Mirsepehr Pedram, Mohammad mehdi Dehghan, Javad Sadeghinejad, Majid Masoudifard, Saeideh Eftekhari, Roja Ebrahimi

International Clinical Neuroscience Journal, Vol. 8 No. 3 (2021), , Page 118-123


 Background: Although various studied have been done to improve therapeutic strategies in resolving spinal cord injuries, robust clinical treatment is not yet available. Developing a standard animal model is essential to achieve effective treatment for such injuries. The present study was performed to introduce a simple, applicable, and minimally invasive approach for access to epidural space in cats.

Methods: We used a percutaneous approach from the lumbosacral junction for stainless steel cannula insertion to the epidural space without fluoroscopy. CT scan, conventional magnetic resonance imaging (MRI), tractography, and behavioral evaluation were used to assess the correct position of the cannula and the neurological condition of the animal.

Results: MRI results showed no significant change in signal intensity index of neural structures under lumbosacral junction. These observations are further supported by tractography, and also behavioral examination during the study.

Conclusion: We found that the percutaneous approach from the lumbosacral junction is a simple and applicable approach that has no side effects and artifact formation in MRI evaluation.

Effectiveness of Acceptance and Commitment Therapy on Occupational Stress and Anxiety of Nurses Caring for Patients With COVID-19 in Tehran

Hasan Mosazadeh, prof.Aleksandra Błachnio, Bijan Pirnia

International Clinical Neuroscience Journal, Vol. 8 No. 3 (2021), , Page 124-128

Background: This research aims to evaluate the impact of acceptance and commitment therapy (ACT) on the occupational stress and the anxiety of nurses.

Methods: This was an experimental study with pre-test post-test design with a control group. We included all nurses caring for patients with COVID-19 in governmental hospitals in Tehran during six months of 2020. Beck’s Anxiety Inventory (BAI) and Steinmetz Occupational Stress Questionnaire were used for data collection.

Results: Box’s test (P=0.225) showed that the covariance-variance matrices were homogeneous. Levine’s test also indicated that the assumption of variance equality was observed. The amounts of ETA square root showed that 66.3% of the anxiety variance and 51.3% of the occupational stress variance could be predicted in the posttest through ACT.

Conclusion: The rate of occupational stress and anxiety of the test group significantly decreased compared with the control group after the intervention. Therefore, ACT could decrease the occupational stress and anxiety of nurses and the therapists could use this approach for improving the mental health of nurses.

Geriatric Cerebrovascular Neurosurgery: Institutional Experience from Khoula Hospital

Abdulrahman Al-Mirza, Omar Al-Taei , Tariq Al-Saadi

International Clinical Neuroscience Journal, Vol. 8 No. 3 (2021), , Page 129-134


 Background: The aging of the healthy population without severe morbidity exposes them to cerebrovascular diseases and demand effective management. This study aimed to study the prevalence of geriatric cerebrovascular neurosurgical conditions in the Neurosurgical Department at Khoula Hospital, Muscat, Sultanate of Oman.

Methods: A retrospective chart review of was done on geriatric cases admitted to the Neurosurgery Department in Khoula Hospital as an example of a neurosurgical center in a high-income developing country from January 2016 to 31st December 2019. Patients’

demographics, risk factors, diagnosis, Glasgow Coma Scale (GCS) on arrival, medications used, and length of stay were recorded.

Results: 109 patients aged over 65 years were recruited in our retrospective review with a mean age of 74.12 years. Male-to-female ratio was (1.2:1). Intracerebral hemorrhage (ICH) was the most common vascular diagnosis (39.0%) followed by subarachnoid hemorrhage (SAH) (22.9%). Most patients (41.9%) had a GCS score of less than 8. About one-fifth of the patients received antiplatelet and anticoagulant medications. Most of the patients underwent surgical intervention (61.9%). 59% of the patients stayed in the hospital for less than 15 days. There were significant associations between the length of stay, treatment types (surgical vs. conservative), and age (P < 0.05).

Conclusion: Cerebrovascular pathologies are a growing cause of mortality and morbidity worldwide including developing countries because of the increasing number of elderly people. Antiplatelet medication and anticoagulants should be used with caution in the elderly.

Machine Learning-Based Clinical Adjusted Selection of Predicting Risk Factors for Shunt Infection in Children

Ehsan Moradi, Malihe Sabeti, Nasrin Shahbazi, Zohreh Habibi, Farideh Nejat

International Clinical Neuroscience Journal, Vol. 8 No. 3 (2021), , Page 135-143


 Background: Shunt Infection is a common complication of shunt insertion in children which can lead to bad neuro-developmental conditions and impose a considerable economic burden for the health care system. So, identifying predictive factors of shunt infection could help us in the proper improvement of this deteriorating condition.

Methods: In this study, related risk factors of 68 patients with history of shunt infection and 80 matched controls without any history of shunt infection, who were all operated in a single referral hospital were assessed. Three machine learning (ML)-based measures including sparsity, correlation, and redundancy along with specialist’s score were applied to select the most important predictive risk factors for shunt infection. ML was determined by summation of sparsity, correlation and redundancy measures, and the final total score was considered as normalization (ML-based score + specialist score).

Results: According to the total score, prematurity, first ventriculoperitoneal shunting (VPS) age, intraventricular hemorrhage (IVH), myelomeningocele (MMC) and low birth weight had higher weights as shunt infection risk factors. icterus, trauma, co-infection and tumor had the lowest weights and history of meningitis and number of shunt revisions were defined as intermediate risk factors.

Conclusion: The “ML-based clinical adjusted” method may be used as a complementary tool to help neurosurgeons in better patient selection and more accurate follow-up of children with higher risk of shunt infection.

The Comparing Bender-Gestalt Test and Quantitative Electroencephalography for Brain Trauma Diagnosis in Depressive and Attention Deficit Hyperactivity Disorders

Samaneh Shakeri, Reza Bidaki, Hamid Mirhosseini, Mina Kiani

International Clinical Neuroscience Journal, Vol. 8 No. 3 (2021), , Page 144-148


 Background: Some experts assert there is an association between traumatic brain injury and cognitive impairments such as attention deficit hyperactivity disorder (ADHD) and depressive disorder. Furthermore, children and adults with ADHD struggle with focusing, organizing tasks, and feeling restless. They might experience sadness, guilt, irritability, low self-confidence and helplessness. In this regard, ADHD and depressive disorder occasionally occur together. We aimed to compare the clinical application of the Bender-Gestalt test (BGT) and electroencephalography in screening brain damage in the patients with the mentioned disorders.

Methods: This was a cross-sectional study to assess diagnostic accuracy. Eighty patients with depression (n=35) and ADHD (n=45) resulting from brain damage aged 10-35 years who had been referred by the psychologist or psychiatrist to Imam Hossein Clinic in Yazd. Both the BGT and quantitative electroencephalography (QEEG) results existed in their files. Patients with any serious medical, other psychiatric disorders or history of drug dependency were excluded. Paired t test was used to analyze the differences.

Results: The brain damage score was different in the two tests. Based on the paired t test, the BGT was a more valid screening test. Also, the score of the two tests were different in the depression and ADHD mean scores (P < 0.05).

Conclusion: BGT was a more reliable tool compared to QEEG for diagnosing brain damage within the patients with the mentioned disorders.

Case Report

Hemorrhagic Posterior Reversible Encephalopathy Syndrome: A Rare Neurological Complication of COVID-19 Infection

Esmaeil Khan Mohammadi, Marziyeh Shahrabi , Mohsen Koosha

International Clinical Neuroscience Journal, Vol. 8 No. 3 (2021), , Page 149-152

Neurological complications of COVID-19 are well documented. However, there are limited reports of posterior reversible encephalopathy syndrome (PRES) associated with COVID-19 in the literature. Herein, we described a 21-year-old man with a history of bipolar disease and opioid addiction who was admitted because of COVID-19 infection. He suddenly experienced a convulsive status epilepticus following hypertension crisis. The patient was intubated and underwent antiepileptic and anti-hypertensive therapy. His brain imaging was compatible with PRES. The patient gradually improved and was eventually discharged after 40 days. On the next month follow-up, the patient was able to walk with a cane without a history of seizure. In this report, we aimed to highlight the less common cerebrovascular complication of COVID-19 infection.


Correction to “In Vitro Assessment of Synthetic Nano Engineered Graft Designed for Further Clinical Study in Nerve Regeneration”

Ali Sadeghi, Fatholah Moztarzadeh, Jamshid Aghazadeh Mohandesi, Claudia Grothe, Kirsten Haastert Talini, Ali Reza Zali, Reza Jalili Khoshnoud

International Clinical Neuroscience Journal, Vol. 8 No. 3 (2021), , Page 153

In the article entitled “In vitro assessment of synthetic nano engineered graft designed for further clinical study in nerve regeneration” which published in International Clinical Neuroscience Journal 2018;5(3)86-91, Figure 6 contained some errors, in which panels A, C, and D have been reported mistakenly. This mistake happened inadvertently during the data processing and data collection. The corrected Figure 6 and corresponding caption is presented in the present correction, in which the correct SEM images replaces in panels A, C, and D. The reader should note that this error does not affect the scientific quality of the work and no other section of the manuscript is affected by this error. In addition, the correction does not affect the conclusions of that paper. We would like to apologise for any inconvenience caused.