Letter to Editor

Fungal Central Nervous System Infections in Patients With COVID-19

Mohammad Mahdi Rabiei, Alireza Zali, Sara Rahmati Roodsari, Zahra Arab-Mazar, Ensieh Lotfali

International Clinical Neuroscience Journal, Vol. 8 No. 4 (2021), 30 October 2021, Page 154-156

Recent studies have indicated that fungal co-infections have a major impact on the morbidity and mortality of patients with COVID-19. In these patients, the excessive production of inflammatory cytokines and the reduction in CD4 + T and CD8 + T cell count entails susceptibility to fungal infections.1 In addition to impaired cell-mediated immunity, comorbidities and immunosuppressive medications have a significant role in the development of fungal infections and have serious impacts on clinical outcomes.1-3

Review Article

Functional Roles and Biological Mechanisms of Circular RNAs and Their Encoded Peptides in Glioma: A Narrative Review

Seyedeh Zahra Bakhti, Sana Dadashi , Anahita Dah Pahlevan, Fatemeh Kafshresan

International Clinical Neuroscience Journal, Vol. 8 No. 4 (2021), 30 October 2021, Page 157-167

Circular RNAs (circRNAs) are a complicated class of non-coding RNAs that have a covalently closed loop structure and are very stable and cautious. Multiple biological processes of malignancy, including tumorigenesis, development, invasion, metastasis, apoptosis, and vascularization, are disrupted by an increased number of circRNAs. Recent research has showed that circRNAs, functioning as microRNA (miRNA) sponges or protein scaffolds, interacting with RNA-binding proteins (RBPs), and autophagy regulators, affect the transcription and splicing regulation. Many circRNAs have tissue-specific expression patterns and are heavily conserved. CircRNA levels in neurons are dynamically modulated. Growing evidence suggests that circRNAs are highly abundant in neural tissues, perhaps owing to the proliferation of particular genes that promote circularization, implying that circRNA dysregulation is linked to nervous system disorders including glioma. The most widespread and deadly primary malignant brain tumor is glioma. CircRNA has a close connection to glioma, according to reported research. Here, the current knowledge about the properties of circRNAs is introduced and the biological and molecular functions of circRNAs are described. Then, the clinical association of circRNAs with glioma/glioblastoma and their level of expression and their regulatory mechanisms in tumorigenesis are discussed. Moreover, the potential of circRNAs as diagnostic biomarkers and predictors of brain cancer risk and possible therapeutic targets in medicine is examined.

Original / Research Article

Factors Associated With Neurogenic Bowel Dysfunction Severity in Spinal Cord Injury: A Cross-sectional Study

Ida Mohammadi, Mohammadhosein Akhlaghpasand, Roozbeh Tavanaei, Maryam Golmohammadi, Alireza Zali, Saeed Oraee-Yazdani

International Clinical Neuroscience Journal, Vol. 8 No. 4 (2021), 30 October 2021, Page 168-174

Background: Neurogenic bowel dysfunction (NBD) caused by spinal cord injury (SCI) is a major life limiting issue for many patients. However, studies detailing the factors contributing to bowel problems are scarce. The aim of this cross-sectional questionnaire-based study was to evaluate the associations between different aspects of bowel problems and characteristics of SCI, such as time since injury (TSI), level of injury (LOI), and the cause of injury.
Methods: Two questionnaires (the NBD score questionnaire and the Cleveland clinic constipation system score questionnaire) were administered to complete, traumatic patients with SCI that matched the designated criteria. The total scores and the subscales were then regressed to TSI and LOI, and the distribution patterns of NBD score severity according to LOI and cause of injury were shown in a diagram.
Results: Within the subscales of the NBD score, frequency of defecation, digital stimulation or evacuation of the anorectum, and perianal skin problems were all significantly and positively correlated with the TSI, yet the frequency of fecal incontinence was negatively associated with this variable. Moreover, uneasiness, headache, or perspiration during defecation and regular use of drops against constipation were negatively associated with the LOI. In the diagrams, patterns of NBD score severity were similar according to LOI, but visibly differed according to cause. With respect to the CCCS score (Cleveland Clinic Constipation Scoring System), the score itself was shown to be positively associated with TSI. Within the subscales, difficulty, time spent in lavatory, and duration of constipation were positively correlated with TSI. Furthermore, type of assistance was negatively associated with the LOI.
Conclusion: Different characteristics of SCI, TSI, LOI, and cause, each are significantly and distinctly associated with different aspects of the bowel problems that patients with SCI face.

Evaluating the Components of Alexithymia in Patients With Obsessive-Compulsive Disorder

Mina Bozorg; Changiz Rahimi, Nurallah Mohammadi

International Clinical Neuroscience Journal, Vol. 8 No. 4 (2021), 30 October 2021, Page 175-179

Background: This study aimed to evaluate the differences in alexithymia components between patients with obsessive-compulsive disorder (OCD) and normal individuals.
Methods: In this ex-post facto study, 23 obsessive-compulsive outpatients’ selected by available sampling method and 22 personnel of the same hospitals (Taft Comprehensive Psychiatric Hospital, Imam Ali, Shahid Rahnemoon, and Baghayipoor Clinics) were selected as a control group in 2015 in Yazd, Iran. Yale-Brown Obsessive-Compulsive and Toronto Alexithymia Scale-20 were used in this study.
Results: Data were analyzed by multivariate analysis of variance (MANOVA). The results showed that patients with OCD were significantly different from the control group in the total alexithymia score (F=7.232, P=0.01). However, both groups had significant differences only in the subscale of difficulty in identifying feelings.
Conclusion: It can be concluded that both groups had significant differences in the total alexithymia score and one of its subscales.

A Novel Spike-Wave Discharge Detection Framework Based on the Morphological Characteristics of Brain Electrical Activity Phase Space in an Animal Model

Saleh Lashkari, Ali Moghimi, Hamid Reza Kobravi, Mohamad Amin Younessi Heravi

International Clinical Neuroscience Journal, Vol. 8 No. 4 (2021), 30 October 2021, Page 180-187

Background: Animal models of absence epilepsy are widely used in childhood absence epilepsy studies. Absence seizures appear in the brain’s electrical activity as a specific spike wave discharge (SWD) pattern. Reviewing long-term brain electrical activity is time-consuming and automatic methods are necessary. On the other hand, nonlinear techniques such as phase space are effective in brain electrical activity analysis. In this study, we present a novel SWD-detection framework based on the geometrical characteristics of the phase space.
Methods: The method consists of the following steps: (1) Rat stereotaxic surgery and cortical electrode implantation, (2) Long-term brain electrical activity recording, (3) Phase space reconstruction, (4) Extracting geometrical features such as volume, occupied space, and curvature of brain signal trajectories, and (5) Detecting SDWs based on the thresholding method. We evaluated the approach with the accuracy of the SWDs detection method.
Results: It has been demonstrated that the features change significantly in transition from a normal state to epileptic seizures. The proposed approach detected SWDs with 98% accuracy.
Conclusion: The result supports that nonlinear approaches can identify the dynamics of brain electrical activity signals.

Effectiveness of Emotion Regulation Training and Assertiveness Training on Resilience and Clinical Symptoms of Students with Generalized Anxiety Disorder

Masoud Ahmadi, Masoud Ghasemi, Mansoureh Shahriari Ahmadi

International Clinical Neuroscience Journal, Vol. 8 No. 4 (2021), 30 October 2021, Page 188-192

Background: Generalized anxiety disorder is among the most common psychiatric disorders. We aimed to compare the effectiveness of emotion regulation training and assertiveness training on resilience and clinical symptoms of students with generalized anxiety disorder.
Methods: This study was a quasi-experimental pretest-posttest study with a control group. The statistical population included all 16-18 years old male high school students in Karaj who were studying in the academic year 2019-2020, of whom 75 were selected by multi-stage random sampling and assigned to two groups of 25. Participants in experimental group 1 received eight sessions of assertiveness training for 60 minutes per week. Participants in experimental group 2 received five sessions of emotion regulation training for 60 minutes per week, and participants in the control group did not receive any intervention. The Generalized Anxiety Disorder and Resilience questionnaires were used to collect data.
Results: Multivariate analysis of covariance (MANCOVA) showed that both assertiveness and emotion regulation training programs increased resilience and reduced clinical signs of generalized anxiety disorder in the experimental groups (P < 0.001). Moreover, there was no significant difference between the effectiveness of the two training programs.
Conclusion: It is suggested that assertiveness and emotion regulation training be provided for students and included in their curriculum, to enhance assertiveness and emotion regulation skills.

The The Research Status of Neurological Surgery Residents; A Survey of Iranian Residency Programs

Mohammad Hossein Khosravi, Afsaneh Mehri, Sama Jabbaripour, Fatemeh Kazemi, Zahra Khosravi, Sayedali Ahmadi

International Clinical Neuroscience Journal, Vol. 8 No. 4 (2021), 30 October 2021, Page 193-197

Background: Research activities promote the appreciation for evidence-based medicine (EBM), quality patient care and clinical competence of resident physicians. We decided to investigate the research background of Iranian neurological surgery residents and their attitude toward research through a survey.
Methods: This cross-sectional study was done on Iranian neurological surgery resident physicians between February and April 2020. We provided an online survey, including 13 questions, using Google form and then sent the link to survey via WhatsApp application. Following the first post, two more reminders were sent to the groups after 2 and 4 weeks.
Results: Responses were received from 89 respondents from which about 88% used to spend two hours or less per week for research. Almost equal numbers of resident physicians chose academic position (n = 43) or private practice (n = 39) as their future job. Only seven respondents stated immigration for assumed future job position. Clinical research (47%) was the most frequent type of research done by participants and clinical research education (43.2%) during medical school was the most common way of obtaining research experience. Agreement with doing research during residency program (45.6%) was more than disagreement (22.4%) and neutral attitude (32%).
Conclusion: There is a low tendency among Iranian neurological surgery residents for conducting research projects during their programs. Lack of a proper research curriculum, heavy clinical duties and consequent shortage of time as well as insufficient encouraging points, are the main reasons. Designing a research plan for residency programs may successfully increase the research involvement rate.

Case Report

Spontaneous spinal epidural hematoma: Two cases report and the literature review

Duc Duy Tri Tran, Quoc Bao Nguyen, Van Tri Truong, Thai Duong Truong, Dinh Thanh Phan, Thanh Minh Nguyen

International Clinical Neuroscience Journal, Vol. 8 No. 4 (2021), 30 October 2021, Page 198-204

Spontaneous spinal epidural hematoma (SSEH) is a rare disease but may lead to life-threatening consequences if not timely diagnosed and managed. Emergent hematoma evacuation is indicated before neurological deficits become irreversible. We report two cases. The first case was a 45-year-old man brought to hospital because of an acute onset of quadriparesis and urinary incontinence. His cervical magnetic resonance imaging (MRI) showed an epidural hematoma at the C5-C6 level with severe spinal cord compression. He underwent an emergency C5-C6 right hemi-laminotomy to remove the clot and decompress the cord. Postoperatively, his left-sided deficits immediately resolved. His urinary function returned to normal two weeks after the surgery. He could independently walk two months later. The second case was a 57-year-old man admitted to the hospital because of severe neck pain and paresthesia in both arms. He had been using an antiplatelet for two months. His MRI revealed an epidural hematoma from C2 to C4 with spinal cord compression on the right. This patient was successfully treated with conservative treatment. If SSEH is left undiagnosed and untreated, the neurological deficits may be permanent. Early emergent hematoma evacuation contributes to a favorable outcome. Conservative management is reasonable if neurological deficits are not severe.

Atypical Finding of MRI in a CLN type 5 patient

Antonio Gomes Lima Júnior, Nina Maia Pinheiro de Abreu, João Paulo Carmo Rodrigues, Marcus Vinícius Buratti Leal, Anielly Sampaio Clarindo, André Luiz Santos Pessoa, Laura Vitória Melo Gomes, Antonio Helder Costa Vasconcelos, Pablo Coimbra de Araujo Coimbra

International Clinical Neuroscience Journal, Vol. 8 No. 4 (2021), 30 October 2021, Page 205-207

Ceroid neuronal lipofuscinosis (CLN) is a rare group of autosomal recessive neurodegenerative diseases that cause developmental delay and seizures. Herein, we present a case of a 7-year-old girl who referred for magnetic resonance imaging (MRI) following cognitive impairment and seizures. MRI was performed demonstrating some usual findings, and, surprisingly, a normal-sized cerebellum. This case draws attention to not hold to just the classical imaging presentation in order to suspect some leukodystrophy.

Migraine Headache as a Presenting Feature of Multiple Sclerosis: A Case Report

Mohammad Mahdi Rabiei, Zahra Cheraghi, Mahtab Ramezani, Hossein Pakdaman

International Clinical Neuroscience Journal, Vol. 8 No. 4 (2021), 30 October 2021, Page 208-211

Multiple sclerosis (MS) is a chronic inflammatory disease, causing neuronal demyelination and axonal damage in the central nervous system. Symptoms of MS vary widely because of different grades of sensory, motor, and cognitive dysfunctions. Although headache as the initial symptom of MS is rare, it is a common comorbidity that affects most patients. However, it is unclear that the headache manifestation in newly diagnosed people with MS should be considered as an MS attack or merely a comorbid condition. We report the case of a 31-year-old woman with newly diagnosed MS who presented with exacerbation of headache episodes without any abnormal neurological exam findings. The headaches did not respond to nonsteroidal anti-inflammatory drugs and triptans. After administration of methylprednisolone, the headaches were significantly improved, and during 3 months of follow-up receiving glatiramer acetate, no episode of headache has occurred. This case demonstrates the possible relationship between migraine and MS in newly diagnosed patients. New-onset headaches, a change in the pattern of previous episodes, and inadequate clinical drug response to headache treatment should all be taken seriously and warrant further investigation. Thereby, early diagnosis and proper treatment for patients with MS could improve their quality of life.