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Since the coronavirus disease 2019 (COVID-19) pandemic, due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, accumulating evidence indicates that SARS-CoV-2 infection may be associated with various neurological manifestations, including acute cerebrovascular events (i.e., stroke and cerebral venous thrombosis). These events can occur prior to, during and even after the onset of COVID-19’s general symptoms. Although the mechanisms underlying the cerebrovascular complications in patients with COVID-19 are yet to be fully elucidated, the hypercoagulability state, inflammation and altered angiotensin-converting enzyme 2 (ACE-2) signaling in association with SARS-CoV-2 may play key roles. ACE-2 plays a critical role in preserving heart and brain homeostasis. In this review, we discuss the current state of knowledge of the possible mechanisms underlying the acute cerebrovascular events in patients with COVID-19, and we review the current epidemiological studies and case reports of neurovascular complications in association with SARS-CoV-2, as well as the relevant therapeutic approaches that have been considered worldwide. As the number of published COVID-19 cases with cerebrovascular events is growing, prospective studies would help gather more valuable insights into the pathophysiology of cerebrovascular events, effective therapies, and the factors predicting poor functional outcomes related to such events in COVID-19 patients.

Since the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a growing body of evidence indicates that besides common COVID-19 symptoms, patients may develop various neurological manifestations affecting both the central and peripheral nervous systems as well as skeletal muscles. These manifestations can occur prior, during and even after the onset of COVID-19 general symptoms. In this Review, we discuss the possible neuroimmunological mechanisms underlying the nervous system and skeletal muscle involvement, and viral triggered neuroimmunological conditions associated with SARS-CoV-2, as well as therapeutic approaches that have been considered for these specific complications worldwide., Highlights • Patients with coronavirus disease 2019 (COVID-19) may variably develop neurological manifestations. • Neuroinflammation and autoimmunity may underlie COVID-19 neurological complications. • COVID-19 neuroimmunological complications include Guillain-Barré syndromes, myopathy, and encephalomyelitis. • Immunotherapy may variably improve outcome in COVID-19 related neuroimmunological complications.

The processing capabilities and advantages of mobile devices equipped with portable sensors provide the basis for new context-aware services and applications tailored to the user environment and daily activities. People on the move have a grown need for real-time information and services anytime and anywhere. Context information in mobile phones e.g., location, user activity, calendar and speed can significantly improve the user experience in the current situation. A review of the literature suggests that context awareness in mobile phone can be very helpful and considered as inevitable technique in future of mobile phone application. In this paper, we give a short review about context awareness and then critically analyzed related researches to the context awareness in mobile phone. Furthermore, we proposed an architecture to reduce cost of using Global Positioning System (GPS) and improves localization in indoors area. The review argues the weakness and strength of these studies, and aims to (a) indicate the most important context in mobile phone, (b) Improving localization in indoor areas (c) reducing battery consumption of GPS sensor in mobile phone.

Objective: Multiple sclerosis (MS) shows evidence of many distinctive aspects of an autoimmune disorder, including a polygenic inheritance. A recent candidate gene for susceptibility to MS is CD24, which has also been shown to be associated with disease progression. This study was designed to examine whether there is a relationship between the CD24 genotype, oligoclonal band (OCB) status and IgG index in the cerebrospinal fluid (CSF) of MS patients. Methods: A total of 27 definite MS patients were enrolled in this cross-sectional study. Blood samples were collected from a peripheral vein, and CSF was obtained by lumbar puncture. The CD24 gene was sequenced in the blood specimen, and albumin and IgG concentrations were measured in both CSF and serum. We compared both IgG index and OCB status in patients with and without CD24V/V. The correlation between MS severity score (MSSS), OCB status, CD24 genotype and IgG index was studied. Results: Only 15 patients were OCB positive. Among patients with negative OCBs, only 2 patients had the V/V genotype. Furthermore, in those with the V/V genotype, IgG index was not significantly elevated (p = 0.322). Patients with the V/V genotype had a significantly higher MSSS (p = 0. 04), but neither the presence of OCBs nor the IgG index showed significant correlation with MSSS (p = 0.379 and 0.20, respectively). Conclusion: We could not show any relationship between the CD24V/V genotype, OCB status and IgG index. This could be interpreted as indicating that the CD24V/V allele exerts its effects on the disease course independently of CSF IgG synthesis.

Objective: We conducted a longitudinal prospective study to evaluate the long-term effect of pregnancy on the progression of multiple sclerosis (MS). Method: Parous female MS patients were extracted from the database of Isfahan Multiple Sclerosis Society (IMSS). Through comparing the annual relapsing rate during a mean of 4 years before pregnancy versus a mean of 6 years after delivery, MS progression influenced by the pregnancy was analyzed. Result: 102 female patients were included in our study. The mean annual relapsing rate 4 years prior to pregnancy was significantly higher than at the subsequent 6 years after delivery (1.06 vs. 0.45, p < 0.001). In addition, the annual relapsing rate in years prior to pregnancy was significantly higher than each trimester of gestation (p < 0.001). Furthermore, there was a 2.2-fold increased risk of having a relapse in individuals who had experienced more relapses prior to pregnancy, and a 0.8-fold decreased in the risk of having more relapses with older age at the onset of MS. Conclusion: Although the course of MS was deteriorated 3 months after delivery, it was not statistically significant comparing annual relapsing rates during the years prior to pregnancy. Moreover, the rate of disease progression slowed down in the 6-year period monitored after delivery.

As one of the most common neurological disorders, restless legs syndrome (RLS) is generally underdiagnosed and undertreated. Considering the lack of knowledge regarding the world-wide epidemiology of this common neurological disorder, we carried out a study to estimate the distribution of RLS in Isfahan, a city in the center of Iran. During the one-month period from 8 August 2007 to 8 September 2007, patients older than 18 years referred to eight neurology clinics were asked to fill out two questionnaires. The first questionnaire was derived from the diagnostic criteria for RLS outlined by the International RLS Study Group (IRLSSG). The second covered sociodemographic conditions and some other parameters concerning the clinical characteristics of RLS. Of the 2099 responding patients, 168 (8.00%) fulfilled all four IRLSSG diagnostic criteria for RLS. Their mean age was 43.4 ± 16.63 SD and the prevalence in women (69.64%) was higher than in men (30.36%), with a female-to-male ratio of 1.75. We estimated the RLS prevalence to be 8% in the population of patients referred to the neurology clinics. Moreover, the sex-specific prevalence was 9.06% in females and 5.75% in males, results identical to previous observations in western countries.

Introduction: Metformin and sulfonylureas are different in their mechanism of action whether they manipulate insulin levels for diabetes treatment. We compared the cognitive impairment among type II diabetic patients treated with metformin or glibenclamide (from sulfonylureas group). Method: Within a randomized cross-sectional study, 314 subjects were recruited from Isfahan Endocrine and Metabolism Research Center, consisting of 4 groups. Group 1 was treated exclusively by metformin and Group 2 with glibenclamide, Group 3 was patients treated by diet and Group 4 was healthy individuals. Cognitive function was estimated among patients with Mini Mental State Examination (MMSE). Results: In diabetic groups mean MMS was significantly lower than healthy individuals (27.46±0.197 vs. 28.31±2.24, P-value=0.000). No difference was observed among diabetic groups. (Group1: 27.44±0.415, Group2: 27.61±0.405, Group3: 27.34±0.403, P- value=0.899).

Purpose We aimed to define the possible risk factors for acute and remote seizures in patients with cerebral vein and sinus thrombosis (CVST). Method Ninety-four patients were recruited prospectively at Al-Zahra Hospital, Isfahan, Iran, between April 2007 and April 2012. To identify seizure predictors, we compared demographic, clinical and imaging factors between patients with or without acute and remote seizures. Results Of the 94 patients, 32 (34%) experienced at least one seizure after CVST development. Bivariate analysis showed a significant association of remote seizure with loss of consciousness at presentation ( P =0.05, OR: 5.11, 95%CI: 1.07–24.30), supratentorial lesions ( P =0.02, OR: 9.04, 95%CI: 1.04–78.55), lesions in the occipital lobe ( P =0.00, OR: 12.75, 95%CI: 2.28–71.16), lesions in the temporal and parietal lobes, thrombophilia ( P =0.03, OR: 5.87, 95%CI: 1.21–28.39), seizure in the acute phase ( P =0.00, OR: 13.14, 95%CI: 2.54–201.2) and sigmoid sinus thrombosis ( P =0.00, OR: 12.5, 95%CI: 2.23–69.79). Seizures in the acute phase were also more common in patients with paresis ( P =0.00, OR: 4.88, 95%CI: 1.91–12.46), hemorrhagic lesions indicated by imaging ( P =0.02, OR: 2.77, 95%CI: 1.08–7.10), supratentorial lesions, lesions in the frontal ( P =0.01, OR: 3.81, 95%CI: 1.28–11.31) and parietal lobes ( P =0.00, OR: 5.16, 95%CI: 2–13.29), thrombophilia and history of miscarriage ( P =0.03, OR: 2.91, 95%CI: 1.07–7.91). No factor predicted acute or remote seizure in a multiple logistic regression analysis. Conclusion Our results demonstrate that seizure development in the acute phase is the most significant factor for development of remote seizure. Parenchymal lesions in the supratentorial area were also found to be associated with both acute and remote seizures. However, no factor was predictive of acute or remote seizures in a multivariate analysis.

Anti–aquaporin-4 (AQP4) autoantibody plays a key role in the pathogenesis of neuromyelitis optica (NMO). Studies have shown increased relapse rates in patients with NMO during pregnancy and postpartum. High estrogen levels during pregnancy can increase activation-induced cytidine deaminase expression, which is responsible for immunoglobulin production. Additionally, sex hormones may influence antibody glycosylation, with effects on antibody function. Estrogen decreases apoptosis of self-reactive B cells, through upregulation of antiapoptotic molecules. Furthermore, high estrogen levels during pregnancy can boost B-cell activating factor and type 1 interferon (IFN) production, facilitating development of self-reactive peripheral B cells in association with increased disease activity. Elevated levels of estrogen during pregnancy decrease IFN-γ generation, which causes a shift toward T helper (Th) 2 immunity, thereby propagating NMO pathogenesis. Women with NMO have an elevated rate of pregnancy complications including miscarriage and preeclampsia, which are associated with increased Th17 cells and reduction of T-regulatory cells. These in turn can enhance inflammation in NMO. Increased regulatory natural killer cells (CD56−) during pregnancy can enhance Th2-mediated immunity, thereby increasing inflammation. In the placenta, trophoblasts express AQP4 antigen and are exposed to maternal blood containing anti-AQP4 antibodies. Animal models have shown that anti-AQP4 antibodies can bind to AQP4 antigen in placenta leading to complement deposition and placental necrosis. Reduction of regulatory complements has been associated with placental insufficiency, and it is unclear whether these are altered in NMO. Further studies are required to elucidate the specific mechanisms of disease worsening, as well as the increased rate of complications during pregnancy in women with NMO.

Almost all patients who developed autoimmune thyroid disease associated with encephalopathy were diagnosed to have Hashimoto’s thyroiditis, but a few patients with Graves’ disease who developed encephalopathy have been reported. A 36-year-old female with a 10-year history of Graves’ disease had experienced three episodes of tonic–clonic seizure. At admission, the patient’s status was confused, and she also developed tactile and visual hallucinations. The cranial MRI confirmed white-matter lesion and showed subcortical high signal lesions on T2-weighted images. In EEG record, diffuse slow activity was noticed in both sides. T3 and TSH were decreased, T4 remained normal and thyroid peroxidase antibody (TPO) was evaluated to be more than 2,000 (T4 = 8.4, T3 = 12/9, TSH = 0/14, TPO >2,000). The diagnosis of autoimmune thyroid disease is probable in all patients with signs of encephalopathy with unknown origin, while they have a previous history of thyroid disease.

Exposure to heavy metals has been associated to a higher incidence of multiple sclerosis. In this work, we present a possible relationship between serum mercury levels and development of multiple sclerosis in Isfahan, the third largest city in Iran. Seventy-four patients affected by multiple sclerosis were retrieved from multiple sclerosis (MS) clinic in Isfahan, Iran. By matching sex and age, 74 healthy volunteers were chosen as control group. Blood samples were collected and serum mercury content was determined. Serum mercury level in MS patients was significantly higher than controls (9.6 ± 10.17 vs. 5.7 ± 8.6, P = 0.037). Concerning all MS patients, serum mercury value was significantly higher than the mercury concentration founded in control subjects {odd ratio: 2.39 (CI, 1.96–2.94), P = 0.00}. Serum mercury level is higher in MS patients with odd ratio equal to 2.39 compared with healthy individuals. It may reveal that high mercury levels in serum might help MS development in susceptible individuals. More studies with larger sample size are needed to confirm this hypothesis.