Purpose: To report a case of severe macular edema following the taking of fingolimod in MULTIPLE SCLEROSIS.Case Report: A 34-year-old woman with a long history of RELAPSING-REMITTING MULTIPLE SCLEROSIS presented complaining of blurred vision in the left eye that started 1 week before the presentation. She had been taking fingolimod for 4 months. She was not diabetic and had no history of uveitis but reported an episode of retrobulbar optic neuritis in both eyes. The initial ophthalmic examination, which was performed 2 weeks before initiating fingolimod, revealed a best corrected visual acuity (BCVA) of 20.25 OU and no ocular abnormalities. Upon the recent presentation, BCVA was 20.25 OD and 20.70 OS and there was no afferentpapillary defect. The examination of anterior segment and anterior vitreous was unremarkable. Retinal examination of the left eye revealed cystoid macular edema with no other inflammatory signs or vascular changes. The findings of spectral domain optical coherence tomography (SD-OCT) were compatible with macular edema and indicated that the central macular thickness (CMT) was 605 microns. Fingolimod was discontinued and sinarolac was started three times daily. After 6 weeks, BCVA was 20.25 OD and 20.30 OS.Macular edema was resolved clinically and SD-OCT exhibited a significant reduction in macular edema with a CMT of 277 microns.Conclusion: Fingolimod-associated macular edema is a benign complication of the drug used for MULTIPLE SCLEROSIS and. This complication responds well to the drug discontinuation and topical non-steroidal antiinflammatory administration.

Background: microRNAs are non-coding RNAs that modulate different types of cellular processes like differentiation and cell death. Hitherto several studies have been done to determine the expression profile of microRNAs in patients with MULTIPLE SCLEROSIS (MS) to obtain appropriate biomarkers. In previous studies, it was found that miR-145 was over-expressed. This up-regulation was in patients who did not start taking medicine. Therefore, in this study we assessed the effect of beta interferon on the expression of this microRNA in patients with MULTIPLE SCLEROSIS.Methods: We evaluated the expression pattern of miR-145 in 15 patients who did not start taking medicine and called treatment naive، in 15 patients who were under treatment and also 15 healthy people using real-time polymerase chain reaction method.Findings: The expression level of miR-145 in treatment naive patients was 3.9 fold of healthy people (P=0.005), whereas expression level of this microRNA between healthy people and under treatment patients was not significantly different.Conclusion: Down-regulation of miR-145 in under-treatment patients to the extent of healthy people suggests that probably, this microRNA could be used as predictive biomarker.

Background: Sexual problems are prevalent in women with MULTIPLE SCLEROSIS (MS), and sexual self-efficacy as an effective variable plays an important role in sexual health and sexual quality of life of these women. The aim of this study was to determine the predictors of sexual self-efficacy in women with MULTIPLE SCLEROSIS. Methods: This descriptive analytical study was conducted in Tehran, Iran, with participation of 200 women with MS, who referred to the Iranian MS society, had Expanded Disability Status Scale (EDSS) ≥ 7, and met the inclusion criteria in year 2019; they were selected using convenience sampling method. For data collection and assess the predictor factors of sexual self-efficacy in women with MS, related standard questionnaires were used. Data were analyzed using Pearson correlation coefficient, t-test, one-way ANOVA, and MULTIPLE linear regression model via SPSS software. Findings: The mean age of participants was 36. 33 ± 5. 22 years, and the mean score of sexual self-efficacy was 16. 54 ± 7. 27. After entering the significant variables derived from measuring the relationship between each variable individually with the score of sexual self-efficacy in MULTIPLE linear regression model for controlling confounders, sexual dysfunction (P = 0. 001), anxiety (P = 0. 024), stress (P = 0. 006), and the number of sexual intercourse (P = 0. 013) were significantly predictor factors of sexual self-efficacy in women with MS. Conclusion: The sexual dysfunction, anxiety, stress, and the number of sexual intercourse significantly predicted sexual self-efficacy in women with MS. Therefore, considering these factors in the treatment process of these patients can help to promote sexual self-efficacy and empower them in sexual life.

Background: MULTIPLE SCLEROSIS (MS) is the most prevalent inflammatory demyelinating disease that involves central nervous system. Cognitive disorders are common complaint of patients with MS. Hippocampus is a part of brain that plays significant role in cognition, and is highly sensitive to inflammatory changes induced by MS. This study was the first study conducted to assess hippocampal angle in cognitive disorders occur in patients with MS. Methods: This was a prospective cross-sectional study conducted on 39 patients with MS referred to university hospitals in Isfahan City, Iran, during 2015-17. Patients were divided to two groups of with cognitive and without cognitive disorders based on MULTIPLE SCLEROSIS Neuropsychology Questionnaire (MSNQ). Patients' age, gender, and Expanded Disability Status Score (EDSS) were evaluated. Then, all patients underwent magnetic resonance imaging (MRI) and hippocampal angle, bifrontal diameter (BFD), and third ventricle width (3VW) was measured based on their imaging. Findings: Cognitive dysfunction was significantly in association with patients age (P = 0. 013; B =-0. 164) and EDSS (P = 0. 005; B = 1. 23). No association was found between cognitive impairment and hippocampal angle (P = 0. 270), and EDSS was not significantly correlated with hippocampal angle as well (P = 0. 500, r = 0. 317). In addition, BFD and 3VW were not statistically in correlation with cognitive impairment (P > 0. 050). Conclusion: Based on findings of our study, there was no association between hippocampal angle and neurocognitive function of patients with MS. In addition, this angle was not affected by patients' age and gender as well. Further studies with larger sample populations and consideration of drug regimen and duration of disease are recommended.

Background: One of the diseases in the present century, which unfortunately affects the youths particularly the young girls and women, is the MULTIPLE SCLEROSIS (MS). The cause of this disease is still unclear in the view of medical specialists in the whole world. Given numerous number of MS patients and importance of identifying effective acts to promote their quality of life (QoL), this study accomplished to review the association between social support and the QoL of MS patients.Methods: This descriptive study selected 230 MS patients with simple random sampling method (164 females and 66 males). MS in Isfahan, Iran was measured with a questionnaire. The variables included socioeconomic, socio-cultural, services, patient relative recovery, life satisfaction, enhanced social status, sense of security, confidence, devotion and depression supports in a Likert scale measure. After determining the reliability and validity of the primary study, the final data were analyzed using descriptive statistics and Pearson’s correlation coefficient.Findings: Results of this study showed that there were 71.3% females, 35.7% married, and 30.9% employed subjects. Results showed that there was a statistical significant association between the social support and life satisfaction, enhanced social status, and life expectancy, motivation for accepting the disease and symptoms, increased confidence in MS patients (r=0.28; P<0.0001).Conclusion: The results suggested that the importance of social support can lead to a sense of satisfaction with life and hope in MS patients. However, the social supports financially, educationally, in terms of training and serviced may have an impression on MS patients’ welfare, but due to lack of a definite treatment for this disease, all the social support cannot have a statistical significant association with the relative improvement of the said sufferers.

Background: There is no a comprehensive study on early-onset MULTIPLE SCLEROSIS (EOMS) population on the role of well-known MS risk factors. Moreover, age at puberty and the critical window exposure to environmental risk factors is never investigated in neither adult nor pediatric MS population.Methods: A case-control study, including 97 patients with early-onset MS and 97 matched controls, was conducted in Isfahan MULTIPLE SCLEROSIS Society. Information on age at puberty, gestational risk factors, environmental exposures, and past medical history was obtained from medical charts and interviews.Findings: In logistic regression model, every year of decreasing in pubertal onset in females and males was associated with 1.766 and 2.250 folds increase in risk of early-onset MS, respectively. In utero exposure to cigarette smoking was significantly associated with 2.33 (P=0.010), and having smoker parents or passive smokers before puberty had 2.88 (P=0.006) fold in risk of early-onset MS. One hour less daily sun exposure increased the risk of early-onset MS as 2.007 folds (P<0.001) after adjustment for age and sex.Conclusion: In utero and parental exposure to smoking as well as history of measles and appendectomy are risk factors for early-onset MS. Future studies should shed more light on the true interaction between pineal gland, gender, smoking, sunlight and other environmental and genetic risk factors in adult and pediatric MS population.