Low-frequency rTMS over the LE motor area can improve clinical measures of muscle spasticity and motor function. More studies are needed to clarify the changes underlying this improvement in spasticity. Implications for Rehabilitation Spasticity is a common disorder and one of the causes of long-term disability after stroke. Physical therapy modalities, oral medications, focal intervention and surgical procedures have been used for spasticity reduction. Beneficial effect of the repetitive transcranial magnetic stimulation (rTMS) for post-stroke upper extremity spasticity reduction and motor function improvement was demonstrated in previous studies. This study shows amelioration of lower extremity spasticity and motor function improvement after five daily sessions of inhibitory rTMS to the unaffected brain hemisphere which lasted for at least 1 week following the intervention.

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Background -The Covid-19 pandemic imposed the most devastating challenge on healthcare systems worldwide. Iran was among the first countries that had to confront serious shortages in RT-PCR testing for SARS-CoV-2 and ventilators availabilities throughout the COVID-19 outbreak. Results-998 patients (57% male, median age 54 years) with positive chest CT-scan changes were included in this study. Among them, 558 patients were examined with rRT-PCR test and 73·8% tested positive. Case fatality rate was 20·68% and 7·53% among test-positive and test negative hospitalized patients, respectively. While only 5·2% of patients were ICU admitted, case fatality rates outside ICU were 17·70% and 4·65% in test-positive and test-negative non-ICU admitted patients, correspondingly. The independent associates of death were age ≥ 70 years, testing positive with rRT-PCR test, having immunodeficiency disorders and ICU admission. Conclusions -Hospitalized COVID-19 patients with mild symptoms despite positive chest CT changes and major comorbidities were more probable to have negative rRT-PCR test result, hence lower case fatality rate and a more favorable outcome.

Background: Brucellosis as a zoonotic disease is controlled in many developed countries though it still remains endemic in the majority of Middle Eastern and developing countries. Objectives: The purpose of this study was to identify the demographic features, clinical manifestations, and laboratory tests of patients diagnosed with brucellosis in Ghazvin province of Iran. Methods: In this cross-sectional study, medical records of 83 cases with brucellosis (54 males and 29 females) over a 3-year period (from June, 2012 to June, 2015) were reviewed, retrospectively. Demographic features, clinical signs and symptoms, hematologic findings, and liver enzyme level were derived from the patients' medical record. Results: The mean age of cases was 42.5±18.3 years. Constitutional symptoms, which were noted in 45 (54%) cases, were the most common symptom of the disease. Clinical manifestations, including Sacroileitis, arthritis, and epididymo-orchitis were seen in 20 (24.1%), 10 (12%), and 7 (8.4%) cases, respectively. One case of Endocarditis (1.2%) was noted. Anemia as the most frequent blood abnormality was seen in 44 (53%) cases. Leukopenia and leukocytosis were noted in 17 (20.5%) and 9 (10.8%) patients, respectively. Thrombocytopenia and thrombocytosis were detected in 26 (31.3%) and 3 (3.6%) of the patients, respectively. Bicytopenia and pancytopenia were revealed in 9 (10.8%) and 11 (13.3%) cases, respectively. Elevated level of liver enzymes, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) were detected in 29 (34.9), 37 (44.6), and 51 (61.5) patients, respectively. Conclusions: Brucellosis could affect every organ system of the human body. Variable manifestations and laboratory findings of brucellosis must be kept in mind, especially in endemic areas.

Background: The coronavirus disease 2019 (COVID-19) pandemic imposed the most devastating challenge on healthcare systems worldwide. Iran was among the first countries that had to confront serious shortages in reverse-transcriptase-polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and ventilators availabilities throughout the COVID-19 outbreak. Objectives: This study aimed to investigate the clinical course of hospitalized COVID-19 patients with different real-time RT-PCR test results during the first three weeks of the outbreak in Qazvin province, Iran. Methods: In this retrospective cohort study, patients with a positive chest computed tomography (CT) scan for COVID-19 who were admitted to all 12 hospitals across Qazvin province, Iran, between February 20 and March 11, 2020, were included and followed up until March 27, 2020. A multivariate logistic regression model was applied to compare the independent associates of death among COVID-19 patients. Then, patients were categorized into six groups based on admission to the intensive care unit (ICU) and rRT-PCR test status (positive, negative, or no test). Also, multilevel logistic regression was used to compare the odds of surviving in each group against the reference group (PCR negative patients not-received ICU) to show if the rational allocation of ICU occurred while its capacity is limited. Results: In this study, we included 998 patients (57% male; median age: 54 years) with positive chest CT scan changes. Among them, 558 patients were examined with rRT-PCR test and 73.8% tested positive. Case fatality rate (CFR) was 20.68 and 7.53% among hospitalized patients with positive and negative tests, respectively. While only 5.2% of patients were admitted to the ICU, CFR outside ICU was 17.70 and 4.65% in patients with positive and negative results not admitted to the ICU, respectively. Conclusions: Total CFR in all hospitalized COVID-19 patients in Qazvin province during the first three weeks of the pandemic was 11.7%. Also, according to the results, the main risk factors included a positive rRT-PCR test, age more than 70 years, and having two or more comorbidities or just immunodeficiency disorders. Hence, the ICU admission criteria or prioritized ICU beds allocation should be considered with more emphasis on rRT-PCR results when the capacity of ICU beds is low.