Background: The combination of sofosbuvir and daclatasvir has shown preliminary efficacy for hospitalized patients with COVID-19 in four open-label studies with small sample sizes. This larger trial aimed to assess if the addition of sofosbuvir/daclatasvir to standard care improved clinical outcomes in hospitalized patients with COVID-19. Methods: This was a placebo-controlled, double-blind, randomized clinical trial in adults hospitalized with COVID-19 at 19 hospitals in Iran. Patients were randomized to oral sofosbuvir/daclatasvir 400/60 mg once-daily or placebo in addition to standard of care. Patients were included if they had positive PCR or diagnostic chest CT, O2 saturation <95% and compatible symptoms. The primary outcome was hospital discharge within 10 days of randomization. Secondary outcomes included mortality and time to clinical events. The trial is registered on the Iran Registry of Clinical Trials under IRCT20200624047908N1. Results: Between July and October 2020, 1083 patients were randomized to either the sofosbuvir/daclatasvir arm (n = 541) or the placebo arm (n = 542). No significant difference was observed in the primary outcome of hospital discharge within 10 days, which was achieved by 415/541 (77%) in the sofosbuvir/daclatasvir arm and 411/542 (76%) in the placebo arm [risk ratio (RR) 1.01, 95% CI 0.95–1.08, P = 0.734]. In-hospital mortality was 60/541 (11%) in the sofosbuvir/daclatasvir arm versus 55/542 (10%) in the placebo arm (RR 1.09, 95% CI 0.77–1.54, P = 0.615). No differences were observed in time to hospital discharge or time to in-hospital mortality. Conclusions: We observed no significant effect of sofosbuvir/daclatasvir versus placebo on hospital discharge or survival in hospitalized COVID-19 patients.

Purpose Transcranial magnetic stimulation (TMS) has emerged as a promising treatment for various neuropsychiatric conditions, including depression, obsessive–compulsive disorder, and Parkinson's disease. Recent research has focused on evaluating its effectiveness in treating patients with anorexia nervosa (AN). This systematic review and meta-analysis examined the impact of TMS on patients with AN and evaluated any potential adverse effects. Methods We conducted search according to PRISMA guidelines and comprehensively analyzed data from multiple databases, including Pubmed, Scopus, Embase, Web of Science, and the Cochrane Library, up to September 13th. Statistical analysis utilized the Comprehensive Meta-analysis software version 3.0. Results The systematic review encompassed 17 studies, with nine undergoing meta-analyses. The primary target for TMS was the dorsolateral prefrontal cortex, with two studies targeting the dorsomedial prefrontal cortex, one targeting the insula and one targeting the inferior parietal lobe. The findings revealed a significant increase in body mass index (BMI) following TMS (SMD: −0.025, 95% CI: −0.0505 to −0.005, P-value = 0.045). Additionally, the Eating Disorder Examination Questionnaire (EDE-Q) score was quantitatively reported in six studies, which permitted its inclusion in the meta-analysis. The analysis exhibited a significant decrease in EDE-Q score after TMS (SMD: 0.634, 95% CI: 0.349–0.919, P-value < 0.001). Subgroup analysis based on TMS session duration indicated that the effect size of TMS on EDE-Q score is more pronounced when the session duration exceeds 20 min. Conclusion TMS represents an effective therapy for patients with AN, leading to improvements in both BMI and core symptoms of AN, with minor and transient side effects. Level of evidence Level I, systematic reviews and meta-analyses.

Patients who have Parkinson's disease (PD) present several non-motor issues, such as sexual dysfunction. Deep brain stimulation (DBS) is a great treatment for PD and could affect both motor and non-motor symptoms of patients. The main goal of the current study is to evaluate the impact of DBS on the sexual dysfunction among patients with PD. Five databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library) were searched for records. Studies that measured the effect of DBS sexual function were included. The risk of bias assessment tool of non-randomized studies of interventions (ROBINS-I) was used to assess the quality of the included studies. The before and after data extraction and statistical analysis were performed using the Comprehensive Meta-analysis software (CMA) version 3.0. Ten studies were included in the systematic review; six of them were eligible to perform a meta-analysis with a total sample size of 532 participants and a mean age of 62.21 ± 1.59 years. All participants performed STN-DBS. The sexual function of participants after STN-DBS implantation significantly increased (SMD = -0.124, 95% CI: -0.209 to -0.038, P-value = 0.005). It also did not have any publication bias. Additionally, their quality of life mounts significantly (SMD = -0.712, 95% CI: -1.002 to -0.422, p-value <0.001). Our systematic review highlights the potential effect of STN-DBS on reducing the sexual dysfunction of patients with PD and boosting their quality of life.

Musicogenic epilepsy (ME) is a rare form of reflex epilepsy with a prevalence of 1 in 10,000,000. Recent research suggests a potential link between ME and autoimmune encephalitis, particularly involving glutamic acid decarboxylase 65‐isoform (GAD65) antibodies. A 48‐year‐old female presented with a one‐year history of music‐triggered seizures. Her episodes were characterized by an initial aura followed by unresponsiveness and oral automatisms. Electroencephalography revealed abnormalities in the left anterior temporal lobe and temporal leads. Laboratory studies showed positive anti‐GAD65 antibodies. The patient was treated with a combination of antiepileptic medication (Lamotrigine) and corticosteroids and intravenous immunoglobulin. This case contributes to the growing evidence supporting an association between ME and autoimmune mechanisms, particularly GAD65 antibody‐mediated autoimmunity. It highlights the importance of screening autoimmune factors in ME patients and highlights the need for further research into targeted treatment strategies.

Background: Synovial sarcoma is a rare soft tissue sarcoma, with incidences of 0.81/1,000,000 in children and 1.42/1,000,000 in adults. It is most commonly found in soft tissue and rarely in bone. It often has a slow growth pattern and a benign radiologic appearance. Case presentation: This study reports a case of metacarpal synovial sarcoma occurring in the hand-wrist of a 32-year-old Iranian man presented with the chief complaint of a lump on the dorsal ulnar side of his left hand and wrist. Initially, the first physician suspected the case to be a ganglion cyst. After two months of conservative treatment, the size of the lesion gradually increased. Magnetic resonance imaging (MRI) was performed and after an excisional biopsy and a postoperative histological analysis, the tumor was identified as a synovial sarcoma. The patient underwent a scheduled surgical procedure. Unfortunately, he had poor follow-ups and brought the pathologic results two months later when, the tumor had incredible growth, which makes this presentation rare. Conclusions: Since early diagnosis can lead to higher survival rates, this report increases doctors' awareness of this extremely malignant tumor that is rarely seen.