Time of interferon-β 1a injection and duration of treatment affect clinical side effects and acute changes of plasma hormone and cytokine levels in multiple sclerosis patients

During initiation of interferon-beta (IFN-β) therapy, many multiple sclerosis (MS) patients experience systemic side effects which may depend on the time point of IFN-β injection. We investigated the time course of plasma hormone-, cytokine- and cytokine-receptor concentrations after the first injection of IFN-β either at 8.00 a.m. (group A) or at 6.00 p.m. (group B) and quantified clinical side effects within the first 9 h in 16 medication free patients with relapsing-remitting MS. This investigation was repeated after 6-month IFN-β therapy. Plasma ACTH and cortisol concentrations followed their physiological rhythms, with lower levels in the evening compared to the morning, but raised earlier and stronger in group B after IFN-β administration. IFN-β injection in the evening led to a prompter increase of plasma IL-6 concentrations and temperature during the first hours and correlated to more intense clinical side effects compared to group A. Plasma IL-10 concentrations increased more in group A compared to group B, but sTNF-RI and sTNF-RII concentrations raised 7 h after IFN-β injection only in group B. Acute effects on plasma hormone and cytokine concentrations adapted after 6-month IFN-β treatment, while diurnal variations were still present. Baseline sTNF-RII concentrations were elevated after 6-month IFN-β therapy only in group A. Our results show that time point of IFN-β injection has differential effects on acute changes of plasma hormone and cytokine concentrations and is related to systemic side effects. This may have implications on the tolerability and effectiveness of IFN-β therapy. Multiple Sclerosis 2007; 13: 1138—1145. http://msj.sagepub.com

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Anal sphincter dysfunction in multiple sclerosis: an observation manometric study

Open Medicine ◽

10.1515/med-2016-0088 ◽

2016 ◽

Vol 11 (1) ◽

pp. 509-517 ◽

Cited By ~ 3

Author(s):

Silvia Marola ◽

Alessia Ferrarese ◽

Enrico Gibin ◽

Marco Capobianco ◽

Antonio Bertolotto ◽

...

Keyword(s):

Multiple Sclerosis ◽

Fecal Incontinence ◽

Anal Pressure ◽

Before And After ◽

Group A ◽

The Difference ◽

Resting Anal Pressure ◽

Group B ◽

Multiple Sclerosis Patients ◽

Group D

AbstractConstipation, obstructed defecation, and fecal incontinence are frequent complaints in multiple sclerosis. The literature on the pathophysiological mechanisms underlying these disorders is scant. Using anorectal manometry, we compared the anorectal function in patients with and without multiple sclerosis.136 patients referred from our Center for Multiple Sclerosis to the Coloproctology Outpatient Clinic, between January 2005 and December 2011, were enrolled. The patients were divided into four groups: multiple sclerosis patients with constipation (group A); multiple sclerosis patients with fecal incontinence (group B); non-multiple sclerosis patients with constipation (group C); non-multiple sclerosis patients with fecal incontinence (group D). Anorectal manometry was performed to measure: resting anal pressure; maximum squeeze pressure; rectoanal inhibitory reflex; filling pressure and urge pressure. The difference between resting anal pressure before and after maximum squeeze maneuvers was defined as the change in resting anal pressure calculated for each patient.ResultsGroup A patients were noted to have greater sphincter hypotonia at rest and during contraction compared with those in group C (p=0.02); the rectal sensitivity threshold was lower in group B than in group D patients (p=0.02). No voluntary postcontraction sphincter relaxation was observed in either group A or group B patients (p=0.891 and p=0.939, respectively).ConclusionsThe decrease in the difference in resting anal pressure before and after maximum squeeze maneuvers suggests post-contraction sphincter spasticity, indicating impaired pelvic floor coordination in multiple sclerosis patients. A knowledge of manometric alterations in such patients may be clinically relevant in the selection of patients for appropriate treatments and for planning targeted rehabilitation therapy.

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Atorvastatin Combined To Interferon to Verify the Efficacy (ACTIVE) in relapsing— remitting active multiple sclerosis patients: a longitudinal controlled trial of combination therapy

Multiple Sclerosis Journal ◽

10.1177/1352458509358909 ◽

2010 ◽

Vol 16 (4) ◽

pp. 450-454 ◽

Cited By ~ 53

Author(s):

Roberta Lanzillo ◽

Giuseppe Orefice ◽

Mario Quarantelli ◽

Carlo Rinaldi ◽

Anna Prinster ◽

...

Keyword(s):

Multiple Sclerosis ◽

Low Dose ◽

Interferon Beta ◽

High Dose ◽

Contrast Enhanced ◽

Relapsing Remitting ◽

Group A ◽

Group B ◽

Multiple Sclerosis Patients ◽

High Dose Interferon

A large body of evidence suggests that, besides their cholesterol-lowering effect, statins exert anti-inflammatory action. Consequently, statins may have therapeutic potential in immune-mediated disorders such as multiple sclerosis. Our objectives were to determine safety, tolerability and efficacy of low-dose atorvastatin plus high-dose interferon beta-1a in multiple sclerosis patients responding poorly to interferon beta-1a alone. Relapsing—remitting multiple sclerosis patients, aged 18—50 years, with contrast-enhanced lesions or relapses while on therapy with interferon beta-1a 44 µg (three times weekly) for 12 months, were randomized to combination therapy (interferon + atorvastatin 20 mg per day; group A) or interferon alone (group B) for 24 months. Patients underwent blood analysis and clinical assessment with the Expanded Disability Status Scale every 3 months, and brain gadolinium-enhanced magnetic resonance imaging at screening, and 12 and 24 months thereafter. Primary outcome measure was contrast-enhanced lesion number. Secondary outcome measures were number of relapses, EDSS variation and safety laboratory data. Forty-five patients were randomized to group A ( n = 21) or B ( n = 24). At 24 months, group A had significantly fewer contrast-enhanced lesions versus baseline ( p = 0.007) and significantly fewer relapses versus the two pre-randomization years ( p < 0.001). At survival analysis, the risk for a 1-point EDSS increase was slightly higher in group B than in group A (p = 0.053). Low-dose atorvastatin may be beneficial, as add-on therapy, in poor responders to high-dose interferon beta-1a alone.

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MISSED ABORTION

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.02.2433 ◽

2010 ◽

Vol 17 (02) ◽

pp. 295-299

Author(s):

IKRAMULLAH KHAN ◽

IK TIAR ◽

NOREEN SHEZADI

Keyword(s):

Side Effects ◽

First Trimester ◽

Cervical Dilatation ◽

Systemic Effects ◽

Lower Abdomen ◽

Cervical Priming ◽

Group A ◽

Systemic Side Effects ◽

Vaginal Misoprostol ◽

Group B

Objective: To compare the effectiveness of extra-amniotic cervical catheter and vaginal misoprostol as a cervical priming agent prior to surgical evacuation in first trimester missed abortions. Design: Randomized clinical trial. Setting: At lady Willingdon hospital gynecology unit 1 from 1st March 2008 to 28th February 2009. Methods: 100 patients with diagnosis of missed abortions of up to 12 weeks + 6 days were studied. The primigravida were included. They were divided in two groups. In group. A (50) patients 400 microgram (2 tablet ) misoprostol were placed high up in posterior vaginal fornix while in group B (50) patients extra-amniotic. Foleys catheter was placed aseptically 6 hour before surgical intervention as priming agent. Exclusion criteria: All multigravida, patients sensitive to prostaglandin, and with disturbed coagulation were excluded. Main Outcome Measures: The main out comes are 1, cervical dilatation and effacement 2,complications like fever, pain lower abdomen, headache and vomiting 3, amount of bleeding in ml after application of agent. Results: Cervical catheter proved to be good cervical priming agent comparable to misoprostol. Cervical dilatation was significantly better in misoprostol (> 10 mm 44%, > 8mm 30%, > 5mm 20%) as compared to Foleys group (>10 mm 24%, > 8mm 38%, > 5mm 20%) while in 3 (6%) dose of misoprostol was repeated and in 10 (20%) patient in Foleys group has no effect. The side effects occurred in both groups but systemic effects were more in misoprostol, pain lower abdomen 42% VS 46%, backache 18% VS 26%, fever 10% VS nil, headache 16% VS nil and no side effect 14% VS28%) as compared to Foleys catheter. Systemic effects were absent in Foleys catheter due to inert nature. Bleeding occurred in all patientswith misoprostol while it was absent in 48% cases in Foleys group (>60ml 42% VS 8%, <40ml 32% VS 14% < 20ml 26% VS 30%). 48% cases had no bleeding in Foleys group. Conclusion: Cervical catheter proved to be good priming agent due to lesser systemic side effects as compared to misoprostol.

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A PROSPECTIVE STUDY TO ANALYSE THE SIDE EFFECTS OF OLMESARTAN MEDOXOMIL AND ENALAPRIL IN HYPERTENSIVE SUBJECTS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i12.25460 ◽

2018 ◽

Vol 11 (12) ◽

pp. 258

Author(s):

Parminderpal Singh ◽

Kiranjit Kiranjit

Keyword(s):

Drug Therapy ◽

Side Effects ◽

Postural Hypotension ◽

Olmesartan Medoxomil ◽

National Commission ◽

Group A ◽

Group B ◽

Taste Alteration ◽

A Prospective Study

Objective: The present study was aimed to analyze the side effects of olmesartan medoxomil and enalapril in hypertensive subjects.Methods: The study consisted of newly diagnosed hypertension categorized according to 7th report of Joint National Commission on prevention, detection, evaluation, and treatment of high blood pressure. The subjects were divided into two groups. The Group A subjects received olmesartan, and Group B subjects received enalapril. Pressure was recorded both in supine and sitting positions. The appearance of side effects was observed in the follow-up, i.e., dry cough, headache, postural hypotension, angioedema, dizziness, skin rashes, taste alterations, and urticaria. A statistical data were prepared on the basis of information obtained and analyzed thoroughly for antihypertensive effects and side effects of olmesartan and enalapril. SPSS software was used for analysis.Results: There was observed an increase in the incidence of taste alteration with drug therapy in Group B (Enalapril). There was observed an increase in the incidence of postural hypotension with drug therapy in both groups. In Group A (Olmesartan), the incidence of postural hypotension at the beginning of trial, 4 weeks, and 8 weeks was 0%, 2%, and 2%, respectively. In Group A (Olmesartan), there was no incidence of a headache at the beginning of trial, at 4 weeks and 8 weeks.Conclusion: From the study, it can be concluded that both olmesartan and enalapril are effective in Stage I and Stage II hypertension, but olmesartan is tolerated well with lesser side effects.

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Stopping Disease-Modifying Therapy in Nonrelapsing Multiple Sclerosis

International Journal of MS Care ◽

10.7224/1537-2073.2015-032 ◽

2017 ◽

Vol 19 (1) ◽

pp. 11-14 ◽

Cited By ~ 16

Author(s):

Gary Birnbaum

Keyword(s):

Multiple Sclerosis ◽

Acute Disease ◽

Published Data ◽

Secondary Progressive ◽

Disease Modifying Therapy ◽

Scale Scores ◽

Group A ◽

Multiple Variables ◽

Disease Modifying ◽

Group B

Background: Current disease-modifying therapies (DMTs) are of benefit only in people with relapsing forms of multiple sclerosis (RMS). Thus, safely stopping DMTs in people with secondary progressive MS may be possible. Methods: Two groups of patients with MS were studied. Group A consisted of 77 patients with secondary progressive MS and no evidence of acute central nervous system inflammation for 2 to 20 years. These patients were advised to stop DMTs. Group B consisted of 17 individuals with RMS who stopped DMTs on their own. Both groups were evaluated at treatment cessation and for a minimum of 1 year thereafter. Multiple variables were assessed to determine those that predicted recurrent acute disease. Results: Nine patients in group A (11.7%) and ten patients in group B (58.8%) had recurrent acute disease, almost always within 1 to 2 years of stopping treatment. The only variable of significance in group A distinguishing stable and relapsing patients was age (P = .0003), with relapsing patients being younger. Group B patients were younger and had significantly lower Expanded Disability Status Scale scores than group A, with no significant differences in age between relapsed and stable patients. Conclusions: The DMTs can be stopped safely in older patients with MS (≥7 decades) with no evidence of acute disease for 2 years or longer, with an almost 90% probability of remaining free of acute recurrence. The high proportion of untreated patients with RMS experiencing recurrent acute disease is consistent with published data.

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Prophylactic corneal cross-linking in LASIK surgery: effects on visual outcome and recovery time

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v17i1.451 ◽

2020 ◽

Vol 17 (1) ◽

pp. 61-68

Author(s):

Dominique Clare Oh ◽

Yiong Huak Chan ◽

Sao Bing Lee ◽

Jovina Li Shuen See

Keyword(s):

Visual Acuity ◽

Side Effects ◽

Recovery Time ◽

Visual Outcome ◽

Cross Linking ◽

Safe Procedure ◽

Distance Visual Acuity ◽

Visual Outcomes ◽

Group A ◽

Group B

Introduction: Collagen cross-linking is a useful adjunct in preventing corneal ectasia after laser-assisted in situ keratomileusis (LASIK). This study aimed to evaluate whether prophylactic cross-linking in IntraLase LASIK affects optimum visual outcome and recovery time in the immediate post-surgery period and is associated with any side effects. Methods: This was a retrospective case study on the right eyes of 100 Chinese subjects aged 18 to 40 years who underwent IntraLase LASIK. Fifty subjects who underwentcross-linking after completing LASIK (Group A) were compared with 50 subjects who did not undergo LASIK (Group B). Cases were evaluated for pre- and post-operative spherical equivalent, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), recovery time and presence of side effects. Results: At 1 week post-LASIK, mean (SD) UDVA of Group A subjects was poorer than Group B, at 1.05 (0.19) vs 1.17 (0.19) (p = 0.036); however, there was no significant difference in CDVA (p = 0.095). By 1 month post-LASIK, differences in both UDVA and CDVA were insignificant (p = 0.055, 0.106, respectively). Mean recovery time was 2.72 (95% confidence interval [CI] = 0.64-4.7) days longer in Group A (p = 0.010), although by 1 month post-LASIK, both groups were able to achieve CDVA equal to or better than that achieved pre-LASIK. Incidence of mild inflammation and dry eyes post-LASIK was similar in both groups (p = 1.00, 0.749, respectively); no other complications were observed. Conclusion: No differences in visual outcomes at and occurrence of side effects at 1 month post-LASIK were observed between subjects who underwent cross-linking prior to refractive surgery and those who did not. However, the group that underwent cross-linking had a slightly longer mean recovery time. Our study supports prophylactic cross-linking as a safe procedure that does not affect immediate visual outcomes among the Chinese population when used in adjunct with LASIK surgery.

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BIOBRAN MGN-3

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.01.4869 ◽

2012 ◽

Vol 20 (01) ◽

pp. 13-16

Author(s):

Ahmad Ijaz Masood ◽

RABEETA SHEIKH ◽

RANA ATIQUE ANWER

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Hair Loss ◽

White Blood Cells ◽

Food Supplement ◽

Severe Nausea ◽

Treatment Side Effects ◽

Group A ◽

Group B

Objective: The aim of study was to assess the effect of Biobran in reducing of chemotherapy induced side effects in termsof tiredness, anorexia, vomiting and hair loss and quality of life in terms of weight loss. Setting: Radiotherapy Department, NishtarHospital Multan. Material and Methods: Fifty patients of breast cancer were enrolled randomly in two groups. Group-A patients weregiven 3 gram dose of Biobran MGN-3 per day one week before and one week after chemotherapy. Group-B patient were givenchemotherapy alone. Total six cycles of chemotherapy were given. No multivitamin or food supplements were given during this study.Chemotherapy induced side effects (tiredness, anorexia, and vomiting, hair loss) were assessed by questionnaire to the patients beforestart of each cycle. Weight was checked before each cycle to assess weight gain or loss. White blood cells were checked by completeblood count just before and one week after chemotherapy. Results: Between six months, 50 patients were enrolled in RadiotherapyDepartment, Nishtar Hospital Multan. There was a significant reduction in tiredness and anorexia in group-A patients. 20 (80%) patients ofgroup-A felt increase in their diet and no tiredness without any appetizer or multivitamin. But group-B patients demanded for appetizer dueto severe anorexia after chemotherapy except 3 (12%) patients who didn’t use any appetizer or food supplement. In group-A, 15 (60%)patients didn’t need any anti-emetic as compared to group-B all patient (100%) experienced severe nausea during and afterchemotherapy. Group-A patients experienced less hair fall 7 (28%) patients as compared to other group which is 25 (100%) patients.Conclusions: The study showed that, by helping to optimize the immune system, Biobran MGN-3 can not only help maximize treatmentsuccess, but also minimize treatment side effects and improve quality of life during treatment and in recovery.

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A Comparison of Oral Gabapentin and Oral Pregabalin as Preemptive Analgesia for Orthopedic Surgery Under Spinal Anaesthesia

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0901.15 ◽

2021 ◽

Vol 9 (1) ◽

pp. 74-78

Author(s):

Neena Jain ◽

Rahul Bankapur ◽

Preeti Lamba ◽

saurav Singh

Keyword(s):

Side Effects ◽

Postoperative Pain ◽

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Orthopedic Surgery ◽

Lower Limb ◽

Analgesic Efficacy ◽

Double Blind Study ◽

Group A ◽

Group B

Background and Aims: Gabapentin and pregabalin, by decreasing noxious stimulus induced excitatory neurotransmitter release at central nervous system, may attenuate central sensitization and eventually decrease development of postoperative pain. We evaluated preemptive analgesic efficacy of single dose of oral gabapentin 600 mg and pregabalin 75mg for postoperative pain in patients undergoing lower limb orthopedic surgery under spinal anesthesia. Material and methods: A prospective, randomized, double blind study was conducted on 70 patients aged between 18 to 60 years with ASA grade 1 and 2 posted for lower limb surgeries under spinal anaesthesia. Patients were allocated into Group A and Group B receiving oral gabapentin(600mg) and oral pregabalin (75mg) respectively 1.5 hours before surgery. Primary objective was assessing duration and quality of analgesia by Visual Analogue Scale (VAS) score at 2,4,6,8,10,12,16,20 and 24 hours.Secondary objective was to assess total dose of rescue analgesic in first 24 hours, perioperative hemodynamic change and various side effects. Statistical Analysis used: Categorical data was compared using Chi- square test. Quantitative parametric data was analysed using unpaired student t-test. P value < 0.05 was considered statistically significant. Results: Mean duration of analgesia in Group A (10.53 ± 2.686 hours) was longer than Group B (7.943±3.199hr) (P = 0.0006).Mean number of analgesic dosesrequired in first 24 hourswere less in Group A (1.429 ± 0.5021) ascompared to Group B (1.771±0.6897) (P = 0.0202).All patients remained hemodynamically stable with no significant side effects noted in either group. Conclusion: We conclude that preemptive analgesic efficacy of oral gabapentin 600mg is better in comparison to oral pregabalin 75 mg for patients posted for lower limb orthopedic surgeries under spinal anesthesia.

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Effectiveness and safety of povidone iodine for prolonged lung air-leak after lung surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211067637 ◽

2021 ◽

pp. 021849232110676

Author(s):

Zied Chaari ◽

Abdessalem Hentati ◽

Aimen Ben Ayed ◽

Walid Abid ◽

Imed Frikha

Keyword(s):

Side Effects ◽

Povidone Iodine ◽

Prospective Trial ◽

Lung Surgery ◽

Air Leak ◽

Pulmonary Surgery ◽

Hospitalization Period ◽

Group A ◽

The Mean ◽

Group B

Background Pulmonary surgery is often associated with postoperative prolonged parenchymal air-leak. The purpose of this study was to determine efficacy and safety of povidone iodine as treatment of prolonged parenchymal air-leak following all-types of lung surgery. Methods This prospective trial was conducted from June 2019 to December 2020, and designed under PanAfrican Clinical Trials Registry requirements. Patients having prolonged parenchymal air-leak were randomly allocated to povidone iodine protocol (Group A) or surveillance without povidone iodine (Group B). We collected the number of povidone iodine injections required before bubbling stopped, total drainage period, tolerance after injection, complications and side-effects. Comparative study was performed to evaluate povidone iodine efficacy. Results Following randomization, Group A included 19 patients, and Group B 21. Both groups were comparable. The mean drainage period was 9.21 days in Group A (6–14 days) and 15.62 days in Group B (7–31 days) ( p = 0.001). The mean hospitalization period was 11.05 days in Group A (7–16 days) and 18.9 days in Group B (9–38 days) ( p < 0.0001). The mean follow-up period was 6.8 months (3–18 months). No deaths were noted in either groups. Four side-effects were reported in Group A (21%) and four serious complications were noticed in Group B (19%). No recurrences were reported in Group A versus one recurrence of homolateral pneumothorax in Group B (4.76%). Conclusions Povidone iodine is an effective and safe solution for pleurodesis. It is associated with a low complication rate that remains acceptable, and could be proposed as treatment of prolonged parenchymal air-leak after lung resections.

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