Relationship between Carnitine Deficiency and Tyrosine Kinase Inhibitor Use in Patients with Chronic Myeloid Leukemia

Background: Some chemotherapeutic agents cause carnitine deficiency, which confers general fatigue; however, there is no study on carnitine deficiency in patients with chronic myeloid leukemia (CML) during tyrosine kinase inhibitor (TKI) therapy. Objective: This study investigated carnitine concentrations in patients with CML treated with TKIs. Method: This study included patients with well-controlled CML. Total carnitine and free carnitine concentrations were evaluated using the enzyme cycling method. The Brief Fatigue Inventory (BFI) and Cancer Fatigue Scale (CFS) were used to assess general fatigue developed during TKI therapy. Results: Fifty-five patients on TKIs were included; 12 (21.8%) had low free carnitine concentrations. Free carnitine concentrations were higher in men than in women. Younger age was closely associated with lower free carnitine concentrations. TKI type, TKI dose, treatment response, or therapy duration were not associated with free carnitine concentrations. None of the scores (the global fatigue score with the BFI and CFS score) correlated with carnitine concentrations. Concentrations of free carnitine in the treatment-free remission group were slightly higher than those in the TKI group, with only 9.1% having a low concentration of free carnitine. Conclusion: Carnitine deficiency is probably not a major cause of general fatigue, but may occur in patients with CML receiving TKIs.

Fatigue in children and adolescents perinatally infected with human immunodeficiency virus: an observational study

Background Fatigue is common among adults living with human immunodeficiency virus (HIV) as well as children with a chronic disease (CCD). Fatigue can have disastrous effects on health status, including health related quality of life (HRQOL). Even so, fatigue is underexplored in children and adolescents perinatally infected with HIV (PHIV+) in the Netherlands. The objective of this observational study is to explore fatigue in PHIV+ and its association with their HRQOL. Methods We measured HRQOL and fatigue using the Pediatric Quality of Life Inventory™ (PedsQL 4.0) and the PedsQL Multidimensional Fatigue Scale (MFS). The PedsQL MFS encompasses three subscales: general fatigue, sleep/rest fatigue and cognitive fatigue, and a total fatigue score. We compared outcomes of PHIV+ children and adolescents in the Amsterdam University Medical Centre with three groups: 1) HIV-uninfected controls (HIV-) matched for age, sex, region of birth, socioeconomic status and adoption status, 2) CCD, and 3) the general Dutch population. Within the PHIV+ group we explored associations between fatigue and HRQOL. Results We enrolled 14 PHIV+ (median age 10.2 years [IQR 9.2–11.4]) and 14 HIV-. Compared to CCD, PHIV+ significantly reported less general fatigue (mean difference 13.0, 95% CI 1.3 to 24.8). PHIV+ did not score significantly different on any of the other PedsQL MFS scales compared to HIV-, CCD or the general Dutch population. PHIV children scored relatively low on the cognitive fatigue scale in comparison to HIV-uninfected matched controls, CCD and the general population, although these differences did not reach significance. Among PHIV+, a lower score on total fatigue, general fatigue and cognitive fatigue was associated with a lower HRQOL score. Conclusions The results of this study suggest that PHIV children and adolescents do not experience more symptoms of fatigue than their healthy peers. However, PHIV children and adolescents may be more likely to experience cognitive fatigue. Fatigue in PHIV also appears to be associated with children’s HRQOL. Further research should confirm these exploratory findings.

Prevalence of fatigue in adults with congenital heart disease

Aims: The aim of this cross-sectional study was to examine the prevalence of the multidimensional phenomenon of fatigue in adults with congenital heart disease. Background: Adults with congenital heart disease are a growing population, and patient-reported outcomes can provide valuable information about the patient’s experience of living with CHD. Fatigue is a multidimensional phenomenon that can be described as an overwhelming feeling of exhaustion with a reduced capacity of mental and physical work. Fatigue can be observed clinically in adults with congenital heart disease, but the actual prevalence is unknown. Methods: Fatigue was assessed by the Multidimensional Fatigue Inventory which enables the respondent to report the presence of fatigue according to five dimensions: “general fatigue,” “physical fatigue,” “mental fatigue,” “reduced motivation,” and “reduced activity.” The questionnaire was sent to 463 patients in Lund and Umeå. Four groups with complex CHD and two groups with moderately complex CHD were included. The reliability (internal consistency) of the Multidimensional Fatigue Inventory was tested for all dimensions and groups of diagnosis. Results: The response rate was 56.6% (n= 262). In patients with complex CHD, 40.0–59.4% reported severe to very severe general fatigue, and patients with a single ventricle reported the highest prevalence (59.4%). Among patients with complex CHD, 29.2–40.0% reported severe to very severe mental fatigue. The Multidimensional Fatigue Inventory had a high reliability measured with Cronbach’s alpha. Conclusions: The study findings show a relatively high prevalence of fatigue in adults with congenital heart disease, and general fatigue was the most prevalent. Further studies are needed regarding fatigue and its causes and consequences in adults with congenital heart disease. Relevance to clinical practice: The Multidimensional Fatigue Inventory proved to be an instrument with high reliability and low internal loss, which suggests that the instrument may be suitable to use as a patient-reported outcome in the care of adults with congenital heart disease, preferably at repeated occasions.

Idiopathic combined adrenocorticotropin and growth hormone deficiency mimicking chronic fatigue syndrome

A 42-year-old man who had suffered from severe fatigue for 5 years was diagnosed as having chronic fatigue syndrome (CFS) and fibromyalgia. Endocrinological workup using combined anterior pituitary function tests showed that the patient had adrenocorticotropin hormone (ACTH) deficiency, with a normal pituitary MRI. Treatment with a physiologic dose of oral hydrocortisone replacement physically ameliorated his general fatigue. A secondary workup using a growth hormone-releasing peptide-2 test revealed that he also had growth hormone (GH) deficiency, and GH replacement therapy was started. His muscle pain and depression were improved by the therapy. Here, we present a rare case of combined deficiency of ACTH and GH in a middle-aged man with severe general fatigue. This case report aims to raise awareness of combined deficiency of ACTH and GH as a differential diagnosis of CFS and its mimics.

Associations between Depression, Anxiety, Fatigue, and Learning Motivating Factors in e-Learning-Based Computer Programming Education

Quarantines imposed due to COVID-19 have forced the rapid implementation of e-learning, but also increased the rates of anxiety, depression, and fatigue, which relate to dramatically diminished e-learning motivation. Thus, it was deemed significant to identify e-learning motivating factors related to mental health. Furthermore, because computer programming skills are among the core competencies that professionals are expected to possess in the era of rapid technology development, it was also considered important to identify the factors relating to computer programming learning. Thus, this study applied the Learning Motivating Factors Questionnaire, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder Scale-7 (GAD-7), and the Multidimensional Fatigue Inventory-20 (MFI-20) instruments. The sample consisted of 444 e-learners, including 189 computer programming e-learners. The results revealed that higher scores of individual attitude and expectation, challenging goals, clear direction, social pressure, and competition significantly varied across depression categories. The scores of challenging goals, and social pressure and competition, significantly varied across anxiety categories. The scores of individual attitude and expectation, challenging goals, and social pressure and competition significantly varied across general fatigue categories. In the group of computer programming e-learners: challenging goals predicted decreased anxiety; clear direction and challenging goals predicted decreased depression; individual attitude and expectation predicted diminished general fatigue; and challenging goals and punishment predicted diminished mental fatigue. Challenging goals statistically significantly predicted lower mental fatigue, and mental fatigue statistically significantly predicted depression and anxiety in both sample groups.

Multidimensional Fatigue in Chinese Meningioma Patients Newly Diagnosed : Prevalence, Severity and Risk Factors

Purpose Few studies have assessed fatigue of meningioma patients. The purpose of this study was to explore the prevalence, severity, and risk factors of multidimensional fatigue, as well as the impact on health-related quality of life (HRQoL) in Chinese meningioma patients newly diagnosed. Methods This cross-sectional study included 120 Chinese meningioma patients recruited from Affiliated Hospital of Nantong University from January 2020 to February 2021. Data were collected before surgery, including demographic, clinical and psychological characteristics, as well as fatigue scores, based on completion of the Multidimensional Fatigue Inventory (MFI-20). Spearman correlation and multiple linear regression were used to analyze the data. Results The results demonstrated that a high prevalence of severe fatigue for each dimension: general fatigue (33.3%), physical fatigue (27.5%), reduced activity (28.3%), reduced motivation (12.5%), mental fatigue (11.7%), and total fatigue (23.3%). Headache and anxiety were predictors of general fatigue. Depression was an independent predictor of physical fatigue. Karnofsky Performance Status (KPS) score and depression independently predicted reduced activity. Depression and Epworth Sleepiness Scale (ESS) score were risk factors predicting reduced motivation, while KPS score and anxiety predicted mental fatigue. Importantly, comorbidity, KPS score, headache, depression, sleep disturbances, and ESS score could predict total fatigue. Furthermore, MFI-20 scores in all dimensions were negatively correlated with Short Form 36 Health Survey (SF-36) scores in all dimensions. Conclusion Our findings indicate that meningioma patients newly diagnosed are frequently affected by fatigue, potentially contributing to impair HRQoL. For patients with risk factors of fatigue, targeted interventions are advised in order to decrease fatigue and improve HRQoL.

Multidimensional Fatigue in Chinese Meningioma Patients Newly Diagnosed: Prevalence, Severity and Risk Factors

Purpose Few studies have assessed fatigue of meningioma patients. The purpose of this study was to explore the prevalence, severity, and risk factors of multidimensional fatigue, as well as the impact on health-related quality of life (HRQoL) in Chinese meningioma patients newly diagnosed. Methods This cross-sectional study included 120 Chinese meningioma patients recruited from Affiliated Hospital of Nantong University from January 2020 to February 2021. Data were collected before surgery, including demographic, clinical and psychological characteristics, as well as fatigue scores, based on completion of the Multidimensional Fatigue Inventory (MFI-20). Spearman correlation and multiple linear regression were used to analyze the data. Results The results demonstrated that a high prevalence of severe fatigue for each dimension: general fatigue (33.3%), physical fatigue (27.5%), reduced activity (28.3%), reduced motivation (12.5%), mental fatigue (11.7%), and total fatigue (23.3%). Headache and anxiety were predictors of general fatigue. Depression was an independent predictor of physical fatigue. Karnofsky Performance Status (KPS) score and depression independently predicted reduced activity. Depression and Epworth Sleepiness Scale (ESS) score were risk factors predicting reduced motivation, while KPS score and anxiety predicted mental fatigue. Importantly, comorbidity, KPS score, headache, depression, sleep disturbances, and ESS score could predict total fatigue. Furthermore, MFI-20 scores in all dimensions were negatively correlated with Short Form 36 Health Survey (SF-36) scores in all dimensions. Conclusion Our findings indicate that meningioma patients newly diagnosed are frequently affected by fatigue, potentially contributing to impair HRQoL. For patients with risk factors of fatigue, targeted interventions are advised in order to decrease fatigue and improve HRQoL.

Fatigue in children and adolescents perinatally infected with human immunodeficiency virus: an observational study

Background Fatigue is common among adults living with human immunodeficiency virus (HIV) as well as children with a chronic disease (CCD). Fatigue can have disastrous effects on health status, including health related quality of life (HRQOL). Even so, fatigue is underexplored in children and adolescents perinatally infected with HIV (PHIV+) in the Netherlands. This study aims to explore fatigue in PHIV + and its association with their HRQOL. Methods We measured HRQOL and fatigue using the Pediatric Quality of Life Inventory™ (PedsQL 4.0) and the PedsQL Multidimensional Fatigue Scale (MFS). The PedsQL MFS encompasses three subscales: general fatigue, sleep/rest fatigue and cognitive fatigue, and a total fatigue score. We compared outcomes of PHIV + with three groups: 1) HIV-uninfected controls (HIV-) matched for age, sex, socioeconomic status and adoption status, 2) CCD, and 3) the general Dutch population. Within the PHIV + group we explored associations between fatigue and HRQOL. Results We enrolled 14 PHIV+ (median age 10.2 years [IQR 9.2–11.4]) and 14 HIV-. Compared to CCD, PHIV + significantly reported less general fatigue (mean difference 13.0, 95% CI 1.3 to 24.8). PHIV + did not score significantly different on any of the other PedsQL MFS scales compared to HIV-, CCD or the general Dutch population. PHIV children scored relatively low on the cognitive fatigue scale in comparison to HIV-uninfected matched controls, CCD and the general population, although these differences did not reach significance. Among PHIV+, a lower score on total fatigue, sleep/rest fatigue and cognitive fatigue was associated with a lower HRQOL score. Conclusions The results of this study suggest that PHIV children and adolescents do not experience more symptoms of fatigue than their healthy peers. However, PHIV children and adolescents may be more likely to experience cognitive fatigue. Fatigue in PHIV also appears to be associated with children’s HRQOL. Further research should confirm these exploratory findings.

Prevalence and Impact of Fatigue in Children With Primary Immunodeficiency Disorders: A Quantitative Single Center Study

Although fatigue is a common symptom in adult patients with Primary Immunodeficiencies (PID), data in pediatric patients are limited. The goal of this study is to estimate the prevalence and impact of fatigue in children with PID as reported by patients, parents and health-care providers. A retrospective single center observational study was performed. Prevalence of fatigue was measured by reviewing medical charts of 54 children in our department who are on immunoglobulin substitution therapy. Both prevalence and impact were also measured by the PedsQL-Multidimensional Fatigue Scale (MFS). This comprises age-appropriate questionnaire for self-report in patients aged 5-18 years and parent proxy-reports for patients aged 2-18 years. General, cognitive, sleep-rest fatigue was measured and a total fatigue score was calculated. Means, standard deviation and Z-scores were calculated using age-specific reference values. Intraclass correlation coefficients (ICC) were calculated for comparison of scores provided by parents vs children’s self-reported scores.Both chart review data and PedsQL-MFS showed fatigue rates of 65%. Pediatric PID patients of all ages had significantly lower scores on all subscales and total score of the PedsQL-MFS compared to healthy children. General fatigue was the most affected subscale in PID patients; indicating fatigue of these patients is mainly physical. Seventy-four % of PID patients had a Z-score lower than -1 on the General fatigue subscale indicating severe fatigue. Child-parent concordance varied between 0.24 and 0.93. Our results show high prevalence and severity of fatigue in children with PID, addressing the importance of this issue in our patient care.

External application of liver compresses to reduce fatigue in patients with metastatic cancer undergoing radiation therapy, a randomized clinical trial

Background Liver compresses are frequently used in integrative medicine as supportive therapy during cancer treatment in order to reduce fatigue. We performed a pilot study to test whether the external application of yarrow liver compresses impacts fatigue in patients with metastatic cancer undergoing radiation therapy. Methods A randomized prospective pilot trial was performed including patients with brain metastasis or bone metastasis of solid tumors. Patients underwent either palliative radiation therapy (RT) of the metastatic lesions (control group) over two weeks or the same RT with additional external application of yarrow liver compresses once daily during RT. The primary objective was improvement on the general fatigue subscale of the multidimensional fatigue inventory (MFI-20) at the end of treatment, where a mean difference of two points is considered clinically relevant. Secondary objectives included psychological distress, quality of life and qualitative analysis with self-established visual analogue scales (VAS). Mean differences in general fatigue at the end of treatment compared to baseline were analyzed using the ANCOVA test. Results From 09/2017 to 08/2019 a total of 39 patients were randomized. Due to drop outs 24 patients (12 per group) were available for analysis. Patients in the intervention group received a mean number of 10.5 (range, 7–14) applications of yarrow liver compresses. The mean improvement at the end of therapy on the general fatigue subscale of the MFI-20 was 2 points in favor of the intervention group (p = 0.13), and all other MFI-20 subscales showed at least a trend towards improvement in favor of the intervention group. Likewise, psychological distress and VAS data was improved, the latter reaching statistical significance for the symptoms fatigue, tension and lack of drive. Major toxicities were not observed. Conclusions External application of liver compresses appears to reduce fatigue within a clinical relevant range in patients with metastatic cancer undergoing radiation therapy. Trial registration: ISRCTN, ICTRP DRKS00012999