Use of follow-on fingolimod for multiple sclerosis: Analysis of effectiveness and patient reported outcomes in a real-world clinical setting

BACKGROUND

Follow-on disease modifying therapies (FO-DMTs) do not always require Phase III studies. There are concerns that cheaper FO-DMTs are only used to reduce healthcare costs. However, the well-being of people with MS (pwMS) should be a priority. We aimed to evaluate the efficacy, safety and treatment satisfaction of one of the FO- Fingolimod (FTY) used in Turkey with the approval of Turkish Ministry of Health.

METHODS

PwMS under FTY were recruited from 13 centers and real-world data and answers of satisfaction and adherence statements of pwMS on FTY treatment were analyzed.

RESULTS

Data of 239 pwMS were obtained. The duration of FTY treatment was 2.5 ± 0.8 (1-4) years in pwMS who were included in the study and whose treatment continued for at least one year. Significant decreases in annual relapse rate (p < 0.001), Expanded Disability Status Scale (p < 0.001) and neuroimaging findings (p < 0.001) were observed. While 64% of the patients were satisfied and 71.5% were found to adherent with this FO-FTY.

CONCLUSION

This multicenter retrospective study found that the efficacy, safety and treatment adherence of a prescribed FO-FTY were consistent with the results of real-world studies. Studies including real-world data may provide guidance to address issues related to FO-FTY use.

Anti-GAD Encephalitis Following COVID-19 Vaccination: A Case Report

Since December 2020, a significantly higher number of people worldwide have been vaccinated for coronavirus disease 2019 (COVID-19). Neurological complications have been reported after these vaccines, although a definitive causal relationship has not been proven in the available literature. We describe a 51-year-old man presenting with anti-glutamic acid decarboxylase (anti-GAD) antibody positive autoimmune encephalitis with progressive cognitive impairment and behavioral abnormalities, presenting shortly after the second dose of mRNA COVID-19 vaccine, possibly representing a serious vaccine-related adverse event. Response to high-dose steroid and intravenous immunoglobulin treatment was positive. As many people around the world have been vaccinated against COVID-19, this case shows that autoimmune encephalitis and even anti-GAD antibody positive autoimmune encephalitis can develop as a side effect after this new vaccine, but with early diagnosis and appropriate treatment, the clinic can have a good prognosis. Observational studies with large numbers of patients are needed to explain causality.

Erratum: Clinical and Demographic Characteristics and Two-Year Efficacy and Safety Data of 508 Multiple Sclerosis Patients with Fingolimod Treatment

[This corrects the article on p. 23 in vol. 60, PMID: 36911568.].

Clinical and Demographic Characteristics and Two-Year Efficacy and Safety Data of 508 Multiple Sclerosis Patients with Fingolimod Treatment

Introduction

Fingolimod is the first oral immunomodulatory treatment used as secondary care therapy in the treatment of multiple sclerosis for the last 10 years. The objective of our study is to reveal the experiences of the first generic fingolimod active ingredient treatment in different centers across Turkey.

Method

The first generic fingolimod efficacy and safety data of patients followed-up in 29 different clinical multiple sclerosis units in Turkey were analyzed retrospectively. Data regarding efficacy and safety of the patients were transferred to the data system both before the treatment and on the 6th, 12^th and 24^th month following the treatment. The data were analyzed using the IBM SPSS 20.00. P value of <0.05 was considered to be statistically significant.

Results

A total of 508 multiple sclerosis patients, 331 of whom were women, were included in the study. Upon comparing the Expanded Disability Status values before and after the treatment, a significant decrease was observed, especially at month 6 and thereafter. Since bradycardia occurred in 11 of the patients (2.3%), the first dose had to be longer than 6 hours. During the observation of the first dose, no issues that could prevent the use of the drug occured. Side effects were seen in 49 (10.3%) patients during the course of fingolimod treatment. Respectively, the most frequent side effects were bradycardia, hypotension, headache, dizziness and tachycardia.

Conclusion

The observed results regarding efficacy and safety were similar to clinical trial data in the literature and real life data in terms of the first equivalent with fingolimod active ingredient.

Scientific View of the Global Literature on Medical Error Reporting and Reporting Systems From 1977 to 2021: A Bibliometric Analysis

BACKGROUND

Error reporting is vital for the prevention of medical errors. Despite the importance of error reporting, underreporting of medical errors is a common reality in many countries. Therefore, barriers to error reporting and reporting systems are a constantly evolving field of research. For this reason, studies on medical error reporting and reporting systems should be evaluated multidimensionally.

AIM

The aim of this study is to evaluate the global research on medical error reporting and reporting systems through bibliometric analysis to obtain a structured macroscopic overview of the features and developments.

METHODS

A bibliometric analysis of 1464 publications from 1970 to 2021 was performed to map the literature of medical error reporting and assess the structure of the scientific community.

RESULTS

After 2000, the number of publications increased annually until a maximum of 2020 was reached. The International Journal for Quality in Health Care and the Journal of Patient Safety have been the most productive journals when it comes to publishing on the subject. Trend topics of keyword plus have changed over time. The United States (1399), England (580), and Australia (478) are the 3 nations with the highest number of publications. On the other hand, it is seen that the subject has yet to be discussed in a few developing or underdeveloped countries.

CONCLUSIONS

This bibliometric analysis shows that the number of publications and authors and cross-country cooperation are low regarding error reporting. The low number of publications and the lack of cooperation, especially in developing countries, reveal the importance of global cooperation.

The relationship between nursing students' professional attitudes and caring behaviors: A cross-sectional study

PURPOSE

This study aimed to determine the relationship between nursing students' professional attitudes and caring behaviors.

DESIGN AND METHODS

The research is a cross-sectional, descriptive, and correlational study. The study was conducted with 202 nursing students. The participation rate was 95%.

FINDINGS

The total Instrument of Professional Attitude for Student Nurses mean score was 106.708 ± 20.24 and the Caring Behaviors Inventory-24 mean score of the nursing students was 5.23 ± 0.88. A positive weak correlation was found between total Instrument of Professional Attitude for Student Nurses scores and sub-dimension scores, and Caring Behaviors Inventory-24 total scores of nursing students (p < .05).

PRACTICE IMPLICATIONS

The present study has demonstrated that the professional attitudes of students positively affect caring behaviors.

Comparison of matrix metalloproteinase 9 and 14 levels in vitreous samples in diabetic and non-diabetic patients: a case control study

Background

MMP-9 plays a prominent role in inflammation and MMP-14 take part in angiogenesis. The objective of this study is to compare MMP-9 and MMP-14 levels between diabetic and non-diabetic patients.

Methods

The patients who scheduled for pars plana vitrectomy were included in our study. Patients are divided into 2 groups: the diabetic group and non-diabetic group. Age, gender, intraocular pressure(IOP), visual acuity (VA) were reported. Color fundus photography, fundus fluorescein angiography, optic coherence tomography (OCT) were performed before and after the operation. MMP-9 and MMP-14 levels in vitreous samples were analyzed with a reader device by ELISA method. Mann–Whitney U test and logistic regressions were used in statistical analysis, p < 0.05 accepted as statistically significant.

Results

70 eyes of 70 patients who received pars plana vitrectomy were enrolled in the study and divided into 2 groups: 34 patients in the diabetic group, 36 patients in the non-diabetic group. The average age of diabetic patients was 60.14 ± 10.20, and non-diabetic patients was 64.22 ± 11.16, respectively. The average MMP-9 (0.67 ± 0.66 ng/ml) and MMP-14 (0.16 ± 0.45 ng/ml) values in the diabetic group were significantly higher than the average MMP-9 (0.21 ± 0.05 ng/ml) and MMP-14 (and 0.07 ± 0.02 ng/ml) values in the non-diabetic group (P < 0.01). Also, it was observed that MMP-9 and MMP-14 levels increases as the diabetic disease duration increases. The risk of diabetes incidence increased with high levels of MMP-9 and MMP-14.

Conclusion

Due to the higher levels of MMP-9 and MMP-14 in the pathogenesis of diabetic retinopathy, these proteins may probably be among the therapeutic targets in the prevention and treatment of retinopathy.

The Atrophy of the Vagus Nerve Correlated With Gastrointestinal Non-Motor Symptoms Scores, in Parkinson’s Disease: A Sonography Research Study

Objective:

To investigate the vagus nerve (VN) dimensional changes with Parkinson’s disease (PD), compared with healthy subjects. Additionally, it is important to investigate whether there is any relationships between these changes and patient’s motor and non-motor symptoms (NMS) of PD.

Materials and Methods:

A cohort of 43 patients with PD formed a group that was compared with 44 patients without PD, denoted as the healthy subject (HS) group. The diameter and areas of VN of study groups were measured using ultrasonography (US). The study groups were further divided into <65 and ≥65 subgroups, to evaluate the possible effect of age on the VN and evaluated relationships of VN dimensions, between subgroups. In the PD group, a correlational analysis was conducted between the diameter and area of the VN and the motor and NMS scores.

Results:

There was statistically significant difference in right ( P = .002) and left VN diameters ( P = .007) and in right ( P = .001) and left VN areas ( P = .007), between study groups. There was no significant difference in right and left VN diameters and the right and left VN areas, between subgroups. There was moderately negative correlation between gastrointestinal NMS scores and right VN area ( r = −0.499, P = .002), left VN area ( r = −0.499, P = .002), right VN diameter ( r = −0.378, P = .023), left VN diameter ( r = −0.385, P = .021), respectively.

Conclusion:

The US demonstrated that VN dimensions may possibly reduce in those patients affected by PD. In this cohort, it appears that an increase in gastrointestinal NMS scores may be explained by atrophy of the VN.

Quantitative phase imaging of erythrocyte in epilepsy patients

The present study focuses on the quantitative phase imaging of erythrocytes with the aim to compare the morphological differences between epilepsy patients under antiepileptic treatment, who have no other disease which may affect the erythrocyte morphology, and the healthy control group. The white light diffraction phase microscopy (WDPM) has been used to obtain the interferogram of the erythrocyte surfaces. The continuous wavelet transform with Paul wavelet has been chosen to calculate the surface profiles from this interferogram image. For the determination of alteration in morphology, besides WDPM, erythrocyte surfaces have been investigated by light microscope and scanning electron microscope. In this way, it has been possible to see the difference in terms of precision and implementation between the most commonly used methods with regard to the quantitative phase imaging. Erythrocytes from all the samples have been examined and displayed in both two- and three-dimensional way. We have observed that erythrocytes of patients with effective antiepileptic blood levels were more affected in morphology than healthy subjects. When we compared the erythrocyte morphological changes of patients who received monotherapy or polytherapy, no difference was observed. In conclusion, antiepileptic drugs (AEDs) cause red blood cell (RBC) morphological changes and a combined usage of WDPM with Paul wavelet and light microscopy methods are very convenient for studying the erythrocyte morphologies on multiple patients.

Percepção de estudantes de doutorado em enfermagem sobre planejamento de carreira e prioridades de pesquisa

Resumo Objetivo: O objetivo deste estudo foi descrever os pontos de vista de estudantes de doutorado em enfermagem antes do início e durante o doutorado sobre mudanças no planejamento da carreira e prioridades de pesquisa. Métodos: O estudo foi de natureza qualitativa, tendo sido realizado com 16 entrevistas no Instituto de Ciências da Saúde, Faculdade de Enfermagem. Foram realizadas entrevistas individuais com 16 estudantes de doutorado matriculados em diferentes especialidades acadêmicas. Após as entrevistas, as gravações de áudio foram primeiramente transcritas e depois categorizadas. Os dados foram submetidos a análise de conteúdo. Resultados: Após análise de conteúdo, três temas principais (“mudanças no planejamento da carreira”, “prioridades de pesquisa” e “desenvolvimento”) e seis categorias foram formuladas a partir dos dados obtidos. Os participantes afirmaram ter consciência de ter feito várias mudanças nos planos de carreira ao iniciar seu projeto de doutorado, e o trabalho no projeto mudou o desenvolvimento profissional e melhorou as habilidades acadêmicas. Conclusão: Nossos resultados indicam que os estudantes de doutorado devem ser apoiados para serem eficazes na carreira, e a formação no período pós-doutoral também deve ser apoiada. Políticas efetivas em relação ao aperfeiçoamento de enfermeiros doutorandos também devem ser desenvolvidas e implementadas com base em evidências sólidas da utilidade desses suportes.

Unusual Cause of Back Pain in a Multiple Myeloma Patient: Infectious Discitis

A 58 year old patient, followed up for diabetes mellitus and multiple myeloma for ten years and six months, respectively, presented with persistent back pain, weakness at his lower extremity and intermittent fever. Activation markers of myeloma were in normal limits except high erythrocyte sedimentation rate and elevated C-reactive protein. Magnetic resonance imaging revealed increased T1 spinal intensity at the suspected disc level. Discitis was suspected on the basis of MRl and high fever. An intraoperative examination of specimens revealed Staphylococcus aureus. Detailed laboratory and radiological investigations should be performed to diagnose unusual causes of persistent back pain, such as discitis in patients with myeloma.

Hodgkin's Disease: Results of a Single Center in Central Anatolia

Hodgkin's Disease (HD) accounts for about 1% of newly diagnosed malignant diseases. In this study 119 HD cases followed in Erciyes University Hospital were evaluated. 67.2% of the patients was male, 32.8% female. The patients' age ranged from 15 to 72 years with a median of 41.5 years. Of the patients 10.1% was stage I, 29.4% stage II, 39.5% stage III, and 21.0% stage IV. According to Rye classification frequency of histologic subtypes was as follows; 21.0% lymphocyte predominant, 25.2% nodular sclerosis, 43.7% mixed cellularity, and 10.1% lymphocyte depletion. Combination chemotherapy consisting cyclophosphamide, vincristine, procarbazine and prednisolone (COPP) was used as first line treatment in 59.7% of patients. Complete remission was achieved in 84.9% of patients and partial remission in 5.0% of patients; response could not be obtained in remaining 10.1% of patients. Disease progression or recurrence was observed in 30.2% of patients. Five year survival rate was found as 70.8% of all patients, 90.1% for stage I-II, 55.3% for stage III-IV patients (p= 0.03).

Extreme Thrombocytosis after Penetrating Femoral Venous Injury

Lower extremity trauma is an uncommon cause of reactive thrombocytosis. A 17-year-old male patient with an extreme increase in platelet count caused by penetrating femoral venous injury is presented. During his stay in hospital, two thrombotic attacks were observed. Such events should be considered as high risk for thrombosis and anticoagulant therapy administered.