The effect of distance nurse-led fatigue management on fatigue, sleep quality, and self-efficacy in patients with multiple sclerosis: a quasi-experimental study

BACKGROUND

Fatigue is one of the most common problems in patients with multiple sclerosis (MS) and has adverse effects on their sleep status and self-efficacy. This study aimed to determine the effect of distance nurse-led fatigue management on fatigue, sleep quality, and self-efficacy in patients with MS.

METHODS

This quasi-experimental study was performed on 60 patients with MS in Arak, Iran. Subjects were randomly assigned into intervention and control groups. The intervention group received eight sessions of nurse-led fatigue management training through the Skyroom platform. The control group received only the usual programs. Data were collected before and two months after the intervention using the Fatigue Severity Scale, the Pittsburgh Sleep Quality Index, and the Multiple Sclerosis Self-Efficacy Scale. The significance level in this study was determined 0.05.

RESULTS

After the intervention, the mean score of fatigue severity in the intervention group was significantly lower than the control group (2.52 ± 0.40 vs 5.65 ± 0.52) (P < 0.001). Also, after the intervention, the mean score of self-efficacy in the intervention group was significantly higher than the control group (49.37 ± 3.25 vs 24.43 ± 2.52) (P < 0.001). Furthermore, after the intervention the mean score of sleep quality was lower in intervention group (11.92 ± 2.01) than the control group (15.46 ± 1.40) (P < 0.001).

CONCLUSION

Distance nurse-led fatigue management improved fatigue, sleep quality, and self-efficacy in patients with MS. We recommend the use of these courses as an important step toward improving fatigue, sleep quality, and self-efficacy among these patients.

Gene expression of semaphorin-3A, semaphorin-7A, neuropilin-1, plexin-C1, and β1 integrin in treated-multiple sclerosis patients

OBJECTIVE

Recently, members of the semaphorin family have received major attention in various medical fields, especially autoimmunity. In this study, we selected semaphorin-3A (Sema3A), semaphorin-7A (Sema7A), and their receptors to determine the possible relationship between these molecules and multiple sclerosis (MS).

METHOD

We measured the gene expression of Sema3A, Sema7A, neuropilin-1 (NP-1), plexin-C1, and β1 integrin in the blood samples of relapsing-remitting multiple sclerosis (RRMS) patients, treated with high-dose interferon-β1a (IFN-β1a), low-dose IFN-β1a, IFN-β1b, and glatiramer acetate (GA) via quantitative real-time polymerase chain reaction (qRT-PCR) assay, and then, compared the results of treatment-naive patients with the healthy controls.

RESULTS

The gene expression of Sema3A (P = 0.02), NP-1 (P < 0.001), and plexin-C1 (P < 0.01) significantly decreased in the treatment-naive group, compared to the healthy controls. Sema3A significantly increased in all treated patients, compared to the treatment-naive patients (P < 0.001). However, expression of NP-1 (P < 0.001), plexin-C1 (P < 0.001), and β1 integrin (P < 0.05) only increased in patients receiving high-dose IFN-β1a, IFN-β1b, and GA. Expression of Sema7A increased in only two groups of patients treated with IFN-β1b (P < 0.001) and GA (P = 0.018), without any significant decrease in the treatment-naive group, compared to the healthy controls (P > 0.05).

CONCLUSION

Our findings confirm that the presence of Sema3A, Sema7A, and their receptors can play critical roles in the treatment of MS patients. Therefore, they can be potential target molecules for MS treatment in the future.

Assessment of CCL27 and IL-11 in Multiple Sclerosis Patients Treated with Interferon-β and Glatiramer Acetate

INTRODUCTION

Multiple sclerosis (MS) is a neuroinflammatory autoimmune disease which involves the central nervous -system. Although the primary cause of MS is obscure, effects of some cytokine and chemokine patterns in both innate and adaptive immune systems have been described. -Objectives: Since limited studies have examined the role of interleukin (IL)-11 and chemokine CCL27 in MS, we aimed to identify changes in IL-11 and CCL27 gene expression and serum levels in relapsing-remitting MS (RRMS) patients, treated with interferon (IFN)-β and glatiramer acetate (GA).

METHODS

The serum level and gene expression of IL-11 and CCL27 were measured and compared between treatment-naïve MS patients and RRMS patients who were treated with high-dose IFN-β1a, low-dose IFN-β1a, IFN-β1b, and GA via enzyme-linked immunosorbent assay (ELISA) and quantitative real-time polymerase chain reaction.

RESULTS

A significant decrease was observed in the serum level of CCL27 in treatment-naïve patients and IFN-β1b-treated patients compared to the healthy controls. On the other hand, a significant increase was found in the protein level of CCL27 in low-dose and high-dose IFN-β1a groups compared to the treatment-naïve group. In addition, CCL27 gene expression was higher in patients treated with GA than in the treatment-naïve group. There were no significant changes in the gene expression or protein level of IL-11 in all experimental groups. Additionally, a positive correlation was found between IL-11 and CCL-27.

CONCLUSION

Our results suggest the inflammatory role of CCL27 in MS patients, while IFN-β1a seems to play a compensatory role for this chemokine.

Comparison of the effect of apotel and pregabalin on postoperative pain among patients undergoing lower limb orthopedic surgeries

Introduction

Proper control of postoperative pain is one of the major challenges after surgery. Such pains result in physical complications, increased metabolism, exacerbations of underlying diseases, and increased blood pressure. The aim of the present study was to compare the effect of apotel and pregabalin on postoperative pain among patients undergoing lower limb surgery.

Materials and Methods

This study is a double-blind randomized clinical trial. About 75 patients undergoing lower limb orthopedic surgeries in Valiasr Hospital in Arak, Iran, were enrolled in the study. Patients were divided into three groups as follow: The first group received a 150-mg pregabalin capsule 2 h before the surgery. The placebo group received capsule that was replaced by starch. Furthermore, other group received 1 g of apotel in 200 mL of normal saline, 20 min before surgery. Pain at 2, 4, 12, and 24 h after surgery was recorded based on visual analogue scale. The amount of opioid use was recorded in the first 24 h in milligrams. Patient sedation was recorded by Ramsey Sedation Scale at 2, 6, 12, and 24 h after surgery. Finally, the data were analyzed using SPSS-20.

Results

Pain in the apotel group was found to be lower when comparing with other group in 2, 4, 12, and 24 h after surgery (P = 0.0001). Ramsey score was found to be more in the pregabalin group at 2.6, 12, and 24 h after surgery (P < 0.05). In addition, the lowest opioid use was in the apotel group (P = 0.0001).

Conclusion

Our findings revealed that apotel had a better effect on pain management, whereas pregabalin exhibited better effect on the sedation of patients.

Attention Deficit Hyperactivity Disorder and Anxiety in Children With Malignancy

Attention deficit hyperactivity disorder (ADHD) and Anxiety is the most common childhood psychiatric disorder. Based on studies, these disorders are more prevalent in some chronic disease. This study aimed at investigating the prevalence of ADHD and anxiety in children with malignancy and anxiety in their parents and comparing the results with those of the control group. One hundred, 3-15-year-old children with malignancy and 100 healthy children without malignancy or any chronic disease were included in this case-control study as case and control groups, respectively. Subjects were selected from children who were referred to the pediatric ward of Amir Kabir Hospital of Arak, Iran, in the form of simple probability and based on inclusion and exclusion criteria. ADHD and Anxiety were diagnosed by Conner's Parent Rating Scale-48 (CPRS-48) and Hamilton Anxiety Rating Scale (HARS) and were confirmed by psychologist consult. Data were analyzed by Student t-test in SPSS18. ADHD was observed in 23 cases (23%) with malignancy and 5 controls (5%) (P=0.001). In the case group, 57 children (57%) and 45 of their parents (45%) were suffering from anxiety while in the control group the figure was observed in 12 children (12%) and 11 of their parents (11%) (P=0.001). ADHD and anxiety are more common in children with malignancy as compared with children without malignancy and anxiety is also more common in their parents. Therefore, implementing interventions and psychiatric counseling are recommended for these children and their parents.