Tension and trauma releasing exercises for people with multiple sclerosis - An exploratory pilot study

BACKGROUND AND AIM

Multiple sclerosis (MS) is characterized by increasing symptom burden leading many people with MS to use complementary treatments. TRE (Tension and Trauma Releasing Exercises) is a mind-body therapeutic method aiming to release muscle tension and stress. People with MS (PwMS) have reported benefits from TRE, but no scientific studies have investigated the effects of TRE on PwMS. Aim: To test a TRE program for PwMS and thereby explore outcome measures to be applied in future randomized studies.

EXPERIMENTAL PROCEDURE

A nine-week TRE program was completed by nine participants: Five were women, age ranged from 44 to 66 years, and time since diagnosis ranged from 2 to 21 years. Outcome measures included self-reported day-to-day levels of nine different symptoms as well as sleep quality and stress level. Modified Fatigue Impact Scale (MFIS) fatigue score and spasticity level of the ankle plantar flexors, assessed using a Portable Spasticity Assessment Device (PSAD), were measured pre and post intervention.

RESULTS

Decreases were seen in the mean scores of all nine self-reported day-to-day symptoms as well as stress level, while sleep quality mean score increased. LME analyses showed that all changes were statistically significant except one (bowel dysfunction). Mean MFIS-measured fatigue level decreased significantly from a score of 43.7 (SD = 13.6) to a score of 22.0 (SD = 12.3). No significant change was reported in PSAD-measured spasticity level.

CONCLUSION

The study indicates possible effects of TRE on PwMS on several self-reported outcome measures. Larger, randomized studies should be carried out to explore the findings further.

Use of natural medicine and dietary supplements concomitant with conventional medicine among people with Multiple Sclerosis

BACKGROUND

The use of complementary and alternative medicine (CAM) are widespread among people with Multiple Sclerosis (PwMS) and are often used concomitant with conventional treatment. Natural medicine and dietary supplements (NADS) are the most frequently used CAM modality and among other patient groups use of NADS concomitant with conventional medicine has been reported as a potential risk to patients' safety due to risk of drug interactions. The use of NADS concomitant with conventional medicine has, however, not been investigated among PwMS. This study's aim was to investigate the prevalence of NADS and conventional MS-related medicine use among PwMS, specific types of NADS and conventional MS-related medicine used, the prevalence of NADS used concomitant with conventional MS-related medicine, and to characterize PwMS who use NADS and PwMS who use NADS concomitant with conventional MS-related medicine in a Danish context.

METHODS

The study was a cross-sectional study conducted as an interviewer-administered survey via phone in April 2019. The questionnaire includes questions about the use of NADS and conventional MS medicine as well as sociodemographic and health-related factors. In total 384 PwMS answered the questionnaire. Both descriptive and logistic analyses were used to analyze the data.

RESULTS

The results show that the majority of PwMS use conventional MS-related medicine. In total, 85 % (n=322) had used at least one NADS within the last 12 months including vitamin D. When excluding vitamin D, the use of NADS within the last 12 months was 78.4% (n=298). Beside vitamin D the most reported types of NADS used were fatty acids (37%), Multivitamins (37%), and Calcium (35%). A total of 75.8% (n=288) reported using NADS concomitant with conventional MS medicine, and the products most often combined with conventional MS medicine were Vitamin D, Multivitamin, Calcium, Magnesium, and fatty acids. The results suggest that PwMS using NADS concomitant with conventional MS-related medicine are characterized by a high prevalence of young and newly diagnosed patients with a high education level.

CONCLUSION

The study contributes to a better understanding of NADS used among PwMS. The study shows that the majority of PwMS use NADS and that they use it concomitant with conventional MS-medicine. Furthermore, the detailed mapping of the specific types of NADS used gives a nuanced insight into the specific products of NADS used among PwMS, including different kinds of vitamins, minerals, and herbal remedies.

Plasma cholinesterase activity and duration of action of mivacurium in phenotypically normal patients

BACKGROUND

The short duration of action of mivacurium is due to its rapid hydrolysis by plasma cholinesterase (pChe). In patients with normal phenotype, low pChe activity because of, for instance, disease or intake of drugs may prolong the duration of action of mivacurium. The purpose of this study was to evaluate the relationship between pChe activity and the duration of action of mivacurium 0.2 mg/kg in phenotypically normal patients.

MATERIAL

Forty-three adult patients with normal pChe phenotype and low or normal pChe activity, undergoing a variety of surgical procedures were included in the study with their informed consent and Ethics Committee approval. The neuromuscular block was monitored using TOF stimulation every 12 s and mechanomyography. The time to reappearance of the first response to TOF stimulation was measured.

RESULTS

The patients pChe activities ranged from 45 to 1272 U/l (normal range 660-1620 U/l) and the time to first response to TOF from 8.1 to 62.7 min. An inverse relationship between enzyme activity and duration of action of mivacurium was found. The relationship was described by the equation: log10 (time) =alpha- beta log10 (pChe), where alpha (SD) is 2.547 (0.186) and beta (SD) 0.454 (0.069).

CONCLUSION

In patients with phenotypically normal pChe, prediction of the duration of action of mivacurium is possible from the patients actual pChe activity. In patients with pChe activities below the normal range, the time to reappearance of the first response to TOF stimulation may vary from 10 to 180 min Only patients with pChe activities <220 U/l had a significantly prolonged duration of action of mivacurium.

Cost-effectiveness of introducing a third-generation test for HBsAg in Danish blood donors

Owing to the low incidence of hepatitis B in Denmark, screening of blood donors for HBsAg has mostly been done by immunoelectroosmophoresis (IEOP). The purpose of the present study was to carry out a cost-effectiveness analysis prior to the introduction of a third-generation test for HBsAg in Danish blood donors. The analysis was performed on data from a subsequent screening of 48 750 blood units by radioimmunoassay (RIA) 3 weeks after donation. The RIA-pos., IEOP-neg. blood donors identified in the study were evaluated by a follow-up examination, and the recipients of RIA-pos., IEOP-neg. blood units were monitored for up to 9 months as to the development of acute hepatitis B. The study shows that the estimated cost for each prevented case of transfusion-associated hepatitis B in Denmark is US$ 1100 when screening donors not previously tested by a third-generation technique, and US$ 240 000 when screening donors tested before by this technique.