MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial.

OBJECTIVE: Health-related quality of life (HRQOL) is often much reduced among individuals with multiple sclerosis (MS), and incidences of depression, fatigue, and anxiety are high. We examined effects of a mindfulness-based intervention (MBI) compared to usual care (UC) upon HRQOL, depression, and fatigue among adults with relapsing-remitting or secondary progressive MS. METHODS: A total of 150 patients were randomly assigned to the intervention (n = 76) or to UC (n = 74). MBI consisted of a structured 8-week program of mindfulness training. Assessments were made at baseline, postintervention, and 6 months follow-up. Primary outcomes included disease-specific and disease-aspecific HRQOL, depression, and fatigue. Anxiety, personal goal attainment, and adherence to homework were secondary outcomes. RESULTS: Attrition was low in the intervention group (5%) and attendance rate high (92%). Employing intention-to-treat analysis, MBI, compared with UC, improved nonphysical dimensions of primary outcomes at postintervention and follow-up (p < 0.002); effect sizes, 0.4-0.9 posttreatment and 0.3-0.5 at follow-up. When analyses were repeated among subgroups with clinically relevant levels of preintervention depression, fatigue, or anxiety, postintervention and follow-up effects remained significant and effect sizes were larger than for the total sample. CONCLUSIONS: In addition to evidence of improved HRQOL and well-being, these findings demonstrate broad feasibility and acceptance of, as well as satisfaction and adherence with, a program of mindfulness training for patients with MS. The results may also have treatment implications for other chronic disorders that diminish HRQOL. CLASSIFICATION OF EVIDENCE: This trial provides Class III evidence that MBI compared with UC improved HRQOL, fatigue, and depression up to 6 months postintervention.

Airborne contact dermatitis induced by parthenium: a study of 50 cases in South India.

Airborne contact dermatitis (ABCD) is a commonly occurring form of allergic contact dermatitis with varied aetiology, often posing a diagnostic challenge in management. A study was carried out on patients with a clinical picture and history consistent with ABCD due to exposure to Parthenium hysterophorus (parthenium weed), who were patch tested. There were 50 patients with parthenium-induced ABCD (36 men and 14 women; age range 24-75 years). The majority (90%) of the patients were farmers and most of the patients (74.5%) had exacerbations during summer. The most common type of dermatitis was the classic pattern (46%) followed by the mixed pattern (30%), erythroderma (14%) and chronic actinic dermatitis (10%). Of the 40 cases patch tested with the Indian standard series of antigens, 36 (90%) cases had patch-test results positive for parthenium.

In vitro and in vivo evaluation of albumin-encapsulated primaquine diphosphate prepared by nebulization into heated oil.

Nebulization of an aqueous mixture of primaquine diphosphate and albumin into heated vegetable oil produces spherical particles with an average size of 6 microm. The microparticles are relatively stabile in buffers of pH 7.2 and 4.5 and completely degrade when exposed to proteolytic enzymes such as trypsin. Pharmacokinetic evaluation of the albumin-encapsulated primaquine diphosphate shows significantly higher levels in mouse liver tissue relative to free drug 2-48 h post-IP administration. Higher AUC (2.8x), lower steady-state volume of distribution (10x) and slower half-life (2.5x) relative to an equivalent dose of free primaquine diphosphate suggest liver targeting and sustained release of the drug from the microparticles.

Health and indigenous development.

PIP: The benefits of using alternative medicine in remote rural areas is discussed with specific references to a tribal area in the district of Dhule of Maharashtra state, India, among the Bhils, Koknas, and Vanjaras. Those involved in the development of health care in the area believe that the tribal people have been exploited in education, health, and agriculture and have shown remarkable endurance in withstanding the effects of a profit seeking society. Private profit-seeking allopathic practitioners exploited the trust of the tribal people until 1985, when the allopathic approach to health care was abandoned. The local medicine men, the Vaidus, were asked to teach 3 health workers to identify roots, develop medicines from plants, and prepare and administer simple herbal remedies for common illnesses. This training was conducted at the Academy of Development Sciences in Kashele, Maharashtra. After the training was completed, each health worker was assigned 10 villages near Nandurbar. Each health worker contacted the Vaidus of each village and exchanged information. The revival of traditional knowledge was also reinforced by the preparation and showing a slides of various medicinal plants in the areas among the 30 villages. Workshops were also conducted along the Vaidus, who were open to exchanging information as long as it was not misused or practiced for personal gain. The Vaidus believed that the person administering treatment had to be honest, have respect for plants, know how to diagnose the illness, and be able to administer the remedy correctly. As a consequence, in the case of Shri Chunnilal Rupsingh of Vadzakhan village, the traditional application of Aloe barbadensis for an infected wound on his hand proved to be the best option. The treatment, available at the private clinic in Nandurbar a considerable distance from the village, was expensive and required multiple return trips. Health care problems of women still need to be addressed; the maintenance of herbal and medicinal gardens is being encouraged.^ieng

Pharmacokinetic analysis of cyclosporine in adjuvant arthritic rats.

Cyclosporine A (CsA) has been shown to be effective in patients with rheumatoid arthritis and to prevent the development and improve the symptoms of adjuvant-induced arthritis in rats. Since abnormal drug disposition has been reported in inflammatory conditions, we have evaluated the pharmacokinetics of CsA in this animal model of arthritis. We found a statistically significant decrease in the rate of disappearance of blood concentrations of CsA following iv administration to arthritic rats. The plasma half-life of CsA increased with a corresponding decrease in total body clearance. The volume of distribution remained unchanged. This abnormality in CsA kinetics was not observed in these animals until 10 days after adjuvant injection. The administration of CsA (15 mg/kg ip) twice daily to arthritic rats for 8 days produced a 39.8% and 49.5% inhibition of swelling in the right and left hindpaw, respectively. There was also a 63.5% decrease in the arthrogram score. Trough levels of CsA in arthritic animals were initially higher than in controls during this treatment but returned to control values after 8 days of dosing, suggesting reversal of abnormal disposition with improvement of the disease. The addition of indomethacin to the dosing regimen resulted in a significant increase in trough levels of CsA, indicating a drug interaction between these two compounds. Possible mechanisms responsible for these observations with CsA are discussed.

A method for evaluating therapy for hay fever. A comparison of four treatments.

This study was undertaken in order to develop a method for comparing the value of different forms of treatment for hay fever. A cross-over trial was carried out in sixty-one patients, comparing four treatments: topical corticosteroids, topical cromoglycates, placebo tablets and oxatomide (a new oral treatment with antihistamine and cromoglycate-like properties). Three methods were used to compare these treatments: (1) post-treatment symptom questionnaires; (2) daily analogue line scores of symptoms; and (3) nasal FEV1. Of these, daily analogue line diary scores, with an analysis which took into account variation in pollen count, proved to be the most sensitive. By employing this diary method, it was shown that all three active treatments were significantly better than placebo and that topical corticosteroids were significantly better than topical cromoglycates. The activity of oxatomide was found to be not significantly different from that of steroids or cromoglycate, but it was associated with more frequent side-effects. It is suggested that daily diaries, combining symptom relief and freedom from side effects into a single score of 'usefulness' adjusted for pollen count, are suitable means for comparing treatments for hay fever.

An analysis of skin prick test reactions in 656 asthmatic patients.

Of 656 asthmatic patients referred specifically for allergy assessments, 544 (84 percent) gave positive immediate skin prick tests to at least one of 22 common allergens used routinely. Comparison of these skin test positive patients with the 102 (16 percent) who were skin test negative showed a number of significant differences. The majority of the skin test positive patients (52 percent) were less than 10 years old at the time of onset of the asthma, whereas, of the skin test negative patients, 56 percent were aged over 30 years at the time of onset. Seventy per cent report rhinitis compared with 48 per cent of the skin test negative patients, and 29 per cent reported infantile eczema compared with 9 per cent. Symptoms attributed to house dust, pollens, and animals were noted two to three times more frequently by the skin test positive patients, while corticosteroid drugs had been used more commonly by the skin test negative patients (45 percent compared with 35 percent). No significant differences were observed with the other factors studied, namely, history of urticaria or angio-oedema, family history of "allergic" disease, and awareness of sensitivity to foods, aspirin or penicillin. Prick test reactions in the skin test positive patients were most commonly seen to house dust or the acarine mite, Dermatophagoides farinae (82 percent), followed by pollens (66 percent), animal danders (38 percent), foods (16 percent), Aspergillus fumigatus (16 percent), and other moulds (21 percent). There was a highly significant association of positive history with positive prick test for all allergens studied.