Hypopituitarism – diagnosis amgen i ME neu CFS

Posted on June 13, 2013 by wames

One of the conditions that can be wrongly diagnosed as CFS is post-traumatic hypopituitarism (PTHP). Symptoms include fatigue, muscle weakness, dizziness and nausea and can occur at any time after a head injury, even many years later. Other causes of PTHP include tumors, stroke, infections of the brain, radiation treatment.

The pituitary gland produces hormones that control many functions of otherprovided by GPs and endocrinologists. Treatments vary depending on the type of damage to the gland.

More information:

Head injury and hypopituitarism

Christine’s story

Phil’s story

Pituitary foundation

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Dr Nigel Speight yn amlinellu hanes ME

Posted on June 12, 2013 by wames

WAMES’ medical advisor and consultant paediatrician Nigel Speight reviews the major historical developments of the last 50 years, describes the clinical pattern and spectrum of severity, and then explores the current major controversies surrounding the subject.

Myalgic encephalomyelitis/chronic fatigue syndrome: Review of history, clinical features, and controversies.  Nigel Speight in Saudi J Med Med Sci 2013;1:11-3

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Differences in physical functioning between relatively active and passive patients with CFS

Posted on June 12, 2013 by wames

Research Abstract

Objective: According to the Cognitive behavioral therapy (CBT) protocol for patients with Chronic Fatigue Syndrome (CFS), therapists are advised to categorize patients in relatively active and passive patients. However, evidence to support the differences in physical functioning between these subgroups is limited. Using the baseline data from a multicentre randomized controlled trial (FatiGo), the differences in actual and perceived physical functioning between active and passive patients with CFS were evaluated.

Methods: Sixty patients, who received CBT during the FatiGo trial were included. Based on the expert opinion and using the definitions of subgroups defined in the CBT protocols, the therapist categorized the patient. Data from an activity monitor was used to calculate actual physical functioning, physical activity, daily uptime, activity fluctuations and duration of rest during daily life. Perceived physical functioning was assessed by measuring physical activity, physical functioning and functional impairment with the Checklist Individual Strength, Short Form-36 and Sickness-Impact Profile 8.

Results: Relatively active patients have a significantly higher daily uptime and show significantly less fluctuations in activities between days. Passive patients experience a significantly lower level of physical functioning and feel more functionally impaired in their mobility. However, no significant differences were found in the other actual or perceived physical functioning indices.

Conclusions: A clear difference in actual and perceived physical functioning between relatively active and passive patients with CFS as judged by their therapists could not be found. Future research is needed to form a consensus on how to categorize subgroups of patients with CFS.

Differences in physical functioning between relatively active and passive patients with Chronic Fatigue Syndrome  CWM Desiréeet al  Journal of Psychosomatic Research 03 June 2013

FatiGo study protocol: Cognitive behavioural therapy versus multidisciplinary rehabilitation treatment for patients with chronic fatigue syndrome: study protocol for a randomised controlled trial Vos-Vromans et al.

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Mycotocsinau a geir mewn pobl â CFS

Posted on June 10, 2013 by wames

Research Abstract 

Background: Over the past 20 years, exposure to mycotoxin producing mold has been recognized as a significant health risk. Scientific literature has demonstrated mycotoxins as possible causes of human disease in water-damaged buildings (WDB).

Aim: This study was conducted to determine if selected mycotoxins could be identified in human urine from patients suffering from chronic fatigue syndrome (CFS).

Method: Patients (n = 112) with a prior diagnosis of CFS were evaluated for mold exposure and the presence of mycotoxins in their urine. Urine was tested for aflatoxins (AT), ochratoxin A (OTA) and macrocyclic trichothecenes (MT) using Enzyme Linked Immunosorbent Assays (ELISA).

Results: Urine specimens from 104 of 112 patients (93%) were positive for at least one mycotoxin (one in the equivocal range). Almost 30% of the cases had more than one mycotoxin present. OTA was the most prevalent mycotoxin detected (83%) with MT as the next most common (44%). Exposure histories indicated current and/or past exposure to WDB in over 90% of cases. Environmental testing was performed in the WDB from a subset of these patients. This testing revealed the presence of potentially mycotoxin producing mold species and mycotoxins in the environment of the WDB. Prior testing in a healthy control population with no history of exposure to a WDB or moldy environment (n = 55) by the same laboratory, utilizing the same methods, revealed no positive cases at the limits of detection.

Detection of Mycotoxins in Patients with Chronic Fatigue Syndrome  Joseph H. Brewer, Jack D. Thrasher, David C. Straus, Roberta A. Madison and Dennis Hooper  Toxins 2013, 5(4), 605-617

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HERV dod o hyd ym mherfedd pobl ag ME

Posted on June 10, 2013 by wames

Research Abstract

Background: Myalgic encephalomyelitis (ME) is a debilitating illness of unknown etiology characterized by neurocognitive dysfunction, inflammation, immune abnormalities and gastrointestinal distress. An increasing body of evidence suggests that disruptions in the gut may contribute to the induction of neuroinflammation.

Therefore, reports of human endogenous retroviral (HERV) expression in association with neuroinflammatory diseases prompted us to investigate the gut of individuals with ME for the presence of HERV proteins.

Results: In eight out of 12 individuals with ME, immunoreactivity to HERV proteins was observed in duodenal biopsies. In contrast, no immunoreactivity was detected in any of the eight controls. Immunoreactivity to HERV Gag and Env proteins was uniquely co-localized in hematopoietic cells expressing the C-type lectin receptor CLEC4C (CD303/BDCA2), the co-stimulatory marker CD86 and the class II major histocompatibility complex HLA-DR, consistent with plasmacytoid dendritic cells (pDCs).

Conclusion: Although the significance of HERVs present in the pDCs of individuals with ME has yet to be determined, these data raise the possibility of an involvment of pDCs and HERVs in ME pathology. To our knowledge, this report describes the first direct association between pDCs and HERVs in human disease.

Plasmacytoid Dendritic Cells in the Duodenum of Individuals Diagnosed with Myalgic Encephalomyelitis Are Uniquely Immunoreactive to Antibodies to Human Endogenous Retroviral Proteins   Kenny L de Meirleir et al  In Vivo March-April 2013 vol. 27 no. 2 177-187

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Cytokine flucutations reflect fluctutations in fatigue severity

Posted on June 6, 2013 by wames

Research Abstract

Background: Chronic fatigue syndrome (CFS) is a debilitating disorder characterized by persistent fatigue that is not alleviated by rest. The lack of a clearly identified underlying mechanism has hindered the development of effective treatments. Studies have demonstrated elevated levels of inflammatory factors in patients with CFS, but findings are contradictory across studies and no biomarkers have been consistently supported. Single time-point approaches potentially overlook important features of CFS, such as fluctuations in fatigue severity. We have observed that individuals with CFS demonstrate significant day-to-day variability in their fatigue severity.

Methods: Therefore, to complement previous studies, we implemented a novel longitudinal study design to investigate the role of cytokines in CFS pathophysiology. Ten women meeting the Fukuda diagnostic criteria for CFS and ten healthy age- and body mass index (BMI)-matched women underwent 25 consecutive days of blood draws and self-reporting of symptom severity. A 51-plex cytokine panel via Luminex was performed for each of the 500 serum samples collected.

Our primary hypothesis was that daily fatigue severity would be significantly correlated with the inflammatory adipokine leptin, in the women with CFS and not in the healthy control women. As a post-hoc analysis, a machine learning algorithm using all 51 cytokines was implemented to determine whether immune factors could distinguish high from low fatigue days.

Results: Self-reported fatigue severity was significantly correlated with leptin levels in six of the participants with CFS and one healthy control, supporting our primary hypothesis. The machine learning algorithm distinguished high from low fatigue days in the CFS group with 78.3% accuracy.

Conclusions: Our results support the role of cytokines in the pathophysiology of CFS.

Daily cytokine fluctuations, driven by leptin, are associated with fatigue severity in chronic fatigue syndrome: evidence of inflammatory pathology.  Elizabeth Ann Stringer, Katharine Susanne Baker, Ian R Carroll, Jose G Montoya, Lily Chu, Holden T Maecker and Jarred W Younger  Journal of Translational Medicine 2013, 11:93

 

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Research review of cognitive impairments in CFS and POTS

Posted on June 6, 2013 by wames

Review abstract

Chronic fatigue syndrome (CFS) is characterized by fatigue, sleep dysfunction, and cognitive deficits (Fukuda et al., 1994).

Research surrounding cognitive functioning among patients with CFS has found difficulty with memory, attention, and information processing. A similar disorder, postural tachycardia syndrome (POTS), is characterized by increased heart rate, fatigue, and mental cloudiness (Raj et al., 2009).

Potential implications of cognitive deficits for patients with CFS and/or POTS are discussed, including difficulties with school and/or employment. A few biological theories (i.e., kindling, impairments in the central nervous system, and difficulty with blood flow) have emerged as potential explanations for the cognitive deficits reported in both CFS and POTS.

Future research should continue to examine possible explanations for cognitive impairments in CFS and POTS, and ultimately use this information to try and reduce cognitive impairments for these patients.

Cognitive impairments associated with CFS and POTS  Lindzi Shanks, Leonard A. Jason, Meredyth Evans and Abigail Brown  Front. Physiol., 16 May 2013

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Cur pen (idiopathic intracranial hypertension) a CFS

Posted on June 5, 2013 by wames

Research Abstract

Introduction: Headache is common in chronic fatigue syndrome, a condition of unknown cause in which there are no clinical signs. Fatigue is common in idiopathic intracranial hypertension, a headache condition of unknown cause in which the only clinical signs are those of raised intracranial pressure, signs which may be absent. Might, therefore, idiopathic intracranial hypertension be present in some patients diagnosed with chronic fatigue syndrome? Could the two conditions be related?

Methods: From June 2007, patients attending a specialist clinic who fulfilled the diagnostic criteria for chronic fatigue syndrome and in whom headache was an especially prominent symptom were offered CT venography and lumbar puncture, looking for evidence of raised intracranial pressure.

Results: Of the 20 patients who accepted lumbar puncture, eight had pressures of 20 cm H2O or greater, including three who had pressures of 25 cm H2O or greater. Mean pressure was 19 cm H2O.

Conclusions: Some patients with headache and a diagnosis of chronic fatigue syndrome have unrecognised and occult idiopathic intracranial hypertension. The possibility that the two conditions are related cannot be excluded.

Looking for idiopathic intracranial hypertension in patients with chronic fatigue syndrome. Dr Nicholas Higgins, Prof. John Pickard, Prof. Andrew Lever,  Journal of Observational Pain Medicine, 15 May 2013

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Patrymau ‘Abnormal Visual Attention’ yn ME

Posted on June 5, 2013 by wames

Research Abstract

Purpose: To experimentally assess visual attention difficulties commonly reported by those with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Methods:  Twenty-nine ME/CFS patients and 29 controls took part in the study. Performance was assessed using the Useful Field of View (UFOV), a spatial cueing task and visual search.

Results:  Patients and controls performed similarly on the processing speed subtest of the UFOV. However, patients exhibited marginally worse performance compared with controls on the divided attention subtest and significantly worse performance on the selective attention subtest.

In the spatial cueing task, they were slower than controls to respond to the presence of the target, particularly when cues were invalid. They were also impaired, relative to controls, on visual search tasks.

Conclusions:  We have provided experimental evidence for ME/CFS-related difficulties in directing visual attention. These findings support the subjective reports of those with ME/CFS and could represent a potential means to improve diagnosis.

Patterns of Abnormal Visual Attention in Myalgic Encephalomyelitis.  Hutchinson CV, Badham SP. Optometry and Vision Science, 17 May 2013 [Epub ahead of print]

 

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Ffisiotherapydd yn rhybuddio therapi ‘graded exercise’ (GET) mewn ME/CFS

Posted on June 4, 2013 by wames

Physio Michelle Bull has a special interest in exercise for people with chronic fatigue – because her son has the condition

I read the article about graded exercise therapy (GET) (Frontline, 20 March) with great interest as a physiotherapist and mother of a teenage son with ME or chronic fatigue syndrome. I have read a lot around this subject on the internet, and have found a large number of online support communities and discussion groups.

There is a huge amount of controversy regarding the use of GET among these online support communities, with the majority reporting it to be detrimental to patients’ health. This is believed to be due to inappropriately planned or progressed exercise programmes, possibly undertaken independently, or under supervision from a person without the appropriate experience.

I have certainly had to develop my skills and knowledge in this field to support my son. Establishing an accurate baseline is essential for these patients.

Post-exertional neuroimmune exhaustion is extreme fatigue not relieved by rest or sleep and can be delayed in onset for 72 hours.

My son would be able to exercise for five minutes with little apparent immediate problem but three days later he would be confined to bed for over a week while he tried to recover.

In addition, mental effort has the same effect as physical effort. Ten minutes of maths homework has the same effect as exercising for 10 minutes. Mental activities must therefore be considered when baselining children’s activity levels and setting an exercise regime.

It is concerning that physio is being talked about online as something that makes children with ME’s symptoms worse. As a profession we need to ensure we are improving the health of all our patients – treating conditions we are competent to treat, carrying out thorough assessment and regular review of progress, and adapting exercise programmes as required.

I believe that physical activity does have a role to play in the care of people with ME. But this needs to be individualised for each patient rather than adhering to a rigid protocol.

We can’t risk making any of our patients worse with our therapeutic interventions.

Michelle Bull is a physio and project manager at the London Cancer Alliance

Viewpoint – Take it easy  Frontline, Journal of the Chartered Society of Physiotherapy, 15 May 2013.

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