Abstract

BACKGROUND

Chronic fatigue syndrome/myalgic encephalitis (CFS/ME) is rarely diagnosed in South Asia (SA), although the symptoms of this condition are seen in the population. Lessons from UK based South Asian, Black and Minority Ethnic (BME) communities may be of value in identifying barriers to diagnosis of CFS/ME in SA.

OBJECTIVE

To explore why CFS/ME may not be commonly diagnosed in SA. Settings and Design: A secondary analysis of qualitative data on the diagnosis and management of CFS/ME in BME people of predominantly South Asian origin in the UK using 27 semi-structured qualitative interviews with people with CFE/ME, carers, general practitioners (GPs), and community leaders.

RESULTS

CFS/ME is seen among the BME communities in the UK. People from BME communities in the UK can present to healthcare practitioners with vague physical complaints and they can hold a biomedical model of illness. Patients found it useful to have a label of CFS/ME although some GPs felt it to be a negative label. Access to healthcare can be limited by GPs reluctance to diagnose CFS/ME, their lack of knowledge and patients negative experiences. Cultural aspects among BME patients in the UK also act as a barrier to the diagnosis of CFS/ME.

CONCLUSION

Cultural values and practices influence the diagnosis of CFS/ME in BME communities. The variations in the perceptions around CFS/ME among patients, carers, and health professionals may pose challenges in diagnosing CFS/ME in SA as well. Raising awareness of CFS/ME would improve the diagnosis and management of patients with CFS/ME in SA.

Diagnosing chronic fatigue syndrome in south asians: Lessons from a secondary analysis of a UK qualitative study, by R  Erandie Ediriweera De Silva, Kerin Bayliss, Lisa Riste, Carolyn A Chew-Graham in the Journal of Family Medicine and Primary Care 2013;2:277-82

Abstract

Irritable bowel syndrome (IBS) is a multifactorial chronic disorder characterized by various abdominal complaints and a worldwide prevalence of 10% – 20%. Although its etiology and pathophysiology are complex and still not completely understood, aberrations along the microbe-gut-brain axis are known to play a central role.

IBS is characterized by interrelated alterations in intestinal barrier function, gut microbe composition, immune activation, afferent sensory signaling and brain activity. Pharmaceutical treatment is generally ineffective and, hence, most therapeutic strategies are based on non-drug approaches.

A promising option is the administration of probiotics, in which lactic acid bacteria strains are considered specifically beneficial. This review aims to provide a concise, although comprehensive, overview of the role of lactic acid bacteria in the pathophysiology and treatment of IBS.

The Role of Lactic Acid Bacteria in the Pathophysiology and Treatment of Irritable Bowel Syndrome (IBS), by Julia König, Ignacio Rangel, Robert J. Brummer, in Food and Nutrition Sciences (Open Access), November 13.

Extract:

People diagnosed with CFS/ME consistently report that they experience vision-related symptoms associated with their illness and some of these reports are being verified experimentally.  Although vision-related symptoms may represent a significant clinical feature of CFS/ME that could be useful in its diagnosis, they have yet to be included in clinical guidelines.

A recently developed, standardised measure designed to assess core CFS/ME symptoms, The DePaul Symptom Questionnaire (DSQ),5 includes four vision-related items…

Vision-related symptoms as a clinical feature of chronic fatigue syndrome/myalgic encephalomyelitis? Evidence from the DePaul Symptom Questionnaire, by Claire V Hutchinson, John Maltby, Stephen P Badham, Leonard A Jason, in British Journal of Opthalmology, 1 November 2013

Abstract

Aim: The aim of this supplement study was to evaluate French oak wood extract (Robuvit®, Horphag Research Ltd) used as a supplement in association with a defined management plan for chronic fatigue syndrome (CFS) in healthy subjects with CFS, a condition that has, so far, no specific treatment or management standards.

Methods: Robuvit® is a new proprietary and exclusive extract of oak wood with important antoxidant actions. The dosage of the supplementation was 200 mg/day for at least 6 months. The CFS questionnaire and the Brief Mood Introspection Scale (BMIS) questionnaire were used to evaluate mood variations associated with CFS patients. The CFS form includes an analogue scale to record the variations of single symptoms with a score range of 0-10. At inclusion into the registry study, at least 5 symptoms were present. All subjects (age range 35-44; BMI range 24-26) with CFS were tested for oxidative stress: 61 out of 91 subjects had an increased value of oxidative stress. The BMIS scale evaluating mood changes in time was also used. The evaluation was repeated at 3 and 6 months.

Results: Out of 91 eligible subjects with CFS, 48 subjects (31 with increased oxidative stress) were accepted as part of the supplement registry study using Robuvit; 43 (30 with increased oxidative stress) were accepted as controls using only the management plan. In the Robuvit® group there were 3 drop outs; also 3 controls were lost. Oxidative stress was increased in 64.58% of subjects that used Robuvit and in 69.7% of controls. The average values of oxidative stress were expressed for the whole group. The average follow up was 199.3;9.2 days in the Robuvit group and 202.2;5.5 in the control group with a minimum of 6 months.

Considering variations in oxidative stress, there was no significant average change in controls, but a significant decrease from the initial values was observed in Robuvit subjects after 3 and 6 months. The CFS questionnaire variations in score indicated that there was a significant improvement for most symptoms after 3 and 6 months in the Robuvit group. Positive variations were also present in controls, indicating the positive effect of an increased attention to CFS. The improvement in signs/symptoms was significantly more valuable in subjects using the oak wood extract considering the main 8 symptoms and the accessory symptoms.

Considering the BMIS variations, the totals for positive and negative items were significantly more favourable for Robuvit subjects. Overall mood evaluation in the oak wood extract group improved from an inclusion average of -6.93;2.1 to +4.32;2.6 at 6 months; in contrast it changed from -6.5;2.5 to -3.4;1.5 in controls. No side effects were observed during the supplementation with Robuvit. The compliance was optimal with 93% of the capsules correctly used.

Conclusion: This promising pilot supplement registry study indicates a new opportunity of management for these difficult and often neglected patients. Correlation between oxidative stress and CFS have to be better explored.

Improved management of primary chronic fatigue syndrome with the supplement French oak wood extract (Robuvit®): a pilot, registry evaluation by G Belcaro et al, in  Panminerva Med. 2013 Nov 14. [Epub ahead of print]

Abstract

PURPOSE

Cardiopulmonary exercise testing (CPET) is used to determine the etiology of unexplained exercise symptoms in otherwise healthy patients and those with well defined cardiopulmonary disease. Test results vary by baseline physical activity levels which are difficult to assess objectively.

METHODS

We performed submaximal exercise testing on 40 physically active, healthy control patients as part of a prospective trial to evaluate the exercise response in patients with chronic fatigue syndrome. All patients provided a self-assessment of fitness using a series of previously validated visual analogue scales (VAS). We evaluated the relationship between baseline fitness and physiologic response to exercise.

RESULTS

Mean age and BMI for the group were 30.7±8.8 and 27.0±3.6 respectively. There were 25 males (62.5%), 23 caucasians (57.5%) and 13 (32.5%) African Americans.

On a VAS from one to ten with ten being optimal, patients rated their current endurance, fitness and muscular strength at 7.8±1.5, 7.9±1.1 and 7.3±1.9. Self-assessment of endurance was significantly correlated with maximum respiratory rate (r=-0.34, p=0.03), fitness showed a trend toward correlation with heart rate reserve (r=0.27, p=0.09) and muscular strength was significantly correlated with peak heart rate (r=-0.43, p=0.01), heart rate reserve (r=0.33, p=0.04) and O2-pulse at VO2 max (r=0.37, p=0.02).

Female assessment of fitness and muscle strength showed good correlation with work rate achieved (0.40 and 0.53 respectively).

CONCLUSIONS

In a group of young, physically fit patients self assessment is correlated with aerobic fitness measured on symptom targeted, sub-maximal exercise testing. VAS scores for muscular strength seemed to be a better predictor of the cardiac response to exercise than were scores for endurance or fitness.

CLINICAL IMPLICATIONS

Visual analogue scales can be used to provide a baseline assessment of fitness, In conjunction with other factors known to predict responses to exercise these scales could theoretically help better define normality for a given patient.

Self-Assessment Using a Validated Visual Analogue Scale Predicts Response to Submaximal Exercise Testing, by T Hauser & A Holley in Chest Journal, 1 October 2013

Mae Corff Gwarchod Iechyd Gogledd Cymru – CIC, yn annog pobl i roi eu barn am sut mae’r gwasanaethau GIG lleol yn cwrdd â gofynion cleifion o ran eu dewis o iaith.

Dywedodd Geoff Ryall-Harvey, Prif Swyddog Cyngor Iechyd Cymuned Gogledd Cymru (CIC), ‘Mae’r adroddiadau diweddar yn y wasg sy’n sôn fod rhai cleifion wedi cael problemau gyda fferyllfeydd yn paratoi presgripsiynau sydd wedi eu hysgrifennu gyda’r cyfarwyddiadau yn y Gymraeg o bryder gwirioneddol i ni.’

Gellir gweld arolwg ar-lein CIC

I gael gwybodaeth bellach am yr arolwg neu i roi gwybod eich barn i CIC, cysylltwch â CIC ar 01248 679284 neu ebost neu ewch i’n gwefan .

“Exercise and ME/CFS – the evidence” is an event organised by the Bristol North Fibro & ME/CFS Support Group on 5th Feb from 6-9.15 pm at the Watershed in Bristol.

The evening will include a short 30 min version of the film – the young ME patients’ stories – backed up by a presentation by Prof Mark VanNess about the research from the Workwell Foundation with Staci Stevens and Chris Snell, previously at the Pacific Fatigue Lab California. This work is very significant in that it objectively demonstrates the reality of the cardinal symptom of ME – post exertional malaise, or the post exertional exacerbation of symptoms which can prove so damaging to patients. Their work counters assertions made by proponents of graded exercise and the PACE Trial that the fatigue and disability of CFS and ME is merely caused by deconditioning and that GET and CBT are the most effective treatment options for patients.

Dr Nigel Speight (WAMES advisor) who speaks in the film will also explain some of the problems encountered by families and medical professionals when trying to help young patients.

Attendance can gain 2 CPD credits for health professionals.

Tickets – £10 – are available from the website

More information and a programme on the film website