Comparing idiopathic chronic fatigue & ME/CFS in males: response to 2-day CPET protocol

Comparing Idiopathic Chronic Fatigue and Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) in males: response to Two-Day Cardiopulmonary Exercise Testing protocol, by C Linda M C van Campen, Frans C Visser in Healthcare (Basel). 2021 Jun 5;9(6):683 [doi: 10.3390/healthcare9060683]

 

Research abstract:

(1) Introduction:

Multiple studies have shown that peak oxygen consumption is reduced in the majority of myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) patients, using the gold standard for measuring exercise intolerance: cardiopulmonary exercise testing (CPET). A 2-day CPET protocol has shown different results on day 2 in ME/CFS patients compared to sedentary controls. No comparison is known between ME/CFS and idiopathic chronic fatigue (ICF) for 2-day CPET protocols.

We compared ME/CFS patients with patients with chronic fatigue who did not fulfil the ME/CFS criteria in a male population and hypothesized a different pattern of response would be present during the 2nd day CPET.

(2) Methods:

We compared 25 male patients with ICF who had completed a 2-day CPET protocol to an age-/gender-matched group of 26 male ME/CFS patients.

Measures of oxygen consumption (VO2), heart rate (HR), systolic and diastolic blood pressure, workload (Work), and respiratory exchange ratio (RER) were collected at maximal (peak) and ventilatory threshold (VT) intensities.

(3) Results:

Baseline characteristics for both groups were similar for age, body mass index (BMI), body surface area, (BSA), and disease duration.

A significant difference was present in the number of patients with fibromyalgia (seven ME/CFS patients vs. zero ICF patients). Heart rate at rest and the RER did not differ significantly between CPET 1 and CPET 2. All other CPET parameters at the ventilatory threshold and maximum exercise differed significantly (p-value between 0.002 and <0.0001).

ME/CFS patients showed a deterioration of performance on CPET2 as reflected by VO2 and workload at peak exercise and ventilatory threshold, whereas ICF patients showed improved performance on CPET2 with no significant change in peak workload.

(4) Conclusion:

This study confirms that male ME/CFS patients have a reduction in exercise capacity in response to a second-day CPET. These results are similar to published results in male ME/CFS populations. Patients diagnosed with ICF show a different response on day 2, more similar to sedentary and healthy controls.

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Systematic review of mind-body interventions to treat ME/CFS

Systematic review of mind-body interventions to treat Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, by Samaneh Khanpour Ardestani, Mohammad Karkhaneh, Eleanor Stein, Salima Punja, Daniela R. Junqueira, Tatiana Kuzmyn, Michelle Pearson, Laurie Smith, Karin Olson, Sunita Vohra in Medicina Vol 57, #7, p 652, June 24, 2021 [doi.org/10.3390/medicina57070652] This article belongs to the Special Issue ME/CFS: Causes, Clinical Features and Diagnosis

 

Review abstract:

Background and Objectives

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a chronic condition distinguished by disabling fatigue associated with post-exertional malaise, as well as changes to sleep, autonomic functioning, and cognition. Mind-body interventions (MBIs) utilize the ongoing interaction between the mind and body to improve health and wellbeing.

Purpose

To systematically review studies using MBIs for the treatment of ME/CFS symptoms.

Materials and Methods

MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane CENTRAL were searched (inception to September 2020). Interventional studies on adults diagnosed with ME/CFS, using one of the MBIs in comparison with any placebo, standard of care treatment or waitlist control, and measuring outcomes relevant to the signs and symptoms of ME/CFS and quality of life were assessed for inclusion.

Characteristics and findings of the included studies were summarized using a descriptive approach.

Results

12 out of 382 retrieved references were included. Seven studies were randomized controlled trials (RCTs) with one including three reports (1 RCT, 2 single-arms); others were single-arm trials. Interventions included mindfulness-based stress reduction, mindfulness-based cognitive therapy, relaxation, Qigong, cognitive-behavioral stress management, acceptance and commitment therapy and isometric yoga.

The outcomes measured most often were fatigue severity, anxiety/ depression, and quality of life. Fatigue severity and symptoms of anxiety/depression were improved in nine and eight studies respectively, and three studies found that MBIs improved quality of life.

Conclusions

Fatigue severity, anxiety/depression and physical and mental functioning were shown to be improved in patients receiving MBIs. However, small sample sizes, heterogeneous diagnostic criteria, and a high risk of bias may challenge this result. Further research using standardized outcomes would help advance the field.

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Central autonomic network disturbance in ME/CFS

Central autonomic network disturbance in Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome: a pilot study, by Mark Zinn, Marcie L Zinn, Leonard A Jason in NeuroRegulation Vol 8, #2, pp 73-86, June 30 2021

 

Research abstract:

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating disease of the central nervous system known to be associated with multiple behavioral symptoms (fatigue, low stamina, dizziness, etc.) combined with autonomic nervous system (ANS) dysfunction, thus implicating the central autonomic network (CAN).

Post-exertional malaise (PEM) is a core feature of ME/CFS, characterized by a pathological reduction in stamina in response to performing minor physical or mental tasks, often lasting at least 24 hours.

Exact low-resolution electromagnetic tomography (eLORETA) allows non-invasive investigation of cortical regions of interest that may contribute to better understanding of the role of the brain disturbances in behavioral manifestations of PEM.

This pilot study therefore aimed to use eLORETA to characterize changes in current density in cortical structures related to the CAN following submaximal isometric handgrip exercise in 7 patients with ME/CFS and 6 neurotypical healthy controls (HCs). Resting EEG was recorded at pre-, post- handgrip, and 24 hours later. Findings showed that hand grip dynamometersignificant differences occurred immediately post-test, which were most pronounced after 24 hours, particularly in the low alpha (8-10 Hz) and low beta (13-18 Hz) frequency sub-bands. Together, the present findings offer support for EEG source localization techniques to investigate PEM. If confirmed, this study could provide a useful instrument for functional diagnosis and evaluation of treatment outcomes.

 

Phoenix rising: Central Autonomic Network Disturbance in People with ME: A Conversation with Dr. Mark Zinn      Aug 2021

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Doctors with ME – new professional association

Doctors with ME

 

Recently launched is the global professional association for medical practitioners, scientists and researchers with myalgic encephalomyelitis.

The DwME mission and vision:

To improve patient outcomes worldwide by empowering medics, scientists, and policymakers with up to date practices and scientific rigour, fostering collaboration between professionals, the industries they serve, patients and the public.

To build a future where every surgery, hospital, agency, insurance provider and employer is enabled with accurate information that supports their patients, clients, shareholders and wider stakeholders.

Led by doctors with ME

  • Dr KN Hng – founder
  • Dr Nina Muirhead – director
  • Dr Keith Geraghty – director
  • Dr Richard Ramyar – business & strategy advisor

Honorary fellows:

  • Prof Jonathan Edwards – UK
  • Prof Leonard Jason – USA
  • Prof Anthony Komaroff – USA
  • Prof Ian Lipkin – USA
  • Prof Alain Moreau – Canada
  • Prof Derek Pheby – UK
  • Prof Chris Ponting – UK
  • Prof Ron Tompkins – USA
  • Dr Lucinda Bateman – USA
  • Tom Kindlon – Ireland
  • Dr Karl Morten – UK
  • Dr Charles Shepherd – UK
  • Dr David Strain – UK
  • Dr Nigel Speight – UK
  • Dr David Tuller – USA

Find out more about what DwME will be doing and how they will do it.

Like them on Facebook: https://www.facebook.com/doctorswithme/

Follow them on twitter @doctorswithme

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Research: Whole-body cryotherapy & static-stretching exercises in CFS patients

Changes in the allostatic response to whole-body cryotherapy and static-stretching exercises in Chronic Fatigue Syndrome patients vs. healthy individuals, by Sławomir Kujawski, Anna M Bach, Joanna Slomko, Derek FH Pheby, Modra Murovska, Julia L Newton, Paweł Zalewski in Journal of Clinical Medicine Vol 10, no. 13, p 2795 25 June 2021

 

Research abstract:

This study represents a comparison of the functional interrelation of fatigue and cognitive, cardiovascular and autonomic nervous systems in a group of Chronic Fatigue Syndrome (CFS) patients compared with those in healthy individuals at different stages of analysis: at baseline and after changes induced by whole-body cryotherapy (WBC) combined with a static-stretching (SS) program.

The study included 32 patients (Fukuda criteria) and 18 healthy controls. Fatigue, cognitive, cardiovascular and autonomic function and arterial stiffness were measured before and after 10 sessions of WBC with SS.

In the patients, a disturbance in homeostasis was observed. The network relationship based on differences before and after intervention showed comparatively higher stress and eccentricity in the CFS group: 50.9 p/m 56.1 vs. 6.35 p/m 8.72, p=0.002, r=0.28; and 4.8 p/m 0.7 vs. 2.4 p/m 1, p<0.001, r=0.46, respectively.

Before and after intervention, in the CFS group increased fatigue was related to baroreceptor function, and baroreceptor function was in turn related to aortic stiffness, but no such relationships were observed in the control group. Differences in the network structure underlying the interrelation among the four measured criteria were observed in both groups, before the intervention and after ten sessions of whole cryotherapy with a static stretching exercise.

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Insights from ME/CFS may help unravel the pathogenesis of post-acute COVID-19 syndrome

Insights from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome may help unravel the pathogenesis of post-acute COVID-19 syndrome, by Anthony L Komaroff, W Ian Lipkin in Trends in Molecular Medicine, 7 June 2021 [doi.org/10.1016/j.molmed.2021.06.002]

 

Highlights:

  • In some people, the aftermath of acute coronavirus disease 2019 (COVID-19) is a lingering illness with fatigue and cognitive defects, known as post–COVID-19 syndrome or ‘long COVID.’
  • Post–COVID-19 syndrome is similar to postinfectious fatigue syndromes triggered by other infectious agents and to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a condition that patients often report is preceded by an infectious-like illness.
  • ME/CFS is associated with underlying abnormalities of the central and autonomic nervous systems, immune dysregulation, disordered energy metabolism, and redox imbalance. It is currently unclear if the same abnormalities will be identified in post–COVID-19 syndrome.
  • The USA and other developed nations have committed considerable support for research on post–COVID-19 illnesses.

Review abstract:

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause chronic and acute disease. Postacute sequelae of SARS-CoV-2 infection (PASC) include injury to the lungs, heart, kidneys, and brain that may produce a variety of symptoms. PASC also includes a post–coronavirus disease 2019 (COVID-19) syndrome (‘long COVID’) with features that can follow other acute infectious diseases and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Here we summarize what is known about the pathogenesis of ME/CFS and of ‘acute’ COVID-19, and we speculate that the pathogenesis of post–COVID-19 syndrome in some people may be similar to that of ME/CFS.

We propose molecular mechanisms that might explain the fatigue and related symptoms in both illnesses, and we suggest a research agenda for both ME/CFS and post–COVID-19 syndrome.

Comment from Health rising: Experts Assert Insights From ME/CFS Needed to Understand Long COVID

We’re just beginning to learn about long COVID, but some possible connections have shown up. Besides the wide overlap in symptoms, the mixed results from attempts to find evidence of the virus in the central nervous system suggest that it’s the “host response to the virus and microvascular damage” occurring from that – rather than the direct effects of the virus – that is probably causing symptoms. Indeed, they believe the virus probably does much of its damage via its effects on the vascular system (blood vessels). The widespread “microinfarcts” found in COVID-19 could be contributing to the cognitive problems found.

These findings alone present plenty of potential overlap with ME/CFS and fibromyalgia, with several studies suggesting the microcirculation, in particular, has been disturbed.

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Introducing WAMES volunteers: Mia Boardman

Introducing WAMES volunteers: social media volunteer

 

Hi! I’m Mia.

I am the volunteer in charge of the newly created WAMES Instagram account. I joined WAMES as a volunteer because I liked the idea of being able to help others that are in my situation, especially young people like me. Running the Instagram account allows me post about things I wish I would have been able to see when I had ME!

Before I developed ME, I was a Welsh national swimmer, just about to begin my first year of GCSEs.  At the age of 14 though, I developed a chronic pain that lasted almost 3 months to the day before it stopped. After the pain had disappeared, I was left with chronic fatigue that prevented me from being able to attend school or continue swimming. I had to be home tutored and complete my GCSEs at home.

After 2 years of suffering with ME, I made a full recovery and 5 years on from my diagnosis, my life is back to normal (if it was ever normal to begin with!) I am on my way to university to study Biomedical Science and I have started swimming again.

Read other volunteers’ stories:

Michelle

Sharon

Jan

Tony

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CFS & bone marrow defects of the jaw (case report)

Chronic Fatigue Syndrome and bone marrow defects of the jaw – a case report on additional dental X-Ray diagnostics with ultrasound, by Johann Lechner, Fabian Schick in Cureus 2021 May; 13(5): e14837. [doi: 10.7759/cureus.14837]

 

Article purpose: 

This paper aims to demonstrate the additional benefit of ultrasound in the diagnosis of chronic osteolysis and osteonecrosis (bone marrow defects) of the jaw shown in a clinical case report.

Patients and Methods:

A case of chronic fatigue syndrome (CFS) in a young man presenting the typical, ambiguous symptoms, which were accompanied by headaches and tinnitus. X-ray techniques, namely panoramic radiographs (OPG) and cone beam computed tomography (DVT/CBCT), failed to produce any remarkable findings of bone marrow defects (BMDJ) in the jawbone. However, the measurement of bone density using trans-alveolar ultrasound (TAU) indicated a possible bone marrow defect in the lower left jawbone.

Results:

Surgery was undertaken at the conspicuous area. Additional to softened, ischemic, fatty tissue, a black area was revealed, which was surprisingly subsequently identified as aspergillosis by histopathological analysis. In addition, the excessive local RANTES/CCL5 expression found in the affected area confirmed the necessity for surgical debridement and additional findings of TAU.

Conclusion:

In contrast to radiography, complementary TAU imaging of the BMDJ revealed chronic inflammatory signaling RANTES/CCL5 pathways and fungal colonization. This case report supports the need for additional diagnostic techniques beyond radiographic modalities, which can help to elucidate the diagnostic composition and knowledge of the bone manifestations of systemic diseases.

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Post-acute COVID-19 symptoms, a potential link with ME/CFS (Mexico)

Post-acute COVID-19 symptoms, a potential link with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A 6-month survey in a Mexican cohort, by J Antonio Gonzalez-Hermosillo, Jhanea Patricia Martinez-Lopez, Sofia Antonieta Carrillo-Lampon, Dayanara Ruiz-Ojeda, Sharon Herrera-Ramirez, Luis M. Amezcua-Guerra, Maria del Rocio Martinez-Alvarado in Brain Sciences Vol 11, #6, p 760, June 8, 2021

 

Research abstract:

The aim of this study was to describe the clinical evolution during 6 months of follow-up of adults recovered from COVID-19. We tried to determine how many met the definition of Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS). A total of 130 patients (51.0 p/m 14 years, 34.6% female) were enrolled. Symptoms were common, participants reported a median number of 9 (IQR 5-14) symptoms.

Fatigue was the most common symptom (61/130; 46.9%). Patients with fatigue were older 53.9 p/m 13.5 years compared with 48.5 p/m 13.3 years in those without fatigue (p=0.02) and had a longer length of hospital stay, 17 p/m 14 days vs. 13 p/m 10 days (p=0.04).

There was no difference in other comorbidities between patients with fatigue and those without it, and no association between COVID-19 severity and fatigue. After multivariate adjustment of all baseline clinical features, only age 40 to 50 years old was positively associated with fatigue, OR 2.5 (95% CI 1.05-6.05) p=0.03.

In our survey, only 17 (13%) patients met the Institute of Medicine’s criteria for ‘systemic exertion intolerance disease,’ the new name of ME/CFS.

In conclusion, in some patients, the features of post-acute COVID-19 syndrome overlap with the clinical features of ME/CFS.

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Expert consensus on the diagnosis, service provision & care of people with ME/CFS in Europe (EUROMENE)

European Network on Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (EUROMENE): Expert Consensus on the Diagnosis, Service Provision, and Care of People with ME/CFS in Europe

 

Research abstract:

Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation in Science and Technology (COST)-COST action 15111-from 2016 to 2020.

The main goal of the Cost Action was to assess the existing knowledge and experience on health care delivery for people with Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) in European countries, and to enhance coordinated research and health care provision in this field.

We report our findings and make recommendations for clinical diagnosis, health services and care for people with ME/CFS in Europe, as prepared by the group of clinicians and researchers from 22 countries and 55 European health professionals and researchers, who have been informed by people with ME/CFS.

 

5. Concluding Remarks and Recommendations for Developing and Organising ME/CFS Services

The following are general recommendations for fully implemented services, but we appreciate that they are not achievable in the short term in many places, especially where knowledge and training in the field are limited or other resources are scarce.

We encourage countries and regions to plan for their services, training, and educational needs according to the specific needs and characteristics of their population and patients and their organizational structures and resources.

A national champion for each country or regions within countries would be highly desirable, especially in places with no or very scarce provision of services for ME/CFS.

For fully functioning services, we recommend 2–4 ME/CFS specialist doctors/1 million population, with a supporting multi-disciplinary team, to include professionals such as nurses, nurse practitioners, occupational therapists, psychologists, dieticians, social workers, etc.; these would staff outpatient services for diagnosis and follow up.

The specialist may be a doctor with expertise in ME/CFS. Internists, neurologists, immunologists, rheumatologists, infectious diseases specialists, and general practitioners are particularly suited for this role, but it may be done by doctors of any specialty, as long as they have the right expertise or training. For children, this role is to be filled by paediatricians.

At the time of writing, we are not aware of any specific programme for the training of doctors to become specialists in ME/CFS, something that has often occurred informally so far. The training and provision of services in secondary care should be aligned with the training of primary care physicians to manage cases in the community. We recognize that the above target is ambitious, considering the current capacity and status of service provision in the continent. They should be seen as tentative and should not replace the assessment of patients’ needs and structure and capacity of services at local and national levels.

The current reality of health services suggests that, where specialist services are not well developed, we follow a minimum standard of care for those with ME/CFS that may rely on virtual health and app-technology as well as on a strong partnership with primary care.

The minimum desirable is one ME/CFS centre providing specialist services for a 10 million population. These services should also consider the characteristics of the population, including ethnic and cultural diversity.

Furthermore, we recommend that the specialist services should have the primary aim of confirming diagnosis and setting up treatment/ management plans, which should be agreed upon and carried out by a multidisciplinary team. The follow-up could use multi-media approaches, such as remote consultations or telemedicine, as appropriate according to local circumstances and medical regulations.

Local care for people with significant disability may need to be provided by primary care teams or local doctors with knowledge about ME/CFS, with support from the specialist services as appropriate. The option of smaller satellite clinics linked to the specialist service would provide full assistance for most and the “eyes” of a competent health professional, in support of remote consultations from the specialist for complex cases.

There is no suggestion that people with ME/CFS require more social support than people with other chronic diseases, and we are most certainly not implying that the disease is primarily psychological in nature. We are, though, very well aware that people with other chronic diseases, such as for example diabetes or multiple sclerosis, do not have the same problems of disbelief and lack of legitimisation experienced by people with ME/CFS. All people with chronic diseases need, and should be entitled to, social support, but few experience the same difficulty accessing it as people with ME/CFS.

Finally, it is important to consider that addressing the substantial needs of people with ME/CFS requires a multi-sectoral approach (Box 13), as well as ensuring that health services are organised and delivered effectively. Much of the needs of people affected by ME/CFS arise from their reduced ability to function in society and in more extreme cases on their total dependence on care for basic needs. Work, life, and education may be disrupted, with substantial economic and personal impacts on individuals and their families; lack of understanding and support, and often stigma, adding to the burden of physical suffering from symptoms.

It is extremely important to prioritize research and education of health professionals and others in society, so as to address the scientific and societal poor understanding of the scale of the problem faced.

Authors & Source:

Luis Nacul, François Jérôme Authier, Carmen Scheibenbogen, Lorenzo Lorusso, Ingrid Bergliot Helland, Jose Alegre Martin, Carmen Adella Sirbu, Anne Marit Mengshoel, Olli Polo, Uta Behrends, Henrik Nielsen, Patricia Grabowski, Slobodan Sekulic, Nuno Sepulveda, Fernando Estévez-López, Pawel Zalewski, Derek F H Pheby, Jesus Castro-Marrero, Giorgos K Sakkas, Enrica Capelli, Ivan Brundsdlund, John Cullinan, Angelika Krumina, Jonas Bergquist, Modra Murovska, Ruud C W Vermuelen, Eliana M Lacerda in Medicina 2021, 57(5), 510; [doi.org/10.3390/medicina57050510] 19 May 2021 (This article belongs to the Special Issue ME/CFS: Causes, Clinical Features and Diagnosis)

 

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