Tag: 1993

Prevalence of fatigue and chronic fatigue syndrome in a primary care practice

Abstract:

BACKGROUND: Our goals were to determine the prevalence of unusual, debilitating fatigue and the frequency with which it was associated with the chronic fatigue syndrome (CFS) or other physical or psychological illness in an outpatient clinic population.

METHODS: We prospectively evaluated a cohort of 1000 consecutive patients in a primary care clinic in an urban, hospital-based general medicine practice. The study protocol included a detailed history, physical examination, and laboratory and psychiatric testing.

RESULTS: Five patients who came because of CFS studies were excluded. Of the remaining 995, 323 reported fatigue, and 271 (27%) complained of at least 6 months of unusual fatigue that interfered with their daily lives. Of the 271, self-report or record review revealed a medical or psychiatric condition that could have explained the fatigue in 186 (69%). Thus, 85 (8.5%) of 995 patients had a debilitating fatigue of at least 6 months’ duration, without apparent cause. Of these patients, 48 refused further evaluation, and 11 were unavailable for follow-up; 26 completed the protocol. Three of the 26 were hypothyroid, and one had a major psychiatric disorder. Of the remaining 22 patients, three met Centers for Disease Control and Prevention criteria for CFS, four met British criteria, and 10 met the Australian case definition. The point prevalences of CFS were thus 0.3% (95% confidence interval [CI], 0% to 0.6%), 0.4% (95% CI, 0% to 0.8%), and 1.0% (95% CI, 0.4% to 1.6%) using the Centers for Disease Control and Prevention, British, and Australian case definitions, respectively. These estimates were conservative, because they assumed that none of the patients who refused evaluation or were unavailable for follow-up would meet criteria for CFS.

CONCLUSIONS: While chronic, debilitating fatigue is common in medical outpatients, CFS is relatively uncommon. Prevalence depends substantially on the case definition used.

 

Source: Bates DW, Schmitt W, Buchwald D, Ware NC, Lee J, Thoyer E, Kornish RJ, Komaroff AL. Prevalence of fatigue and chronic fatigue syndrome in a primary care practice. Arch Intern Med. 1993 Dec 27;153(24):2759-65. http://www.ncbi.nlm.nih.gov/pubmed/8257251

 

A controlled study of brain magnetic resonance imaging in patients with the chronic fatigue syndrome

Abstract:

Two neuroradiologists compared the brain MR scans of 52 patients with the CDC criteria for the chronic fatigue syndrome (CFS) with those of 52 age and sex matched controls who had undergone imaging because of histories of head trauma or headache.

CFS patients had significantly more abnormal scans than controls–27% vs 2%. Abnormalities seen were foci of increased white matter T2 signal in 9 CFS patients and one control and ventricular or sulcal enlargement in 5 CFS patients. Follow up of patients with subcortical signal hyperintensities revealed 3 who had symptoms suggestive of other known medical causes of what appeared to be CFS.

The data indicate that some CFS patients have some organic problem manifesting itself on neuroimaging. But, finding MR abnormalities should warn the physician that the patient’s symptoms may be secondary to some other medical illness and not simply primary CFS.

 

Source: Natelson BH, Cohen JM, Brassloff I, Lee HJ. A controlled study of brain magnetic resonance imaging in patients with the chronic fatigue syndrome. J Neurol Sci. 1993 Dec 15;120(2):213-7. http://www.ncbi.nlm.nih.gov/pubmed/8138812

 

Serum folate and chronic fatigue syndrome

Abstract:

We assayed serum folate levels of 60 patients with chronic fatigue syndrome (CFS) and found that 50% had values below 3.0 micrograms/l. Some patients with CFS are deficient in folic acid.

Comment in: Folate and chronic fatigue syndrome. [Neurology. 1994]

 

Source: Jacobson W, Saich T, Borysiewicz LK, Behan WM, Behan PO, Wreghitt TG. Serum folate and chronic fatigue syndrome. Neurology. 1993 Dec;43(12):2645-7. http://www.ncbi.nlm.nih.gov/pubmed/8255470

 

Post-viral fatigue syndrome. A longitudinal assessment in varsity athletes

Abstract:

Maximal oxygen uptake, anaerobic threshold (AT), isometric strength of the elbow flexor and knee extensor muscles, isometric strength endurance exhaustion time (prolonged contraction at 66% of maximal isometric strength), uphill sprinting exhaustion time were longitudinally studied in eight varsity endurance runners with post-viral fatigue syndrome (PVFS).

Prolonged impairment of exercise performance is evident during the course of PVFS. Although maximal oxygen uptake (VO2max) had returned to pre-infection values 13 months after the viral illness (4.160 vs 4.0 L.min-1), AT was still significantly reduced [52 ml.kg-1.min-1, 18.6 km.hr-1, 176 bpm, and 82% of VO2max vs. 49.1 ml.kg-1.min-1 (p < 0.05), 175 bpm (NS), 17.2 km.hr-1 (p < 0.01) and 79% of VO2max (NS)].

Maximal isometric contraction strength of the upper limb remained constant (282 N vs. 274 N), while knee extensor muscles strength decreased significantly (730 N vs. 701 N, p < 0.05). Strength endurance was still significantly reduced by the end of the study (arm average pre-infection: 46.2 sec; end of study: 29.3 sec, p < 0.001; leg average pre-infection: 66.4 sec; end of study: 49.1 sec, p < 0.01). Up hill sprinting time was similarly reduced by the end of the study period (29.3 sec vs. 16.2 sec, p < 0.01).

Both aerobic and anaerobic exercise variables are seriously affected by post-viral fatigue syndrome, and one year may not be sufficient to fully recover.

 

Source: Maffulli N, Testa V, Capasso G. Post-viral fatigue syndrome. A longitudinal assessment in varsity athletes. J Sports Med Phys Fitness. 1993 Dec;33(4):392-9. http://www.ncbi.nlm.nih.gov/pubmed/8035588

 

Prevalence of chronic fatigue syndrome-related symptoms among nurses

Abstract:

Chronic Fatigue Syndrome is an illness that is characterized by debilitating fatigue and a group of other related symptoms. Few epidemiological studies have been conducted, and none have focused on a nursing population. The present study is the first to assess the prevalence of Chronic Fatigue Syndrome-related symptoms in a sample of nurses. Demographic characteristics, symptoms, and possible prevalence rates are presented and discussed. When using both narrow and more inclusive criteria to define this symptom complex, higher rates of this disorder were found than in previous epidemiological studies. The implications of these findings are discussed.

 

Source: Jason LA, Taylor SL, Johnson S, Goldston SE, Salina D, Bishop P, Wagner L. Prevalence of chronic fatigue syndrome-related symptoms among nurses. Eval Health Prof. 1993 Dec;16(4):385-99. http://www.ncbi.nlm.nih.gov/pubmed/10130552

 

Repetitively negative changing T waves at 24-h electrocardiographic monitors in patients with the chronic fatigue syndrome. Left ventricular dysfunction in a cohort

Abstract:

This study surveys the occurrence of repetitively negative to flat T waves, alternating with normal upright T waves in 24-h electrocardiographic recordings from a subspecialty infectious diseases outpatient practice during the years 1982 to 1990. Patients with normal resting electrocardiogram in the assayed leads, but with repetitively inverted to isoelectric abnormal T waves at Holter monitors, were considered to have abnormal readings.

A total of 300 patients had undergone a 24-h Holter monitor. This group included 24 individuals with chronic fatigue syndrome (CFS). This population was restricted to individuals 50 years old or younger, and the patients with CFS are compared with the patients without CFS.

One of the more striking differences between the two groups was the difference in abnormal Holter readings. The patients with CFS all had abnormal Holter readings, while 22.4 percent patients without CFS had abnormal readings (p < 0.01). We further report the occurrence of mild left ventricular dysfunction in 8 of 60 patients in continuing studies of this population with CFS, younger than 50 years old, and with no risk factors for coronary artery disease.

All 60 patients with CFS showed repetitively flat to inverted T waves alternating with normal T waves. Stress multiple gated acquisitions (MUGAs) (labeled erythrocytes with stannous pyrophosphate) were abnormal in eight patients with CFS. Although resting ejection fractions (EFs) were normal (mean, 60 percent), with increasing work loads (Kilopon meters [Kpms]), gross left ventricular dysfunction occurred. The fatigue of patients with CFS may be related to subtle cardiac dysfunction occurring at work loads common to ordinary living.

 

Source: Lerner AM, Lawrie C, Dworkin HS. Repetitively negative changing T waves at 24-h electrocardiographic monitors in patients with the chronic fatigue syndrome. Left ventricular dysfunction in a cohort. Chest. 1993 Nov;104(5):1417-21. http://www.ncbi.nlm.nih.gov/pubmed/8222798

 

Chronic fatigue in primary care attenders

Abstract:

From 686 patients attending primary care physicians, 77 were identified by a screening procedure as having chronic fatigue. Of these, 65 were given a comprehensive psychological, social and physical evaluation.

Seventeen cases (26%) met criteria for the chronic fatigue syndrome. Forty-seven (72%) received an ICD-9 diagnosis of whom 23 had neurotic depression, with a further 5 meeting criteria for neurasthenia.

Forty-nine were ‘cases’ as defined by the revised Clinical Interview Schedule (CIS-R), and 42 if the fatigue item was excluded. Psychiatric morbidity was more related to levels of social stresses than was severity of fatigue.

The main difference between these subjects and those examined in hospital settings is that the former are less liable to attribute their symptoms to wholly physical causes, including viruses, as opposed to social or psychological factors. Identification and management of persistent fatigue in primary care may prevent the secondary disabilities seen in patients with chronic fatigue syndromes.

 

Source: McDonald E, David AS, Pelosi AJ, Mann AH. Chronic fatigue in primary care attenders. Psychol Med. 1993 Nov;23(4):987-98. http://www.ncbi.nlm.nih.gov/pubmed/8134522

 

The chronic fatigue syndrome

Abstract:

The chronic fatigue syndrome (CFS) including myalgic encephalomyelitis and the postviral syndrome is a term used today to describe a not fully recognized disease characterized primarily by chronic or recurrent debilitating fatigue and various combinations of neuromuscular and neuropsychological symptoms. The term CFS has been introduced and defined by the Centers for Disease Control (CDC) in Atlanta. Fatigue is one of the most common symptoms in medicine, but CFS as defined by CDC has appeared to be quite rare in the general population. Researchers have suggested that the syndrome is a heterogenous immunologic disorder that follows viral infection, but despite numerous studies on the subject the etiologic factor of the syndrome is unknown. CFS is a controversial diagnosis. In a very high percentage of patients with the CFS depression, phobias or anxiety disorders have frequently preceded the onset of the chronic fatigue. There are many overlapping symptoms between CFS and major depression. Some clinicians suggest that it is not obvious that CFS can be distinguished from neurasthenia.

 

Source: Białyszewski A. [The chronic fatigue syndrome]. Psychiatr Pol. 1993 Nov-Dec;27(6):601-11 [Article in Polish] http://www.ncbi.nlm.nih.gov/pubmed/8134494

 

The grey area of effort syndrome and hyperventilation: from Thomas Lewis to today

Abstract:

Lewis used the diagnosis ‘effort syndrome’ for subjects whose ability to make and sustain effort had been reduced by homeostatic failure. A major element was depletion of the body’s capacity for buffering the acids produced by exercise.

In his view this systems disorder was not to be regarded as a specific organ disease, and losing sight of the metabolic element would foster the invention of fanciful, unphysiological diagnoses. His views were dismissed because normal resting plasma bicarbonate levels were considered by others in that era to exclude serious depletion of the body’s total capacity for buffering the effects of exertion.

Today, effort syndrome is still a useful diagnosis for a condition of exhaustion and failure of performance associated with depletion of the body’s buffering systems. Other elements associated with homeostatic failure are now recognised, principally emotional hyperarousal and hyperventilation. Their physiological interrelationships are described. Effort syndrome is amenable to recovery through rehabilitation, and it may be a mistake to treat chronic fatigue syndrome and unspecific illness without including it in the differential diagnosis.

 

Source: Nixon PG. The grey area of effort syndrome and hyperventilation: from Thomas Lewis to today. J R Coll Physicians Lond. 1993 Oct;27(4):377-83. http://www.ncbi.nlm.nih.gov/pubmed/8289156

 

Chronic fatigue syndrome

Abstract:

The authors followed up for a period of 1-14 years 52 patients with CFS who met the criteria outlined by Holmes. The group comprised 10 men and 42 women. In 15% of these patients after a mean period of 5.5 years thyroiditis was diagnosed. Complete recovery was recorded in 20%, improvement in 32% of the patients, on average after 7 years. In the course of treatment mainly immunomodulating preparations were used. Indication of these drugs was individual based on immunological examinations. The success was only partial. The clinical condition of the patients did not correlate with serological findings of IgM, IgA and IgG antibodies against VCA nor with antibodies against EA of the EBV virus.

 

Source: Fucíková T, Petanová J. Chronic fatigue syndrome. Vnitr Lek. 1993 Oct;39(10):995-1002. [Article in Czech] http://www.ncbi.nlm.nih.gov/pubmed/8236872