Tuesday, December 30, 2008

Association of peripheral inflammatory markers with chronic fatigue in a population-based sample.

Brain Behav Immun. 2008 Dec 11. [Epub ahead of print]

Association of peripheral inflammatory markers with chronic fatigue in a population-based sample.


Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1365C Clifton Road, Room 5004, Atlanta, GA 30322, USA.

Alterations in the innate immune response may contribute to the pathogenesis of chronic fatigue syndrome (CFS). However, studies have been limited by small sample sizes, use of patients from tertiary care settings, inappropriate selection of controls, and failure to control for confounding demographic, medical and behavioral factors independently associated with immune activity. It is also not known whether specific symptoms account for observed associations between CFS and the innate immune response. To address these limitations, the current study examined plasma concentrations of high-sensitivity c-reactive protein (hs-CRP), white blood cell count (WBC) and a combined inflammation factor in a large population-based sample. Log-transformed mean plasma concentrations of hs-CRP were increased in subjects with CFS (n=102) and in subjects with unwellness symptoms that did not meet diagnostic criteria for CFS (defined as "insufficient fatigue" [ISF]) (n=240) when compared to subjects who were well (n=115). Log transformed WBC was increased in ISF and was increased at a trend level in CFS. The combined inflammation factor was increased in both CFS and ISF. Subjects with CFS and ISF did not differ on any of the inflammation measures. In the entire subject population, the physical component summary score (PCS), but not the mental component summary score (MCS), from the Medical Outcomes Study Short Form-36 (SF-36) was negatively associated with each of the inflammation measures. Depressive symptoms were also associated with increased log hs-CRP. After adjustment for age, sex, race, location of residence, BMI, depressive status and immune-modulating medications, subjects classified as ISF continued to demonstrate increased log hs-CRP, WBC and elevations on the inflammation factor when compared to well controls; however, associations between CFS and log hs-CRP and the inflammation factor were no longer statistically significant. After adjustment, PCS score also remained independently associated each of the inflammation measures. These findings support a role for innate immune activation in unexplained fatigue and unwellness, but do not suggest that immune activation is specific to CFS.

PMID: 19111923 [PubMed - as supplied by publisher]

Normalization of leaky gut in chronic fatigue syndrome (CFS) is accompanied by a clinical improvement: effects of age, duration of illness and the translocation of LPS from gram-negative bacteria.

Neuro Endocrinol Lett. 2008 Dec 29;29(6). [Epub ahead of print]

Normalization of leaky gut in chronic fatigue syndrome (CFS) is accompanied by a clinical improvement: effects of age, duration of illness and the translocation of LPS from gram-negative bacteria.


M-Care4U Outpatient Clinics, and the Clinical Research Center for Mental Health, Belgium.

BACKGROUND: There is now evidence that an increased translocation of LPS from gram negative bacteria with subsequent gut-derived inflammation, i.e. induction of systemic inflammation and oxidative & nitrosative stress (IO&NS), is a new pathway in chronic fatigue syndrome (CFS). METHODS: The present study examines the serum concentrations of IgA and IgM to LPS of gram-negative enterobacteria, i.e. Hafnia Alvei; Pseudomonas Aeruginosa, Morganella Morganii, Pseudomonas Putida, Citrobacter Koseri, and Klebsielle Pneumoniae in CFS patients both before and after intake of natural anti-inflammatory and anti-oxidative substances (NAIOSs), such as glutamine, N-acetyl cysteine and zinc, in conjunction with a leaky gut diet during 10-14 months. We measured the above immune variables as well as the Fibromyalgia and Chronic Fatigue Syndrome Rating Scale in 41 patients with CFS before and 10-14 months after intake of NAIOSs. RESULTS: Subchronic intake of those NAIOSs significantly attenuates the initially increased IgA and IgM responses to LPS of gram negative bacteria. Up to 24 patients showed a significant clinical improvement or remission 10-14 months after intake of NAIOSs. A good clinical response is significantly predicted by attenuated IgA and IgM responses to LPS, the younger age of the patients, and a shorter duration of illness (< 5 years). DISCUSSION: The results show that normalization of the IgA and IgM responses to translocated LPS may predict clinical outcome in CFS. The results support the view that a weakened tight junction barrier with subsequent gut-derived inflammation is a novel pathway in CFS and that it is a new target for drug development in CFS. Meanwhile, CFS patients with leaky gut can be treated with specific NAIOSs and a leaky gut diet.

PMID: 19112401 [PubMed - as supplied by publisher]

Increased asthma and respiratory symptoms in children exposed to petrochemical pollution.

J Allergy Clin Immunol. 2008 Dec 24. [Epub ahead of print]

Increased asthma and respiratory symptoms in children exposed to petrochemical pollution.


Instituto del Desarrollo de Investigaciones Pediátricas (IDIP) Prof Dr Fernando Viteri Hospital de Niños SM Ludovica, La Plata, Argentina.

BACKGROUND: Epidemiologic studies show statistical associations between levels of air pollutants and respiratory outcomes. OBJECTIVE: We sought to determine the effects of exposure to petrochemical pollution on the respiratory health of children. METHODS: Children aged 6 to 12 years living close to the petrochemical plants in La Plata, Argentina (n = 282), were compared with those living in a region with exposure to heavy traffic (n = 270) or in 2 relatively nonpolluted areas (n = 639). Parents answered a validated questionnaire providing health and demographic data. A random sample (n = 181) had lung function measured. Particulate matter and outdoor and indoor volatile organic compound levels were measured during 4-week study periods and reported as overall means for each study area. RESULTS: Children living near the petrochemical plant had more asthma (24.8% vs 10.1% to 11.5%), more asthma exacerbations (6.7 vs 2.9-3.6 per year), more respiratory symptoms (current wheeze, dyspnea, nocturnal cough, and rhinitis), and lower lung function (>13% decrease in FEV(1) percent predicted) than those living in other regions. Length of residence in the area was a significant risk factor, but age, sex, body mass index, proximity to busy roads and other nonpetrochemical industries, length of breast-feeding, and socioeconomic and demographic characteristics of children or their families were not. CONCLUSION: Exposure to particulate matter and volatile organic compounds arising from petrochemical plants but not from high traffic density was associated ith worse respiratory health in children.

PMID: 19111332 [PubMed - as supplied by publisher]

Saturday, December 27, 2008

NEWSLETTER: MCS America News - January 2009

January 2009, Volume 4, Issue 1


Entire PDF Edition: http://mcs-america.org/january2009.pdf  (View, Download, and Print)
NEW!  Entire Online Edition:
http://mcs-america.org/mcsanewsjanuary2009.htm   (View as a Webpage)


Direct Links to Articles Inside This Issue:


Hepatitis B Shot Linked to Male Developmental Disability

PDF Version:    http://mcs-america.org/January2009pg123.pdf

Online Version:  http://mcs-america.org/MCSAnewsJanuary2009.htm#_Hepatitis_B_Shot_


Applying for Disability Benefits for MCS:  Issues to Consider

PDF Version:    http://mcs-america.org/January2009pg45.pdf 

Online Version:  http://mcs-america.org/MCSAnewsJanuary2009.htm#_Applying_for_Disability_


Fibromyalgia Diagnosis and Treatment Part 3

PDF Version:    http://mcs-america.org/January2009pg6789101112.pdf

Online Version:  http://mcs-america.org/MCSAnewsJanuary2009.htm#_Fibromyalgia_Diagnosis_and_1


Beginning Work on a House with MCS

PDF Version:    http://mcs-america.org/January2009pg131415.pdf

Online Version:  http://mcs-america.org/MCSAnewsJanuary2009.htm#_Beginning_Work_on_1


Children's Cognitive Health in Chronic Fatigue Syndrome (CFS)

PDF Version:    http://mcs-america.org/January2009pg16.pdf 

Online Version:   http://mcs-america.org/MCSAnewsJanuary2009.htm#_Children_and_Cognitive


Pesticide Exposure May Lead to Depression

PDF Version:    http://mcs-america.org/January2009pg1718.pdf

Online Version:  http://mcs-america.org/MCSAnewsJanuary2009.htm#_Pesticide_Exposure_May_


Restless Leg Syndrome Associated with Fibromyalgia

PDF Version:    http://mcs-america.org/January2009pg1920.pdf 

Online Version:  http://mcs-america.org/MCSAnewsJanuary2009.htm#_Restless_Leg_Syndrome_


Cardiovascular Evidence of MCS

PDF Version:    http://mcs-america.org/January2009pg2122.pdf

Online Version:  http://mcs-america.org/MCSAnewsJanuary2009.htm#_Cardiovascular_Evidence_of_


Q&A:  Insurance Coverage for MCS

PDF Version:    http://mcs-america.org/January2009pg23.pdf  

Online Version:    http://mcs-america.org/MCSAnewsJanuary2009.htm#_Q&A:__Insurance_


Diagnostic Markers for Chronic Fatigue Syndrome (CFS)

PDF Version:    http://mcs-america.org/January2009pg24.pdf 

Online Version:  http://mcs-america.org/MCSAnewsJanuary2009.htm#_Diagnostic_Markers_for_


Restorative Sleep Resolves Pain?

PDF Version:    http://mcs-america.org/January2009pg25.pdf 

Online Version:    http://mcs-america.org/MCSAnewsJanuary2009.htm#_Restorative_Sleep_Resolves_1


Lifestyle Management Can't Cure Chronic Fatigue Syndrome (CFS)

PDF Version:    http://mcs-america.org/January2009pg2627.pdf 

Online Version:    http://mcs-america.org/MCSAnewsJanuary2009.htm#_Lifestyle_Management_Not


Patient Support & Resources

PDF Version:    http://mcs-america.org/January2009pg2829303132333435.pdf

Online Version:    http://mcs-america.org/MCSAnewsJanuary2009.htm#_Resources_and_Support


Community News

PDF Version:    http://mcs-america.org/January2009pg36.pdf

Online Version:    http://mcs-america.org/MCSAnewsJanuary2009.htm#_Community_News_


Featured Research Studies

PDF Version:    http://mcs-america.org/January2009pg373839.pdf

Online Version:    http://mcs-america.org/MCSAnewsJanuary2009.htm#_Featured_Research_Studies_2


Multiple Chemical Sensitivities America




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International award winner works in enforced solitude: Implications for health care providers

Jezierski, M.  International award winner works in enforced solitude: Implications for health care providers.  J Emerg Nurs.  1999;25:69-72.

Severely incapacitated by chemically induced permanent injuries, a North Dakota woman is conducting national research and activism within the confines of her home, with far-reaching consequences and recognition.
Thirteen years ago, Cindy Duehring, a pre-med student in Seattle, was severely poisoned when her apartment was treated with pesticides that were applied directly to her belongings, saturating her furniture, clothing, and other items. The exterminator told Cindy that the chemicals were so safe "a baby could lick them off the floor." Shortly after the fumigation, Cindy experienced nausea, diarrhea, hypersalivation, blurred vision, fatigue, and muscle cramps. Several times the symptoms were so severe that she went to a 24-hour clinic, where she was diagnosed as having a severe flu virus. Cindy was experiencing the classic symptoms of organophosphate poisoning. Unfortunately, the poisoning was not diagnosed until months later, when an astute physician recognized the symptoms and ordered serial cholinesterase enzyme testing, but by then it was too late. Cindy later learned that the company was violating federal law by using these chemicals and that her clothing should have been disposed of as hazardous waste. The pesticides, 2 chemicals illegally combined by the exterminator, were known to cause massive bird kills when used on golf courses and sod farms, as well as to poison people, resulting in numerous chronic health problems, including multiple chemical sensitivity (MCS). Not knowing the effects of the pesticides used, Cindy wore her treated clothing. This incident changed her life forever.

Thursday, December 25, 2008

The food and drug administration agrees to classify mercury fillings.

J Environ Pathol Toxicol Oncol. 2008;27(4):303-5.

The food and drug administration agrees to classify mercury fillings.


Legacy Emanuel Verified Level I Shock Trauma Center for Children and Adults, Legacy Emanuel Hospital, Portland, OR, USA. richardedlichmd@gmail.com

In the United States Court of Appeals of the District of Columbia Circuit, the Appellants Mom's Against Mercury, Connecticut Coalition for Environmental Justice, Oregonians for Life, California Citizens for Health Freedom, Kevin J. Biggers, Karen Johnson, Linda Brocato, R. Andrew Landerman, and Antia Vazquez Tibaul filed a petition for review of Regulatory Inaction by the Food and Drug Administration (FDA). On Monday June 2, 2008, the lawsuit was settled with the FDA after it agreed to classify mercury fillings. During its negotiation session with the Appellants, the FDA indicated that it would change its website on mercury fillings. The FDA no longer claims that no science exists about the safety of mercury amalgam or that other countries have acted for environmental reasons only. On its website, the FDA now states the following: "Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetus." The FDA also states that "Pregnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner." The FDA decision to classify mercury fillings is a reflection of the legislations enacted in Europe and Canada that highlight the neurotoxic effects of mercury fillings.

PMID: 19105536 [PubMed - in process]

Heavy metal induced oxidative stress & its possible reversal by chelation therapy.

Indian J Med Res. 2008 Oct;128(4):501-23.

Heavy metal induced oxidative stress & its possible reversal by chelation therapy.


Division of Pharmacology & Toxicology, Defence Research & Development Establishment, Gwalior, India.

Exposure to heavy metals is a common phenomenon due to their environmental pervasiveness. Metal intoxication particularly neurotoxicity, genotoxicity, or carcinogenicity is widely known. This review summarizes our current understanding about the mechanism by which metalloids or heavy metals (particularly arsenic, lead, cadmium and mercury) induce their toxic effects. The unifying factor in determining toxicity and carcinogenicity for all these metals is the generation of reactive oxygen and nitrogen species. The toxic manifestations of these metals are caused primarily due to imbalance between pro-oxidant and antioxidant homeostasis which is termed as oxidative stress. Besides these metals have high affinity for thiol groups containing enzymes and proteins, which are responsible for normal cellular defense mechanism. Long term exposure to these metals could lead to apoptosis. Signaling components affected by metals include growth factor receptors, G-proteins, MAP kinases and transcription factors. Chelation therapy with chelating agents like calcium disodium ethylenediamine tetra acetic acid (CaNa(2)EDTA), British Anti Lewisite (BAL), sodium 2,3- dimercaptopropane 1-sulfonate (DMPS), meso 2,3-dimercaptosuccinic acid (DMSA) etc., is considered to be the best known treatment against metal poisoning. Despite many years of research we are still far away from effective treatment against toxicity caused due to exposure to heavy metals/metalloids. The treatment with these chelating agents is compromised with number of serious side-effects. Studies show that supplementation of antioxidants along-with a chelating agent prove to be a better treatment regimen than monotherapy with chelating agents. This review attempts a comprehensive account of recent developments in the research on heavy metal poisoning particularly the role of oxidative stress/ free radicals in the toxic manifestation, an update about the recent strategies for the treatment with chelating agents and a possible beneficial role of antioxidants supplementation to achieve the optimum effects. We have selected only arsenic, lead, mercury and cadmium for this article keeping in view current concerns and literature available.

PMID: 19106443 [PubMed - in process]

A comprehensive review of mercury provoked autism.

Indian J Med Res. 2008 Oct;128(4):383-411.

A comprehensive review of mercury provoked autism.


The Institute of Chronic Illnesses, Silver Spring, MD, USA.

Emerging evidence supports the theory that some autism spectrum disorders (ASDs) may result from a combination of genetic/biochemical susceptibility, specifically a reduced ability to excrete mercury (Hg), and exposure to Hg at critical developmental periods. Elemental/inorganic Hg is released into the air/water where it becomes methylated and accumulates in animal tissues. The US population is primarily exposed to methyl-Hg by fish consumption. In addition, many pharmaceuticals have been, and some continue to be, a ubiquitous source of danger because they contain mercurials. Mercurials may be found in drugs for the eye, ear, nose, throat, and skin; in bleaching creams; as preservatives in cosmetics, tooth pastes, lens solutions, vaccines, allergy test and immunotherapy solutions; in antiseptics, disinfectants, and contraceptives; in fungicides and herbicides; in dental fillings and thermometers; and many other products. Hg has been found to cause immune, sensory, neurological, motor, and behavioural dysfunctions similar to traits defining/associated with ASDs, and that these similarities extend to neuroanatomy, neurotransmitters, and biochemistry. Furthermore, a review of molecular mechanisms indicates that Hg exposure can induce death, disorganization and/or damage to selected neurons in the brain similar to that seen in recent ASD brain pathology studies, and this alteration may likely produce the symptoms by which ASDs are diagnosed. Finally, a review of treatments suggests that ASD patients who undergo protocols to reduce Hg and/or its effects show significant clinical improvements in some cases. In conclusion, the overwhelming preponderance of the evidence favours acceptance that Hg exposure is capable of causing some ASDs.

PMID: 19106436 [PubMed - in process]

Wednesday, December 24, 2008

Is there an association between fibromyalgia and below-normal levels of urinary cortisol?

BMC Res Notes. 2008 Dec 22;1(1):134. [Epub ahead of print]

Is there an association between fibromyalgia and below-normal levels of urinary cortisol?


ABSTRACT: BACKGROUND: Adynamia in fibromyalgia (FM) may be an expression of a functional deficit of the hypothalamic-pituitary-adrenal axis and be associated with below-normal levels of urinary cortisol. Our aim was to demonstrate that urinary cortisol was lower in patients with FM than in healthy subjects. FINDINGS: We measured urinary cortisol levels for a sample of 47 women aged 29 to 64 years (mean age 53 years), diagnosed with FM 2-3 years previously, and compared the results with those for a control sample of 58 healthy women of a similar age. Samples of 24-hour urine were appropriately collected and levels of urinary cortisol were measured using the fluorescence polarization immunoassay method. The mean cortisol value for the women with FM was 65.40+/-27.10 microg/L, significantly lower than the mean cortisol level for the control group, at 90.83+/-38.17 microg/L (p < 0.001). CONCLUSION: Our study confirms that women with FM have significantly lower urinary cortisol levels than healthy women.

PMID: 19102778 [PubMed - as supplied by publisher]

Tuesday, December 23, 2008

Facing the Challenge of Data Transfer from Animal Models to Humans: the Case of Persistent Organohalogens

Facing the Challenge of Data Transfer from Animal Models to Humans: the Case of Persistent Organohalogens

Alexander Suvorov email and Larissa Takser email

Département Obstétrique Gynécologie, Faculté de Médecine et des sciences de la santé, Université de Sherbrooke, 3001, 12 avenue Nord, Sherbrooke, Québec, Canada, J1H 5N4

author email corresponding author email

Environmental Health 2008, 7:58doi:10.1186/1476-069X-7-58

Published: 13 November 2008


A well-documented fact for a group of persistent, bioaccumulating organohalogens contaminants, namely polychlorinated biphenyls (PCBs), is that appropriate regulation was delayed, on average, up to 50 years. Some of the delay may be attributed to the fact that the science of toxicology was in its infancy when PCBs were introduced in 1920's. Nevertheless, even following the development of modern toxicology this story repeats itself 45 years later with polybrominated diphenyl ethers (PBDEs) another compound of concern for public health. The question is why? One possible explanation may be the low coherence between experimental studies of toxic effects in animal models and human studies. To explore this further, we reviewed a total of 807 PubMed abstracts and full texts reporting studies of toxic effects of PCB and PBDE in animal models. Our analysis documents that human epidemiological studies of PBDE stand to gain little from animal studies due to the following: 1) the significant delay between the commercialisation of a substance and studies with animal models; 2) experimental exposure levels in animals are several orders of magnitude higher than exposures in the general human population; 3) the limited set of evidence-based endocrine endpoints; 4) the traditional testing sequence (adult animals – neonates – foetuses) postpones investigation of the critical developmental stages; 5) limited number of animal species with human-like toxicokinetics, physiology of development and pregnancy; 6) lack of suitable experimental outcomes for the purpose of epidemiological studies. Our comparison of published PCB and PBDE studies underscore an important shortcoming: history has, unfortunately, repeated itself. Broadening the crosstalk between the various branches of toxicology should therefore accelerate accumulation of data to enable timely and appropriate regulatory action.

Sunday, December 21, 2008

Effects of extremely low frequency electromagnetic fields on testes in guinea pig.

 Pak J Biol Sci. 2007 Dec 15;10(24):4519-22.

Effects of extremely low frequency electromagnetic fields on testes in guinea pig.


Department of Biology, Faculty of Science, Urmia University, Iran.

This study is carried out to measure the changes in testosterone hormone level and changes in testes tissue on 36 adult male Guinea pigs that divided to 6 groups. Group A as control group exposed to nil Electromagnetic Field (EMF) for two hours per day for 5 days duration, group B exposed to 0.013 microT in 5 Hz to the Same duration period, group C exposed to 0.207 microT in 50 Hz in similar conditions, group D exposed for 4 h day(-1) for 5 days in 0.013 microT, group E tested in 0.207 microT as group D, group F used as controlled group exposed for four hours per day in nil electromagnetic field. Guinea pig blood was tested after 5 days. Then data analyzed by t-test. The results indicated a significantly difference between control group and tested group of four and two hours, testosterone level decreased (p < 0.001), also testes tissues were sampled and observed main tissue changes in some treatments.

PMID: 19093523 [PubMed - in process]

Friday, December 19, 2008

The kilauea volcano adult health study.

Nurs Res. 2009 Jan-Feb;58(1):23-31.

The kilauea volcano adult health study.


Bernadette M. Longo, PhD, RN, is Assistant Professor, Orvis School of Nursing, University of Nevada-Reno, and Department of Public Health, Oregon State University, Corvallis.

BACKGROUND:: Millions of people reside near active volcanoes, yet data are limited on effects to human health. The Kilauea Volcano is the largest point source for sulfur dioxide in the United States, releasing air pollution on nearby communities since 1983. OBJECTIVE:: The objectives of this study were to provide the first population-based epidemiological estimates and qualitative descriptions of cardiorespiratory health effects associated with volcanic air pollution. METHODS:: An environmental-epidemiological design was used. Exposure levels of Kilauea's air pollutants were determined by environmental sampling. Prevalence estimates of cardiorespiratory health effects in adults were measured (N = 335) and compared between an exposed and nonexposed reference community. Descriptions of the human-environment interaction with the long-standing eruption were recorded from informants in the natural setting. RESULTS:: Ambient and indoor concentrations of volcanic air pollution were above the World Health Organization's recommended exposure levels. There were statistically significant increased odds associated with exposure for self-reported cough, phlegm, rhinorrhea, sore and dry throat, sinus congestion, wheezing, eye irritation, and diagnosed bronchitis. Thirty-five percent of the informants perceived that their health was affected by the eruption, mainly current and former smokers and those with chronic respiratory disease. DISCUSSION:: Hypotheses were supported regarding particulate air pollution and the association with adverse cardiovascular functioning. This emerging environmental health issue is under continuing investigation.

PMID: 19092552 [PubMed - in process]

The expert patients programme online, a 1-year study of an Internet-based self-management programme for people with long-term conditions.

Chronic Illn. 2008 Dec;4(4):247-56.

The expert patients programme online, a 1-year study of an Internet-based self-management programme for people with long-term conditions.


Stanford University School of Medicine, Stanford Patient Education Research Center, 1000 Welch Rd, Palo Alto, CA 94306, USA.

OBJECTIVES: Evaluate the effectiveness of an online self-management programme (EPP Online) for England residents with long-term conditions. METHODS: A prospective longitudinal study. Data were collected online at baseline, 6 and 12 months. The intervention was an asynchronous 6-week chronic-disease self-management programme offered online. We measured seven health status measures (health distress, self-rated health, illness intrusiveness, disability, fatigue, pain and shortness of breath), four behaviours (aerobic exercise, stretching exercise, stress management and communications with physician), and five utilization measures (GP visits, pharmacy visits, PT/OT visits, emergency visits and hospitalizations). We also measured self-efficacy and satisfaction with the health care system. RESULTS: A total of 568 completed baseline data: 546 (81%) completed 6 months and 443 (78%) completed 1 year. Significant improvements (p<0.01) were found at 6 months for all variables except self-rated health, disability, stretching, hospitalizations and nights in hospital. At 12 months only decrease in disability, nights in hospital and hospitalizations were not significant with reduction in visits to emergency departments being marginally significant (p = 0.012). Both self-efficacy and satisfaction with the health care system improved significantly. DISCUSSION: The peer-led online programme conditions appears to decrease symptoms, improve health behaviours, self-efficacy and satisfaction with the health care system and reducing health care utilization up to 1 year.

PMID: 19091933 [PubMed - in process]

Are chronic fatigue and chronic fatigue syndrome valid clinical entities across countries and health-care settings?

Aust N Z J Psychiatry. 2009 Jan;43(1):25-35.Click here to read Links

Are chronic fatigue and chronic fatigue syndrome valid clinical entities across countries and health-care settings?


Brain and Mind Research Institute, Camperdown, NSW, Australia. ianh@med.usyd.edu.au

OBJECTIVE: The validity of the diagnosis of chronic fatigue syndrome and related chronic fatigue states remains controversial, particularly in psychiatry. This project utilized international epidemiological and clinical research data to test construct validity across diagnostic categories, health-care settings and countries. Relevant demographic, symptom and diagnostic data were obtained from 33 studies in 21 countries. The subjects had fatigue lasting 1-6 months (prolonged fatigue), or >6 months (chronic fatigue), or met diagnostic criteria for chronic fatigue syndrome. METHOD: Common symptom domains were derived by factor analytic techniques. Mean scores on each symptom factor were compared across diagnostic categories, health-care settings and countries. RESULTS: Data were obtained on 37,724 subjects (n = 20,845 female, 57%), including from population-based studies (n = 15,749, 42%), studies in primary care (n = 19 472, 52%), and secondary or specialist tertiary referral clinics (n = 2503, 7%). The sample included 2013 subjects with chronic fatigue, and 1958 with chronic fatigue syndrome. A five-factor model of the key symptom domains was preferred ('musculoskeletal pain/fatigue', 'neurocognitive difficulties', 'inflammation', 'sleep disturbance/fatigue' and 'mood disturbance') and was comparable across subject groups and settings. Although the core symptom profiles were similar, some differences in symptoms were observed across diagnostic categories, health-care settings and between countries. CONCLUSIONS: The construct validity of chronic fatigue and chronic fatigue syndrome is supported by an empirically derived factor structure from existing international datasets.

PMID: 19085525 [PubMed - in process]

Patients With Pain Disorder Show Gray-Matter Loss in Pain-Processing Structures: A Voxel-Based Morphometric Study.

Psychosom Med. 2008 Dec 10. [Epub ahead of print]Click here to read Links

Patients With Pain Disorder Show Gray-Matter Loss in Pain-Processing Structures: A Voxel-Based Morphometric Study.


Neurologische Klinik und Poliklinik (M.V., M.M., T.S., T.R.T.), Klinikum rechts der Isar, Technische Universität München, Germany; Abteilung Psychosomatik und Psychotherapie (H.G.), Medizinische Hochschule Hannover, Germany; Klinik und Poliklinik für Psychiatrie und Psychotherapie (C.S.), Klinikum rechts der Isar, Technische Universität München, Germany; Klinik und Poliklinik für Psychosomatische Medizin (H.G., P.H.), Psychotherapie und Med. Psychologie, Klinikum rechts der Isar, Technische Universität München, Germany; Abteilung für Neuroradiologie (C.Z.), Institut für Röntgendiagnostik, Klinikum rechts der Isar, Technische Universität München, Germany.

Objective: To investigate whether the functional changes in pain disorder might be reflected by structural brain changes. Pain disorder assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria is characterized by persistent and distressing chronic pain at one or more body sites which cannot be fully explained by a physiological process or somatic disorder. Psychological factors are thought to play a major role. Recent neuroimaging studies evidenced altered pain processing in patients suffering from this disorder. Methods: Fourteen right-handed women fulfilling the DSM-IV criteria for pain disorder and 25 healthy age-matched women were investigated with magnetic resonance imaging. In the voxel-based morphometry analysis, we compared both groups for changes of gray-matter density. We included age and Beck Depression Inventory scores as nuisance variables to minimize possible confounding effects of age or depressive comorbidity. Results: In the patient group, we found significant gray-matter decreases in the prefrontal, cingulate, and insular cortex. These regions are known to be critically involved in the modulation of subjective pain experiences. Conclusions: In the context of similar results in patients with other functional pain syndromes, such as fibromyalgia and chronic back pain, we suggest that structural changes in fronto-limbic brain circuits represent not only an objective marker of these pain syndromes but also constitute a critical pathophysiological element. These findings represent a further proof of the important role of central changes in pain disorder.

PMID: 19073757 [PubMed - as supplied by publisher]

Saturday, December 13, 2008

Autism Spectrum Disorders and Identified Toxic Land Fills: Co-Occurrence Across States

Autism Spectrum Disorders and Identified Toxic Land Fills: Co-Occurrence Across States

Xue Ming et a
Environmental Health Insights 2008:2 55–59

Abstract: It is believed that gene by environmental interactions contribute to the pathogenesis of autism spectrum disorders (ASD). We hypothesize that ASD are associated with early and repeated exposures to any of a number of toxicants or mixtures of toxicants. It is the cumulative effects of these repeated exposures acting upon genetically susceptible individuals that lead to the phenotypes of ASD. We report our initial observations of a considerable overlap of identifi ed toxic landfills in the State of New Jersey and the residence of an ASD cohort, and a correlation between the identifi ed toxic Superfund sites on each U.S. state and the total number of diagnosed cases of ASD in those states. The residence of 495 ASD patients in New Jersey by zip code and the toxic landfi ll sites were plotted on a map of Northern New Jersey. The area of highest ASD cases coincides with the highest density of toxic landfi ll sites while the area with lowest ASD cases has the lowest density of toxic landfi ll sites. Furthermore, the number of toxic Superfund sites and autism rate across 49 of the 50 states shows a statistically signifi cant correlation (i.e. the number of identifi ed superfund sites correlates with the rate of autism per 1000 residents in 49 of the states (p = 0.015; excluding the state of Oregon). These signifi cant observations call for further organized studies to elucidate possible role(s) of environmental toxicants contributing to the pathogenesis of ASD.

Thursday, December 11, 2008

Nitric oxide modulation mediates the protective effect of trazodone in a mouse model of chronic fatigue syndrome.

Pharmacol Rep. 2008 Sep-Oct;60(5):664-72.

Nitric oxide modulation mediates the protective effect of trazodone in a mouse model of chronic fatigue syndrome.


Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India. kumaruips@yahoo.com.

The present study was conducted with the aim of elucidating the possible role of nitric oxide (NO) in the neuroprotective effects of trazodone used to treat chronic fatigue syndrome (CFS) in mice. Male albino mice were forced to swim for a six minute session each day for 7 days and the immobility period was recorded every other day. Trazodone (5 mg/kg and 10 mg/kg) was administered each day 30 min before the forced swim test. In addition, L-arginine (100 mg/kg) and L-NAME (5 mg/kg) were administered 15 min before administration of trazodone (5 mg/kg). Various behavioral tests, including locomotor (actophotometer) and anxiety (mirror chamber and plus maze) tests, as well as biochemical parameters (lipid peroxidation, reduced glutathione, catalase, and nitrites) were evaluated on the 8th day. Forced swimming for 7 days caused a chronic fatigue-like condition, anxiety-like behavior, impairments in locomotor activity, and oxidative damage (increased lipid peroxidation and nitrite levels, and depletions in the reduced forms of glutathione and catalase activity) in animals. Pretreatment with L-NAME (5 mg/kg) potentiated the antioxidant effect of trazodone (5 mg/kg). However, L-arginine (100 mg/kg) pretreatment reversed the protective effect of trazodone (5 mg/kg) (p < 0.05). The present study suggests the possible involvement of NO signaling in the protective effect of trazodone.

PMID: 19066412 [PubMed - in process]

Wednesday, December 10, 2008

Complement activation in tear fluid during occupational mold challenge.

Ocul Immunol Inflamm. 2008 Sep-Oct;16(5):224-9.

Complement activation in tear fluid during occupational mold challenge.


Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland.

Introduction: Indoor air quality is important in occupational healthcare when evaluating the health risks of a work environment. Components of the classical and alternative complement pathways are present in ocular tissues and fluids. The authors determined the levels of complement components C1INH, C3, and C4 in sera and C3a in tear fluids of normal persons and of those who were exposed to molds. Methods: Nine patients environmentally exposed to molds and 6 controls were selected from the Indoor Air Clinic of the Skin and Allergy Hospital. Tear fluid samples were collected from patients during the exposure to molds and after 2 weeks without mold exposure. At the same time, conjunctival cytology samples were obtained from each patient. Tear fluid was taken from 6 control subjects. All had negative skin prick tests to common environmental allergens. Results: In 4 patients subjective eye symptoms and tear fluid C3a levels decreased during 2 weeks of sick leave as did conjunctival eosinophils but other inflammatory cells were unchanged. Conclusion: Elevated complement C3a levels in tear fluids may be influenced by environmental exposure to molds. According to the authors' clinical experience, eosinophilia is not a consistent finding in patients exposed to molds. However, molds may cause eosinophilic inflammation in the eye.

PMID: 19065417 [PubMed - in process]

Plasma Cytokine Fluctuations Over Time in Healthy Controls and Patients with Fibromyalgia.

Exp Biol Med (Maywood). 2008 Dec 8. [Epub ahead of print]

Plasma Cytokine Fluctuations Over Time in Healthy Controls and Patients with Fibromyalgia.


Department of Work Stress Control; Japan National Institute of Occupational Safety and Health.

We examined the pattern of cytokine secretion across the 24 hr day for women with widespread pain and tenderness having the diagnosis of fibromyalgia (FM) and matched healthy controls. Subjects were given time to habituate to being in a clinical research laboratory environment and then were sampled for cytokines without their being disturbed for a 24 hr period including an 8 hr sleep period. Cytokine levels were uniformly low but characterized by bursts of secretion. Bursting occurred either in singlets or in doublets with a range from 88 to 131 min between doublets. There was an element of synchronization of these bursts with most occurring at the beginning of sampling. FM patients showed a shift to increased IL-10 in the night-time compared to controls. The relation between this anti-inflammatory cytokine to the pro-inflammatory cytokines studied also differed between groups: FM patients showed a reduced ratio of IL-10 burst amplitude to that of pro-inflammatory cytokines IL-1beta, IL-8, and TNF-alpha. We interpret this to indicate a skew away from the normal balance favoring pro-inflammatory cytokines in controls toward one favoring an anti-inflammatory response in FM. These changes toward anti-inflammatory predominance in FM may explain their common complaint of disturbed sleep because these cytokines are known to disrupt sleep.

PMID: 19064941 [PubMed - as supplied by publisher]

Restless Legs Syndrome Is Common among Female Patients with Fibromyalgia.

Eur Neurol. 2008 Dec 9;61(2):107-111. [Epub ahead of print]

Restless Legs Syndrome Is Common among Female Patients with Fibromyalgia.


Sleep Disorders Center, Avesta Hospital, Avesta, Sweden.

Background: The prevalence of restless legs syndrome (RLS) among the general population is 2-15%, and with fibromyalgia syndrome (FMS) 2%. Both RLS and FMS are more common among women. The aim of our study was to evaluate the prevalence of RLS in a group of female patients diagnosed with FMS and to compare the occurrence of symptoms of daytime sleepiness and experienced sleep disorders between fibromyalgia patients with or without RLS. Method: Three hundred and thirty-two female patients, 20-60 years old, diagnosed with FMS at Skönviks Rehab between 2002 and 2006, answered a questionnaire mailed to their home address. The questionnaire consisted of the international RLS study group criteria as well as of questions concerning symptoms of insomnia and daytime sleepiness measured according to the Epworth Sleepiness Scale. Results: Nearly 64% of the women were also suffering from RLS. More patients suffering from both RLS and FMS were affected by problems of initiating and maintaining sleep than those suffering from FMS only. More patients suffering from both RLS and FMS did not feel refreshed on awakening compared with those suffering from FMS without RLS. The patients with concomitant RLS and FMS were more often hypersomnolent than those suffering from FMS only. Conclusion: This study shows that 64% of a group of female patients diagnosed with fibromyalgia also concurrently suffered from RLS. Compared with patients who suffer from FMS only, patients with both FMS and RLS more often experience sleep disturbances and pronounced daytime sleepiness. Copyright © 2008 S. Karger AG, Basel.

PMID: 19065057 [PubMed - as supplied by publisher]

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