Chronic Fatigue Syndrome – Possibility for Future Treatment?
Sangita Keshavan
In a college student’s life, fatigue is a common complaint. But most college students would blame their tired attitude on a late night, or on having too much on their plate. Most, however, would not consider their case as extreme as that of Lynn Gilderdale, whose experience with chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) left her in a paralyzed state.
Described as “progressive, paralyzing and commonly fatal”, CFS/ME has devastating effects largely because of the depression associated with it. It is correlated with depression – the reason for the increased morality in patients with CFS/ME is largely because of suicide. People with a history of depression are at increased risk for CFS/ME; similarly, those with CFS/ME have a higher chance of depression. The article cites the National Institute for Health and Clinical Excellence (NICE) as recommending cognitive behavioral therapy and graded exercise therapy for CFS/ME in adults and children. Children have been shown to have better outcomes. However, patients with severe CFS/ME do not show as much improvement despite such programs; however, the article suggests if these programs are adapted, they can act as triggers for recovery.
The article goes on to discuss the dangers of the defeatist attitude amongst doctors. Doctors do not want to become entangled in such a sensitive and difficult issue. Because many are reluctant to accept CFS/ME as a real disease, some believe that we must stress the incurable aspects of the disease and the fatal possibility – something that could be damaging to patients. It goes on to discuss how alternative treatments must be used, such as physiotherapy, community support and dietetic advice. It also talks about how professionals must take into account various influences on people, including the Internet.
CFS/ME is an incredibly difficult disease, which obviously requires further research and honing of treatments.
Reference: BMJ 2010;340:c738
Image: Sleep. Available here.
Orthopedic Surgical Outcomes
Hoai Le
In a new study, it appears that hospitals with greater volume and specialization have better orthopedic surgical outcomes. After adjustments for patient characteristics and hospital volume, patients undergoing joint replacement in hospitals with more specialized care were less likely to die and had fewer complications than those in less specialized hospitals. It is suggested that this might be due to improved care in higher volume institutions and that surgeons there have more experience. Even though the study was limited to Medicare patients age 65 and older, Hagen and colleagues stand by their support of increased specialization and believe that the apparent association between surgical outcome and specialization in their study could have greater implications on the medical system.
Reference: BMJ 2010;340:c160
Chronic Disease in Children
Three groups of children, spanning from 1988 to 2006 included in the National Longitudinal Survey of Youth (NLYS), were analyzed. It revealed that chronic conditions more than doubled. One explanation could be that better access to care might have resulted in the increased diagnosis of chronic conditions. For example, the survival rates for cancer, prematurity and congenital disorders have increased beyond which was imaginable a little while ago. Additionally, in 1998 the federal Maternal and Child Health Bureau expanded the definition of children with special health needs to incorporate physical, developmental, emotional and behavioral conditions.
Furthermore, there seemed to be evidence in dynamic changes in onset, duration and resolution of these chronic conditions. In order to determine whether these changes were real, NLSY identified chronic conditions through questioning the parents on the condition of the child. The findings of the surveys supported these dynamic changes and from a developmental perspective, these dynamic changes are to be expected in childhood. For example, asthma can be influenced by the onset of puberty, stressful transitions or changes in family environments.
The increase in chronic conditions seemed to be driven by an increase in obesity, a slight increase in asthma, but little change in learning and behavioral problems, despite increases in ADHD and mental disorders. These findings raise the question of whether there is a link between asthma, obesity and ADHD. In fact, there is evidence that high levels of early childhood stress may result in poor executive function and impulse control. As can be seen, obesity is not the only childhood condition that needs to be dealt with, and prevention of childhood diseases also prevents age related diseases as adults. Therefore, the need for change, as well as the results of inaction, is too big to be ignored.
Reference: JAMA. 2010;303(7):665-666
Finding New Sources for Technetium 99
Isotope, technetium 99 is used to measure blood flow in the heart and to help diagnose bon and breast cancers. Two-thirds of the world’s supply of this isotope, comes from two reactors in Ontario and the Netherlands. The reactor in Ontario has been closed for nine months due to repairs and is not expected to reopen until at least April, while the one in the Netherlands closed for six months, beginning February 19. The closing of these two reactors is anticipated to result in a severe shortage of the isotope. However, Covidien, a company in St. Louis, which purifies material created in reactors and packages them in a usable form for radiologists, announced that it had signed a contractor with the operators of the Maria reactor, near Warsaw. Although this will likely only fill a small gap, Dr. Michael M. Graham, professor of radiology at the University of Iowa and a member of the board of the Society of Nuclear Medicine says that it “could make the difference between being able to limp along and shutting down.” Other companies are also trying to find ways to fill this gap, like General Electric that has a plan to make technetium 99 using neutrons from power reactors and Babcock & Wilcox, a company in Virginia, which has a plan for a liquid-fueled reactor.
Reference: Wald, Matthew L. (2010, 16 February). New Source of an Isotope in Medicine Is Found. The New York Times. Retrieved February 28, 2010 from http://www.nytimes.com/2010/02/17/health/17isotope.html?ref=health.
New Genomes Decoded Reveal Genetic Variations and Clues to Evolution
The genomes of South Africa’s Archbishop Desmond Tutu and an indigenous Bushman from Nambia have recently been decoded and the results were published in an issue of Nature. The goal of this study is to eventually enable researchers and drug companies to personalize medicine for people of all ethnicities and societies; until now, most of the genomes that were decoded were those of Europeans. However, the publication of individual human genomes is controversial because of the risk of it being used against the individuals to deny them claims to property and leading to workplace and insurance discrimination. However, early analysis has revealed 1.3 million genetic variations not previously found and could lead to important insights. It also provided clue to human evolution. This indigenous people are of particular interest to researchers because they are believed to represent the oldest lineage of modern humans and are much more diverse than other populations. It is this genetic variation that might be used to explain their unique characteristics like their good sense of hearing, vision and smell and physical abilities.
Reference: Stein, Rob. (2010, February 18). Genomes of Archbishop Tutu, Bushman decoded in developing-world health push. The Washington Post. Retrieved February 28, 2010 from http://www.washingtonpost.com/wp-dyn/content/article/2010/02/17/AR2010021702466.html.
Orthopedic Surgical Outcomes
Hoai Le
In a new study, it appears that hospitals with greater volume and specialization have better orthopedic surgical outcomes. After adjustments for patient characteristics and hospital volume, patients undergoing joint replacement in hospitals with more specialized care were less likely to die and had fewer complications than those in less specialized hospitals. It is suggested that this might be due to improved care in higher volume institutions and that surgeons there have more experience. Even though the study was limited to Medicare patients age 65 and older, Hagen and colleagues stand by their support of increased specialization and believe that the apparent association between surgical outcome and specialization in their study could have greater implications on the medical system.
Reference: BMJ 2010;340:c160
Chronic Disease in Children
Three groups of children, spanning from 1988 to 2006 included in the National Longitudinal Survey of Youth (NLYS), were analyzed. It revealed that chronic conditions more than doubled. One explanation could be that better access to care might have resulted in the increased diagnosis of chronic conditions. For example, the survival rates for cancer, prematurity and congenital disorders have increased beyond which was imaginable a little while ago. Additionally, in 1998 the federal Maternal and Child Health Bureau expanded the definition of children with special health needs to incorporate physical, developmental, emotional and behavioral conditions.
Furthermore, there seemed to be evidence in dynamic changes in onset, duration and resolution of these chronic conditions. In order to determine whether these changes were real, NLSY identified chronic conditions through questioning the parents on the condition of the child. The findings of the surveys supported these dynamic changes and from a developmental perspective, these dynamic changes are to be expected in childhood. For example, asthma can be influenced by the onset of puberty, stressful transitions or changes in family environments.
The increase in chronic conditions seemed to be driven by an increase in obesity, a slight increase in asthma, but little change in learning and behavioral problems, despite increases in ADHD and mental disorders. These findings raise the question of whether there is a link between asthma, obesity and ADHD. In fact, there is evidence that high levels of early childhood stress may result in poor executive function and impulse control. As can be seen, obesity is not the only childhood condition that needs to be dealt with, and prevention of childhood diseases also prevents age related diseases as adults. Therefore, the need for change, as well as the results of inaction, is too big to be ignored.
Reference: JAMA. 2010;303(7):665-666
Finding New Sources for Technetium 99
Isotope, technetium 99 is used to measure blood flow in the heart and to help diagnose bon and breast cancers. Two-thirds of the world’s supply of this isotope, comes from two reactors in Ontario and the Netherlands. The reactor in Ontario has been closed for nine months due to repairs and is not expected to reopen until at least April, while the one in the Netherlands closed for six months, beginning February 19. The closing of these two reactors is anticipated to result in a severe shortage of the isotope. However, Covidien, a company in St. Louis, which purifies material created in reactors and packages them in a usable form for radiologists, announced that it had signed a contractor with the operators of the Maria reactor, near Warsaw. Although this will likely only fill a small gap, Dr. Michael M. Graham, professor of radiology at the University of Iowa and a member of the board of the Society of Nuclear Medicine says that it “could make the difference between being able to limp along and shutting down.” Other companies are also trying to find ways to fill this gap, like General Electric that has a plan to make technetium 99 using neutrons from power reactors and Babcock & Wilcox, a company in Virginia, which has a plan for a liquid-fueled reactor.
Reference: Wald, Matthew L. (2010, 16 February). New Source of an Isotope in Medicine Is Found. The New York Times. Retrieved February 28, 2010 from http://www.nytimes.com/2010/02/17/health/17isotope.html?ref=health.
New Genomes Decoded Reveal Genetic Variations and Clues to Evolution
The genomes of South Africa’s Archbishop Desmond Tutu and an indigenous Bushman from Nambia have recently been decoded and the results were published in an issue of Nature. The goal of this study is to eventually enable researchers and drug companies to personalize medicine for people of all ethnicities and societies; until now, most of the genomes that were decoded were those of Europeans. However, the publication of individual human genomes is controversial because of the risk of it being used against the individuals to deny them claims to property and leading to workplace and insurance discrimination. However, early analysis has revealed 1.3 million genetic variations not previously found and could lead to important insights. It also provided clue to human evolution. This indigenous people are of particular interest to researchers because they are believed to represent the oldest lineage of modern humans and are much more diverse than other populations. It is this genetic variation that might be used to explain their unique characteristics like their good sense of hearing, vision and smell and physical abilities.
Reference: Stein, Rob. (2010, February 18). Genomes of Archbishop Tutu, Bushman decoded in developing-world health push. The Washington Post. Retrieved February 28, 2010 from http://www.washingtonpost.com/wp-dyn/content/article/2010/02/17/AR2010021702466.html.
Eriene-Heidi Sidhom is the 2009 - 2010 News and Analysis Editor.
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