No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Asthenia in patients attending the outpatient clinic. Valuation through the rating scale fatigue
Abstract
Introduction: Many patients attending out patient clinics with a set of nonspecific symptoms and signs that suggest the diagnosis asthenia, without organic cause to explain the symptoms. In order to determine which of was these patients confirmed the diagnosis of functional asthenia, was performed a prospective nation wide, study to diagnose and quantify the intensity of fatigue in these patients and measure the effectiveness of sulbutiamine 400 mg/day treatment short-term drug frontline. Results: 74,7% of patients were females with a mean age of 43,7 ± 12,5 years old and 25,3% were males with a mean age of 41,7 ± 13,5 years old. At baseline, the FSS score was 49,7 ± 7,3 points; at day 7 was 37,2 ± 8,8 points with a decrease of 25,2% and at day 15 was 28,0 ± 9,8 points, with a decrease of 43,7% respective to baseline, being statistically significant (p< 0,0001 and p< 0,0001 at day 7 and day 15, respectively). The percentage of response to treatment was 77,7% at day 15. Sulbutiamine was a very well tolerated treatment, there were reported mild adverse events in 132 patients (38,7%) at day 7 and in 115 patients (33,7%) at day 15. Conclusions: Sulbutiamine 400 mg/day is a secure treatment, it is well tolerated and effective in improving the asthenia symptoms, as demonstrated in this clinical trial by the significant decrease in the FSS mean score and the percentage of patients with asthenia at day 15 of treatment.
ResearchGate has not been able to resolve any citations for this publication.
Chronic fatigue syndrome (CFS) affects disproportionately more women than men, and the condition is more common at perimenopause. We examined gynecological history events as risk factors for CFS.
In a case-control study from a randomly selected population sample from Wichita, Kansas, 36 women with CFS and 48 nonfatigued controls, of similar age, race, and body mass index (BMI), answered a structured gynecological history questionnaire.
CFS cases and controls had the same mean age (51 years) and age at menarche (12 years). Overall, a greater proportion of women with CFS than controls reported pelvic pain unrelated to menstruation (22.2% vs. 1.7%, p = 0.004), endometriosis (36.1% vs. 16.7, %, p = 0.046), and periods of amenorrhea (53.9 % vs. 46.2%, p = 0.06). Compared to controls, women in the CFS group had a higher mean number of pregnancies (2.8 vs 2.0, p = 0.05) and gynecological surgeries (1.8 vs. 1.1, p = 0.05). Similar proportions of the CFS (69.4%) and control (72.9%) groups were menopausal. Although menopausal women in the CFS and control groups had similar mean age (55.5 and 55.8, respectively), menopause occurred about 4.4 years earlier in the CFS group (41.7 years vs. 46.1 years, respectively, p = 0.11). Among menopausal women, 76% of the CFS group reported hysterectomy vs. 54.6% of controls (p = 0.09), and 56% of women with CFS reported oophorectomy vs. 34.3% of controls (p = 0.11).
The higher prevalence of gynecological conditions and gynecological surgeries in women with CFS highlights the importance of evaluating gynecological health in these patients and the need for more research to clarify the chronologic and the pathophysiological relationships between these conditions and CFS.
The media has shown some interest in children with chronic fatigue syndrome, although national coverage does not always accurately reflect the position of the current medical publications. For example, one television programme indicated that most adolescents with the illness might expect to be ill for at least four years, a suggestion that research papers do not confirm. It is thus prudent to consider what current research tells us, particularly when there is an apparent disparity of views about the illness between parents, support groups, and professionals.
An editorial in the British Medical Journal 1and a report from the joint working group of the Royal Colleges of Physicians, Psychiatrists and General Practitioners2 both called for more work to be carried out on the assessment and management of children and adolescents with chronic fatigue syndrome. This review seeks to delineate our knowledge from published work as it currently stands and suggests an important area of further work.
Many terms have been used over the years for illnesses involving severe and prolonged fatigue. In the middle of the 19th century the term neurasthenia was used.3 It was believed that neurasthenia was a form of “nervous exhaustion” brought about by an injury to the nervous system. The treatment advised was rest, and a term apparently given to such people was “sofa cases”.4 Similar euphemisms exist today. Such terms as “skiver’s sickness” and the term “yuppie flu” have been used, although there is no evidence to suggest a clear socioeconomic correlation.2 Many other disorders described and defined over the years have much in common. They include fibromyalgia,5 myasthenia,6neuromyasthenia,7 myalgic encephalomyelitis (ME),8 postviral fatigue syndrome,9idiopathic chronic fatigue and myalgic syndrome,10 Iceland disease,11 Royal Free disease,12 chronic Epstein-Barr virus (EBV) infection,13 …
Purposes/Aims: To identify subgroups of women in late menopausal transition (MT) stage who experienced the same cluster of symptoms and to identify indicators that predicted membership in these distinct subgroups.
Rationale/Conceptual Basis/Background: The number of women reaching menopause grows exponentially each year. An expected 40 million women will reach menopause in the next decade. Approximately 65% - 75% of these women will experience bothersome vasomotor symptoms (VMS), an estimated 85% will report one or more symptoms such as hot flashes, mood disturbances or sleep disruption.. To date menopausal symptom management research has focused on single symptoms. However, a majority of women report multiple symptoms varying in severity from mild to severe. Understanding the interrelationships among symptoms is an important first step to improve symptom management. To do this we need to not only focus our attention on the clustering of symptoms but on how women with the same symptom profiles cluster together.
Methods: The sample consisted of a subset of Seattle Midlife Women’s Health Study participants who were in late MT stage and provided self-report data on symptoms experienced between 1990 and 2005. Latent class analysis (LCA) was used to identify subgroups of women who experienced similar clusters of the following 5 symptoms: problem concentrating, hot flashes, joint ache, mood changes, and awakening at night. LCA with multivariate logistic regression was used to indentify covariates that predicted membership in each subgroup.
Results: Four subgroups of women were identified: 1) low severity for all symptoms except for joint ache which was moderate (65%); 2) high severity for all symptoms except for hot flashes which was moderate (13%); 3) high severity for hot flashes, joint ache and awakening at night; low severity for mood changes and problem concentrating (12%); 4) high severity for problem concentrating, joint ache; moderate severity for hot flashes and awakening at night; low severity for mood changes (10%). A clear delineation between subgroups based on individual characteristics was not fully elucidated.
Implications: Shifting the focus from single symptoms to symptom clusters will facilitate the identification of the unique symptom experience for individual women.
This review analyses the recent literature devoted to two related fatigue syndromes: chronic fatigue syndrome (CFS) and acute onset postviral fatigue syndrome (PVFS). The articles are grouped into five pathogenic tracks: infectious agents, immune system, skeletic muscle, hypothalamo-pituitary-adrenal (HPA) axis and psychiatric factors. Although a particular infectious agent is unlikely to be responsible for all CFS cases, evidence is shown that host-parasite relationships are modified in a large proportion of patients with chronic fatigue. Antibody titres against infectious agents are often elevated and replication of several viruses could be increased. Chronic activation of the immune system is also observed and could be due to the reactivation of persistent or latent infectious agents such as herpes viruses (i.e. HHV-6) or enteroviruses. It could also be favorised by an impaired negative feedback of the HPA axis on the immune system. A model is proposed where the abnormalities of the HPA axis are primary events and are mainly responsible for a chronic activation of the immune system which in turn induces an increased replication of several viruses under the control of cellular transcription factors. These replicating viruses together with cytokines such as TNF-alpha would secondarily induce functional disorders of muscle and several aspects of asthenia itself.
Sleepiness and fatigue are conceptually distinct but pervasively confounded in research, measurement instruments, clinical settings, and everyday spoken language. The purpose of the present study was to construct two scales that represent unconfounded measures of sleepiness and fatigue, using widely used questionnaires.
Four questionnaires purporting to measure sleepiness [Stanford Sleepiness Scale (SSS); Epworth Sleepiness Scale (ESS)] or fatigue [Fatigue Severity Scale (FSS); Chalder Fatigue Scale (CFS)] were administered, as well as a battery measuring sleep, psychological, and health functioning variables, to three samples: 19 individuals with chronic fatigue syndrome, 14 with narcolepsy, and 11 normal control subjects.
Analyses revealed two distinct sets of items (six sleepiness and three fatigue items) that were combined into two scales. These newly formed scales are only minimally correlated and represent separate constructs that have reasonably distinctive patterns of association. Findings were replicated and validated in a sample of 128 older individuals complaining of daytime sleepiness and/or fatigue.
We conclude that (a) it is possible to derive empirically distinct sleepiness and fatigue scales from existing, commonly used self-report instruments, (b) the Empirical Sleepiness Scale is limited to the experience of daytime sleep tendency, while (c) the Empirical Fatigue Scale is associated more broadly with insomnia, psychological maladjustment, and poorer perceived health function. The important clinical implication of the new Empirical Sleepiness and Fatigue Scales is in the ability to identify "sleepiness which is not fatigue," a construct closely related to primary sleep disorders, such as sleep apnea/hypopnea syndrome, for which there is both available and effective treatment.