Andy
Retired committee member
CFS is a diagnostic dilemma for physicians and social scientists because of the varying nonspecific symptoms and lack of physical findings to support a diagnosis of actual pathology. In many ways, this is a disease of exclusion for other causes for chronic fatigue. The major test for determining physical disability is the treadmill exercise test, which provides valuable information if correctly performed. However, some CFS patients present with pre-procedure tachycardia that questions the results of this test, and the mental deficits of CFS are potentially compromised by a lack of objectivity of patients‘complaints.
This report describes the findings of medical adjudication for social security purposes of 400 cases over 7 years from a single institution. The basic evaluation included a careful history, physical exam, laboratory tests, lung function testing, ECG, and treadmill exercise testing. In cases with mental complaints (34 cases), blood levels of the cytokine’s interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were obtained because production of these cytokines have been associated with CSF-like symptoms following various illnesses.
For example, a cohort of breast cancer patients who had received chemotherapy and/or radiotherapy developed CFS-like symptoms and were found to have increased expression of RNA encoding IL-6 and TNF-α in their leucocytes.2 Increased production of these cytokines have also been demonstrated in patients with prior SARS-CoV-19 infection who developed Long Covid 19.3 TNF-α is an early cytokine to mediate pro-inflammatory responses by inducing nuclear factor kappa B (NF-kB), which is responsible for the expression of multiple proinflammatory genes in the cell nucleus.4 This was also shown in some patients with Immune-mediated inflammatory diseases.5
Open access, https://meridian.allenpress.com/jim...ic-Fatigue-Syndrome-Challenges-for-Evaluation
This report describes the findings of medical adjudication for social security purposes of 400 cases over 7 years from a single institution. The basic evaluation included a careful history, physical exam, laboratory tests, lung function testing, ECG, and treadmill exercise testing. In cases with mental complaints (34 cases), blood levels of the cytokine’s interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were obtained because production of these cytokines have been associated with CSF-like symptoms following various illnesses.
For example, a cohort of breast cancer patients who had received chemotherapy and/or radiotherapy developed CFS-like symptoms and were found to have increased expression of RNA encoding IL-6 and TNF-α in their leucocytes.2 Increased production of these cytokines have also been demonstrated in patients with prior SARS-CoV-19 infection who developed Long Covid 19.3 TNF-α is an early cytokine to mediate pro-inflammatory responses by inducing nuclear factor kappa B (NF-kB), which is responsible for the expression of multiple proinflammatory genes in the cell nucleus.4 This was also shown in some patients with Immune-mediated inflammatory diseases.5
Open access, https://meridian.allenpress.com/jim...ic-Fatigue-Syndrome-Challenges-for-Evaluation
