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Healthcare, Special Issue: ME/CFS ― The Severely and Very Severely Affected
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===Case reports=== *[https://doi.org/10.3390/healthcare8030211 Severe ME in Children]<ref name="Speight2020">{{Cite journal | last = Speight | first = Nigel | authorlink = Nigel Speight | date = Sep 2020 | title = Severe ME in Children | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551866/|journal=Healthcare|language=en|volume=8|issue=3 | pages = 211|doi=10.3390/healthcare8030211|pmc=PMC7551866|pmid=32674263|access-date=|quote=|via=}}</ref> (Jul 14, 2020) by Nigel Speight. ''Healthcare 2020, 8(3), 211.'' <blockquote>'''Abstract -''' A current problem regarding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is the large proportion of doctors that are either not trained or refuse to recognize ME/CFS as a genuine clinical entity, and as a result do not diagnose it. An additional problem is that most of the clinical and research studies currently available on ME are focused on patients who are ambulant and able to attend clinics and there is very limited data on patients who are very severe (housebound or bedbound), despite the fact that they constitute an estimated 25% of all ME/CFS cases. This author has personal experience of managing and advising on numerous cases of severe paediatric ME, and offers a series of case reports of individual cases as a means of illustrating various points regarding clinical presentation, together with general principles of appropriate management.</blockquote> *[https://doi.org/10.3390/healthcare9020215 Three Cases of Severe ME/CFS in Adults]<ref name="Williams2021">{{Cite journal | last = Williams | first = Leah R. | authorlink = | last2 = Isaacson-Barash | first2 = Carol | authorlink2 = | date = Feb 2021 | title = Three Cases of Severe ME/CFS in Adults| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920463|journal=Healthcare|language=en|volume=9|issue=2 | pages = 215|doi=10.3390/healthcare9020215|pmc=PMC7920463|pmid=33669438|access-date=|quote=|via=}}</ref> (Feb 16, 2021) by Leah R. Williams and Carol Isaacson-Barash. ''Healthcare 2021, 9(2), 215.'' <blockquote>'''Abstract -''' Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, only partially understood multi-system disease whose onset and severity vary widely. Symptoms include overwhelming [[fatigue]], [[post-exertional malaise]], [[sleep dysfunction|sleep disruptions]], gastrointestinal issues, [[headache]]s, [[orthostatic intolerance]], [[cognitive impairment]], etc. ME/CFS is a physiological disease with an onset often triggered by a viral or bacterial infection, and sometimes by toxins. Some patients have a mild case and are able to function nearly on a par with healthy individuals, while others are moderately ill and still others are severely, or even, very severely ill. The cohort of moderately to very severely ill is often housebound or bedbound, has lost employment or career, and has engaged in a long, and often futile, search for treatment and relief. Here, we present three case studies, one each of a moderately ill, a severely ill, and a very severely ill person, to demonstrate the complexity of the disease, the suffering of these patients, and what health care providers can do to help.</blockquote> *[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070213 Life-Threatening Malnutrition in Very Severe ME/CFS]<ref name="malnutrition">{{Cite journal | last = Baxter | first = Helen | authorlink = | last2 = Speight | first2 = Nigel | authorlink2 = Nigel Speight | last3 = Weir | first3 = William | authorlink3 = William Weir | date = Apr 2021 | title = Life-Threatening Malnutrition in Very Severe ME/CFS| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070213|journal=Healthcare|language=en|volume=9|issue=4 | pages = 459|doi=10.3390/healthcare9040459|pmc=PMC8070213|pmid=33919671|access-date=|quote=|via=}}</ref> (Apr 14, 2021) by Helen Baxter, Nigel Speight and William Weir. ''Healthcare 2021, 9(4), 459.'' <blockquote>'''Abstract -''' Very severe Myalgic Encephalomyelitis (ME), (also known as Chronic Fatigue Syndrome) can lead to problems with nutrition and hydration. The reasons can be an inability to swallow, severe gastrointestinal problems tolerating food or the patient being too debilitated to eat and drink. Some patients with very severe ME will require tube feeding, either enterally or parenterally. There can often be a significant delay in implementing this, due to professional opinion, allowing the patient to become severely malnourished. Healthcare professionals may fail to recognize that the problems are a direct consequence of very severe ME, preferring to postulate psychological theories rather than addressing the primary clinical need. We present five case reports in which delay in instigating tube feeding led to severe malnutrition of a life-threatening degree. This case study aims to alert healthcare professionals to these realities.</blockquote>
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