Journal of Chronic Fatigue Syndrome: Volume 10, Issue 3-4, 2002

Volume 10, Issue 3-4, 2002

 * Editorial by Roberto Patarca-Montero
 * Activity Limitations and Participation Restrictions in Patients with Chronic Fatigue Syndrome—Construction of a Disease Specific Questionnaire"'Abstract - Review of the literature indicated the lack of disease specific measures for assessing activity limitations and participation restriction in patients with Chronic Fatigue Syndrome. Retrospective analysis of Karnofsky Performance Status questionnaires and Activities of Daily Living questionnaires (a Dutch version of the Barthel index, modified for CFS) of 141 subjects was performed to create a new questionnaire. Data analysis resulted in the following item selection, based on most frequently reported activity limitations and participation restriction; cleaning, washing dishes and returning them to cupboard, iron, do the wash, gardening, replace light bulb, walking, climb one flight of stairs, stand one hour, sit two hours, doing groceries, thirty minutes of computer work, carrying heavy objects, write a full page letter, use a screwdriver, hammer a nail, make one bed, reading, social activities, doing sports, studying, driving a car, going to school/working, preparing meals and caring for a child. These data were used to create the CFS-Activities and Participation Questionnaire (CFS-APQ). The reliability and different aspects of validity of this new measure still need to be established.'"
 * Influence of Melatonin on Quality of Life in Patients with Chronic Fatigue and Late Melatonin Onset"'Abstract - Medical Outcome Study Short Form-36 (MOS SF-36) qualities of life scores were studied in 38 chronic fatigue patients with late melatonin onset before and after treatment with melatonin. Before start of the treatment, quality of life was assessed twice. Pre-treatment scores were compared with each other and with the scores of 43 patients with Delayed Sleep Phase Syndrome and of 1063 healthy subjects. Melatonin, 5 mg, was taken orally, 5 hours before baseline salivary endogenous dim light melatonin onset. After mean (SD) treatment of 13.7 (0.8) weeks, quality of life scores “physical functioning,” “energy/vitality,” “bodily pain,” and “general health perception” improved (p values, respectively, 0.017, 0.002, 0.002 and 0.009). In the pre-treatment period (mean [SD] interval: 6.5 [0.6] weeks) “social functioning” and “general health perception” improved (p = 0.013 and 0.010, respectively). In the chronic fatigue patients the quality of life scores did not differ from those of the Delayed Sleep Phase Syndrome patients, except for “physical functioning,” “energy/vitality” and “general health perception.” These were significantly lower. All chronic fatigue patients's scores were significantly lower than those of the healthy subjects except for “health transition.” Chronic fatigue patients with late melatonin onset have a significant quality-of-life burden, similar to Delayed Sleep Phase Syndrome patients. Several quality of life dimensions improved after treatment with melatonin.'"
 * Levels of Nitric Oxide Synthase Product Citrulline Are Elevated in Sera of Chronic Fatigue Syndrome Patients"'Abstract - Serum levels of citrulline, a product of nitric oxide synthase activity, were measured in 36 CFS patients and 16 controls to determine whether synthase activity may be elevated in CFS patients. Serum citrulline levels were found to be significantly elevated in CFS patients and, in addition, there was a trend towards higher levels in CFS patients with stronger symptoms. These results provide support for the view that nitric oxide synthase activity tends to be elevated in CFS patients, thus supporting a prediction of the elevated nitric oxide/peroxynitrite theory of CFS etiology.'"
 * Toxins and Immunity in Chronic Fatigue Syndrome"'Abstract - In this paper, Dr. Richardson illustrates links between exposure, absorption and effects of viruses, bacteria, and inorganic toxins, and their toll on the immune system, as potential causes of chronic symptomatology as seen in chronic fatigue syndrome.'"
 * The Paul-Bunnell Heterophile Antibody Determinant in Epstein-Barr Virus-Associated Disease"'Abstract - Reactivation of latent herpes viruses (notably Epstein-Barr virus, human herpesvirus-6) is commonly seen in chronic fatigue syndrome and it is believed to contribute to symptom perpetuation. Epstein-Barr virus (EBV), which was first isolated by Epstein, Barr and Achong (1964) from a cultured Burkitts's lymphoma lymphoblast cell line, is the etiological agent for infectious mononucleosis (IM), polyclonal and oligoclonal lymphomas associated with primary and acquired immunodeficiencies, and the complications of X-linked lymphoproliferative syndrome (XLP) (Cantani and Mastrantoni, 1989; Englund, 1988; Ernberg et al., 1990; Jones and Straus, 1987; Okano et al., 1988; Purtilo, 1987; Purtilo et al., 1981; Rowe et al., 1986; Saemundsen et al., 1981) and nasopharyngeal cancer (Pearson et al., 1984). Furthermore, people who have had IM have higher rates of subsequent development of malignant lymphoproliferative disorders (Abo et al., 1982; Snydman et al., 1982) and Hodgkins's disease (Green et al., 1979; Mueller, 1987; Poppema et al., 1985; Weiss et al., 1989), while patients with XLP have a higher incidence of non-Hodgkins's malignant lymphoma (Harrington et al., 1987). The precise role of EBV in these diseases or in CFS is not well understood. Nonetheless, it is known that EBV infection triggers the formation of heterophile antibodies that, for many decades, have formed the basis for serologic diagnosis of IM. In this review, we discuss the discovery, species variation, and structure of the erythrocyte membrane-associated Paul-Bunnell (PB) heterophile antibody determinant, its implications to IM diagnosis, and its potential contribution to defective immune surveillance, such as that seen in chronic fatigue syndrome.'"
 * Effects of Benzalkonium Salts on G-protein-Mediated Processes and Surface Membranes: Relevance to Microbial- and Chemical-Induced Diseases"'Abstract - Benzalkonium salts comprise a group of positively charged surface-active alkylamine biocides with the general formula alkyldi-methylbenzylammonium chloride or bromide. They interact with guanine nucleotide triphosphate-binding proteins (G proteins), thereby affecting signal transduction in a variety of cell types and processes. The present report reviews the known and potential basic science research and clinical applications and manifestations of benzalkonium salts. Benzalkonium salts have antiproliferative effects on a variety of cells (including T cells) through G-protein-dependent pathways, affect cytokine gene expression (downregulate tumor necrosis factor expression), and are also effective bactericidal, fungicidal, and virucidal agents with multisite (direct and immunologically-mediated) inhibitory activity against many pathogens, including the human immunodeficiency virus (HIV), papillomavirus, and herpesviruses. Therefore, benzalkonium salts not only appear to be effective as disinfectants and spermicides but may also prove useful in the prevention and treatment of several diseases, particularly those linked to viruses and originating at the skin or mucosal surface. The untoward effects of benzalkonium salts are also discussed as a paradigm for chemical-induced diseases.'"