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
"änd the mental deficits of CFS are potentially compromised by lack of objectivity of patients'complaints" "However, some CFS patients present with pre-procedure tachycardia that questions the result of this test" (treadmill) When someone writes a paper should he not study the subject first? I'd better leave the rest of the paper to the specialists. I noticed a lot of prejudice, but I'm not objective because of CFS, the writer dropped the ME part somewhere.
The author, despite citing the IOM report, has understood nothing. My CPET was normal and I now I'm even able to do sports, but I'm still seriously limited in my ability to carry out ordinary daily activities. The limitation is in the amount of time per day that I can do things because for some reason they are abnormally stressful to my body and I can only handle so much of that stress.
Might be worth poitning out that this is published in "The Journal of Insurance Medicine The Journal of Insurance Medicine is the official journal of the American Academy of Insurance Medicine. It is a peer-reviewed medical journal published quarterly, now exclusively, online. It is designed with the insurance company medical director throughout the world in mind. Many of the articles will also be of interest to actuaries and lay underwriters as well as physicians in clinical practice."
