NIH Study Provides Long-Awaited Insight Into Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

This Medical News article discusses a new US National Institutes of Health study of patients with the chronic­and chronically misunderstood­disease.

Contribution of sex and gender roles to the incidence of post-infectious irritable bowel syndrome in a prospective study.

Post-infectious irritable bowel syndrome (PI-IBS) occurs in about 10% of cases following gastroenteritis. The incidence of IBS is higher in females. However, it is not clear whether this is due to biological or psychosocial factors. We aimed to investigate the influence of gender roles on the incidence of PI-IBS, alongside traditional risk factors. Our study included 231 patients diagnosed with gastroenteritis who were hospitalized and treated with antibiotics between 2018 and 2021. The Korean Sex Role Inventory-Short Form (KSRI-SF), based on the Bem Sex Role Inventory (BSRI) was used to categorize patients (androgynous, masculine, feminine, and undifferentiated types). Six months after treatment, we conducted a telephone survey to confirm the presence of PI-IBS using the ROME IV criteria. Among the patients, 43.3% were female, and the mean age was 43.67 ± 16.09 years. After 6 months, 34 patients developed PI-IBS. Univariate analysis revealed that younger age, female sex, KSRI-SF undifferentiated type, and longer duration of antibiotic use independently influenced the occurrence of PI-IBS. Multivariate analysis showed that PI-IBS was associated with the KSRI-SF undifferentiated type and higher C-reactive protein (CRP) levels. Our study showed that the KSRI-SF undifferentiated type and high CRP levels at initial infection were associated with PI-IBS.

Outpatient visits before and after Lyme disease diagnosis in a Maryland employer-based health plan.

BACKGROUND: Insurance claims data have been used to inform an understanding of Lyme disease epidemiology and cost of care, however few such studies have incorporated post-treatment symptoms following diagnosis. Using longitudinal data from a private, employer-based health plan in an endemic US state, we compared outpatient care utilization pre- and post-Lyme disease diagnosis. We hypothesized that utilization would be higher in the post-diagnosis period, and that temporal trends would differ by age and gender. METHODS: Members with Lyme disease were required to have both a corresponding ICD-9 code and a fill of an antibiotic indicated for treatment of the infection within 30 days of diagnosis. A 2-year 'pre- diagnosis' period and a 2-year 'post-diagnosis period' were centered around the diagnosis month. Lyme disease-relevant outpatient care visits were defined as specific primary care, specialty care, or urgent care visits. Descriptive statistics examined visits during these pre- and post-diagnosis periods, and the association between these periods and the number of visits was explored using generalized linear mixed effects models adjusting for age, season of the year, and gender. RESULTS: The rate of outpatient visits increased 26% from the pre to the post-Lyme disease diagnosis periods among our 317-member sample (rate ratio = 1.26 [1.18, 1.36], p < 0.001). Descriptively, care utilization increases appeared to persist across months in the post-diagnosis period. Women's care utilization increased by 36% (1.36 [1.24, 1.50], p < 0.001), a significantly higher increase than the 14% increase found among men (1.14 [1.02, 1.27], p = 0.017). This gender difference was mainly driven by adult members. We found a borderline significant 17% increase in visits for children < 18 years, (1.17 [0.99, 1.38], p = 0.068), and a 31% increase for adults ≥ 18 years (1.31 [1.21, 1.42], p < 0.001). CONCLUSIONS: Although modest at the population level, the statistically significant increases in post-Lyme diagnosis outpatient care we observed were persistent and unevenly distributed across demographic and place of service categories. As Lyme disease cases continue to grow, so will the cumulative prevalence of persistent symptoms after treatment. Therefore, it will be important to confirm these findings and understand their significance for care utilization and cost, particularly against the backdrop of other post-acute infectious syndromes.

Pediatric neuropsychiatric disorders with motor and nonmotor phenomena.

The concept of pediatric autoimmune neuropsychiatric disorders associated with group A beta-hemolytic streptococcus (PANDAS) has become seminal since first introduced more than two decades ago. At the time of this writing, most neurologists, pediatricians, psychiatrists, and general pediatricians will probably have heard of this association or treated an affected child with PANDAS. The concept of an acute-onset, and typically self-limited, postinfectious autoimmune neuropsychiatric disorder resembling PANDAS manifesting vocal and motor tics and obsessive-compulsive disorder has broadened to other putative microbes and related endogenous and exogenous disease triggers. These disorders with common features of hypometabolism in the medial temporal lobe and hippocampus in brain 18fluorodeoxyglucose positron emission tomography fused to magnetic resonance imaging (FDG PET-MRI), form a spectrum: with the neuropsychiatric disorder Tourette syndrome and PANDAS with its well-defined etiopathogenesis at one end, and pediatric abrupt-onset neuropsychiatric syndrome (PANS), alone or associated with specific bacterial and viral pathogens, at the other end. The designation of PANS in the absence of a specific trigger, as an exclusionary diagnosis, reflects the current problem in nosology.

Emerging role of the gut microbiome in post-infectious irritable bowel syndrome: A literature review.

Post-infectious irritable bowel syndrome (PI-IBS) is a particular type of IBS, with symptom onset after an acute episode of infectious gastroenteritis. Despite infectious disease resolution and clearance of the inciting pathogen agent, 10% of patients will develop PI-IBS. In susceptible individuals, the exposure to pathogenic organisms leads to a marked shift in the gut microbiota with prolonged changes in host-microbiota interactions. These changes can affect the gut-brain axis and the visceral sensitivity, disrupting the intestinal barrier, altering neuromuscular function, triggering persistent low inflammation, and sustaining the onset of IBS symptoms. There is no specific treatment strategy for PI-IBS. Different drug classes can be used to treat PI-IBS similar to patients with IBS in general, guided by their clinical symptoms. This review summarizes the current evidence for microbial dysbiosis in PI-IBS and analyzes the available data regarding the role of the microbiome in mediating the central and peripheral dysfunctions that lead to IBS symptoms. It also discusses the current state of evidence on therapies targeting the microbiome in the management of PI-IBS. The results of microbial modulation strategies used in relieving IBS symptomatology are encouraging. Several studies on PI-IBS animal models reported promising results. However, published data that describe the efficacy and safety of microbial targeted therapy in PI-IBS patients are scarce. Future research is required.

Multisystem Inflammatory Syndrome in Children and Kawasaki Disease: A Spectrum of Postinfectious Hyperinflammatory Disease.

Kawasaki disease and multisystem inflammatory syndrome in children are hyperinflammatory conditions that share similar emerging pathophysiology hypotheses, clinical features, treatment strategies, and outcomes. Although both conditions have key differences, growing evidence suggests that both conditions might be closely related on a larger spectrum of postinfectious autoimmune responses.

Psicologia, Conselho Federal de Psicologia e covid-19: enfrentamento às desigualdades psicossociais no Brasil / Psychology, FCP, and covid-19: facing the psychosocial inequalities in Brazil / Psicología, Consejo Federal de Psicología y covid-19: enfrentando las desigualdades psicosociales en Brasil

A pandemia da covid-19 impôs transformações no cotidiano mundial, em âmbito micro e macroestrutural. Seu impacto psicológico desestabiliza e evidencia desigualdades e vulnerabilidades psicossociais brasileiras. Configura-se como um estudo de perspectiva crítica, com base na Psicologia Sócio-histórica, com o objetivo de mapear os posicionamentos da Psicologia, vindos de diferentes campos, diante das ações de saúde mental. Para tanto, utiliza-se o site do Conselho Federal de Psicologia para a análise de 62 documentos, que resultaram em dois eixos de produção crítica: 1) a relação da Psicologia com o Conselho Federal de Psicologia; e 2) da Psicologia com a sociedade. Revela-se o abismo social entre segmentos da sociedade brasileira; formas de exclusão da população carcerária; violência doméstica contra as mulheres e as crianças; dificuldades de acesso a estratégias sociais, na educação e na saúde, e de superação dos impasses acirrados com a infecção global pelo novo coronavírus. Conclui-se que a diversidade de públicos, temáticas, áreas de atuação e referenciais teóricos materializa um compromisso crítico e científico da Psicologia.(AU)

The COVID-19 pandemic imposed transformations in the world daily life, at the micro and macrostructural levels. Its psychological impact destabilizes and highlights Brazilian inequalities and psychosocial vulnerabilities. This is a critical perspective study, based in socio-historical Psychology, aiming to map the positions of Psychology, from different fields, in the face of mental health actions. To this end, the Federal Council of Psychology website is utilized to analyze 62 documents, which resulted in two axes of critical production: 1) the relation between Psychology and the Federal Council of Psychology; and 2) Psychology with society. They reveal the social gap between segments of Brazilian society; ways of excluding prison po7pulation; domestic violence against women and children; and difficulties in accessing social strategies, in education and health, and in overcoming impasses aggravated by the global infection by the new coronavirus. In conclusion, the diversity of public, themes, areas of professional performance, and theoretical references materialize Psychology's critical and scientific commitment.(AU)

La pandemia del COVID-19 provocó transformaciones globales en lo cotidiano a nivel micro y macroestructural. Su impacto psicológico desestabiliza y destaca las desigualdades y vulnerabilidades psicosociales en Brasil. Esta es una investigación en la perspectiva crítica, basada en la psicología sociohistórica, con el objetivo de mapear las posiciones de la Psicología, procedentes de diferentes campos, frente a las acciones de salud mental. Para este fin, se utiliza el sitio web del Consejo Federal de Psicología para el análisis de 62 documentos, lo que resultó en dos ejes de producción crítica: 1) la relación de la Psicología con el Consejo Federal de Psicología; y 2) de la Psicología con la sociedad. Se revelan la brecha social entre los segmentos de la sociedad brasileña; las formas de exclusión de la población carcelaria; la violencia doméstica contra las mujeres y los niños; y las dificultades para acceder a las estrategias sociales, en la educación y la salud, para superar los impasses agravados por la infección global por el nuevo coronavirus. Se concluye que la diversidad de públicos, temáticas, áreas de actividad y referentes teóricos materializa un compromiso crítico y científico de la Psicología.(AU)

Is SARS-CoV-2 the only cause of long-COVID?

Around 10% of adults infected with SARS-CoV-2 that survive a first episode of COVID-19 appear to experience long-term clinical manifestations. The signs and symptoms of this post-acute COVID-19 syndrome (PACS) include fatigue, dyspnea, joint pain, myalgia, chest pain, cough, anosmia, dysgeusia, headache, depression, anxiety, memory loss, concentration difficulties, and insomnia. These sequelae remind the constellation of clinical manifestations previously recognized as myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS). This condition has been described following distinct infectious events, mostly acute viral illnesses. In this way, the pathophysiology of PACS might overlap with mechanisms involved in other post-infectious fatigue syndromes. The risk of PACS is more frequent in women than men. Additional host genetic factors could be involved. There is a dysregulation of multiple body organs and systems, involving the immune system, the coagulation cascade, endocrine organs, autonomic nervous system, microbiota-gut-brain axis, hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-thyroid axis, etc. Hypothetically, an abnormal response to certain infectious agents could trigger the development of postinfectious fatigue syndromes.