Pitfalls in cytokine measurements - Plasma TGF-ß1 in chronic fatigue syndrome.

BACKGROUND: Serum TGF-ß1 concentrations are reported to be elevated in chronic fatigue syndrome (CFS). However, measurement of circulating cytokines is a complex procedure and control of pre-analytical procedures is essential. The objective of the current study was to measure circulating TGF-ß1 concentrations in CFS patients compared to healthy controls, taking into account differences in pre-analytical procedures. METHODS: Two cohorts of female CFS patients were included. In both studies patients were asked to bring a healthy, age-matched control. At baseline, TGF-ß1 levels were measured in plasma and additionally P-selectin, a marker of platelet activity, was determined in a subgroup of participants. RESULTS: 50 patients and 48 controls were included in cohort I, and 90 patients and 29 controls in cohort II. Within the cohorts there were no differences in TGF-ß1 concentrations. However, between the cohorts there was a large discrepancy, which appeared to be caused by differences in g-force of the centrifuges used. The lower g-force used in cohort II (1361 g) caused more platelet activation, reflected by higher p-selectin concentrations, compared to cohort I (p < 0.0001), which was confirmed in a second independent experiment. There was a correlation between TGF-ß1 and p-selectin concentrations (r 0.79, p < 0.0001). CONCLUSION: These results demonstrate that control of pre-analytical procedures is an essential aspect when measuring circulating cytokines. No evidence for enhanced TGF-ß1 in patients with CFS was found.

[Report of the Dutch National Health Council on chronic fatigue syndrome]. / GR-rapport over chronische-vermoeidheidssyndroom.

In our opinion, the recent report of the Dutch National Health Council on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) lacks balance: it is very critical on the quality of evidence regarding behavioural interventions, but lacks a critical attitude regarding the presumed somatic components of the disorder. Without solid evidence, the report coins ME/CFS as a severe multisystem disease, and it embraces the diagnostic criteria of the American Institute of Medicine. We underscore the remarks in the report that physicians should not be reluctant to make diagnosis in patients with the disorder, and that these patients should be approached with empathy and respect. Regarding a future research programme, there is need for a well-designed research agenda.

Postural orthostatic tachycardia is not a useful diagnostic marker for chronic fatigue syndrome.

BACKGROUND: Postural orthostatic tachycardia syndrome (POTS) is considered a diagnostic marker for chronic fatigue syndrome (CFS). OBJECTIVES: The aims of this study were to (i) compare POTS prevalence in a CFS cohort with fatigued patients not meeting CFS criteria, and (ii) assess activity, impairment and response to cognitive behavioural therapy (CBT) in CFS patients with POTS (POTS-CFS) and without POTS (non-POTS-CFS). METHODS: Prospective cohort study at the Radboud University Medical Centre in the Netherlands. Between June 2013 and December 2014, 863 consecutive patients with persistent fatigue were screened. Patients underwent an active standing test, filled out questionnaires and wore an activity-sensing device for a period of 12 days. RESULTS: A total of 419 patients with CFS and 341 non-CFS fatigued patients were included in the study. POTS prevalence in adult patients with CFS was 5.7% vs. 6.9% in non-CFS adults (P = 0.54). In adolescents, prevalence rates were 18.2% and 17.4%, respectively (P = 0.93). Adult patients with POTS-CFS were younger (30 ± 12 vs. 40 ± 13 years, P = 0.001) and had a higher supine heart rate (71 ± 11 vs. 65 ± 9 beats per min, P = 0.009) compared with non-POTS-CFS patients. Severity and activity patterns did not differ between groups. In patients with CFS, criteria for Systemic Exertion Intolerance Disease (SEID) were met in 76% of adults and 67% of adolescents. In these patients with CFS fulfilling the SEID criteria, the prevalence of POTS was not different from that in the overall CFS population. POTS-CFS adolescents had less clinically significant improvement after CBT than non-POTS-CFS adolescents (58% vs. 88%, P = 0.017). CONCLUSION: In adults with CFS, the prevalence of POTS was low, was not different from the rate in non-CFS fatigued patients and was not related to disease severity or treatment outcome. In POTS-CFS adolescents, CBT was less successful than in non-POTS-CFS patients. The evaluation of POTS appears to be of limited value for the diagnosis of CFS.

Diabetes in patients with HIV: patient characteristics, management and screening.

BACKGROUND: As HIV management has become more successful during the past years, non-communicable diseases have become more prevalent among HIV-infected individuals. As a result, more HIV-infected patients die of cardiovascular diseases, with diabetes being one of the main risk factors. This study evaluates screening and management of diabetes among HIV-infected patients in a university hospital in the Netherlands. METHODS: We examined clinical characteristics, glycaemic control and cardiovascular risk management of HIV-infected patients with coexisting diabetes, and determined the frequency of diabetes screening in those without. RESULTS: Of 518 HIV-infected patients, 28 had been diagnosed with diabetes (5.4%), mostly (20÷28) after being diagnosed with HIV. Patients with coexisting diabetes were older, had a longer duration of HIV, lower CD4 cell counts and higher body mass index (BMI), and were more likely to use aspirin, statins and antihypertensive medication than those without diabetes (all p < 0.05). HbA1c values were below 7% (53 mmol÷mol) in 54% of patients. Targets for systolic blood pressure (< 140 mmHg), LDL cholesterol (< 2.5 mmol÷l) and BMI (< 25 kg÷m2) were achieved by 82%, 50% and 29% of patients, respectively. Annual ophthalmology examination, screening for microalbuminuria and foot control were rarely performed. Among the patients without known diabetes, diabetes screening during the past year had been performed using (non-fasting) plasma glucose in 56% and HbA1c in 10%, but 42% of patients had not been screened. CONCLUSION: For HIV-infected individuals with diabetes, glycaemic control and cardiovascular risk management were reasonable, but screening for microvascular complications was rarely performed. Annual diabetes screening of HIV-infected patients was not routine.