[Exercise prescription in post-COVID syndrome: A challenge for primary healthcare]. / Prescripción de ejercicio en condición pos-COVID. Un reto en Atención Primaria.

After the SARS-CoV-2 pandemic we face a new global epidemic: the Post-COVID Syndrome. This novel condition has fluctuating progression and a wide range of symptoms, such as fatigue, headaches, muscle pain or breathlessness. Although its pathophysiology is not clear, a multiorganic affection is suspected, altering the immune, cardiorespitatory and nervous systems. Whereas there is no consensus over its treatment, most of the researches conclude the effectiveness of therapeutic exercise and a multicomponent rehabilitation, coordinating and cooperating between different health professionals. A functional, respiratory and strength evaluation prior to treatment prescription is highly recommended, since it will help professionals to precisely prescribe and objectively measure the evolution of our patients. In this article we suggest a few tests, adequate to primary health requirements, to evaluate our patients' initial condition, as well as the most secure way to initiate a therapeutic exercise programme, together with other healthcare providers.

COVID persistente: ¿es en realidad una encefalomielitis miálgica? Revisión bibliográfica y consideraciones / Long COVID: Is it really myalgic encephalomyelitis? Bibliographic review and considerations

Las secuelas clínicas de una enfermedad tan extendida como la COVID-19 pueden ser de gran importancia para la atención primaria por su prevalencia y la morbilidad que conllevan. La definición de COVID persistente y el establecimiento de su temporalidad son dispares pero algunos autores consideran plausible que este síndrome sea en realidad una encefalomielitis miálgica. Se observan similitudes al comparar los Criterios Internacionales de Consenso para el diagnóstico de encefalomielitis miálgica con los síntomas descritos para la COVID persistente. Se recomienda la realización de analítica sanguínea, pulsioximetría, radiografía de tórax y ecografía torácica en los pacientes con síntomas persistentes después de la infección aguda. El manejo en ambos cuadros consiste en el tratamiento de los principales síntomas. La posibilidad de que la COVID-19 pueda dar lugar a un cuadro crónico como la encefalomielitis miálgica hace imprescindible un seguimiento a largo plazo de los pacientes que han presentado esta infección (AU)

Clinical sequelae of a disease as widespread as COVID-19 can be of great importance for primary care due to their prevalence and the morbidity they entail. The definition of long COVID and the establishment of its temporality are various, but some authors consider possible that this syndrome is actually myalgic encephalomyelitis. Similarities are observed when comparing the International Consensus Criteria for the diagnosis of myalgic encephalomyelitis with the symptoms described for long COVID. Blood tests, pulse oximetry, chest radiography, and thoracic ultrasound are recommended in patients with persistent symptoms after acute infection. Management in both conditions consists of treating the main symptoms. The possibility that COVID-19 can lead to a chronic condition such as myalgic encephalomyelitis makes long-term follow-up of patients who have suffered from this infection essential (AU)

[Long COVID: Is it really myalgic encephalomyelitis? Bibliographic review and considerations]. / COVID persistente: ¿es en realidad una encefalomielitis miálgica? Revisión bibliográfica y consideraciones.

Clinical sequelae of a disease as widespread as COVID-19 can be of great importance for primary care due to their prevalence and the morbidity they entail. The definition of long COVID and the establishment of its temporality are various, but some authors consider possible that this syndrome is actually myalgic encephalomyelitis. Similarities are observed when comparing the International Consensus Criteria for the diagnosis of myalgic encephalomyelitis with the symptoms described for long COVID. Blood tests, pulse oximetry, chest radiography, and thoracic ultrasound are recommended in patients with persistent symptoms after acute infection. Management in both conditions consists of treating the main symptoms. The possibility that COVID-19 can lead to a chronic condition such as myalgic encephalomyelitis makes long-term follow-up of patients who have suffered from this infection essential.

Correlación entre el Cuestionario Respiratorio de Saint George, la Escala de Severidad de la Fatiga y la Escala de Actividades de la Vida Diaria London Chest en pacientes que se recuperaron de COVID-19 e ingresaron a un programa de rehabilitación pulmonar / Correlation between the Saint George's Respiratory Questionnaire, the Fatigue Severity Scale and the London Chest Activities of Daily Living Scale in patients who recovered from COVID-19 and entered a pulmonary rehabilitation program

Introducción. Una vez declarada la pandemia por COVID-19, los servicios de rehabilitación empezaron a prepararse para la atención, mediante diferentes abordajes, de los pacientes que se recuperaran de esta enfermedad. Objetivo. Correlacionar los resultados obtenidos en el Cuestionario Respiratorio de Saint George (CRSG), la Escala de Severidad de la Fatiga (FSS) y la Escala de Actividades de la Vida Diaria London Chest (LCADL) aplicados en pacientes recuperados de COVID-19 para medir su calidad de vida y la fatiga. Métodos. Estudio descriptivo retrospectivo realizado en 60 pacientes recuperados de COVID-19, moderado o grave, que ingresaron al programa de rehabilitación pulmonar de un hospital de tercer nivel de Bogotá, Colombia, entre el primero de octubre de 2020 y el 30 de junio de 2021. Se analizaron variables demográficas y para caracterizar la calidad de vida y la fatiga de los participantes se utilizó el cuestionario CRSG, la escala FSS y la escala LCADL, cuyos resultados se compararon mediante correlación de Spearman. Para el análisis estadístico se utilizó el programa de SPSS versión 28. Resultados. La fatiga está correlacionada con la calidad de vida, y al ser identificada se puede intervenir mediante los ejercicios terapéuticos de los programas de rehabilitación pulmonar, lo cual optimiza los resultados esperados. Conclusiones. Existe una adecuada correlación entre las escalas CRSG y LCADL; esto es importante porque aplicar escalas de calidad de vida en pacientes con SARS-CoV-2 permite conocer las áreas que pueden ser intervenidas mediante programas de rehabilitación pulmonar para lograr una intervención adecuada

Introduction. Once the COVID-19 pandemic was declared, rehabilitation services began to prepare for the care, through different approaches, of patients recovering from this disease. Objective. To correlate the results obtained in the Saint George's Respiratory Questionnaire (CRSG), the Fatigue Severity Scale (FSS) and the London Chest Activities of Daily Living Scale (LCADL) applied in patients recovered from COVID-19 to measure their quality of life and fatigue. Methods. Retrospective descriptive study conducted in 60 patients recovered from COVID-19, moderate or severe, who were admitted to the pulmonary rehabilitation program of a third level hospital in Bogota, Colombia, between October 1, 2020 and June 30, 2021. Demographic variables were analyzed and the CRSG questionnaire, the FSS scale and the LCADL scale were used to characterize the quality of life and fatigue of the participants, whose results were compared by Spearman correlation. SPSS version 28 was used for statistical analysis. Results. Fatigue is correlated with quality of life, and when identified, it can be intervened by means of therapeutic exercises in pulmonary rehabilitation programs, which optimizes the expected results. Conclusions. There is an adequate correlation between the CRSG and LCADL scales; this is important because applying quality of life scales in patients with SARS-CoV-2 allows us to know the areas that can be intervened through pulmonary rehabilitation programs to achieve an adequate intervention.

Síndrome Pos-COVID y Síndrome de Fatiga Crónica: ¿Dos caras de la misma moneda? / POST-COVID SYNDROME AND CHRONIC FATIGUE SYNDROME: TWO SIDES OF THE SAME COIN

El síndrome de fatiga crónica es una enfermedad caracterizada, principalmente, por la manifestación de la fatiga, el dolor muscular difuso, y alteraciones en el sueño, en un periodo de no menos de 6 meses y que no son explicables por alguna causa. Es llamativo que, luego de un periodo de tiempo de padecer la COVID-19, los pacientes presenten síntomas similares a los hallados en el síndrome de fatiga crónica. A esta afección se la denomino síndrome pos-COVID. Los virus son los principales sospechosos en la aparición de ambos síndromes, estos podrían ocasionar la generación de daño mitocondrial, una neuroinflamación, alteración en el sistema glinfático o la disfunción en el eje hipotálamo-pituitario-adrenal entre otros. Dichos mecanismos serían los implicados en la aparición de los síntomas que padecen los pacientes con estos síndromes. El objetivo de esta revisión literaria es analizar y describir los posibles mecanismos que explicarían la manifestación de los síntomas del síndrome de fatiga crónica en los pacientes que hayan sufrido la COVID-19. Hasta el momento no existen tratamientos totalmente efectivos para erradicar los síntomas en ambos síndromes. Dado el abanico de síntomas que padecen estos pacientes, el enfoque terapéutico debe ser interdisciplinario para tratar de mejorar su calidad de vida.

The therapeutic effect of sports on relieving chronic fatigue / O efeito terapêutico dos esportes no alívio da fadiga crônica / El efecto terapéutico de los deportes para aliviar la fatiga crónica

ABSTRACT Introduction Chronic fatigue syndrome (CFS) is a group of long-term fatigue; the rest is difficult to achieve. At the same time, it is accompanied by corresponding physical dysfunction and psychological and mental symptoms. It is very meaningful to find exercise countermeasures to cope with chronic fatigue syndrome actively. Object This article analyzes the current students' CFS to realize the cognition of the disease. At the same time, it analyzes the effect of sports on the treatment of chronic fatigue to help students formulate related sports programs. Method The article conducts a related questionnaire survey and analysis of students and analyzes CFS and exercise status symptoms. Results Generally, students with CFS did not actively participate in sports and had poor physical fitness, especially muscle endurance and cardiopulmonary function. However, students who actively participate in sports training basically do not have CFS. Conclusion CFS students should strengthen physical exercise and improve the CFS situation through exercise. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução a síndrome da fadiga crônica (SFC) é um grupo de fadiga de longa duração; o descanso é difícil de conseguir. Ao mesmo tempo, é acompanhado por disfunção física correspondente e sintomas psicológicos e mentais. É muito significativo encontrar contramedidas de exercícios para lidar ativamente com a síndrome da fadiga crônica. Objetivo este artigo analisa o CFS de alunos atuais para a compreensão da doença. Ao mesmo tempo, analisa o efeito dos esportes no tratamento da fadiga crônica para ajudar os alunos a formular programas esportivos relacionados. Método o artigo conduz uma pesquisa de questionário relacionada e análise de alunos e analisa CFS e sintomas de status de exercício. Resultados Geralmente, os alunos com SFC não participavam ativamente de esportes e apresentavam má aptidão física, principalmente resistência muscular e função cardiopulmonar. Por outro lado, os alunos que participam ativamente do treinamento esportivo basicamente não possuem CFS. Conclusão os alunos do CFS devem fortalecer o exercício físico e melhorar a situação do CFS por meio do exercício. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción El síndrome de fatiga crónica (SFC) es un grupo de fatiga a largo plazo; el descanso es difícil de conseguir. Al mismo tiempo, se acompaña de la correspondiente disfunción física y síntomas psicológicos y mentales. Es muy significativo encontrar contramedidas de ejercicio para hacer frente activamente al síndrome de fatiga crónica. Objeto Este artículo analiza el SFC de los estudiantes actuales para comprender la enfermedad. Al mismo tiempo, analiza el efecto del deporte en el tratamiento de la fatiga crónica para ayudar a los estudiantes a formular programas deportivos relacionados. Método El artículo lleva a cabo un cuestionario relacionado y un análisis de los estudiantes y analiza los síntomas del SFC y el estado del ejercicio. Resultados En general, los estudiantes con SFC no participaron activamente en deportes y tenían una mala condición física, especialmente la resistencia muscular y la función cardiopulmonar. Por otro lado, los estudiantes que participan activamente en el entrenamiento deportivo básicamente no tienen SFC. Conclusión Los estudiantes de CFS deben fortalecer el ejercicio físico y mejorar la situación de CFS a través del ejercicio. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Sports medicine treatment based on relieving chronic fatigue and sub-health state / Tratamento da medicina do esporte relacionada ao alivio da fadiga crônica e saúde sub-ótima / Tratamiento de la medicina del deporte relacionada al alivio de la fatiga crónica y salud subóptima

ABSTRACT Introduction: Chronic fatigue syndrome (CFS), also known as chronic fatigue and immune dysfunction syndrome, has become a common disease in modern medicine. Objective: The paper analyzes the impact of exercise training on patients' quality of life with chronic fatigue syndrome. Methods: We conducted fatigue investigations on college students and analyzed the exercise ability of college students with chronic fatigue syndrome. We then compared the findings with healthy college students. In the process, we recorded the physiological indicators and satisfaction scores of the two groups of patients. Results: Muscle endurance and cardiopulmonary function-related exercise ability of the college students with chronic fatigue syndrome are significantly different. After completing the same exercise, the scores of personal exertions were higher. Conclusion: Appropriate and regular exercise can achieve ideal results in the treatment of chronic fatigue syndrome. In-depth research, popularization, and application by scholars is highly suggested. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A síndrome da fadiga crônica (SFC), também conhecida como fadiga crônica e síndrome de disfunção imunológica, tem se tornado uma doença comum para a medicina moderna. Objetivo: Este estudo analisa o impacto do treinamento de exercícios na qualidade de vida de pacientes com síndrome de fadiga crônica. Métodos: Conduzimos investigações sobre a fadiga em estudantes universitários e analisamos a habilidade para exercícios de estudantes universitários com síndrome de fadiga crônica. Durante o processo, registramos indicadores fisiológicos e escores de satisfação dos dois grupos de pacientes. Resultados: A resistência muscular e habilidade em praticar exercícios relacionados à função cardiopulmonar dos estudantes universitários com síndrome de fadiga crônica são significativamente diferentes. Após completar o mesmo exercício, os escores de esforço pessoal eram mais altos. Conclusão: Exercícios adequados e regulares podem atingir resultados ideais no tratamento da síndrome de fadiga crônica. Pesquisas aprofundadas, a popularização e a aplicação por parte de pesquisadores são altamente recomendadas. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: La síndrome de la fatiga crónica (SFC), también conocida como fatiga crónica e inmunodeficiencia, se ha tornado una enfermedad común para la medicina moderna. Objetivo: Este estudio analiza el impacto del entrenamiento de ejercicios en la calidad de vida de pacientes con síndrome de fatiga crónica. Métodos: Conducimos investigaciones sobre la fatiga en estudiantes universitarios y analizamos la habilidad para ejercicios de estudiantes universitarios con síndrome de fatiga crónica. Durante el proceso, registramos indicadores fisiológicos y puntajes de satisfacción de los dos grupos de pacientes. Resultados: La resistencia muscular y habilidad en practicar ejercicios relacionados a la función cardiopulmonar de los estudiantes universitarios con síndrome de fatiga crónica son significativamente diferentes. Tras completar el mismo ejercicio, los puntajes de esfuerzo personal eran más altos. Conclusión: Ejercicios adecuados y regulares pueden atingir resultados ideales en el tratamiento de la síndrome de fatiga crónica. Investigaciones profundizadas, la popularización y la aplicación por los investigadores son altamente recomendadas. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Scientific physical training on the clinical recovery of chronic fatigue injury / Treino físico científico para a recuperação de lesões por fadiga crônica / Entrenamiento físico científico para la recuperación de lesiones por fatiga crónica

ABSTRACT Introduction: Chronic fatigue syndrome is also called chronic fatigue and immune dysfunction syndrome. This disease has now become a common disease in modern medicine. Objective: To explore and analyze the effect of exercise therapy on chronic fatigue syndrome. Methods: We selected 70 patients with chronic fatigue syndrome for the experiment. The exercise group performed gradual exercise, and the control group was inactive. Results: Appropriate and regular exercise can achieve ideal results in the treatment of chronic fatigue syndrome. Conclusion: Studying methods to prevent and recover from fatigue syndrome will help in understanding and focusing attention on the topic of fatigue, as well as being aware of the methods of self-prevention of fatigue syndrome. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A síndrome de fadiga crônica é também chamada de fadiga crônica e síndrome de disfunção imune. Esta doença tem se tornado comum na medicina moderna. Objetivo: Explorar e analisar o efeito da terapia por exercício na síndrome de fadiga crônica. Métodos: Selecionamos 70 pacientes com síndrome de fadiga crônica para o experimento. O grupo de exercício praticou exercícios moderados e o grupo de controle permaneceu inativo. Resultados: Exercícios adequados e regulares podem atingir resultados ideais no tratamento da síndrome de fadiga crônica. Conclusão: O estudo de métodos para prevenir e se recuperar da síndrome de fadiga crônica ajuda ao entender e ficar atento ao tema da fadiga, assim como reconhecer os métodos de autoprevenção da síndrome da fadiga. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: El síndrome de fatiga crónica se llama también fatiga crónica y síndrome de disfunción inmune. Esta enfermedad se ha vuelto común en la medicina moderna. Objetivo: Explorar y analizar el efecto de la terapia por ejercicio en el síndrome de fatiga crónica. Métodos: Seleccionamos 70 pacientes con síndrome de fatiga crónica para el experimento. El grupo de ejercicios practicó ejercicios moderados y el grupo de control permaneció inactivo. Resultados: Ejercicios adecuados y regulares pueden atingir resultados ideales en el tratamiento del síndrome de fatiga crónica. Conclusión: El estudio de métodos para prevenir y recuperarse del síndrome de fatiga crónica ayuda a entender y estar atento al tema de la fatiga, así como reconocer los métodos de autoprevención del síndrome de fatiga. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Síndrome post-COVID-19: epidemiología, criterios diagnósticos y mecanismos patogénicos implicados / Post-COVID-19 syndrome: epidemiology, diagnostic criteria and pathogenic mechanisms involved

Introducción: Numerosos pacientes con COVID-19 leve o grave no tienen una recuperación completa y presentan una gran variedad de síntomas crónicos durante semanas o meses tras la infección, con frecuencia de carácter neurológico, cognitivo o psiquiátrico. Se revisan las evidencias epidemiológicas, los criterios diagnósticos y la patogenia del síndrome post-COVID-19. Desarrollo: El síndrome post-COVID-19 se define por la persistencia de signos y síntomas clínicos que surgen durante o después de padecer la COVID-19, permanecen más de 12 semanas y no se explican por un diagnóstico alternativo. Los síntomas pueden fluctuar o causar brotes. Es una entidad heterogénea que incluye el síndrome de fatiga crónica posvírica, la secuela de múltiples órganos y los efectos de la hospitalización grave/síndrome poscuidados intensivos. Se ha descrito en pacientes con COVID-19 leve o grave y con independencia de la gravedad de los síntomas en la fase aguda. Un 10-65% de los supervivientes que padeció COVID-19 leve/moderada presenta síntomas de síndrome post-COVID-19 durante 12 semanas o más. A los seis meses, los sujetos relatan un promedio de 14 síntomas persistentes. Los síntomas más frecuentes son fatiga, disnea, alteración de la atención, de la concentración, de la memoria y del sueño, ansiedad y depresión. Se desconocen los mecanismos biológicos que subyacen, aunque una respuesta autoinmunitaria e inflamatoria anómala o excesiva puede tener un papel importante. Conclusiones: Las manifestaciones clínicas son diversas, fluctuantes y variables, aunque predominan la fatiga y las quejas neurocognitivas. No existe un consenso definido sobre el síndrome post-COVID-19 y sus criterios diagnósticos no se han sometido a una evaluación psicométrica adecuada.(AU)

Introduction: Many patients with mild or severe COVID-19 do not make a full recovery and have a wide range of chronic symptoms for weeks or months after infection, often of a neurological, cognitive or psychiatric nature. The epidemiological evidence, diagnostic criteria and pathogenesis of post-COVID-19 syndrome are reviewed. Development: Post-COVID-19 syndrome is defined by persistent clinical signs and symptoms that appear while or after suffering COVID-19, persist for more than 12 weeks and cannot be explained by an alternative diagnosis. The symptoms can fluctuate or cause relapses. It is a heterogeneous condition that includes post-viral chronic fatigue syndrome, sequelae in multiple organs and the effects of severe hospitalisation/post-intensive care syndrome. It has been reported in patients with mild or severe COVID-19 and irrespective of the severity of the symptoms in the acute phase. Between 10% and 65% of survivors who had mild/moderate COVID-19 present symptoms of post-COVID-19 syndrome for 12 weeks or more. At six months, subjects report an average of 14 persistent symptoms. The most common symptoms are fatigue, dyspnoea, anxiety, depression, and impaired attention, concentration, memory and sleep. The underlying biological mechanisms are unknown, although an abnormal or excessive autoimmune and inflammatory response may play an important role. Conclusions: Clinical manifestations are diverse, fluctuating and variable, although fatigue and neurocognitive complaints predominate. There is no defined consensus on post-COVID-19 syndrome and its diagnostic criteria have not been subjected to adequate psychometric evaluation.(AU)

Infección por Herpes virus Humano tipo 6 relacionado con manifestaciones dermatológicas y fatiga crónica: serie de casos / Human Herpesvirus type 6 infection related to dermatological manifestations and chronic fatigue: case series

Resumen Introducción: Las manifestaciones clínicas más frecuentes causadas por el Herpes Virus Humano Tipo 6 (HHV-6) ocurren en niños menores de 2 años, presentan lesiones en piel tipo roséola o exantema súbito. En adultos, las manifestaciones clínicas relacionadas a HHV-6 son muy variables, y pueden sobreponerse con otras afecciones. Objetivo: Presentar una serie de casos de pacientes diagnosticados con infección activa por HHV-6, quienes mostraban manifestaciones neurológicas, dermatológicas y de fatiga crónica. Materiales y métodos: Se realizó análisis de historias clínicas de 6 pacientes que fueron diagnosticados con infección activa por HHV-6, a través de métodos moleculares. Resultados: Se reportan 6 pacientes que fueron diagnosticados con infección activa por HHV-6 mediante métodos moleculares, quienes presentaron manifestaciones clínicas comunes tales como: fiebre, cefalea, depresión, decaimiento, pérdida de memoria y concentración, dolor fibromuscular, dolor poliarticular, sueño no reparador, exantema, nevus rubí, liquen plano y parestesias. Conclusiones: A través de esta serie de casos se espera resaltar la importancia de identificar la infección activa por HHV-6 a través de métodos moleculares, y sensibilizar a la comunidad médica sobre el papel que juega el virus en la evolución de diversas patologías.

Abstract Introduction: The most frequent clinical manifestations of Human Herpesvirus 6 (HHV-6) in children under 2 years of age are roseola-like skin lesions and sudden rash. In adults, the clinical manifestations associated with HHV-6 are highly variable and can overlap with other conditions. Objective: To present a case series of patients diagnosed with active HHV-6 infection, who showed neurological, dermatological and chronic fatigue manifestations. Materials and methods: An analysis of medical records of 6 patients who were diagnosed with active HHV-6 infection through molecular methods was performed. Results: 6 patients were diagnosed with active HHV-6 infection using molecular methods, who had common clinical manifestations such as fever, headache, depression, tiredness, loss of memory and concentration, fibromuscular pain, polyarticular pain, nonrestorative sleep, rash, ruby nevus, lichen planus and paresthesia. Conclusions: This case series highlights the importance of identifying active HHV-6 infection through molecular methods and creating awareness in the medical community of the role that the virus plays on the development of diverse pathologies.

Tratamiento multidisciplinar para la fibromialgia y el síndrome de fatiga crónica: una revisión sistemática / Multidisciplinary treatment for fibromyalgia and chronic fatigue syndrome: a systematic review

Los objetivos de esta revisión sistemática fueron examinar la eficacia del tratamiento multidisciplinar (TM) aplicado a pacientes con fibromialgia y síndrome de fatiga crónica (SFC), junto con la exploración de predictores, mediadores y moderadores de resultados. Se realizó una búsqueda bibliográfica exhaustiva en las bases de datos Medline, PsycInfo, Scopus y Cochrane Library en el período 1990- 2018. En total, 31 artículos de fibromialgia y seis de SFC fueron identificados. Los resultados reflejaron que en fibromialgia el TM fue más eficaz que la lista de espera (LDE) y el tratamiento médico habitual, produciendo las mejoras más consistentes en funcionalidad, dolor, calidad de vida y aptitud física. En el SFC los beneficios fueron menores que en fibromialgia, y el TM fue solo más eficaz que la LDE y disminuyó principalmente la discapacidad. Sin embargo, las evidencias no fueron suficientes para constatar la superioridad del TM frente a otros tratamientos activos, ni para consolidar el valor pronóstico de los predictores, mediadores y moderadores de resultados informados (AU)

bstract The aims of this systematic review were to analyze and to compare the efficacy of the multidisciplinary treatment (MT) applied to patients with fibromyalgia and chronic fatigue syndrome (CFS). Also, predictors, mediators and moderators of results were examined. An exhaustive literature search was carried out in the databases Medline, PsycInfo, Scopus and Cochrane Library in the period 1990-2018. In total, 31 articles on fibromyalgia and six on CFS were identified. The results showed that in fibromyalgia, MT was more effective than waiting list controls (WLC) and the usual treatment, producing the most consistent improvements in functionality, pain, quality of life and physical fitness. As to CFS, there were fewer benefits than in fibromyalgia, and the MT was only more effective than the WLC, and it mainly decreased the disability. However, the evidence was not enough to confirm the superiority of MT over other active treatments, nor to consolidate the prognostic value of the predictors, mediators and moderators of the reported results (AU)

[What scientific evidence do the current classifications have in order to assess occupational disability in patients with central sensitisation syndrome?] / ¿Qué evidencia científica tienen los métodos propuestos para valorar la discapacidad laboral de los pacientes con síndrome de sensibilización central?

Central sensitisation syndrome includes disorders such as fibromyalgia, chronic fatigue syndrome, multiple chemical sensitivity, and electromagnetic sensitivity syndrome. These disorders have been acquiring both medical and social relevance due to the increase in prevalence, the absence of a curative treatment, the limitations they cause, and the high healthcare costs they involve. Furthermore, all of them share an unknown aetiology and the absence of objective parameters to establish their diagnosis and severity. Multiple methods and classifications have been proposed to graduate the disability of these patients, but currently none of them have obtained sufficient evidence.

Comorbilidad neuropsiquiátrica en pacientes con fibromialgia / Neuropsychiatric comorbidity in patients with fibromyalgia

RESUMEN Introducción: La fibromialgia es una causa común de dolor crónico en el mundo, con una prevalencia en la población general del 0,2% al 6,4%. Estos pacientes tienen una mayor probabilidad de presentar trastornos neuropsiquiátricos. El objetivo fue describir el perfil sociodemográfico y clínico de pacientes con fibromialgia y comorbilidad neuropsiquiátrica. Métodos: Estudio transversal, descriptivo. Se recolectó información de las historias clínicas de pacientes con fibromialgia y comorbilidad neuropsiquiátrica, de una institución especializada en Antioquia, durante los años 2010 al 2016. Se aplicaron herramientas de estadística descriptiva. Resultados: De 1.106 registros médicos con diagnóstico confirmado de fibromialgia, 497 presentaban comorbilidad neuropsiquiátrica. La mediana de edad fue de 54 años (RIC 15), la mayoría eran mujeres, residían en zona urbana y estaban casados o convivían con su pareja. Estatus socioeconómico bajo-medio y nivel educativo básico-medio, fueron los más reportados. Los síntomas más frecuentes fueron alteraciones del sueño (70,6%), mialgias (66,4%) y fatiga crónica (55,9%). Los trastornos neuropsiquiátricos más frecuentes fueron depresión (85,7%), migraña (35%) y ansiedad (14,7%). Los fármacos más utilizados fueron los inhibidores de la recaptación de serotonina y duales, acetaminofén y gabaérgicos. Manejo con terapias complementarias e intervención psicológica se observaron en baja proporción. Conclusiones: La fibromialgia y las enfermedades neuropsiquiátricas son patologías que coexisten con frecuencia; la presentación sociodemográfica y clínica es similar a lo descrito en la literatura, sin embargo, la presencia de depresión en esta población fue mayor. Un enfoque terapéutico transdisciplinario, favorecería la calidad de vida de los pacientes y el curso de la enfermedad.

ABSTRACT Introduction: Fibromyalgia is a common cause of chronic pain in the world, with a prevalence of 0.2% to 6.4% in the general population. These patients are more likely to have neuropsychiatric disorders. The objective of this study was to describe the sociodemographic and clinical profile of patients with fibromyalgia and neuropsychiatric comorbidity. Methods: A cross-sectional, descriptive study was conducted in which Information was collected from the medical records of patients with fibromyalgia and neuropsychiatric comorbidity, from specialist institution in Antioquia, during the years 2010 to 2016. Descriptive statistics tools were applied. Results: Of the 1,106 medical records with a confirmed diagnosis of fibromyalgia, 497 had neuropsychiatric comorbidity. The median age was 54 years (IQR 15), and the majority were women, residing in an urban area, and were married or living with their partner. Low-medium socioeconomic status and basic-medium educational level were the most reported. The most frequent symptoms were sleep disturbances (70.6%), myalgia (66.4%), and chronic fatigue (55.9%). The most frequent neuropsychiatric disorders were depression (85.7%), migraine (35%), and anxiety (14.7%). The most commonly used drugs were serotonin and dual reuptake inhibitors, acetaminophen, and GABAergic drugs. A low percentage was managed with complementary therapies and psychological intervention. Conclusions: Fibromyalgia and neuropsychiatric diseases are diseases that frequently coexist. Although the sociodemographic and clinical presentation is as described in the literature, the presence of depression was greater in this population. A multidisciplinary therapeutic approach would favour the quality of life of the patients and the course of the disease.

El síndrome de fatiga crónica en el curso de la hepatitis C. Presentación de un caso / Chronic fatigue syndrome in the course of Hepatitis C

RESUMEN Se supone que aproximadamente 80 millones de personas a nivel mundial están infectadas con el virus de la hepatitis C. Un aproximado del 60 % de dichos pacientes aqueja síndrome de fatiga crónica. Se presentó un paciente portador de hepatitis crónica de tipo C, con manifestaciones clínicas de síndrome de fatiga crónica por más de dos años. Se han reportado estudios internacionales que han demostrado la relación existente entre el desarrollo de la respuesta inmune y el daño que ocasiona en el tejido cerebral la infección por virus de hepatitis C. Este trabajo tiene como objetivo la presentación del primer caso que se tiene referencia (AU).

ABSTRACT It is believed that almost 80 million persons are infected with the Hepatitis C virus around the world, and 60 % of them suffer the chronic fatigue syndrome. For that reason we present the case of a patient who is a carrier of the chronic fatigue syndrome for more than two years. Reports of international research have showed the relation between the immune answer and the damage caused by the infection of the hepatitis C virus in the brain tissues. The aim of this work is presenting the first case reported in Cuba (AU).

[From neurasthenia to post-exertion disease: Evolution of the diagnostic criteria of chronic fatigue syndrome/myalgic encephalomyelitis]. / De la neurastenia a la enfermedad postesfuerzo: evolución de los criterios diagnósticos del síndrome de fatiga crónica/encefalomielitis miálgica.

Changes in the terminology and diagnostic criteria for chronic fatigue syndrome/myalgic encephalomyelitis are explained in this paper. This syndrome is a complex and controversial entity of unknown origins. It appears in the medical literature in 1988, although clinical pictures of chronic idiopathic fatigue have been identified since the nineteenth century with different names, from neurasthenia, epidemic neuromyasthenia, and benign myalgic encephalomyelitis up to the current proposal of disease of intolerance to effort (post-effort). All of them allude to a chronic state of generalised fatigue of unknown origin, with limitations to physical and mental effort, accompanied by a set of symptoms that compromise diverse organic systems. The International Classification of Diseases (ICD-10) places this syndrome in the section on neurological disorders (G93.3), although histopathological findings have not yet been found to clarify it. Multiple organic alterations have been documented, but a common biology that clarifies the mechanisms underlying this disease has not been established. It is defined as a neuro-immune-endocrine dysfunction, with an exclusively clinical diagnosis and by exclusion. Several authors have proposed to include CFS/ME within central sensitivity syndromes, alluding to central sensitisation as the common pathophysiological substrate for this, and other syndromes. The role of the family doctor is a key figure in the disease, from the detection of those patients who present a fatigue of unknown nature that is continuous or intermittent for more than 6 months, in order to make an early diagnosis and establish a plan of action against a chronic disease with high levels of morbidity in the physical and mental sphere. OBJECTIVE: To carry out a bibliographic review of the terminology and diagnostic criteria of the chronic fatigue syndrome/myalgic encephalomyelitis, in order to clarify the pathology conceptually, as a usefulness in the diagnosis of Primary Care physicians.

Danza terapéutica y ejercicio físico. efecto sobre la fibromialgia / Therapeutic dance and physical exercise. effect on fibromyalgia / Dança terapéutica e exercício físico. efeito sobre a fibromialgia

Resumen Objetivo: Establecer el efecto de la danza terapéutica y del ejercicio físico sobre la sintomatología y el número de puntos dolorosos en mujeres con fibromialgia. Materiales y métodos: Estudio cuasiexperimental que consideró una muestra probabilística aleatorizada. Un total de 37 mujeres con fibromialgia fueron sometidas a programas de danza terapéutica (n=18) y ejercicio físico (n=19). La edad promedio fue 47,4±8,4 años. La duración de la intervención fue de 3 meses con una frecuencia de entrenamiento de 2 sesiones por semana y una duración de 60 minutos por sesión. Todas las participantes suministraron información que permitió determinar el índice de dolor generalizado y la escala de severidad de síntomas. Resultados: La danza terapéutica y el ejercicio físico disminuyeron significativamente el número de puntos dolorosos (12,1±2,8 a 7,3±3,1 para valores pre y post respectivamente (p=0,000)); y los síntomas asociados a la fibromialgia (8,7±2,3 a 5,7±2,6 para valores pre y post respectivamente (p=0,000)). Conclusiones: La danza terapéutica y el ejercicio físico tienen un efecto benéfico equivalente en la disminución del índice de dolor generalizado, la depresión, los síntomas cognitivos y los trastornos del sueño en mujeres con fibromialgia.

Abstract Objective: To establish the effect of therapeutic dance and physical exercise on the symptomatology and number of painful points in women with fibromyalgia. Materials and methods: Quasi-experimental study that considered a randomized probabilistic sample. A total of 37 women with fibromyalgia underwent therapeutic dance (n=18) and physical exercise (n=19) programs. The average age was 47.4 ± 8.4 years. The length of the intervention was 3 months with a training frequency of 2 sessions per week and a duration of 60 minutes per session. All the participants provided information that allowed to determine the general pain index (GPI) and the scale of symptom severity (SSS). Results: Therapeutic dance and physical exercise significantly decreased the number of painful points (from 12.1 ± 2.8 to 7.3 ± 3.1 for pre- and post-values respectively (p = 0.000)) and the symptoms associated with fibromyalgia (8.7 ± 2.3 to 5.7 ± 2.6 for pre- and post-values respectively (p = 0.000)). Conclusions: Therapeutic dance and physical exercise have an equivalent beneficial effect on the reduction of the general pain index, depression, cognitive symptoms and sleep disorders in women with fibromyalgia.

Resumo Objetivo: Estabelecer o efeito da dança terapêutica e o exercício físico sobre a sintomatologia e o número de pontos dolorosos em mulheres com fibromialgia. Materiais e métodos: Estudo quase experimental que considerou uma amostra probabilística aleatória. Um total de 37 mulheres com fibromialgia foram submetidas a programas de dança terapêutica (n=18) e exercício físico (n=19). A idade média foi 47,4±8,4 anos. A duração da intervenção foi de 3 meses com uma frequência de treinamento de 2 sessões por semana e uma duração de 60 minutos por sessão. Todas as participantes subministraram informação que permitiu determinar o índice da dor generalizada e a escada de severidade de sintomas. Resultados: A dança terapêutica e o exercício físico diminuíram significativamente o número de pontos dolorosos (12,1±2,8 a 7,3±3,1 para valores pré e post respectivamente (p=0,000)); e os sintomas associados à fibromialgia (8,7±2,3 a 5,7±2,6 para valores pré e post respectivamente (p=0,000)). Conclusões: A dança terapêutica e o exercício físico tem um efeito benéfico equivalente na diminuição do índice da dor generalizado, a depressão, os sintomas cognitivos e os transtornos do sono em mulheres com fibromialgia.

HPV vaccination syndrome: A clinical mirage, or a new tragic fibromyalgia model. / Síndrome posvacunal VPH. ¿Un espejismo clínico, o un nuevo modelo trágico de fibromialgia?

Independent investigators have described the onset of a chronic painful dysautonomic syndrome soon after human papillomavirus (HPV) vaccination. The veracity of this syndrome is hotly debated. Many of the reported post-HPV vaccination cases fullfill fibromyalgia diagnostic criteria. This article discusses the arguments favoring the existence of a syndrome associated to HPV vaccination. We propose that fibromyalgia dysautonomic-neuropathic model could help in the diagnostic and therapeutic process in those patients in whom the onset of a painful chronic illness began after HPV immunization. On the other hand, if its veracity is corroborated, HPV vaccination syndrome may become a new tragic fibromyalgia model.

Chronic fatigue syndrome and sleep disorders: clinical associations and diagnostic difficulties. / Síndrome de fatiga crónica y los trastornos del sueño: relaciones clínicas y dificultades diagnósticas.

INTRODUCTION: Chronic fatigue syndrome (CFS) is characterised by the presence of intractable fatigue and non-restorative sleep, symptoms which are also very prevalent in multiple diseases and appear as side effects of different drugs. Numerous studies have shown a high prevalence of sleep disorders in patients with CFS. However, non-restorative sleep and fatigue are frequently symptoms of the sleep disorders themselves, so primary sleep disorders have to be ruled out in many cases of CFS. DEVELOPMENT: This review was performed using a structured search of the MeSH terms ([Sleep]+[Chronic fatigue syndrome]) in the PubMed database. CONCLUSION: Identifying primary sleep disorders in patients meeting diagnostic criteria for CFS will allow for a more comprehensive treatment approach involving new diagnostic and therapeutic strategies that may improve quality of life for these patients.

Gender differences in chronic fatigue syndrome.

BACKGROUND AND OBJECTIVES: Chronic fatigue syndrome (CFS) is a chronic condition that predominantly affects women. To date, there are few epidemiologic studies on CFS in men. The objective of the study was to assess whether there are gender-related differences in CFS, and to define a clinical phenotype in men. PATIENTS AND METHODS: A prospective, cross-sectional cohort study was conducted including CFS patients at the time of diagnosis. Sociodemographic data, clinical variables, comorbid phenomena, fatigue, pain, anxiety/depression, and health quality of life, were assessed in the CFS population. A comparative study was also conducted between genders. RESULTS: The study included 1309 CFS patients, of which 119 (9.1%) were men. The mean age and symptoms onset were lower in men than women. The subjects included 30% single men vs. 15% single women, and 32% of men had specialist work vs. 20% of women. The most common triggering factor was an infection. Widespread pain, muscle spasms, dizziness, sexual dysfunction, Raynaud's phenomenon, morning stiffness, migratory arthralgias, drug and metals allergy, and facial oedema were less frequent in men. Fibromyalgia was present in 29% of men vs. 58% in women. The scores on physical function, physical role, and overall physical health of the SF-36 were higher in men. The sensory and affective dimensions of pain were lower in men. CONCLUSIONS: The clinical phenotype of the men with CFS was young, single, skilled worker, and infection as the main triggering agent. Men had less pain and less muscle and immune symptoms, fewer comorbid phenomena, and a better quality of life.

High prevalence of asymptomatic carriers of Tropheryma whipplei in different populations from the North of Spain.

INTRODUCTION: Tropheryma whipplei is the causative agent of Whipple disease. T. whipplei has also been detected in asymptomatic carriers with a very different prevalence. To date, in Spain, there are no data regarding the prevalence of T. whipplei in a healthy population or in HIV-positive patients, or in chronic fatigue syndrome (CFS). Therefore, the aim of this work was to assess the prevalence of T. whipplei in stools in those populations. METHODS: Stools from 21 HIV-negative subjects, 65 HIV-infected, and 12 CFS patients were analysed using real time-PCR. HIV-negative and positive subjects were divided into two groups, depending on the presence/absence of metabolic syndrome (MS). Positive samples were sequenced. RESULTS: The prevalence of T. whipplei was 25.51% in 98 stool samples analysed. Prevalence in HIV-positive patients was significantly higher than in HIV-negative (33.8% vs. 9.09%, p=0.008). Prevalence in the control group with no associated diseases was 20%, whereas no positive samples were observed in HIV-negative patients with MS, or in those diagnosed with CFS. The prevalence observed in HIV-positive patients without MS was 30.35%, and with MS it was 55.5%. The number of positive samples varies depending on the primers used, although no statistically significant differences were observed. CONCLUSIONS: There is a high prevalence of asymptomatic carriers of T. whipplei among healthy and in HIV-infected people from Spain. The role of T. whipplei in HIV patients with MS is unclear, but the prevalence is higher than in other populations.