Aamna Z. Shah ( Columbian College of Arts and Sciences, George Washington University )
Peggy Chang ( Washington D.C.1 and Johns Hopkins School of Medicine, Baltimore, Maryland2, United States. )
September 2005, Volume 55, Issue 9
Science Vision
Chronic Fatigue: It's Mental!
The study consisted of about two-and-a-half thousand female participants, aged 18-50 years, from Goa, India. Data was collected through interviews of personal and health histories, measurements of hemoglobin concentrations from blood samples, and general medical examinations. Among the participants, 12% (11% to 13%) reported chronic fatigue, defined by the investigators to be an experience of fatigue (feeling tired and/or lacking in energy) for a minimum duration of the previous six months.
The investigators did find that participants who were older, who had experienced hunger in the previous three months, and those facing socioeconomic difficulties were significantly more likely to experience chronic fatigue. After adjusting for such variables, however, they discovered even more significant associations with gender disadvantages and mental health factors. For example, those women who lived in unhappy marriages, were sexually or verbally abused, or had concerns about their husband's extramarital affairs or habits were more prone to report prolonged fatigue. Most importantly, symptoms related to common mental disorders, such as depression and anxiety, and somatoform disorders were determined to be the greatest risk factors for chronic fatigue (two tailed p values < 0.001). On the other hand, no association was found between hemoglobin concentrations and chronic fatigue.
1. Patel V, Kirkwood BR, Weiss H, Pednekar S, Fernandes J, Pereira B, et al. Chronic fatigue in developing countries: population based survey of women in India. BMJ 2005; 330:1190-.
Got an AA Aneurysm?
In the study, they screened a total of about five thousand Danish men aged 64-73 for abdominal aortic aneurysms using ultra-sonography. They detected an abdominal aortic aneurysm in 191 (4.0%) of the participants. An aneurysm was considered to be present if the infrarenal aortic diameter was >3 cm; those with aneurysms >5 cm were referred to a vascular surgeon, while the rest were offered annual scans. Participants, randomized to either the screening or no-screening groups, were followed up for a mean period of 52 months. Compared to the control group of over six thousand men, the screened group underwent significantly fewer (75% less, p=0.002) emergency operations, and had reduced specific mortality due to such aneurysms (67% less, p=0.003). Furthermore, throughout the follow-up time, only 9 deaths due to abdominal aortic aneurysm occurred in the screened group, compared to 27 in the control group. They calculated that the number needed to screen to save one life was 352. The investigators also determined from the study that rescreening patients with an aortic diameter of less than 25 mm seemed unnecessary, but those with diameters between 25 and 29 mm should be rescreened after 5 years.
Thus, this study demonstrates that routine screening for abdominal aortic aneurysm in men aged 64-73 years is worth considering. 1. Lindholt JS, Juul S, Fasting H, Henneberg EW. Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BMJ 2005;750.
Ouch, My Knee Hurts!
Ouch, My Knee Hurts! |
A total of about 300 patients, aged 50-75 years and who had been diagnosed with osteoarthritis according to the American College of Rheumatology criteria, were randomly assigned to one of three groups: acupuncture, minimal acupuncture (superficial needling at non-acupuncture points), or a waiting list control.
Patients in the acupuncture and minimal acupuncture groups received treatment in 12 sessions of 30-minute duration over an 8-week period. All patients completed standard questionnaires at baseline, after 8 weeks, 26 weeks, and 52 weeks to assess degree of pain experienced.
Using the WOMAC (Western Ontario and McMasters Universities) Osteoarthritis Index as the primary outcome measure, investigators found that patients with osteoarthritis of the knee who received acupuncture had significantly less pain after 8 weeks than did patients who received minimal or no acupuncture (mean WOMAC indices of 26.9 in the acupuncture group, 35.8 in the minimal acupuncture group, and 49.6 in the waiting list control). Thus, the difference between the acupuncture vs minimal acupuncture was -8.8 (p<0.0001). The percentage of patients using analgesics in the acupuncture and minimal acupuncture groups decreased between weeks 1 and 8 (from 42% to 22% and from 38% to 23% respectively). However, after 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant (p=0.08). 1. Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S, et al. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet 2005;366:136-43.
Ouch, My Knee Hurts! Can't Breathe? Try GSNO
While most studies on allergic asthma have centered on the roles of bronchoconstrictors and inflammatory mediators on airway hyperresponsivity, Que et al1 took a different approach and chose instead to investigate the effects of endogenous bronchodilators, specifically GSNO, in the disorder. To do so, they compared the effects of allergen challenge between the airways of wild-type mice and mice in which they deleted the gene for GSNO reductase (GSNOR), the enzyme that controls levels of GSNO in the body. Through a series of experiments, they discovered that, after allergen challenge, wild-type mice with airway hyperresponsivity (AHR) demonstrated increased levels of airway GSNOR and are depleted of lung S-nitrosothiols (SNOs). In contrast, the GSNOR-/- mice were found to have higher levels of lung SNOs after allergen challenge and actually appeared to be protected from AHR. Interestingly, the airway GSNO in these GSNOR-/- mice appeared to originate from nitric oxide (NO), of which elevated levels are generally a signature of asthma, derived from cytokine-inducible NO synthase (iNOS). Additionally, investigators found that the protection from asthma in GSNOR-/- mice does not reflect a suppressed immune response to allergen; instead, it appears that SNOs are able to maintain airway patency even when inflammation occurs. All in all, Que et al's reports open up new avenues in our search of therapeutic approaches to alleviating airway obstruction in asthma.
1. Que LG, Liu L, Yan Y, Whitehead GS, Gavett SH, Schwartz DA, et al. Protection from Experimental Asthma by an Endogenous Bronchodilator. Science 2005;308:1618-21.
Something Smells Fishy Around Here
2. Serhan CN, Clish CB, Brannon J, Colgan SP, Chiang N, Gronert K. Novel Functional Sets of Lipid-derived Mediators with Antiinflammatory Actions Generated from Omega-3 Fatty Acids via Cyclooxygenase 2-Nonsteroidal Antiinflammatory Drugs and Transcellular Processing. J. Exp. Med 2000;192:1197-1204.
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