Discover the most talked about and latest scientific content & concepts.

Journal: QJM : monthly journal of the Association of Physicians


Background: Chronic fatigue syndrome (CFS) is relatively common and disabling. Over 8000 patients attend adult services each year, yet little is known about the outcome of patients attending NHS services. AIM: Investigate the outcome of patients with CFS and what factors predict outcome. DESIGN: Longitudinal patient cohort. METHODS: We used data from six CFS/ME (myalgic encephalomyelitis) specialist services to measure changes in fatigue (Chalder Fatigue Scale), physical function (SF-36), anxiety and depression (Hospital Anxiety and Depression Scale) and pain (visual analogue pain rating scale) between clinical assessment and 8-20 months of follow-up. We used multivariable linear regression to investigate baseline factors associated with outcomes at follow-up.Results: Baseline data obtained at clinical assessment were available for 1643 patients, of whom 834 (51%) had complete follow-up data. There were improvements in fatigue [mean difference from assessment to outcome: -6.8; 95% confidence interval (CI) -7.4 to -6.2; P < 0.001]; physical function (4.4; 95% CI 3.0-5.8; P < 0.001), anxiety (-0.6; 95% CI -0.9 to -0.3; P < 0.001), depression (-1.6; 95% CI -1.9 to -1.4; P < 0.001) and pain (-5.3; 95% CI -7.0 to -3.6; P < 0.001). Worse fatigue, physical function and pain at clinical assessment predicted a worse outcome for fatigue at follow-up. Older age, increased pain and physical function at assessment were associated with poorer physical function at follow-up. CONCLUSION: Patients who attend NHS specialist CFS/ME services can expect similar improvements in fatigue, anxiety and depression to participants receiving cognitive behavioural therapy and graded exercise therapy in a recent trial, but are likely to experience less improvement in physical function. Outcomes were predicted by fatigue, disability and pain at assessment.

Concepts: Psychology, Clinical psychology, Fibromyalgia, Cognitive behavioral therapy, Fatigue, Prediction interval, Major depressive disorder, Chronic fatigue syndrome


Encephalitis is the most frequent neurological complication of measles virus infection. This review examines the pathophysiology of measles infection and the presentations, diagnosis and treatment of the four types of measles-induced encephalitis including primary measles encephalitis, acute post-measles encephalitis, measles inclusion body encephalitis and subacute sclerosing panencephalitis. The early symptoms of encephalitis may be nonspecific and can be mistakenly attributed to a systemic infection leading to a delay in diagnosis. This review provides a summary of the symptoms that should cause health care workers to suspect measles-induced encephalitis.

Concepts: Health care, Infectious disease, Medical terms, Virus, Infection, Measles, Encephalitis, Subacute sclerosing panencephalitis


The burden of the hospital experience is a broad issue that has been evaluated in a particular context of intensive care unit (ICU). It is likely, however, that the load is heavy on families even in other hospital wards and not just in the ICU. The present study was designed to assess the prevalence of anxiety and depression in family members of patients admitted in a general medicine department, and to identify associated factors with those symptoms.

Concepts: Anxiety, Family, Psychology, Disease, Physician, Illness, Anthropology, Medical school


A novel Mobile Medical Application (App) App was created on iOS platform (Neurology Dx®) to deduce Differential Diagnoses (DDx) from a set of user selected Symptoms,Signs, Imaging data and Lab findings. The DDx generated by the App was compared for diagnostic accuracy with differentials reasoned by participating Neurology residents when presented with same clinical vignettes.


The association between exposure to head injury and increased risk of neurodegenerative disease, specifically chronic traumatic encephalopathy (CTE), is widely recognized. Historically, this was largely considered a phenomenon restricted to boxers, with more recent case series identifying further ‘high risk’ individuals, such as former American footballers, or military personnel. However, in all cases thus far reported, it is clear that it is the exposure to head injury which is associated with increased dementia risk, and not the circumstances or environment of exposure. As such, there is considerable potential for under-recognition of CTE in patients presenting with neurodegenerative disease, particularly where head injury exposure might have been historical and through sport. This article reviews current understanding of CTE and, via an illustrative case in rugby union, highlights the value of a detailed history on head injury and also draws attention to imaging studies in assessing patients with neurodegenerative disease.

Concepts: Medicine, Neuroscience, Neurology, History, Concussion, Neurotrauma, Football


Thunderstorm asthma is a term used to describe an observed increase in acute bronchospasm cases following the occurrence of thunderstorms in the local vicinity. The roles of accompanying meteorological features and aeroallergens, such as pollen grains and fungal spores, have been studied in an effort to explain why thunderstorm asthma does not accompany all thunderstorms. Despite published evidence being limited and highly variable in quality due to thunderstorm asthma being a rare event, this article reviews this evidence in relation to the role of aeroallergens, meteorological features and the impact of thunderstorm asthma on health services. This review has found that several thunderstorm asthma events have had significant impacts on individuals' health and health services with a range of different aeroallergens identified. This review also makes recommendations for future public health advice relating to thunderstorm asthma on the basis of this identified evidence.

Concepts: Health care, Health economics, Public health, Health, Fungus, Precipitation, Storm, Pollen


Artificial sweeteners are used widely to replace caloric sugar as one of the strategies to lessen caloric intake. However, the association between the risk of obesity and artificially-sweetened soda consumption is controversial. The objective of this meta-analysis aimed to assess the association between consumption of sugar and artificially-sweetened soda and obesity.

Concepts: The Association, Meta-analysis, Sugar, Soft drink, Stevia, Sugar substitute


AIM: Analysis of urine samples collected across a city centre, for the detection of novel psychoactive substances (NPS). DESIGN: Cross-sectional study of anonymized urine samples used for the analysis of classical recreational drugs, NPS and metabolites. METHODS: Pooled urine samples collected from portable stand-alone four-person urinals across a city centre were analysed using full-scan accurate-mass high-resolution liquid chromatography coupled to tandem mass spectrometry. Data were processed against compound databases containing >1700 drug compounds and metabolites. RESULTS: Seven established recreational drugs (3,4-methylenedioxyamphetamine, cocaine, cannabis, ketamine, 3,4-methylenedioxy-N-methylamphetamine, methamphetamine and amphetamine) and six potential NPS [hordenine (all 12 urinals), cathine (11), methylhexaneamine (9), 4-methylmethcathinone (6), methiopropamine and metabolites (2) and methoxetamine and metabolites (1)] were detected. Methylhexaneamine, methiopropamine and hordenine are currently uncontrolled in the UK, whereas methoxetamine is currently subject to a Temporary Class Drug Order. Metabolites of the anabolic steroid nandrolone were found in two urinals and trenbolone metabolites and clenbuterol in one urinal. CONCLUSION: Analysis of pooled urine samples collected anonymously from stand-alone urinals in a large inner city can detect the use of recreational drugs, NPS and anabolic steroids. Metabolite detection indicates actual drug use, metabolism and elimination rather than simply discarded drugs in the urinals. This technique by confirming the actual drug(s) used has the potential to be additive to currently used datasets/key indicators providing more robust information for healthcare authorities, legislative and law enforcement on the drugs actually being used.

Concepts: Metabolism, Drug, Testosterone, Opioid, Psychoactive drug, Anabolic steroid, Ketamine, Recreational drug use


To know the research progress of cupping therapy all over the world,the authors analyze the research of cupping therapy in recent 5 years,it indicates cupping therapy can be applied on extensive curable disease,but has poor clinical evidence. Some improvements on the mechanism research of cupping therapy have been made,but it needs further research. The adverse events of cupping therapy attract attention. The standardization of cupping therapy has emerged.

Concepts: Medicine, Evidence-based medicine, Ayurveda, Acupuncture, Alternative medicine, Traditional Chinese medicine, Gua Sha, Fire cupping


Background: The objective of this meta-analysis was to evaluate the association between a history of kidney stones and kidney cancer. Methods: A literature search was performed from inception until June, 2014. Studies that reported odds ratios or hazard ratios comparing the risk of renal cell carcinoma (RCC) and transitional cell carcinoma of the upper urinary tract (TCC) in patients with the history of kidney stones versus those without the history of kidney stones were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Result: Seven studies were included in our analysis to assess the association between a history of kidney stones and RCC. The pooled RR of RCC in patients with kidney stones was 1.76 (95% CI, 1.24 - 2.49). The subgroup analysis found that the history of kidney stones was associated with increased RCC risk only in males (RR, 1.41 [95% CI, 1.11 - 1.80]), but not in females (RR, 1.13 [95% CI, 0.86-1.49]). Five studies were selected to assess the association between a history of kidney stones and TCC. The pooled RR of TCC in patients with kidney stones was 2.14 (95% CI, 1.35 - 3.40). Conclusion: Our study demonstrates a significant increased risk of RCC and TCC in patients with prior kidney stones. However, the increased risk of RCC was noted only in male patients. This finding suggests that a history of kidney stones is associated with kidney cancer and may impact clinical management and cancer surveillance.

Concepts: Kidney, Male, Urinary bladder, Urinary system, Ureter, Renal pelvis, Renal cell carcinoma, Kidney cancer