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BMJ article on infectious mononucleosis incl. paragraph on CFS

Discussion in 'Latest ME/CFS Research' started by Dolphin, Apr 24, 2015.

  1. Dolphin

    Dolphin Senior Member

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    (Not a recommendation)

    "Infectious mononucleosis" is often called "mono" or "glandular fever".

    http://bmj.com/cgi/content/extract/350/apr21_2/h1825?ct

    BMJ 2015;350:h1825 doi: 10.1136/bmj.h1825 (Published 21 April 2015)

    Clinical Review

    Infectious mononucleosis Paul Lennon specialist registrar 1 , Michael Crotty general practitioner 2 , John E Fenton professor 1

    [..]

    Lennon et al. Table 2.png
     
    Last edited: Apr 24, 2015
  2. Simon

    Simon

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    Huh? Both the table 2 and the individual studies (at least the ones I've read) state the patients were diagnosed with CFS, though some relied on questionnaire report rather than clinical examination. Do you have reference 15?

    eg
     
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  3. Marco

    Marco Grrrrrrr!

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    These two statements strike me as a little contradictory. If the relationship beween infectious mononucleosis and chronic fatigue syndrome "is still questionable" then why the need for a brief 'psycho-educational' intervention to prevent it?
     
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  4. Esther12

    Esther12

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    That study's here: http://qjmed.oxfordjournals.org/content/99/1/49 (They added an extra r to Petersen's name in their table).

    It looks like patients weren't examined for CFS, so they just didn't happen to get a diagnosis in their routine medical care (and knowing that lots of people who fulfil the criteria don't get a diagnosis, I'm not sure how important this is [edit: especially as follow up was only one year]).

    Non-blinded trial that used subjective self-report measures as outcome and showed no difference between treatment group and control (who recieved a leaflet and no therapist time) at 12 months: http://forums.phoenixrising.me/inde...o-educational-intervention-to-aid-reco.13326/
     
    Last edited: Apr 24, 2015
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  5. Dolphin

    Dolphin Senior Member

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    oceiv and Simon like this.
  6. Simon

    Simon

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    Yes, that's a big database study, done entirely on codings entered into a database some time earlier.
    So the studies where patients were prospectively followed and tested for CFS did have CFS post-glandular fever. The database study, where patients were not specifically checked for CFS, didn't find it.

    So basically this is bunk, based on a misreading of a database study and ignoring specific CFS studies:
     
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  7. Dolphin

    Dolphin Senior Member

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  8. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    One wonders why an ENT registrar would be writing a clinical review on infectious mononucleosis (or the relation to CFS). Reviews like this tend to be writing projects given to registrars with essentially no experience of the relevant disease by a boss who is keen for both of them to get a paper on their CV. It is hardly surprising that you often end up with something that looks as if it is written by someone who has no idea of the subject (they don't). It is disappointing that this is published in the BMJ.
     
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  9. user9876

    user9876 Senior Member

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    moderated with many others

    I would have read this as those who were recovering quicker got out of bed earlier. The language 'allowed out of bed' is strange and leading.
     
  10. Esther12

    Esther12

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    Unimportant note:

    They reference this review:

    w52. Candy B, Chalder T, Cleare AJ, et al. Recovery from infectious mononucleosis: a case for more than symptomatic therapy? A systematic review. Br J Gen Pract 2002;52(483):844-51.

    [Free: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1316091/ ]

    Which cites this paper:

    Dalrymple W. Infectious mononucleosis—2. Relation of bed rest
    and activity to prognosis. Postgrad Med J 1964; 35: 345-349.

    Which I can't find.

    To some extent, I tend to assume that people are best off doing what they want when sick rather than being told to behave in some way or other. I was surprised I'd not heard of that trial as the reference was from 2002, but am less surprised if the trial was from 1964.

    I was hoping we'd be able to look at the peer review for this, but maybe the BMJ only does open peer review for certain sorts of papers? I couldn't see anything for this.
     
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  11. Esther12

    Esther12

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    A couple of rapid responses for this posted, one from Shirwan Mirza says:

    http://www.bmj.com/content/350/bmj.h1825/rapid-responses
     
  12. Snow Leopard

    Snow Leopard Hibernating

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    Has anyone here heard of Shirwan Mirza?

    His point is frustrating, in that it is all in what he doesn't say, rather than what he does say. We know that EBV is not the specific cause of ME or CFS and evidence of chronic EBV is fleeting. However, we also know that in prospective studies, that CFS is indeed a consequence of EBV at a high rate - this is where that 7.3-12% figure comes in and this is high quality evidence. Other infections may trigger the illness, but that does not mean the EBV link is unimportant.

    Edit- additional links related to Shirwan Mirza:
    https://www.facebook.com/MECFSmetabolicapproach
    Apparently he is a doctor that does lots of metabolic testing and tries to find exclusionary diagnoses to CFS if at all possible.
     
    Last edited: Apr 28, 2015
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  13. Forbin

    Forbin Senior Member

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    Yes, it certainly is mysterious. All we have to go on are sightings of this ghostly 305 page report by the Institute of Medicine.

    Untitled-2.jpg
     
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