Fibromyalgia syndrome (FMS) is a chronic and debilitating musculoskeletal pain disorder of unknown aetiology with usual accompanying features of fatigue, sleep disturbances and stiff- ness. Its place in medical textbooks was controversial with rheumatologists holding the helm of its management for many years. Over the last decade, abnormalities have been identified at multiple levels in the peripheral, central, and sympathetic nervous systems as well as the hypothalomo-pitutary-adrenal axis stress response system. With the elucidation of these pathways of pain, FMS is known more as a central sensitivity syndrome. This led to tremendous increment in interest in both pharmacological and non-pharmacological treatment of FMS. The United States Food and Drug Administration (FDA) has also successively approved 3 drugs for the management of fibromyalgia – pregabalin, duloxetine and milnacipran. Non-pharmacological modalities showed aerobic exercise, patient education and cognitive behavioural therapy to be most effective. Overall, management of FMS requires a multi-disciplinary approach.
Key words: Aetiology, Fibromyalgia-Fibromyositis Syndromes, History, Pain syndrome
Fibromyalgia syndrome (FMS) is a chronic and debilitating musculoskeletal pain disorder of unknown aetiology with usual accompanying features of fatigue, sleep disturbances and stiff- ness. Its place in medical textbooks was controversial with rheumatologists holding the helm of its management for many years. Over the last decade, abnormalities have been identified at multiple levels in the peripheral, central, and sympathetic nervous systems as well as the hypothalomo-pitutary-adrenal axis stress response system. With the elucidation of these pathways of pain, FMS is known more as a central sensitivity syndrome. This led to tremendous increment in interest in both pharmacological and non-pharmacological treatment of FMS. The United States Food and Drug Administration (FDA) has also successively approved 3 drugs for the management of fibromyalgia – pregabalin, duloxetine and milnacipran. Non-pharmacological modalities showed aerobic exercise, patient education and cognitive behavioural therapy to be most effective. Overall, management of FMS requires a multi-disciplinary approach.
Key words: Aetiology, Fibromyalgia-Fibromyositis Syndromes, History, Pain syndrome
Of 460 patients with peptic ulcer disease seen over a 30-month period, there were 174 elderly patients (defined as > or = 60 years old), constituting 38%. In this group of elderly, gastric ulcers (GU) were observed more frequently than duodenal ulcers (DU) with a ratio of 1.6:1 and the male to female ratio was 1.7:1. In patients < 60 years old, there were more DU than GU with a ratio of 2.7:1, and a higher male to female ratio of 3.7:1. Seventy-two per cent of the elderly had at least one other medical condition with 20% having three or more medical problems. Hypertension and ischaemic heart disease were the most frequently encountered illnesses. Half the elderly presented with upper abdominal pain and one-third had an atypical presentation. Analgesic ingestion in the preceding 4 weeks was present in 29% of the elderly. In the elderly, bleeding was the most frequent complication occurring in 50%; perforation occurred in 2%. In those with bleeding ulcers, 44% had history of analgesic usage. The mortality of bleeding peptic ulcer in the elderly, was 11% and this was largely due to concurrent medical conditions. Only two deaths occurred due to bleeding ulcer.
Mannose-binding lectin (MBL) is a mediator of innate immunity. Individuals with exon 1 structural mutant genotypes are associated with unusual and recurrent infections. We describe a lupus patient who had lifethreatening, concomitant infections -methicillin-resistant staphylococcal aureus (MRSA) pericarditis with tamponade, cryptococcal pneumonia and cytomegalovirus (CMV) pneumonitis. Tests were negative for complements or immunoglobulins deficiencies. There was no human immunodeficiency virus (HIV) infection. She has a homozygous structural mutant variant at codon 54 of the MBL gene. We surmised the severe multiple infections are related to this rare mutant variant, and may be triggered off by corticosteroid therapy.
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