Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Polya partial gastrectomy was performed for peptic ulcer in a previously healthy woman aged 28 years. She complained afterwards of a variety of non-specific symptoms including weakness, tiredness, debility, slowness of walking, poor appetite and constipation. Within ten years her back became bent. She was treated for intercurrent hypertension and epilepsy. Bone fractures on low-impact trauma occurred in her fifties. At 57 years, she was unable to care for herself and had to be admitted to a nursing home. She could still walk slowly with the aid of a stick. For three months at the age of 65 years, she was unable to rise from her chair. Investigations disclosed severe post-gastrectomy bone disease. At no time had she complained of bone pains.
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PMID:Post-gastrectomy bone disease undiagnosed for forty years. 1049 25

When clinicians label a child as having a functional disorder, there is often a pejorative connotation that the symptoms are psychological, imagined, or faked. These symptoms range from chronic abdominal pain to recurrent headaches to fatigue. We say the complaints are functional because we are unable to demonstrate any structural or biochemical abnormality causing them. The degree to which we go searching for these abnormalities varies from case to case and often depends on our own clinical experience, insecurities, and demands of the patient's family. Labeling a child as having a functional complaint can put a tremendous burden on the child and family, because if this concept is presented improperly (as implied above), it can suggest that it is their fault there are symptoms and that if they "got their act together" the symptoms would melt away. Functional gastrointestinal disorders are defined as conditions in which a variable combination of chronic or recurrent gastrointestinal symptoms are present in the absence of demonstrable disease. There may indeed be physiologic abnormalities underlying the symptoms, but at the present time we are unable to detect them. We make a diagnosis based on symptoms, not on demonstrable abnormalities in physical examination or laboratory tests. A number of common pediatric diagnoses fall into this category, including infant regurgitation, chronic nonspecific diarrhea, irritable bowel syndrome, non-ulcer dyspepsia, infant dyschezia, and functional constipation. This paper presents a brief review of our current understanding of each diagnosis and gives suggestions for management.
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PMID:Functional gastrointestinal disorders. 1055 86

The authors assessed the severity of nortriptyline's side-effects in older patients with recurrent major depression during placebo-controlled, double-blind maintenance therapy. Data were from 37 patients completing 2-3 years of maintenance therapy; 29 were on nortriptyline and eight were on placebo. The authors detected a time-by-treatment interaction for dry mouth (greater in nortriptyline-treated patients), but no increased association of nortriptyline with constipation, weight change or orthostatic symptoms. Heart rate was consistently higher in nortriptyline-maintained patients as compared with placebo. The total 'side-effect' score on the Asberg Rating Scale, as well as complaints of physical tiredness, daytime sleepiness and nocturnal sleep disturbance, were related primarily to residual depression rather than treatment with nortriptyline.
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PMID:A double-blind, placebo-controlled assessment of nortriptyline's side-effects during 3-year maintenance treatment in elderly patients with recurrent major depression. 1060 68

Iron deficiency anemia is a significant health problem for women. An intervention utilizing home visits by a nurse and the intake of alternate iron supplements was examined. Outcome measures of hematocrit levels and side effects are reported in this manuscript. Ten African-American inner city homeless women in transitional housing agreed to participate in this longitudinal study. Each participant was encouraged to take the alternate iron supplements for a three month period. Hematocrit values increased from recruitment through the third month. A paired t-test was significant (t value -5.39; df, 9; p < .0001). In addition, the side effect of fatigue decreased from recruitment through the third month. A paired t-test was significant (t value 3.18: df, 7: p = .015). During the weekly and monthly visits, when the subjects were asked if the supplements had any effect on their feelings of well-being, two women stated they had "little effects." In terms of side effects there were no complaints of nausea, stomach ache, or black tarry stools. Of the approximately 12 visits to each subject, constipation was reported only two times by two subjects. While the women did not report black stools they did offer that the vitamins seemed to color their stools green (three reported it one time and two subjects reported it three times). The benefits and the lack of side effects may have far-reaching implications for client populations such as the elderly and pregnant women who typically have difficulty with anemia and constipation alike. The weekly visits by the nurse may have added to the compliance and success of this program.
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PMID:Side effects of alternative iron supplementation: a pilot study. 1061 42

As has been demonstrated in binding studies the two opioids tilidine (CAS 27107-79-7)/naloxone (CAS 357-08-4) and tramadol (CAS 36282-47-0) differ in regard to their affinities to the opioid receptor site. Therefore it is of interest to evaluate whether such a difference in opioid affinity is also seen in the pharmacological effects of clinically relevant doses in man. Following institutional approval by the local ethical committee and informed consent, 12 volunteers received oral doses of tramadol (100 mg), tilidine/naloxone (100 mg) and placebo, respectively, in a randomized, double-blind cross-over design. In order to determine the degree of constipation, oral-caecal transit time was measured using the H2-exhalation test. Additionally, in order to evaluate a centrally mediated effect, the response of the pupil to light was quantified using the pupillary light reflex technique. Both, peripheral and central mediated effects were compared to placebo. Tramadol as well as tilidine/naloxone induced a significant (p < 0.05) prolongation of oral-caecal transit when compared to placebo. However, prolongation of oral-caecal transit was significantly longer in the tilidine/naloxone (p < 0.05) than in the tramadol group. Compared to tramadol, the pronounced constipating effect of tilidine/naloxone is likely to be due to the 10 fold higher affinity of that drug to the peripheral opioid receptor sites in the intestinal tract, which are responsible for normal propulsion. Such difference in binding is underlined by a central effect, the pupillary light reflex response. The amount of constriction of the iris to light was reduced after both opioids. Again, tilidine/naloxone significantly reduced (p < 0.001) the pupillary light reflex when compared to tramadol. Other side effects such as tiredness, nausea, emesis and dry mouth were more often reported after tilidine/naloxone than after tramadol (40% versus 15%; p < 0.05). Vertigo and perspiration were more often reported after tramadol than after after tilidine/naloxone (58% and 78% versus 8%; p < 0.01). All these data support the findings that while tramadol is considered an opioid, it does not mediate its main clinical relevant properties via binding at the opioid receptor. More likely, due to its monoaminergic reuptake mechanism, to a lesser extent opioid-like effects are induced.
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PMID:Effects of tramadol and tilidine/naloxone on oral-caecal transit and pupillary light reflex. 1068 12

AIMS: Quality of life (QL) data are useful in evaluating treatment, in screening or psychosocial morbidity and there is accumulating evidence to show that they predict survival. This study investigated if baseline QL scores are prognostic for patients with oesophageal cancer. METHODS: Between 1993 and 1995, 89 consecutive new patients with oesophageal cancer completed baseline QL assessments with the EORTC QLQ-C30 questionnaire and the dysphagia scale from the oesophageal cancer module. Cox's proportional hazards models were used to assess the impact of QL variables on survival (82 patients have died). RESULTS: Univariate analyses revealed that better baseline physical and role function scores were significantly associated with increased survival (P </= 0.001) and worse fatigue, appetite loss and constipation scores were significantly associated with shorter survival (P < 0.01). Multivariate analysis, taking account of associations between the QL scores and adjusting for age, tumour node metastasis classification T, N and M stage, showed that only physical function at baseline remained significantly associated with survival (P = 0.002); adjusting for sex, histology and comorbid disease did not alter the findings. CONCLUSIONS: There is evidence to suggest that QL parameters may be important prognostic factors for patients with oesophageal cancer. Stronger evidence may be gained from a more highly powered study, and further understanding of the associations between QL variables and clinical data is needed.
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PMID:Prognostic value of quality of life scores in patients with oesophageal cancer 1071 71

Hypothyroidism is a common endocrine disorder affecting 1.4% to 2.0% of women and 0.1% to 0.2% of men. The prevalence of both overt and subclinical hypothyroidism increases with age, affecting 5% to 10% of women over age 50 and 1.25% of men over age 60, with an increasing incidence in women ages 40 to 50. Typical symptoms are consistent with declining metabolic functions and range from vague complaints of fatigue in subclinical deficiency to overt clinical symptoms involving changes in mentation and memory, lethargy, weight gain, cold intolerance, constipation, and goitrous enlargement of the thyroid gland. Atypical presentations such as weight loss, hearing impairment, tinnitus, and carpal tunnel syndrome may occur, especially in the elderly. This case report reviews the presenting symptomatology of an otherwise healthy 43-year-old woman who exhibited typical and atypical symptoms of underlying thyroid deficiency.
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PMID:Diagnosing and treating hypothyroidism. 1075 Jan 23

A multivariate analysis of the data was conducted to evaluate the effects of age, gender, and performance status on symptom profile. A comprehensive prospective analysis of symptoms was conducted in 1,000 patients on initial referral to the Palliative Medicine Program of the Cleveland Clinic. The median number of symptoms per patient was 11 (range 1-27). The ten most prevalent symptoms were pain, easy fatigue, weakness, anorexia, lack of energy, dry mouth, constipation, early satiety, dyspnea, and greater than 10% weight loss. The prevalence of these 10 symptoms ranged from 50% to 84%. Younger age was associated with 11 symptoms: blackout, vomiting, pain, nausea, headache, sedation, bloating, sleep problems, anxiety, depression, and constipation. Gender was associated with 8 symptoms. Males had more dysphagia, hoarseness, >10% weight loss and sleep problems; females, more early satiety, nausea, vomiting, and anxiety. Performance status was associated with 14 symptoms. Advanced cancer patients are polysymptomatic. Ten symptoms are highly prevalent. Symptom prevalence for 24 individual symptoms differs with age, or gender, or performance status.
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PMID:The symptoms of advanced cancer: relationship to age, gender, and performance status in 1,000 patients. 1078 56

To investigate the effects of morphine on cancer patients' health-related quality of life (HRQL), we prospectively studied 40 cancer patients with moderate or severe pain despite treatment with "weak" opioids. The patients were titrated to pain relief using immediate-release (IR) morphine and then switched to slow-release (SR) morphine in the same daily dosages. HRQL was measured by the European Organization for Research and Treatment of Cancer core quality-of-life questionnaire (EORTC QLQ-C30) before the start of morphine (baseline), after stabilization with IR-morphine, and 3 days after start of SR-morphine. The mean titrated daily morphine dosage was 97 mg (range, 60-180). The EORTC QLQ-C30 global health score increased after IR morphine titration (baseline score 40, IR morphine period score 49), but a significant difference from baseline did not persist during the SR morphine period (score 44). The other functional HRQL scores showed no significant fluctuations. After start of IR morphine, two of the HRQL symptom scores increased, nausea/vomiting and constipation, but these changes also did not persist during the SR morphine period. Intensity of pain was associated with a lower level of function and higher intensity of symptoms, but only with relatively small (not higher than 0.44) correlation coefficients. Compared to normative data from the general population, physical function, role function, social function, and global health were impaired in the study patients. The patients also suffered more fatigue, pain, nausea/vomiting, appetite loss, and constipation. In conclusion, in cancer patients with reduced HRQL, the start of morphine therapy had no major influence on aspects of HRQL other than pain.
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PMID:Effects on cancer patients' health-related quality of life after the start of morphine therapy. 1094 65

We assessed the prevalence of self-reported medical complaints among the community-dwelling elderly receiving regular medication, and determined associations between health and sociodemographic variables, and the prevalence of complaints. The study included 170 patients, 60-90 years of age, living at home. Participants were recruited from the 3 main primary care clinics in Rishon LeZion. All were receiving chronic medication and were followed-up utilizing a long-term medication card. Data were gathered in interviews held in patients' homes using a structured questionnaire which included sociodemographics, diseases and medication, mental state assessment by Katzman's score, and a list of 15 medical complaints common among the aged. Relations to age, gender, education, living arrangements, number of diseases and number of medications per patient were determined. Mean age of participants was 73.2 +/- 6.0 years and they suffered an average of 4.07 +/- 2.16 diseases and took 5.10 +/- 2.83 types of drugs. The most prevalent complaints were: weakness and fatigue (65.0%), agitation and restlessness (56.4%), dry mouth (45.6%), constipation (43.6%) and dizziness (43.2%). The number of diseases, gender, education and age had the strongest associations with the prevalence of specific complaints, as well as their total number. The association between number of medications and mean number of complaints was of borderline significance.
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PMID:[Prevalence of medical complaints in the community-dwelling elderly receiving regular medication]. 1095 68


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