Latest preprints

The concept of ME/CFS (notionally standing for myalgic encephalomyelitis/chronic fatigue syndrome) has evolved over the last twenty years. This review compares it with the historical terms chronic fatigue syndrome, myalgic encephalomyelitis, and also post-viral fatigue syndrome, arguing that ME/CFS is better suited to both clinical and research needs, focusing on a symptom-based syndrome characterized by post-exertional malaise, orthostatic intolerance, and an unpredictable, fluctuating time course, rather than specific physiological markers. The need to dissociate the clinical concept from speculative theories of aetiology is emphasised. The breakdown in effective care, especially for severe cases, is highlighted and suggestions made for re-instituting a physician-led service that might allow both safe care and a clinical base for badly needed research.

In the United Kingdom, a small but steady stream of people diagnosed with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) have run into serious problems with nutrition because of difficulties with eating and drinking, and some have not survived. The clinical problem is extremely difficult, with little or no formal evidence on which to base diagnosis-specific recommendations for care, or information about prognosis. In several cases, however, the problem has apparently been compounded by a lack of provision of adequate services, misunderstandings, and conflict between health care professionals over diagnosis and approach to management. The following is a review of the clinical problem, including some suggestions for protocol content that might supplement NICE Guideline NG206. The main conclusion is that there is an urgent need for a consensus amongst professionals that focuses on practice based on reliable evidence rather than theory-laden diagnosis. The author is a physician with no direct involvement in ME/CFS care but with an interest in the clinical and scientific problems the condition poses.

Background: Ceftriaxone has been recommended for empiric treatment for urinary tract and respiratory tract infections, but continued widespread use might increase resistance rates.Objectives: To determine if ceftriaxone usage has increased resistance rates over a three-year period.Methods: We included all patients hospitalized in internal medicine departments from 2019-2021 and extracted administered antibiotics, urine, and blood cultures with resistance reports from the computerized data base. We compared the yearly proportion of patients treated with specific antibiotics and the resistance rates of urine and blood pathogens.Results: Overall, 44.1% of patients received antibiotics during 63.3% of the hospital days. The proportion of patients treated with ceftriaxone increased from 22% in 2019 to around 30% in 2020 and 2021. Resistance rates to ceftriaxone were approximately 30% for Escherichia coli, and 40-50% for Klebsiella pneumonia and Proteus mirabulis without significant changes over the three-year period. The overall usage rates of carbapenems and amikacin were 3.4% and 1.4% respectively, with low resistance rates that did not change over the follow-up period. The resistance rates for blood cultures were the same observed for urine bacteria.Conclusions: We conclude that despite increased usage, resistance rates to ceftriaxone have remained stable over the past three years, and rates of resistance to broader-spectrum antibiotics have remained low. Longer follow-up is necessary to determine whether resistance rates will remain stable, and studies are needed to balance the clinical benefits and drawbacks of using ceftriaxone to treat suspected bacterial infections of the urinary tract and other areas of the body.