Overtraining Syndrome one more piece of the Central Sensitivity Syndrome puzzle

The initial focus of overtraining syndrome was physical overexertion with inadequate rest, causing severe chronic fatigue and decreased performance. The pathophysiological knowledge has subsequently evolved, and although the exact mechanisms of overtraining syndrome are unknown, several hypotheses arise. The most prominent of these are: the existence of an immunoneuroendocrine imbalance and dysfunction of the central nervous system and of the neuroendocrine axis. On the other hand, central sensitivity syndrome encompasses nosological entities that share the pathophysiological mechanisms that cause them, that is, an immunoneuroendocrine and mitochondrial dysfunction as well as an oxidative stress imbalance. The most common entities within central sensitivity syndrome are fibromyalgia, tension headache and/or migraine, chronic fatigue syndrome, irritable bowel syndrome, multiple chemical syndrome, electrosensitivity syndrome, irritable bladder syndrome, and restless leg syndrome, among others. The pathophysiological and clinical analogy between overtraining syndrome and central sensitivity syndrome raises the possibility of including overtraining syndrome within central sensitivity syndrome, since a stressful stimulus such as chronic overtraining coupled with unbalanced compensatory systems can generate, at a given time, immunoneuroendocrine sensitization and therefore central sensitivity syndrome. Resumen El enfoque inicial del síndrome de sobreentrenamiento ha sido el sobreesfuerzo físico con un descanso no adecuado, que provocaba fatiga crónica severa y disminución en el rendimiento. Posteriormente ha ido evolucionando el conocimiento fisiopatológico, y aunque se desconocen los mecanismos fisiopatológicos exactos del síndrome de sobreentrenamiento, se plantean diversas hipótesis. Las más destacadas son: la existencia de un desbalance inmunoneuroendocrino y disfunción del sistema nervioso central y el eje neuroendocrino. Por su parte el síndrome de sensibilidad central engloba entidades nosológicas que tienen en común las razones fisiopatológicas que las ocasionan, esto es, una disfunción inmunoneuroendocrina, mitocondrial y un desbalance del estrés oxidativo. Las entidades más comunes dentro del síndrome de sensibilidad central suelen ser la fibromialgia, la cefalea tensional y/o migraña, el síndrome de fatiga crónica, el síndrome de intestino irritable, el síndrome químico múltiple, el síndrome de electrosensibilidad, el síndrome de la vejiga irritable, el síndrome de piernas inquietas, entre otros. La analogía fisiopatológica y clínica entre el síndrome de sobreentrenamiento y el síndrome de sensibilidad central, plantea la posibilidad de englobar al síndrome de sobreentrenamiento dentro del síndrome de sensibilidad central, ya que ante la presencia de un estímulo estresante como lo es el sobreentrenamiento crónico, unido a sistemas compensadores desequilibrados, puede generar en un momento determinado una sensibilización. Resumo O foco inicial da síndrome do supertreinamento foi o excesso de esforço físico com descanso inadequado, causando fadiga crônica grave e diminuição do desempenho. Posteriormente o conhecimento fisiopatológico evoluiu e, embora os mecanismos exatos da síndrome do supertreinamento sejam desconhecidos, surgem várias hipóteses. Os mais proeminentes são: a existência de um desequilíbrio imunoneuroendócrino e disfunção do sistema nervoso central e do eixo neuroendócrino. Por outro lado, a síndrome da sensibilização central engloba entidades nosológicas que compartilham os mecanismos fisiopatológicos que as causam, ou seja, uma disfunção imunoneuroendócrina e mitocondrial, bem como um desequilíbrio de estresse oxidativo. As entidades mais comuns dentro da síndrome da sensibilização central são fibromialgia, cefaleia e/ou enxaqueca, síndrome de fadiga crônica, síndrome do intestino irritável, síndrome química múltipla, síndrome de eletrosensibilidade, síndrome da bexiga irritável e síndrome das pernas inquietas, entre outros. A analogia fisiopatológica e clínica entre síndrome do supertreinamento e síndrome da sensibilização central levanta a possibilidade de incluir a síndrome do supertreinamento dentro da síndrome da sensibilização central, uma vez que um estímulo estressante, como o supertreinamento crônico, juntamente com sistemas compensatórios desequilibrados, pode gerar, em determinado momento, sensibilização imunoneuroendócrina e, portanto, síndrome da sensibilização central.

Ureteric double-J stent related complications: a single tertiary care center experience from South India

Background: The double-J (DJ) ureteral stents is most commonly used urological procedure and is associated with complications. This study was done to analyse the complications of ureteral DJ stents, modalities of management and outcomes.Methods: The present study is a prospective observational study of patients who presented with DJ stent related complications between February 2016 and November 2017. Patients were evaluated by history, examination, urine analysis, cultures, KUB ultrasonography, abdominal roentgenogram, CT-KUB, intravenous urogram and DTPA renogram. Complications like fever, hematuria and irritable bladder symptoms were managed conservatively. Patients with stent migration underwent endoscopic removal. Combined endourological procedures were performed in single or staged manner in cases with retained DJS with encrustation.Results: Total 120 patients presented with DJ stent complications during the study period. Males were 63.3% and females 36.7%. The mean age was 31.5 years. The majority 65.33% of the stents were placed for postsurgical prophylaxis. Irritable bladder symptoms 42.5% was most common complication, followed by retained stent with encrustation 17.5%, fever 15.9%, hematuria 13.3%, stent migration 5.8% and retained sent with minimal and no encrustation 5%. Stent removal was done in 47 (39.16%) patients; all patients with retained stent, stent migration, 5 (26.3%) patients with fever and 8 (15.6%) patients with irritable bladder symptoms. Common site of encrustation was bladder alone and kidney with bladder in 5 (23.80%) patients each. The mean stent indwelling time was 3.2 years. Twenty-one (17.5%) patients required combined endourological procedures such as cystolithotripsy (CLT), ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL) with intracorporal lithotripsy. One (4.76%) patient required nephrectomy.Conclusions: Double-J stent is an important tool to prevent and relieve obstruction. Their use must be strictly restricted to selected cases with proper documentation, counseling and close tracking. Encrustation in forgotten stents should be managed with stent removal with combined endourologic techniques.

A botanical and pharmacological description of petasites species

The objective of this review was to evaluate the botanical and pharmacological description of Petasites species. Petasides (butterbur) as a perennial shrub which was found in Europe and also in a parts of Asia and North America, has been widely used medicinally for centuries. At present, the main phytopharmacology uses for Petasides extracts are for prophylactic treatment of migraines, as well as an antispasmodic agent for bronchial asthma and pertussis. Furthermore, it has been used effectively in preventing gastric ulcers, and in urinary tract spasms and treating patients with irritable bladder. But still, there is a need for more studies on the potential applications of butterbur extract in medicine.

The Future Holds a Lot of Hope

When we became interested in fibromyalgia over 20 years ago, we quickly learned how it felt to be lonely. The Fibrositis Study Club (now the Fibromyalgia Study Club) of the American Rheumatism Association (now the American College of Rheumatology) had an average attendance of ten at its annual meetings. In 2001, more than 500 rheumatologists attended the same meeting. During the early 1980s, an average of 14 articles a year appeared in the fibromyalgia medical literature, and less than $100,000 was being spent annually on fibromyalgia research. The recognition of fibromyalgia by organized medicine as a distinct syndrome has had a salutary effect on research. As of this writing, 500 articles are now published yearly and $2 million is spent annually on research. All this attention and interest bodes well for more scientific breakthroughs in the field. What can fibromyalgia patients hope for over the next 20 years? In all probability, the name fibromyalgia will be replaced by a more all-encompassing term, one that includes related syndromes that have similar causes and physiologic processes. A better (and catchier) term that combines symptoms and signs reported in tension headache, pain amplification, irritable bowel syndrome, irritable bladder, and chronic fatigue syndrome, among others, will be devised and agreed on. When organized medicine marshals the resources of experts in gastroenterology, infectious disease, rheumatology, and other subspecialties to work together, our knowledge of pain amplification, neurotransmitter-mediated, behaviorally influenced fatigue syndromes will be increased, and research strategies will be better coordinated and focused. Fibromyalgia advocacy groups will unite to increase funding for research and education that will make a difference. We predict that 2–5 percent of the U.S. population has chronic neuromuscular pain with the systemic overlay mentioned above. Over the next 20 years, the precise racial and ethnic backgrounds of these individuals will be identified, as well as the genes that influence the process. Additionally, environmental and occupational factors that cause or aggravate chronic neuromuscular pain will be clarified. Through coordinated strategies involving all forms of media, the public will become aware of what fibromyalgia is and what factors are associated with it.