This study examined circadian rhythms in patients with fibromyalgia syndrome (FMS) by measuring hormone and cytokine levels at various times of day. The results showed abnormal circadian patterns of cortisol and melatonin in FMS patients, including higher nighttime cortisol and lower morning melatonin compared to controls. Serotonin levels were also consistently lower in FMS patients throughout the day. Symptoms of FMS, such as pain, stiffness and fatigue, followed circadian patterns that correlated with these hormonal abnormalities. The study suggests circadian dysfunction may contribute to FMS pathophysiology by disrupting sleep, neurotransmitter regulation and symptom flares.
2020 OA Vision: Emerging Therapeutics on the OA landscapeOARSI
Philip Conaghan MBBS PhD FRACP FRCP
Director, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
Deputy Director, NIHR Leeds Biomedical Research Centre
Diet and breast cancer survival: results of the Continuous Update Project (CUP). Presentation given by Teresa Norat, Principal Investigator Continuous Update Project, Imperial College London.
Comparison of pre-mixed and sequentially intrathecal administration of Clonidine with hyperbaric Bupivacaine in caesarean sections-Adjuvant and hyperbaric Bupivacaine mixing in a single syringe before injecting the drugs intrathecally is an age old practice. It may cause intraoperative hemodynamic changes. Administering local anesthetic and the adjuvant separately may minimize these side effects. So this study was aimed to compare effect of administering hyperbaric Bupivacaine and Clonidine intrathecally as a mixture and sequentially in cases undergoing caesarean section (CS). This study conducted at a District Hospital of Rajasthan in year 2013. Cases undergoing elective caesarean sections were divided into two groups by chit box method each of two groups consists of 30 cases. One group (Group A) is given mixture of Clonidine (75 mcg) and hyperbaric Bupivacaine 0.5% (10 mg) intrathecally, whereas other Group B received Clonidine (75 mcg) followed by hyperbaric Bupivacaine 0.5% (10 mg) through separate syringes. It was found that duration of analgesia was significantly longer in Group B (466 ± 18.2 min) in which the drug was given sequentially than in Group A (334 ± 16 min). Likewise, the time to achieve highest sensory and complete motor block was significantly less in Group B than Group A. So it can be depicted that administering Clonidine and hyperbaric Bupivacaine in a sequential manner is better than mixing of the two drugs.
2020 OA Vision: Emerging Therapeutics on the OA landscapeOARSI
Philip Conaghan MBBS PhD FRACP FRCP
Director, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
Deputy Director, NIHR Leeds Biomedical Research Centre
Diet and breast cancer survival: results of the Continuous Update Project (CUP). Presentation given by Teresa Norat, Principal Investigator Continuous Update Project, Imperial College London.
Comparison of pre-mixed and sequentially intrathecal administration of Clonidine with hyperbaric Bupivacaine in caesarean sections-Adjuvant and hyperbaric Bupivacaine mixing in a single syringe before injecting the drugs intrathecally is an age old practice. It may cause intraoperative hemodynamic changes. Administering local anesthetic and the adjuvant separately may minimize these side effects. So this study was aimed to compare effect of administering hyperbaric Bupivacaine and Clonidine intrathecally as a mixture and sequentially in cases undergoing caesarean section (CS). This study conducted at a District Hospital of Rajasthan in year 2013. Cases undergoing elective caesarean sections were divided into two groups by chit box method each of two groups consists of 30 cases. One group (Group A) is given mixture of Clonidine (75 mcg) and hyperbaric Bupivacaine 0.5% (10 mg) intrathecally, whereas other Group B received Clonidine (75 mcg) followed by hyperbaric Bupivacaine 0.5% (10 mg) through separate syringes. It was found that duration of analgesia was significantly longer in Group B (466 ± 18.2 min) in which the drug was given sequentially than in Group A (334 ± 16 min). Likewise, the time to achieve highest sensory and complete motor block was significantly less in Group B than Group A. So it can be depicted that administering Clonidine and hyperbaric Bupivacaine in a sequential manner is better than mixing of the two drugs.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
The effects of Pranayama yoga on Stress and AnxietyJatin Chaudhary
Stress and anxiety have been implicated as contributors to many chronic diseases and to decreased quality of life, even with pharmacologic treatment. Yoga has been implemented to alleviate both mental and physical ailments. The objective of this study was to assess the effect of pranayama yoga on negative and positive stress levels and state-trait anxiety. Fifteen healthy women subjects(39.12±3.04 years, 57.25±4.52 kg) attended a 6-week pranayama yoga program for 60 minutes, 3 times a week. They were assigned into two groups: A(experimental n=8) and B(control n=7). Both groups were requested not to participate in any physical activity until the end of the study. The pre and post pranayama yoga effects were assessed by using the stress scale(Cohen, Kamarch & Mercelstein, 1983) for positive and negative stress levels and state-trait anxiety inventory: STAI(Spielberger, 1970). The data handling of the test results was used by WINDOWS SPSS 18.0 statistics program with Independent T-test and Paired T-test. Statistical significance was accepted at α=.05. This study had two major findings. First, in both positive and negative stress levels there were no significant changes occur within 6-weeks of pranayama practice. Second, there were positive effects in anxiety conditions on experimental-group subjects.
The observations suggest that pranayama yoga leads to remarkable reduction in the anxiety scores within a period of 6-weeks and contributes to increased relaxation.
Artigo (4) importante para a preparação para o curso de dor lombar crônica. "Características sensoriais da dor lombar crônica inespecífica: uma investigação de subgrupos."
Preventive home monitoring of COPD patients across sectors–an advantage for the patients and healthcare professionals. Birthe Dinesen, Associate professor,
Department of Health Science and Technology, Aalborg University, Denmark
NEURAL NETWORKS AND BOOTSTRAP SIMULATION IN PREDICTION OF OUTCOME OF NON-SMALL CELL LUNG CANCER PATIENTS AFTER COMPLETE LOBECTOMIES AND PNEUMONECTOMIES
This talk was given by Dr. Daniel Lovell of Cincinnati Children's Hospital to a group of patient families, at Systemic Juvenile Idiopathic Arthritis (or SJIA) Family Day on July 22nd, 2017.
I was asked to present something on Fibromyalgia during a Pain Summit. I ended up describing what we know so far about clinical features, evolution of diagnostic criteria and synthesized some recent guidelines.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
The effects of Pranayama yoga on Stress and AnxietyJatin Chaudhary
Stress and anxiety have been implicated as contributors to many chronic diseases and to decreased quality of life, even with pharmacologic treatment. Yoga has been implemented to alleviate both mental and physical ailments. The objective of this study was to assess the effect of pranayama yoga on negative and positive stress levels and state-trait anxiety. Fifteen healthy women subjects(39.12±3.04 years, 57.25±4.52 kg) attended a 6-week pranayama yoga program for 60 minutes, 3 times a week. They were assigned into two groups: A(experimental n=8) and B(control n=7). Both groups were requested not to participate in any physical activity until the end of the study. The pre and post pranayama yoga effects were assessed by using the stress scale(Cohen, Kamarch & Mercelstein, 1983) for positive and negative stress levels and state-trait anxiety inventory: STAI(Spielberger, 1970). The data handling of the test results was used by WINDOWS SPSS 18.0 statistics program with Independent T-test and Paired T-test. Statistical significance was accepted at α=.05. This study had two major findings. First, in both positive and negative stress levels there were no significant changes occur within 6-weeks of pranayama practice. Second, there were positive effects in anxiety conditions on experimental-group subjects.
The observations suggest that pranayama yoga leads to remarkable reduction in the anxiety scores within a period of 6-weeks and contributes to increased relaxation.
Artigo (4) importante para a preparação para o curso de dor lombar crônica. "Características sensoriais da dor lombar crônica inespecífica: uma investigação de subgrupos."
Preventive home monitoring of COPD patients across sectors–an advantage for the patients and healthcare professionals. Birthe Dinesen, Associate professor,
Department of Health Science and Technology, Aalborg University, Denmark
NEURAL NETWORKS AND BOOTSTRAP SIMULATION IN PREDICTION OF OUTCOME OF NON-SMALL CELL LUNG CANCER PATIENTS AFTER COMPLETE LOBECTOMIES AND PNEUMONECTOMIES
This talk was given by Dr. Daniel Lovell of Cincinnati Children's Hospital to a group of patient families, at Systemic Juvenile Idiopathic Arthritis (or SJIA) Family Day on July 22nd, 2017.
I was asked to present something on Fibromyalgia during a Pain Summit. I ended up describing what we know so far about clinical features, evolution of diagnostic criteria and synthesized some recent guidelines.
Associated Factors of Stroke Severity Among Young Adult Stroke Patients in Malaysia from National Neurology Registry 2014 - 2018
Presentation Slides by Ms Fara Waheda Jusoh, presented on the 14th National Conference for Clinical Research (NCCR) 2021 Dr Wu Lien Teh Youth Investigator Awards (YIA) on 19th August 2021
Following are the links for this presentation on Zenodo Repository:
Presentation Slides: https://zenodo.org/record/5348488
E-Poster: https://zenodo.org/record/5348580
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Circadian rhythm in fms
1. “Deciphering the role of circadian rhythm in
Fibromyalgia Syndrome patients
Dr. Ghizal Fatima
Assistant Professor
Department of Biotechnology
Era’s Medical College and Hospital
Lucknow
2. For everything there is a season and time for
every matter under heaven: a time to be born
and a time to die; a time to plant and a time
to pluck up what is planted. A time for sleep
and a time for wake up. God has made
everything beautiful in its time.
- Ecclesiastes
3. Introduction: Why we did this study
• Circadian rhythm regulates the amount of hormones and
neurotransmitters the body produces, and by this it creates circadian
rhythm in balance.
• But in fibromyalgia syndrome there is alteration in hormones and
neurotransmitters production.
• FMS patients have lower melatonin secretion during hours of darkness
which may contribute to disturbed sleep at night, fatigue and
musculoskeletal pain during the day. (Wikner et al.1998)
• Abnormal circadian rhythm of cortisol secretion in FMS patients. (Claw et
al 2003)
• Sleep disorder causes a shift in circadian pattern of cytokines level (IL-
6,TNF-alpha) which is produced less at bed time and more during the day
(Salemi et al,2003)
• The study is conducted to study the relationship of fibromyalgia syndrome
and circadian pattern of release of hormones and cytokines.
4. • 50 patents and 50 controls were enrolled for the study, all the clinical and
biochemical assessments of both patients and controls have been
completed.
• Samples were collected by admitting the patients and controls in the
Department of Rheumatology.
• Clinical assessment is done by questionnaire:-
1- General Assessment Questionnaire (self designed)
2- Fibromyalgia impact Questionnaire Revised (Bennett et al, 2009)
3- Circadian rhythm Phillip questionnaire (www.golite.philip.com)
4- Circadian rhythm symptoms of FMS questionnaire (self designed)
All the data analysis has been completed.
Clinical assessment of Patients and Controls
5. Diagnosis of patients: (FMS)
Diagnosis is based on the standardized criteria developed by the American
College of Rheumatology (1990). The criteria is-
1)-Widespread musculoskeletal pain for at least 3 months.
2)-Tenderness is found in at least 11 out of 18 anatomical sites in
making a fibromyalgia diagnosis with the application of 4 kg pressure by
palpation through first three fingers.
6. Clinical and biochemical characteristics among Study and
Control groups
Parameters FMS=50
[mean ± SD]
Controls=50
[mean ± SD]
P-value
Age [years] 36.7±9.8 32.8±10.5 >0.05
ESR 27.2±9.7 24.9±8.2 >0.05
ALT 39.8±14.1 37.6±14.4 >0.05
FIQR 91.9±8.0 5.0±8.3 <0.01
Tender Points 16.8±1.9 1.9±2.4 <0.01
CRA (Circadian Rhythm
Assessment)
40.80±16.16 14.56±24.41 <0.01
7. Variables FMS patients n=50 (%) Control n=50) (%)
Residence
Rural 17 (34) 11 (22)
Urban 33 (66) 39 (78)
Religion
Hindu 38 (76) 14 (28)
Muslim 12 (24) 36 72)
Marital Status
Married 41 (82) 31 (62)
Unmarried 9 (18) 19 (38)
Tobacco chewing
Yes 2 (4) 4 (8)
No 48 (96) 46 (92)
Widespread pain history
>3 months 14 (28) Nil
>6 months 10 (20) Nil
>1 year 26 (52) Nil
8. Clinical characteristics of women with FMS and control women:
Variables FMS patients n=50
(%)
Control n=50 (%) p-value
Weight loss
Yes 16 (32) 7 (14)
<0.05No 34 (68 43 (86)
Family history
Yes 7 (14) 0 (0)
<0.01No 43 (86) 50 (100)
Muscles twitching
Yes 50 (100) 6 (12) <0.01
No 0 (0) 44 (88)
Disequilibrium in Climbing stairs
Yes 38 (76) 3 (6) <0.01
No 12 (24) 47 (94)
Frequent awakening
Yes 42 (84) 4 (8) <0.01
9. Sleep Status
Yes (Sound sleep) 3 (6) 46 (92) <0.01
No (Disturbed sleep) 47 (94) 4 (8)
Morning Stiffness
Yes 47 (94) 3 (6) <0.01
No 3 (6) 47 (94)
Morning fatigue
Yes 48 (96) 5 (10) <0.01
No 2 (4) 45 (90)
Headache
Yes 43 (86) 24 (48) <0.01
No 7 (14) 26 (52)
Abdominal pain
Yes 28 (56) 20 (40) >0.05
No 22 (44) 30 (60)
Appetite change
Yes 18 (36) 0 (0) <0.01
No 32 (64) 50 (100)
Lack of energy
Yes 49 (98) 8 (16) <0.01
No 1 (2) 42 (84)
Jaw pain
Yes 11 (22) 46 (92) >0.05
No 39 (32) 4 (8)
10. Sampling design
First sample
collected
at 6 a.m.
Second sample
collected
At 12 noon.
Third sample
collected
At 6 p.m.
Fourth sample
collected at
12 mid-night.
Blood samples were collected at the
4 designated times of the day.
However, 6 or 7 control
Samples were collected at
11-11:30 pm and at 6 -6:30 am.
The mid-night samples of patients and
Controls were drawn
And kept for 30 min. for serum
Separation and then stored at
2-8 C. for 6 hr. and centrifuged
In the morning and stored at
-40 C.
11. Objectives: 1
Assessment of the circadian changes in cortisol, melatonin
and serotonin levels in patients with FMS
12. Circadian Rhythm of serum cortisol level in study and control group
Time of Day Study (n=50)
(Mean ± SD)
Control (n=50)
(Mean ± SD)
P-Value
Morning (6 AM)
27.91±12.81 28.30±13.63 >0.05
Afternoon (12 Noon)
14.82±5.91 13.68±6.21 >0.05
Evening (6 PM)
10.68±5.58 8.60±3.61 <0.05
Night (12 Midnight)
15.45±9.80 6.06±3.03 <0.01
13.
14. Circadian Rhythm of serum Melatonin level in study and control group
Time of Day Study (n=50)
(Mean ± SD)
Control (n=50)
(Mean ± SD)
P-Value
Morning (6 AM)
35.18±12.75 19.73±9.98 <0.01
Afternoon(12 Noon)
14.91±6.40 13.48±5.14
>0.05
Evening (6 PM)
17.84±11.57 22.74±16.83 >0.05
Night (12 Midnight)
38.39±18.51 63.68±13.64
<0.01
15.
16. Serum serotonin level was found high in patients but no significant circadian rhythm was
found in serum Serotonin level in study and control group.
Time of Day Study (n=50)
(Mean ± SD)
Control (n=50)
(Mean ± SD)
P-Value
Morning (6 AM)
76.53±34.02 115.54±38.68 <0.01
Afternoon(12 Noon)
86.76±47.46 113.69±28.10 <0.01
Evening (6 PM)
88.06±47.49 108.10±27.31 <0.05
Night (12 Midnight)
89.78±51.27 108.44±26.38 <0.05
17.
18. Objective: 2
Analysis of circadian pattern of symptoms of fibromyalgia and its possible
relationship with cortisol, melatonin and serotonin
21. Decreased
Melatonin Level
Maximum Stress
Elevated Cortisol Level
Impaired sleep
Maximum
Numbness
Worst Stiffness
Fatigue
Least stiffness,
Anxiety and
Pain
Worst
Fibromyalgia Syndrome : Circadian
Rhythm of Symptoms
Feel good time
Day time
Sleepiness
Immense Fatigue
minimally Alert
Difficulty in
Concentration.Dizziness
12
Mid night
12
Noon
6 PM
6 AM
Headache onset
Maximum Pain,
stiffness
and Anxiety
Low Cortisol
level, High
stress
12:Midnight
High alertness
12
Noon
22. Determination of circadian changes in cytokines level (IL-6 and
TNF-alpha) and its possible relationship with melatonin,
serotonin, cortisol and symptoms of FMS.
Objective: 3
23. Time of Day Study (n=50)
(Mean ± SD)
Control (n=50)
(Mean ± SD)
P-Value
Morning (6 AM)
3.04±2.41 2.36±1.75 >0.05
Afternoon(12 Noon)
2.91±2.29 2.19±1.69
>0.05
Evening (6 PM)
2.67±2.17 2.24±1.45 >0.05
Night (12 Midnight)
2.99±2.48 2.15±1.47 >0.05
Serum IL-6 level was not found significant in patients and control group and hence there
was no significant differences observed in the circadian Rhythm of serum IL-6 level in study
and control group.
24.
25. Time of Day Study (n=50)
(Mean ± SD)
Control (n=50)
(Mean ± SD)
P-Value
Morning (6 AM)
5.85±3.63 2.99±2.05 <0.01
Afternoon(12 Noon)
5.86±3.49 3.11±2.02
<0.01
Evening (6 PM)
5.90±3.51 2.96±2.11 <0.01
Night (12 Midnight)
5.88±3.44 2.78±1.99 <0.01
Serum TNF-alpha levels were found significant in patients group but there was no
significant circadian changes observed in serum TNF-alpha level in study and control group.
26.
27. Conclusions
• Our results suggest that the disturbance in the circadian pattern of cortisol is found
in FMS patients. Interestingly, this increase in nocturnal serum cortisol in patients
group suggests deregulated circadian patterns which may explain in part the patient
complaint of unrefreshing sleep. In sum, our results showing lower cortisol values
in the morning, support the hypothesis of a circadian dysfunction of the cortisol
among patients group.
• Further, our results suggest that there was a weak circadian pattern of 5-HT in
patients with FMS. And this decrease in 5-HT levels, might contribute to the
pathogenesis of the disease. Interestingly, the decrease in 5-HT in patients group
throughout the day is important because it may explain in part the patients
complaint of unrefreshing sleep.
• Low melatonin level during the hours of darkness may cause disturbed sleep among
patients group. Due to which patients may complain of increased lethargy,
emotional distress, and cognitive and performance difficulties that accompany the
diffuse pain, fatigue and stiffness in the morning.
• Furthermore, our results suggest that there were no perturbations in the circadian
pattern of serum levels of IL-6 and TNF-alpha in patients with FMS.
28. • The sleep disturbance in FMS patients and that the pain is increased during night-time imply
that the ideal treatment at night hours may promote restful sleep.
• For treatment to be effective, the Chronobiological model implies that there must be a
reduction in the sleep arousal disturbance.
• Moreover, the diurnal variation of symptoms suggests that the optimal midday time for the
least pain and fatigue provides opportunities to promote and to monitor the response to
treatment programmes. For example, excessive physical exertion or energy-consuming tasks
should be discouraged in the early morning or evening.
• On the other hand, any interventional programme would be more acceptable by the patient
during the midday time. Therefore, timing may be crucial in treating FMS and this has
important implications for scheduling activities of daily living and possibly for timing the
administration of medications in FMS patients, and, therefore, these findings may lead to
novel interventions in the treatment of Fibromyalgia Syndrome.
• Future studies are important to validate the results presented here and especially to further
clarify the interplay of circadian rhythm symptoms with hormonal profiles and cytokines.
29. Relevance of the Study:
The observations of abnormalities in melatonin and cortisol which are highly regulated by circadian
pacemaker raise the possibility that there is an abnormality of circadian rhythm in FMS patients.
Moreover, the diurnal variation of symptoms suggests that the optimal midday time for the least pain
and fatigue provides opportunities to promote and to monitor the response to treatment
programmes and has important implications in the assessment of the patients. Therefore, timing
may be crucial in treating disease like FMS and this has important implications for scheduling
activities of daily living and possibly for timing the administration of medications.