A retrospective study was performed to assess the epidemiology, diagnosis, clinic, and laboratory of the patients with tuberculous meningitis (TBM) in a multicentral study. The medical records of adult cases with TBM treated at 12 university hospitals throughout Turkey, between 1985 and 1998 were reviewed using a standardized protocol. The diagnosis of TMB was established with the clinical and laboratory findings and/or microbiological confirmation in cerebrospinal fluid (CSF). The non-microbiologically confirmed cases were diagnosed with five diagnostic sub-criteria which CSF findings, radiological findings, extra-neural tuberculosis, epidemiological findings and response to antituberculous therapy. A total of 469 patients were included in this study. Majority of the patients were from Southeast Anatolia (164 patients, 35.0%) and (108 patients, 23.0%) from East Anatolia regions. There was a close contact with a tuberculous patient in 88 of 341 patients (25.8%) and with a tuberculous family member in 53 of 288 patients (18.4%). BCG scar was positive in 161 of 392 patients (41.1%). Tuberculin skin test was done in 233 patients and was found to be negative in 75. Totally 115 patients died (24.5%) of whom 23 died in 24 hour after admittance. The diagnosis was confirmed with clinical findings and CSF culture and/or Ziehl-Nelson staining in 88 patients (18.8%). Besides clinical criteria, there were three or more diagnostic sub-criteria in 252 cases (53.7%), two diagnostic sub-criteria in 99 cases (21.1%), and any diagnostic sub-criteria in 30 patients (6.4%). Since TBM is a very critical disease, early diagnosis and treatment may reduce fatal outcome and morbidity.

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BackgroundWidespread pain is the central feature of fibromyalgia (FM). The role of physical as opposed to psychological mechanisms in FM pain remains a matter of controversy. Objectives In the present study, we evaluated the dependency of FM pain on other FM clinical features as assessed by the Fibromyalgia Impact Questionnaire (FIQ). Methods Forty two consecutive patients, who had been followed up for at least 2 months, were enrolled. Their mean (SD, range) age, disease duration and follow up duration were 42 (12, 15-78), 8 (11, 0.3-45) and 2.9 (2.2, 0.28 -8.6) years, respectively. They completed FIQ scores as applied to their health status at enrolment in the clinic and at the time of the study. Statistical analyses were done by simple linear regression analyses and oneway analysis of variance. Results were expressed as mean (SD) and a p < 0.05 was considered significant. Results The pain visual analogue scale was 8.9 (1.3) at enrolment versus 2.4 (1.9) at the time of the study (p < 0.001). At enrolment, pain was predicted by morning tiredness (p < 0.001), FM symptom interference with work (p < 0.001) and stiffness (p = 0.001). At the time of the study, pain was predicted by tiredness (p < 0.001), morning tiredness (p < 0.001), FM symptom interference with work (p = 0.003) and stiffness (p = 0.03). Improvement in pain was predicted by pain at enrolment (p = 0.007) (and by no other baseline FIQ scores) and improvements in tiredness (p < 0.001), morning tiredness (p < 0.001), FM symptom interference with work (p < 0.001) and stiffness (p = 0.002). Conclusion Pain and fatigue were strongly interrelated in our FM patients. The physical symptoms fatigue, stiffness and FM symptom interference with work consistently predicted FM pain and its change over time. In contrast, the psychological variables anxiety and depression, as assessed by the FIQ, did not relate to FM pain.

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