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Nevertheless, there is a dearth of large, high-quality, and double-blind-studies

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The immunological findings defined CFS as a low-grade inflammatory disease, indicated by enhanced production of cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), and nuclear factor kappa B (NF-B), dysregulated cytokine levels (increased levels of IL-1, IL-4, IL-5, IL-6, and IL-12 and decreased levels of IL-8, IL-13, and IL-15), autoimmune reactions, oxidative and nitrosative stress, reduced levels of antioxidant markers, mitochondrial dysfunction, increased translocation of Gram-negative bacteria, and altered antiviral response elements (i.e

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A random-effects model was performed to check the heterogeneity of the studies