tv Mysterious Illness Deutsche Welle April 7, 2022 3:15am-4:01am CEST
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to leave eastern parts of ukraine before unexpected russian offensive. moscow is all to be preparing fresh muscles on har keith and the don bass region. after pulling troops from around the capitol. his update at this hour. don't forget there's more on our web site d, w dot com and claire richard sent in for lynn for me and the team here working behind the scenes. thank you so much for watching your time for the experiment about time. ah, it can be measured precisely. and yet each person experiences it differently as if there are different forms of time. but dimension and illusion about time starts april 14th on d, w. ah
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ah, as, as that's pretty much the courtesy, it's like the plug spin polled are moving, the switch has just been turned off. so the photo stomach, imagine being at the amusement park and suddenly there's just noise again, or all the lights go out to clean on the carousel stops, the music disappears or you're disoriented in your fall and you can't do anything about it because to begging tune comes she missed what conclusions that asked him. i felt deathly ill for 8 years to certain. i know my body has changed and this condition is now irreversible. he gave
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them up in the evening. i often sit in despair telling my boyfriend that i can't understand why nobody can find any language. newman has finished and flushing. jen cummings in his mother's brooklyn's voice. why when it's bad, i can't even get out of bed is currently been fun. i'm on my leg should react and there is no paralysis. it's usually like home, find the energy to swing my legs out of the bed. and so i'm short of breath. the cut don't have the strength to use my lungs to mom. so bases mishma that's complex, can't even complete a sentence without taking a breath bill just unfortunately not
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really feared anxious and foolish to clean. of course there's a piece of life missing, especially when you see what others my age are doing. i wish it hasn't affected me as badly yet, but i still have bad days where i can hardly move. my whole body hurts ish, madsen, it makes me afraid that it will become a permanent condition. that is so i'm so in swift just to follow. and yet aileen brown, i'll flip girl and sonya co, 3 of over 100 patients who answered our request for interviews with the german m e . c, f. s. society. they were all willing to tell us that personal stories. the strong response makes it clear just how much suffering and despair the disease has caused
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them. ah, we begin our investigation at the charities hospital in berlin carman shy. ben bogan has been researching emmy cfs for years to come master oncology dalton for him. yet fancy, fancy hits, bookish to my background, isn't on college. it does. and in 2020 technology has now allowed us to get a detailed understanding of so many disease mechanisms that we can use them for specific treatments for, for the know this also applies to neurology and the accountant or to another. but with this disease, we know about it as much as we did others 30 or 40 years ago. for yamaha, the overall number of scientists working on this disease will tied is very small in relation to the disease as frequency and kind of a lot, 200 of criteria kunkle. 17 to 24000000 people suffer from emmys. cfs around the world. in germany, an estimated 300000 in france around 250000 women are more
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frequently affected than men. scientists assume that at most, only half of those affected have been diagnosed. disclosed to the food quasi habits and toyshop. mostly i'm disappointed and i just, i've never imagined that i could be left. so alone with this illness, i did twice a day seminar. there's not only a lack of interest, but a lack of understanding mudding mom like when you speak to politicians, they think you're just an isolated case on that you're not awesome. and the worst thing is that you gradually disappear in 2018. my neighbors thought i had moved away on good welcome. mm. good assistance forensic so tova surveys the 26th of october and i had been getting
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progressively worse since last night and i couldn't do much to day and spent most of the day lying down. even the slightest exertion was too much of fear for me. emmy cfs stands for my allergic and says hello my a light us chronic fatigue syndrome. a complicated name for a complicated illness. deb because i'll go show tis a 10 mile, jake refers to muscle and unsafe a my litres of is an inflammation of the brain and spinal cord marks as is all kinds of guns m group. the term is unfortunate because in most patients there is no evidence of inflammation in the classical sense enough. why isn't? let's endless. m gobbled flight olden phones to normal. it was an attempt to give it a more appropriate name in 2015 on a desert systemic exertion, intolerance, disease, blessings, intolerance. a kunkle is natalia also it's cumbersome,
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but it better describes the call problem. and this problem, and best than, than does this, the, those who suffer from this illness have very low energy reserves and can no longer tolerate exertions and blessed from michigan to love. yet as there are a completely inexplicable physical reaction, your bones hurt so much that you can't get up in the morning like the flu. so you feel weak, you're feverish to feel muscles like just your teeth or our teeth are used to be active, very active listings and not just as a police officer on the street making arrest, even when things got rough water. my private life was also very actors, weren't on the mattress, disappears, does, would, uncompleted common eileen
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got mano, nucleus is 2 years ago. and she hasn't been the same since. she can only occasionally go to school. her parents are mystified by what's happened to their daughter. that she was on summer live, she always used to go out with her friends. boys had seen that she just exercised all the time. she used to work out here at home to work out god, she can't dance any more of a gun. it's a really bad hold. ah, for this month was it had her as a parent, you are helpless. if you don't know what's causing it, was that and what you can do to help and what have you tried to be encouraging and say come on, let's go outside ski and let's take the dog out. well, come with us in local. no, i can't. i don't want to do that. he can be a bit much and reform for this one and send this if i had to describe what the
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illness feels like, i compare it to a battery. and the system and a healthy person gets up in the morning with 100 percent and uses it up over the day. in the evening. they go to bed and it recharges overnight. so they can start the next day with a full battery. until it doesn't work like that for us, we only have a few percent to get through the day. in addition, i took overnight or during rest periods, that our batteries don't really recharge at all. any health issues, we always have to work with only a few percent in our batteries. our bodies are under supplied. we just don't have enough energy. i saw nicole. a former communications designer also caught mano, nucleus is even though she recovered, she caught
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a number of viral infections in 2012 and hasn't been healthy since long in person interviews are too strenuous. so we do the in depth interviews later over the internet. could you briefly describe your symptoms? what are the disease? the symptoms in lot more and more a symptoms emerged over the years. launch fighters? i kept getting salivary gland infections and deer infections. i'm out in 2015. i was in the hospital 3 times with really serious bell problems and, and, and run kindest of burning in the lungs. wouldn't go away. and i went from one doctor to the next. no, i saw neurologist in 2016 or 2017 therefore that he just took one look at my medical file, saw how thick it was and said, i don't even need to see it. i can tell it psychosomatic launches are. most doctors are unaware of the disease,
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even though it was included in the international classification of neurological diseases by the world health organization. in 1969, even today, those affected a wrongly diagnosed a suffering from depression or mental illness. this fall then i most as sin, i went to see my doctor describe my symptoms and told him how i was feeling, but he didn't know what it was either and eventually said my stomach was the problem. so i bent his various alternative medical practitioners, but they couldn't help me either. we've tried a lot, but no one could tell us what's wrong, said sam was populous. since no doctors could help, eileen searched on the internet herself and came across a research project at the technical university of munich and the helm hold center. who to ballons conducted abroad study. at the center on mano nuclear says she met
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young people who did not fully recover after the infection and went on to develop emmy cfs. very few scientists around the world are researching, emmy c. f. s. in children and adolescence. in germany. she's the fast, then best concoct alysia to us loser. a trigger we can characterize best is indeed infection unit or infections with various pathogens. and goodbye vacant. these are mainly viral pathogens. for example, the epstein barr virus, all the sauce virus, sy, but also enter a viruses and for bacteria. and it's a bacteria as well in isolated cases in ironing, finn and i'm accidents and surgery have also been described as a trigger on. however, these cases are not as well understood as cases triggered by infections and healthy people had gotten fellows best. take his own title out,
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then they appear as excessive and noun reactions to one. such manifest in more than 90 percent of humans catch the ab stein, ball virus or e, b, v. during their lifetime, usually in early childhood. the virus often develops without symptoms. and most have no additional consequences. but an infection can reappear as mono nucleus is especially in adolescence and young adults. common symptoms are a high temperature, fatigue, sore throat and swollen lymph nodes most fully recover. some however suff, a life threatening complications including respiratory disease, spleen damage, low blood cell counts or long term conditions like emmy c fs. an estimated 40000 children and adolescents in germany suffer from emmys. c. f. s. a
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diagnosis is complicated. the disease has no biological characteristics that can be used to objectively diagnose an infection. other conditions have to 1st be eliminated as the cause of eileen's permanent exhaustion and pain. the internationally established canadian consensus criteria for emmy c fs helps doctors reach a diagnosis, neurological and cognitive symptoms, immune disorders, muscle and joint pain, headaches, and sleeping dysfunction. the best symptom for distinguishing emmy c. f. s from other cfs conditions is post exertion. all malays, or p e m. the symptoms worse and after patients exert themselves physically or mentally leading to a crash glue. then
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9 months after getting mano nucleus is. eileen was finally diagnosed with emmy c. fs by professor who to parents in munich. but what then? no medicines or therapists have been developed to battled the disease standard treatments, tackle the symptoms instead of norco named their guns and who am i and besides the entire symptom oriented treatment, including cardiovascular support. it is, it's important to give patients good advice to recommend relaxation techniques and how to manage their very low energy reserves. thought they shouldn't over exert themselves, but also get limited exercised da, how short daily walks if possible. so they don't lose what's left of their fitness . nish t. i le let the quantity of alien ah,
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eileen is now taking part in one of utter balance studies. the professor and her team are looking at the course of the disease in emmy c. f. as patients, eileen's pulse and blood pressure are taken regularly and her blood is tested. cardiovascular changes are measured during a standing test. oh, okay, straight legs and lean your head back with you. are you nauseous? i feel dizzy with you, but would you rather lie down this quarter? probably in by dessert conklin is desmond in patton. if the worst thing about this illness is that patients don't actually look ill at home don't. which is also a problem for research because the stigmatization gets in the way of both treatment and scientific attention of random asked me at aunt martha down gets anguish. and,
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but at the moment we are thankful for support from the us national institute of health out in the n i h of teeth or do i deal with getting and velo, thank god. now a little more research is being advanced by the wave from that on off. it's of a nick on, but it's too little with too little public funding and thought our home or as of if with food in germany, most of the patients are left battled the disease on their own, their dependent on private care from relatives and friends, health insurance companies don't yet recognize, emmy c. f. s i think and refused to take over most of the costs of patients. they're reduced to trial and dera in hopes of getting their lives back. have a i lose all school yet. i tried everything yet. really. everything college also i was so desperate shopped on, i then happened to try and off label drug and i was on medical medication that
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meant for different illness also and i experienced what i now know as a crash. what of ice crush on the so i researched the medication and kept coming across an illness. i'd never heard of adult. i'm a concrete go store, cindy, my allergic and stuff. hello. my allied us, follow me really. and i thought yes, that's it. just going all my initiative. it was collusion, love she read it and said you look these people feel like i do on and she sent it to me. and then also i remember that well, advisors know um that text the article was very scary. african aunt i saw passes and i kept wanting to leave as i read it when i had to get out of my office. hm. you was sorry. i didn't think this would happen is
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we'll take a break if you want. i. yes, a short break. i know that's like light of us. on the one hand, i was relieved when i read it and totally recognized myself. although, but on the other, i realized that i'd been fighting it for 6 years roy and would be fighting it for a long time before i could get better again. because if it wasn't, and it's not even clear whether i ever will get better again, guys of the muslim model. ah it's, it's, it's still, it's warmer in your process that began 9 years ago with pneumonia. oh, and in the weeks and years and a fuller towson which i haven't been able to get myself back to where i was once was on beach as well,
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was to diminish. i sound like a 90 year old with a walker, who can only go so far and no further damage. no halsey went from doctor to a doctor for 2 and a half years. no one was able to find anything. then his cardiologist pointed him to carmen, shy, been bargains, outpatient clinic, at the charity hospital, she diagnosed him with m e c f, as in 2016 and the elliptical glitter, the hello. hello, good morning. come with me please. so this is the take a seat and we haven't seen each other for a while. how are you permanent getting worse all the time?
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but slowly, mr. okay. okay, still working? no, i'm on sick leave. okay. and okay. and before then for her, come to the for that i gradually moved from being in the field to desk work and then working from home. and eventually, even that didn't work any more harder. even with breaks. 8 hour days are too much the only and you've brought me these results. yes, yes. all to him you neurotransmitters and smith are no ninty back in. they are really very high. when i saw you 1st, they were elevated away, but the values you have now are extremely high via in different houses. we think these antibodies also regulate the body and you to see a face. their function is disrupted, are from june. it starts and this may mean that exertion can lead your muscles not being properly supplied with blood your quickly and pain can't concentrate. and ultimately, energy production is also controlled by the system. if that is
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a sustain, it could be a major factor for explaining all the complaints of this illness. for spring damage, harden line is dylan, you have an incomplete picture of how this disease functions. as from what is relatively clear, is that it's an illness where the immune system plays a significant role, is only because the disease usually begins after an infection. mention not, i not infect chillin, begin the infection, ramps up the immune system and it doesn't return to its original state. via indifferent was death. we assume that this overactive or mystery to deny in response then takes over the function of the autonomic nervous system. within the autonomic nervous system controls all the bodies, involuntary functions, our heart beat, breathing, digestion, and centrally, the dilation of blood vessels. if during exertion, blood cannot flow freely through the vessel's muscle pain and pour concentration
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are the result not enough oxygen is available to produce energy. the b to to receptor is vital for blood flow regulation and is located on the blood vessels in muscles. it's controlled by adrenalin, which is released during physical exertion, as well as antibodies. in healthy people, blood vessels dilate to increase oxygen supply to muscles, but the charity team found indications that antibodies don't function correctly. in m e c, f s. patients muscles don't get enough oxygen. half lipp curs antibodies are being examined. it isn't, they're packed and had anti cutting because we know the patient has antibodies against the b to, to receptor. what we want to know is which part of the b to, to receptor in with divided up the b to, to receptor into 15 small pieces and stuck each piece onto a different little bait was going to be like nice be so glow in
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a slightly different color, definitely, and then we can see i'm tired. this patient reacts more to the front part. if i got another to the middle part or more, we can pay this with the reaction pattern of healthy people. this would help us understand the disrupted receptor mechanism better, and ideally we would see such a clear different sign that we could use it as a diagnostic test. you have no solution to not the blood taken from my lean is to be used for further research. the munich researches send it with other samples to the julius maxine millions university in board, bog microbiologist, and they're ologist, dr. boop, hash prostate and his team are awaiting the samples. i personally am very fascinated to search for the infectious causes behind the disease. if at all, there is a viral infection being associated in this disease. and if we can find out this virus association can be proof at the molecular level how the virus causes the
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disease. this will be really a big, big breakthrough in this field. and if we can prove that really, viruses are responsible for the disease, then in a long done definitely, we can find a cure to it or a way to interfere in the process of diseased allotment. the scientist has been studying the role of viruses in the human body for many years. he was the 1st to discover the link between the epstein bar virus and m e. c f ass. what we have found out that hope is viruses, particularly human hope, is 5 step 6 and epstein, barbados. they are the most interesting candidates which can contribute to the development of the disease we have found as and that each of the 6 am produces a small oddity and the small army can directly target and mitochondria to fragment
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. and this is already known that m e v v infection also mitochondria, fragmented. so we believe that these virus induced mitochondria fragmentation is one of the most important steps in the development of every surface. our physical and mental performance is determined by tiny little power generators. the mitochondria, healthy mitochondria have a long mash like structure which is important for producing 80 p. r bodies universal energy sauce. when mitochondria fragment and lose their mash like structure, they can no longer function properly and produce energy. ah, in his experiments, he adds antibodies from the blood of emmy c. f. s. patients to healthy cell conscious. he has grown what will then happen to the healthy mitochondria.
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if there is a factor in the system of m as if a spaces which causes mitochondria dysfunction, we expect that this factor will affect the healthy cells and the mitochondria will be fragmented. of 2 different degree. the 1st results appear after between 24 and 48 hours. he's right. the mitochondria from the healthy cell culture have fragmented and broken down into tiny pieces severely affected mitochondria can see that they are on pieces now. yeah, they're not interconnected to each other. if you look into a healthy cell, you can see that the medical of it like interconnected with each other now and this might have gone to is 1st of all week in that immune response. they cannot fight to him any infections. and they produce less energy. the metabolism is
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completely flown. this is how, what happens in some of the senior spaces who pash, prostate research is groundbreaking. and a possible explanation of why emmy cfs patients have low energy levels. but this process could also be used in diagnosis, which would be an enormous advance be at the very beginning stage of testing. you're still not using as a diagnostic, but we're trying to develop this technique. so at this stage, it's very preliminary we, we can get nice results with severe mature, for patients almost 100 percent of his books, but with mild, moderate embassy of his patients. it still goes sometimes wrong. so he's lab work on it, but he needs funding to his work and there are not any public funds available for
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emmy cfs research in germany. donations are all he has low self, emmie cfs research is insufficiently funded. around the world in the united states for example, it ranks very low. u. s. health authorities spend about $14000000.00 on the $2500000.00 emmy cfs sufferers. however, for $1000000.00 multiple sclerosis patients, the same authorities spend $100000000.00. and for the 1200000 people with h i v. 3000000000 the international hash tag emmy action movement is fighting for more research funding recognition of the illness and adequate treatment. they want to draw attention to the precarious situation of those afflicted. in her
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documentary on rest, jennifer bria shows hundreds of empty pads of men's and women's shoes, their symbolic for the millions of people who have disappeared from public life. i just came galena published most of what the done. as soon as i saw the film, i thought i have to do something like that. we have to do something. what? so we have to attack this at the route, 100, all with a handful or perhaps 10 people. we launched millions missing germany named and then planned and carried out our 1st event land linda home with us here for long treatments in germany. for hemi cfs patience is catastrophic, and they have no access to treatment, one after fi, legal battles for every small step like getting a wheelchair and sometimes even subjected to consider all stigmatization and discriminate. shipment is coming off is us ah, ah,
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with national home called bonham. patricia, it was a very exciting time. it really felt like you could make a difference, could change something and didn't have to resign yourself to your family. chicago, mom in norway. there are at least 15000 people with m. e. c fs. a norwegian research team led by aston krueger and olaf miller from bergen university, has long been searching for a drunk that could help them. they came across, retook c mob a few years ago by chance. they had wanted to use it to treat it cancer patient. it was also suffering from emmy cfs after observing at least 8
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patients telling us independently of each other about this, the effect on me and me see if us him, this is her than we decided to try to do some research and our hypothesis from the start has been that them is here for us, could perhaps be a very am dylan, autumn indices, and with a role for what the antibodies under be lymphocytes. and that's why we decided to pursue the nab surveillance. be sounds are important immune sounds in our body that produce antibodies that destroy viruses and bacteria. unfortunately, this process sometimes goes awry and the be cells produce antibodies that don't work properly or actually attack the body itself. this occurs in many auto
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immune diseases like lupus or maya thea gravis. scientists believe that emmy c fs is one such auto immune disease. retook him ab is a medication which temporarily destroys be cells preventing them from producing antibodies to attack a person's own body. in 3 smaller scale trials, they succeed in treating emmy c. f. s. patients with retook c. ma'am. scientists then initiated double blind randomised phase 3 trial with 152 patients. patients and their families around the world are hoping it will be the medication, the can save them. ah,
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why with the swim school? i think the worst staying is the loss of control arms or ma'am, and the more you struggle and hide it, the more the more your health deteriorates. like being in quicksand. the antibodies in the blood of emmy c f, as patients seem to play a significant role, who to balance and her team also want to discover whether they can diagnose the disease based on these antibodies. and whether a marker can be found in the blood. the could simplify the diagnosis. yeah, i'm ready. 5 interested. we asked whether the see a face patient had been infected with the epstein bob iris at some point as into theater. and if so, they should have a few green dawns to her, and they do that is, is a green dog that we also see in some standard diagnostic test, done not diagnostic testing. and whether the unique signature,
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which we see he is related to cfs. if we can only say once we've examined a lot of patients after our vendor gone through the content on t, as in tom during our research reports of the new saws, covey to virus began to appear exponentially. world wide, over 100000000 people have been infected with a new virus, weeks and months after an initial infection. many a still suffering with very similar symptoms to emy cfs relics, mon felt a neuro psychologist and musician contracted corona in march 2020. he still hasn't recovered, suffers from permanent pain cognitive lapses, sleep disorders and extreme exhaustion. limbo nozzle, solice. dick's looked on her the weekend when it began going down hill. i just
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thought i had severe fatigue from the fatigue. did i know the turn? and i know that its post viral devices because of your father's i just googled post viral fatigued without knowing that it's used as a synonym for m e. c fs. as $400.00 foot, i saw that it was precisely these seemingly unrelated symptoms that i had. formerly, i couldn't have imagined an illness that so blake close to smells lower. olive muzzles there. it's as though you just don't exist anymore. yeah. mishma as of offers x till after the 1st wave of the corona virus, it gradually starts to become clear what an infection with the virus really means. professor carmen shaban bogan is war it via didn't notice it. i'm the site. what's in there? i think that around one or 2 percent of those youth had a mild case of cove at 19 could develop cfs and requirements here for when we see
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how dynamic the spread of this virus actually is it. there is great concern that we will have a significantly increasing number of chronically ill m e. c f. s patients in germany because of coven 19. and i trend in fargo from corporate, from an international researchers, including boop, ash prestige are rushing to investigate the long term effects of coven 19. he doesn't think for sars covey to is directly responsible for the long term effects. he believes that latent herpes viruses in the human body are reactivated after a corona infection and weeks later lead to long cove. it prostheses a comparable pattern with m e c, f, as which also develops after a viral infection. if the signature of the ceiling that we are looking at the embassy of his presence at the same in these places. at this moment we are talking
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that symptoms of hemisphere for spaces are similar to these patients who have this long covert. but we don't know it, it just simply an association these know proven her own data to say that okay, a long covert basin is now in emmys here for some reason. and so let me love, i love cornelia. i left school and decided to do remote learning to finish schooling. i can do it from home. my school just wasn't giving me enough support. as many i would have had to continue to go to school normally, which just isn't possible. okay, but since i've been doing everything from home, i definitely feel much better for you. yes. now if you in february he most, most families leave he with a new stock of hope. after talking with us and have known the event been given to patton, we wish we could make patience much earlier i had we wished the illness that clinical
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picture was more widely known. and that any patients who haven't recovered 3 months after infection and show the symptoms for me would be referred to a specialist and begin treatment which it's a list. and also tarzan and and his him to my and her to be handled to begin. and we would then see fewer patients in such a poor condition pushed on clever enough to it over millions of patients around the world are hoping for salvation from norway. the results of the 2 year re took them out. trial are eagerly awaited but then disappointment. the trial is negative, retook the map doesn't have the expected effect level when it was her a bit unexpected. it could have had a negative trial. that is all saw that, that, that can happen. even if you have a, an active drug. but her not seeing a tendency in the right direction was a bigger surprise for us. especially as i said,
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based on our previous experience. on the other hand, we did the changes in the video. some of double bonded study, for example, lower doses in maintenance treatment which may have had an influence on this. the scientists had to have the dose because they received no funding from the pharmaceutical industry. but the research continues the hunt for other drugs that could help patients me. they can use their research, bio bank with 3000 prompts samples or donated by participants in the re took him out trial with if you are, what we're looking for in the future. one thing we're looking for is a bio marker because a lot of patients do not have the m e p s f d diagnosis because the practitioner general practitioner, all the specialist has problems and putting the diagnosis of the patient spot for
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research and about the court is that the disease and possible drugs, scientists everywhere need money. at least 40000000 euros in germany alone. the federal government recently set aside 3700000 euros for research into patient care. a drop in the ocean. in my personal opinion, the only way we can find a solution to this disease is to bring patients, the clinicians and the basic sciences, such as to one umbrella. and our political system can play a very important role in bringing together these 3 pillars. if this happens, i guess next 5 to 6 years, we can help solution to this problem. it also had phases with suicidal forms. first of course i have right here,
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would you want to live like this with my prospect of getting any better, gibson portion, even if the massive research was launched. wow. it wouldn't help me get it until then. i'll try anything. i'm not going to let this track me down if the disease wants to fight and kind of give it one comes on we keep looking at the bench nicholson. there are so few people out there who are able to fight for us can void, or who want to fight for us after you talk of to, to attend. that puts a lot of pressure on our shoulders. thanks. look at, look, you put yourself under pressure. you all's misty because you really want to get out of here again. we all know exactly what we want to do tomorrow.
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d w. and to the conflicts own with sarah kelly. the world has been confronted with horrific images of atrocities, against civilians, allegedly committed by russian forces in ukraine. we can find a car and then paul, of the genocide, how should western allies respond? my guest, i'm cobblestone, is this awaiting foreign minister, gabriella glanced bagget. he told me on the line with 90 minutes long d w. o goal. with listen carefully. don't know how to, to do a goal. ah, feel the magic discover the world
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around you. ah, subscriber to d w documentary on youtube. ah, this is d w. news and these are our top stories. officials in ukraine are urging people to leave eastern areas a fear a renewed assault on the don bass region. as the kremlin pulls russian forces from around the capital. keith, all the world condemned. the killings of civilians in towns including butcher president volota mir's lensky has compared them to nazi war crimes. u. s. president joe biden has accused russia of brutality and in.
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