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The severity of PEM varies widely, with recovery times ranging from hours to weeks, and it has been shown that in CFS patients who have symptoms of PEM, a physical exercise programme may lead to the worsening of their symptoms (Vink and Vink-Niese, 2020)

Mitochondrial Ca 2+ overload due to MCU overactivation increases Ca 2+ sensitivity, enhancing myosin light chain phosphorylation and promoting contraction, and mitochondrial ROS activate redox-sensitive pathways such as MAPK and NF-B, driving VSMC proliferation and neointima formation

Brain fog is rarely a standalone issue

Figure 4 illustrates the effect on the disease's continuous course as well as its repercussions

Lung, WAT, testis, and skeletal muscle preferentially rely on salvage and have low expression of proteins involved in the PreissHandler pathway 41 , with the muscle in particular relying on both NRK1 and NRK2 for supporting its mitochondrial metabolism and fiber type composition 42