P1449Anti-thrombotic management for electrophysiological procedures: results of the European Heart Rhythm Association (EHRA) young investigators survey

Funding Acknowledgements

none

Background

Electrophysiological studies (EPS), with or without ablation, require percutaneous introduction of catheters into the heart to record local electrical activity. Instrumentation of catheters within the blood causes activation of the clotting cascade, increasing the risk of thrombus formation. To date, the electrophysiological community lacks international guidelines on the use of anti-thrombotic therapies before, during and after EPS.

Purpose

To survey the current practice regarding the use of anti-thrombotic therapies across member countries of the European Heart Rhythm Association (EHRA).

Methods

The survey was conducted in February 2019. Electrophysiologists from EHRA member countries were contacted to complete the survey by e-mail, utilizing the EHRA Young EP network. They were asked to answer a questionnaire containing information on anti-thrombotic and anticoagulation management before, during and after left-sided EPS and ablation: atrial tachycardia (AT), accessory pathway (AP) and ventricular tachycardia (VT).

Results

We obtained 41 answers responses from 40 centers in 15 European EHRA member countries. Regarding of antiaggregation, the most used antiplatelet is aspirin (100% before, during and after ablation). The most used anticoagulant was novel oral anticoagulants (NOAC) before ablation (47.1%), during hospitalization (85.2%) and at discharge (70.3%). The administration of anti-thrombotic therapy depended on the procedure time only in 10 cases (24.4%).

For AP, before ablation, only 4 centers (9.7%) administered anti-platelets and 2 (4.9%) anticoagulants. During ablation, heparin was used by 85.4% of respondents maintaining ACT target 300-350 s in 36.6% of cases. At discharge, antiaggregation therapy was prescribed by 22 colleagues (53.7%) and anticoagulation only by one (2.4%).

In patients with AT, before ablation, antiaggregation prophylaxis was prescribed by only 4 centers (19.5%) and anticoagulation by 11 (26.8%). During procedure, almost all centers (40, 97.6%) used heparin with ACT target 300-350 s in 58.5% of cases. At discharge, antiplatelet therapy was recommended by 12 colleagues (29.3%) and anticoagulation by 24 (58.5%).

Regarding VT, before procedure, 8 centers (19.5%) prescribed antiaggregation and 5 (12.2%) anticoagulation prophylaxis. During ablation, all centers used heparin, maintaining ACT target 300-350 s in 58% of cases. The use of antiaggregation or anticoagulation depended on the left ventricle (LV) access in 15 centers (37.5%) and on LV ejection fraction in 11 (26.8%). At discharge, anti-thrombotic therapy was recommended by 16 colleagues (39%) and anticoagulation by 13 (31.7%).

Conclusion

Our survey showed that there is considerable variation in the management of anti-thrombotic therapy surrounding left-sided EPS and ablation. Further studies are necessary to evaluate the right approach to these procedures.

Effects of COVID-19 Home Confinement on Eating Behaviour and Physical Activity: Results of the ECLB-COVID19 International Online Survey

BACKGROUND

Public health recommendations and governmental measures during the COVID-19 pandemic have resulted in numerous restrictions on daily living including social distancing, isolation and home confinement. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on health behaviours and lifestyles at home is undefined. Therefore, an international online survey was launched in April 2020, in seven languages, to elucidate the behavioural and lifestyle consequences of COVID-19 restrictions. This report presents the results from the first thousand responders on physical activity (PA) and nutrition behaviours.

METHODS

Following a structured review of the literature, the "Effects of home Confinement on multiple Lifestyle Behaviours during the COVID-19 outbreak (ECLB-COVID19)" Electronic survey was designed by a steering group of multidisciplinary scientists and academics. The survey was uploaded and shared on the Google online survey platform. Thirty-five research organisations from Europe, North-Africa, Western Asia and the Americas promoted the survey in English, German, French, Arabic, Spanish, Portuguese and Slovenian languages. Questions were presented in a differential format, with questions related to responses "before" and "during" confinement conditions.

RESULTS

1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%) were included in the analysis. The COVID-19 home confinement had a negative effect on all PA intensity levels (vigorous, moderate, walking and overall). Additionally, daily sitting time increased from 5 to 8 h per day. Food consumption and meal patterns (the type of food, eating out of control, snacks between meals, number of main meals) were more unhealthy during confinement, with only alcohol binge drinking decreasing significantly.

CONCLUSION

While isolation is a necessary measure to protect public health, results indicate that it alters physical activity and eating behaviours in a health compromising direction. A more detailed analysis of survey data will allow for a segregation of these responses in different age groups, countries and other subgroups, which will help develop interventions to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.

Effects of Ramadan Observance on Dietary Intake and Body Composition of Adolescent Athletes: Systematic Review and Meta-Analysis

To evaluate the effects of Ramadan observance on dietary intake, body mass and body composition of adolescent athletes (design: systematic review and meta-analysis; data sources: PubMed and Web of Science; eligibility criteria for selecting studies: single-group, pre-post, with or without control-group studies, conducted in athletes aged <19 years, training at least 3 times/week, and published in any language before 12 February 2020). Studies assessing body mass and/or body composition and/or dietary intake were deemed eligible. The methodological quality was assessed using ‘QualSyst’. Of the twelve selected articles evaluating body mass and/or body composition, one was of strong quality and eleven were rated as moderate. Ten articles evaluated dietary intake; four were rated as strong and the remaining moderate in quality. Continuation of training during Ramadan did not change body mass from before to the first week (trivial effect size (ES) = −0.011, p = 0.899) or from before to the fourth week of Ramadan (trivial ES = 0.069, p = 0.277). Additionally, Ramadan observance did not change body fat content from before to the first week (trivial ES = −0.005, p = 0.947) and from before to the fourth week of Ramadan (trivial ES = -0.057, p = 0.947). Lean body mass remained unchanged from before to the fourth week of Ramadan (trivial ES = −0.025, p = 0.876). Dietary data showed the intake of energy (small ES = -0.272, p = 0.182), fat (trivial ES = 0.044, p = 0.842), protein (trivial ES = 0.069, p = 0.720), carbohydrate (trivial ES = 0.075, p = 0.606) and water (trivial ES = −0.115, p = 0.624) remained essentially unchanged during as compared to before Ramadan. Continued training of adolescent athletes at least three times/week during Ramadan observance has no effect on body mass, body composition or dietary intake.

Effects of COVID-19 Home Confinement on Eating Behaviour and Physical Activity: Results of the ECLB-COVID19 International Online Survey

BACKGROUND

Public health recommendations and governmental measures during the COVID-19 pandemic have resulted in numerous restrictions on daily living including social distancing, isolation and home confinement. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on health behaviours and lifestyles at home is undefined. Therefore, an international online survey was launched in April 2020, in seven languages, to elucidate the behavioural and lifestyle consequences of COVID-19 restrictions. This report presents the results from the first thousand responders on physical activity (PA) and nutrition behaviours.

METHODS

Following a structured review of the literature, the "Effects of home Confinement on multiple Lifestyle Behaviours during the COVID-19 outbreak (ECLB-COVID19)" Electronic survey was designed by a steering group of multidisciplinary scientists and academics. The survey was uploaded and shared on the Google online survey platform. Thirty-five research organisations from Europe, North-Africa, Western Asia and the Americas promoted the survey in English, German, French, Arabic, Spanish, Portuguese and Slovenian languages. Questions were presented in a differential format, with questions related to responses "before" and "during" confinement conditions.

RESULTS

1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%) were included in the analysis. The COVID-19 home confinement had a negative effect on all PA intensity levels (vigorous, moderate, walking and overall). Additionally, daily sitting time increased from 5 to 8 h per day. Food consumption and meal patterns (the type of food, eating out of control, snacks between meals, number of main meals) were more unhealthy during confinement, with only alcohol binge drinking decreasing significantly.

CONCLUSION

While isolation is a necessary measure to protect public health, results indicate that it alters physical activity and eating behaviours in a health compromising direction. A more detailed analysis of survey data will allow for a segregation of these responses in different age groups, countries and other subgroups, which will help develop interventions to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.

Effects of COVID-19 Home Confinement on Eating Behaviour and Physical Activity: Results of the ECLB-COVID19 International Online Survey

BACKGROUND

Public health recommendations and governmental measures during the COVID-19 pandemic have resulted in numerous restrictions on daily living including social distancing, isolation and home confinement. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on health behaviours and lifestyles at home is undefined. Therefore, an international online survey was launched in April 2020, in seven languages, to elucidate the behavioural and lifestyle consequences of COVID-19 restrictions. This report presents the results from the first thousand responders on physical activity (PA) and nutrition behaviours.

METHODS

Following a structured review of the literature, the "Effects of home Confinement on multiple Lifestyle Behaviours during the COVID-19 outbreak (ECLB-COVID19)" Electronic survey was designed by a steering group of multidisciplinary scientists and academics. The survey was uploaded and shared on the Google online survey platform. Thirty-five research organisations from Europe, North-Africa, Western Asia and the Americas promoted the survey in English, German, French, Arabic, Spanish, Portuguese and Slovenian languages. Questions were presented in a differential format, with questions related to responses "before" and "during" confinement conditions.

RESULTS

1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%) were included in the analysis. The COVID-19 home confinement had a negative effect on all PA intensity levels (vigorous, moderate, walking and overall). Additionally, daily sitting time increased from 5 to 8 h per day. Food consumption and meal patterns (the type of food, eating out of control, snacks between meals, number of main meals) were more unhealthy during confinement, with only alcohol binge drinking decreasing significantly.

CONCLUSION

While isolation is a necessary measure to protect public health, results indicate that it alters physical activity and eating behaviours in a health compromising direction. A more detailed analysis of survey data will allow for a segregation of these responses in different age groups, countries and other subgroups, which will help develop interventions to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.

Effects of Aerobic-, Anaerobic- and Combined-Based Exercises on Plasma Oxidative Stress Biomarkers in Healthy Untrained Young Adults

Currently, it is well accepted that physical exercise-induced oxidative stress may damage biological structures and impair cellular functions. However, it is still unclear which type of exercise results in the greatest oxidative stress responses among a healthy untrained population. The aim of the present study was to compare the acute oxidative stress response (i.e., 0 to 20 min) following different types of exercise (anaerobic, aerobic, and combined). Ten healthy, untrained males (19.5 ± 1.7 years) performed three randomized exercise bouts: anaerobic (30 s Wingate test), aerobic (30 min at 60% maximal aerobic power (MAP)) or combined (anaerobic and aerobic). Venous blood samples were collected before, as well as at 0 (P0), 5 (P5), 10 (P10), and 20 (P20) min after each session. Rates of malondialdehyde (MDA) and antioxidant activities (i.e., glutathione peroxidase (GPX), superoxide dismutase (SOD), glutathione reductase (GR), α-tocopherol, and total antioxidant status (TAS)) were assessed. Independent of exercise type, plasma MDA, GPX, SOD, and GR contents increased above baseline, whereas plasma α-tocopherol decreased under baseline after the test sessions (p < 0.05). Aerobic and anaerobic exercises generated faster responses (at P0) when compared to the combined exercise (P5 to P10) for the majority of the tested parameters. Plasma TAS content only increased following the aerobic exercise at P10 (p = 0.03). Five to twenty-minutes post exercise, the highest MDA response was registered in the aerobic condition, and the highest GPX and SOD responses were recorded in the anaerobic (at P5) and aerobic (at P20) conditions (p < 0.05). In conclusion, aerobic, anaerobic, or combined exercises have the potential to acutely increase oxidative stress and antioxidant activities, but with different responses magnitude. These findings confirm that oxidative stress response seems to be dependent on the intensity and the duration of the physical exercise and may help in understanding how varying exercise bouts influence the degree of oxidative stress among healthy untrained young adults.

The Effect of (Poly)phenol-Rich Interventions on Cognitive Functions and Neuroprotective Measures in Healthy Aging Adults: A Systematic Review and Meta-Analysis

Context: As the food industry is continually involved in the development of new attractive alternative therapeutic agents, the evaluation of the beneficial impact of (poly)phenols on cognitive and brain function during aging has gained increasing interest. Objective: This systematic review and meta-analysis aimed to evaluate the acute and chronic effects of (poly)phenol-rich diet supplementation on cognitive function and brain health in aging adults. Data Sources: PubMed and Web of Science databases were searched for relevant randomized placebo-controlled trials (RCTs) published from inception to July 2019. Study Selection: Two researchers independently screened 4303 records, using the PICOS criteria: Participants were aging adults; Intervention was based on acute and/or chronic (poly)phenols-rich supplementation; Comparator was any comparator; Outcomes included cognitive function and neuroprotective measures; and Study design was RCTs. A third researcher was consulted when discrepancies arose. Fifteen high-quality (mean PEDro score = 8.8 ± 0.56) RCTs (total participants: 918 healthy older adults) were included in the final sample. Data Extraction: Information on study design, employed treatment, characteristics of participants, outcomes, and the correspondent assessing methods were extracted. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data Analysis and Results: A random-effects meta-analysis was used to pool estimates across studies. Effect size (ES) and its 95% confidence interval (CI) was calculated. Pooled results yielded a trivial ES (−0.2 to 0.03) for brain-derived neurotrophic factor and neuroinflammatory parameters and small (0.36) to moderate (0.82) ES for executive functions. Conclusion: This meta-analysis failed to provide evidence regarding the neuroprotective and anti-inflammatory effect of (poly)phenols supplementation in aging adults. However, findings from individual studies, included in this systematic review, suggest polyphenol-rich supplementation may improve some cognitive and brain functions in older adults. The beneficial effect of polyphenols seems to depend on ingested dose and bioavailability. Results suggest at least an intermediate dose (≥500 mg), and intermediate (≈9%) to high (43%) bioavailability rates are needed to cross the brain blood barrier and to exert a significant effect on cognitive health.

Effects of natural polyphenol-rich pomegranate juice on the acute and delayed response of Homocysteine and steroidal hormones following weightlifting exercises: a double-blind, placebo-controlled trial

BACKGROUND

Maximal strength-speed exercise is a powerful stimulus to acutely increase concentrations of circulating steroid hormones and homocysteine [Hcy]. There is some evidence that antioxidant beverages rich in polyphenols can attenuate [Hcy] levels and modulate endocrine responses in favor of an anabolic environment. Polyphenols-rich pomegranate (POM) have been reported to possess one of the highest antioxidant capacities compared to other purported nutraceuticals and other food stuffs. Studies focused on proving the beneficial effect of POM consumption during maximal strength exercises have only measured physical performance, muscle damage, oxidative stress and inflammatory responses, while POM effects on [Hcy] and hormonal adaptations are lacking. The aim of the present study was to investigate the effect of consuming natural polyphenol-rich pomegranate juice (POMj) on the acute and delayed [Hcy] and steroidal hormonal responses to a weightlifting exercises session.

METHODS

Nine elite weightlifters (21.0 ± 1 years) performed two Olympic-weightlifting sessions after ingesting either the placebo (PLA) or POMj supplements. Venous blood samples were collected at rest and 3 min and 48 h after each session.

RESULTS

Compared to baseline values, circulating cortisol [C] decreased (p < 0.01) and testosterone/cortisol [T/C] ratio increased immediately following the training session in both PLA and POMj conditions (p = 0.003 for PLA and p = 0.02 for POM). During the 48 h recovery period, all tested parameters were shown to recover to baseline values in both conditions with significant increases in [C] and decreases in [T/C] (p < 0.01 for PLA and p < 0.05 for POMj) from 3 min to 48 h post-exercises. Compared to PLA, a lower level of plasma testosterone [T] was registered 3 min post exercise using POMj supplementation (p = 0.012) and a significant decrease (p = 0.04, %change = - 14%) in plasma [Hcy] was registered during the 48 h recovery period only using POMj. A moderate correlation was observed between [Hcy] and [T] responses (p = 0.002, r = - 0.50).

CONCLUSION

In conclusion, supplementation with POMj has the potential to attenuate the acute plasma [T] response, but did not effect 48 h recovery kinetics of [Hcy] following weightlifting exercise. Further studies investigating androgen levels in both plasma and muscular tissue are needed to resolve the functional consequences of the observed acute POMj effect on plasma [T].

TRIAL REGISTRATION

Clinical Trials.gov, ID: NCT02697903. Registered 03 March 2016.

Psychological consequences of COVID-19 home confinement: The ECLB-COVID19 multicenter study

BACKGROUND

Public health recommendations and government measures during the COVID-19 pandemic have enforced restrictions on daily-living. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on mental health and emotional wellbeing is undefined. Therefore, an international online survey (ECLB-COVID19) was launched on April 6, 2020 in seven languages to elucidate the impact of COVID-19 restrictions on mental health and emotional wellbeing.

METHODS

The ECLB-COVID19 electronic survey was designed by a steering group of multidisciplinary scientists, following a structured review of the literature. The survey was uploaded and shared on the Google online-survey-platform and was promoted by thirty-five research organizations from Europe, North-Africa, Western-Asia and the Americas. All participants were asked for their mental wellbeing (SWEMWS) and depressive symptoms (SMFQ) with regard to "during" and "before" home confinement.

RESULTS

Analysis was conducted on the first 1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%). The COVID-19 home confinement had a negative effect on both mental-wellbeing and on mood and feelings. Specifically, a significant decrease (p < .001 and Δ% = 9.4%) in total score of the SWEMWS questionnaire was noted. More individuals (+12.89%) reported a low mental wellbeing "during" compared to "before" home confinement. Furthermore, results from the mood and feelings questionnaire showed a significant increase by 44.9% (p < .001) in SMFQ total score with more people (+10%) showing depressive symptoms "during" compared to "before" home confinement.

CONCLUSION

The ECLB-COVID19 survey revealed an increased psychosocial strain triggered by the home confinement. To mitigate this high risk of mental disorders and to foster an Active and Healthy Confinement Lifestyle (AHCL), a crisis-oriented interdisciplinary intervention is urgently needed.

Psychological consequences of COVID-19 home confinement: The ECLB-COVID19 multicenter study

BACKGROUND

Public health recommendations and government measures during the COVID-19 pandemic have enforced restrictions on daily-living. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on mental health and emotional wellbeing is undefined. Therefore, an international online survey (ECLB-COVID19) was launched on April 6, 2020 in seven languages to elucidate the impact of COVID-19 restrictions on mental health and emotional wellbeing.

METHODS

The ECLB-COVID19 electronic survey was designed by a steering group of multidisciplinary scientists, following a structured review of the literature. The survey was uploaded and shared on the Google online-survey-platform and was promoted by thirty-five research organizations from Europe, North-Africa, Western-Asia and the Americas. All participants were asked for their mental wellbeing (SWEMWS) and depressive symptoms (SMFQ) with regard to "during" and "before" home confinement.

RESULTS

Analysis was conducted on the first 1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%). The COVID-19 home confinement had a negative effect on both mental-wellbeing and on mood and feelings. Specifically, a significant decrease (p < .001 and Δ% = 9.4%) in total score of the SWEMWS questionnaire was noted. More individuals (+12.89%) reported a low mental wellbeing "during" compared to "before" home confinement. Furthermore, results from the mood and feelings questionnaire showed a significant increase by 44.9% (p < .001) in SMFQ total score with more people (+10%) showing depressive symptoms "during" compared to "before" home confinement.

CONCLUSION

The ECLB-COVID19 survey revealed an increased psychosocial strain triggered by the home confinement. To mitigate this high risk of mental disorders and to foster an Active and Healthy Confinement Lifestyle (AHCL), a crisis-oriented interdisciplinary intervention is urgently needed.

Practical recommendations to improve sleep during Ramadan observance in healthy practitioners of physical activity

BACKGROUND

During the month of Ramadan, many Muslims continue to exercise and/or to compete in sporting events. However, the combination of Ramadan observance (RO) and physical activity (PA) is likely to be associated with disrupted sleep-wake patterns.

OBJECTIVES

to (i) evaluate the effects of RO on sleep patterns in practitioners of PA and (ii) provide some evidence-based practical recommendations to improve an active individual's sleep patterns during RO.

METHODS

The entire content of two databases, PubMed/MEDLINE and Web of Science was searched for relevant articles through March, 25 2019. All accepted articles concerned healthy practitioners of PA and have assessed sleep quantity and/or quality and/or daily naps, whether based on objective or subjective methods.

RESULTS

Thirteen studies evaluated total sleep time (TST) of active individuals in relation to RO; TST decreased in five studies, increased in one and remained unchanged in seven studies. Sleep quality was self-estimated in five studies, with three noting a decreased quality of sleep and two reporting no change. The duration of daily naps was increased in two studies. Conclusions and practical recommendations: Continuation of PA during RO did not decrease TST. However, no firm conclusions can be drawn regarding sleep quality/characteristic and daily naps durations. Sleep quantity and quality should be evaluated in order to counteract sleep disturbances. Physically active individuals should avoid large late night meal, and if possible take 20- to 30- minute daytime naps. A 10- minute shower at ∼40°C and a self-administered 6-min mindfulness induction video may be helpful immediately before bedtime. Tryptophan (1g/day) or melatonin (5- 8mg) supplements may also improve sleep characteristics.

Effects of Playing Surface on Physical, Physiological, and Perceptual Responses to a Repeated-Sprint Ability Test: Natural Grass Versus Artificial Turf

PURPOSE

The effect of playing surface on physical performance during a repeated-sprint ability (RSA) test and the mechanisms for any potential playing-surface-dependent effects on RSA performance are equivocal. The purpose of this study was to investigate the effect of natural grass (NG) and artificial turf (AT) on physical performance, ratings of perceived exertion, feeling scale, and blood biomarkers related to anaerobic contribution (blood lactate [Lac]), muscle damage (creatine kinase and lactate dehydrogenase), inflammation (C-reactive protein), and immune function (neutrophils [NEU], lymphocytes [LYM], and monocytes) in response to an RSA test.

METHODS

A total of 9 male professional football players from the same regional team completed 2 sessions of RSA testing (6 × 30 s interspersed with a 35-s recovery) on NG and AT in a randomized order. During the RSA test, total (sum of distances) and peak (highest distance covered in a single repetition) distance covered were determined using a measuring tape, and the decrement in sprinting performance from the first to the last repetition was calculated. Before and after the RSA test, ratings of perceived exertion, feeling scale, and Lac, creatine kinase, lactate dehydrogenase, C-reactive protein, NEU, LYM, and monocytes were recorded in both NG and AT conditions.

RESULTS

Although physical performance declined during the RSA blocks on both surfaces (P = .001), the distance covered declined more on NG (15%) than on AT (11%; P = .04; effect size [ES] = -0.34; 95% confidence interval [CI], -1.21 to 0.56) with a higher total distance covered (+6% [2%]) on AT (P = .018; ES = 1.15; 95% CI, 0.16 to 2.04). In addition, lower ratings of perceived exertion (P = .04; ES = -0.49; 95% CI, -1.36 to 0.42), Lac, NEU, and LYM (P = .03; ES = -0.80; 95% CI, -1.67 to 0.14; ES = -0.16; 95% CI, -1.03 to 0.72; and ES = -0.94; 95% CI, -1.82 to 0.02, respectively) and more positive feelings (P = .02; ES = 0.81; 95% CI, -0.13 to 1.69) were observed after the RSA test performed on AT than on NG. No differences were observed in the remaining physical and blood markers.

CONCLUSION

These findings suggest that RSA performance is enhanced on AT compared with NG. This effect was accompanied by lower fatigue perception and Lac, NEU, and LYM and a more pleasurable feeling. These observations might have implications for physical performance in intermittent team-sport athletes who train and compete on different playing surfaces.

Effects of Ramadan fasting on athletes' hematological indices: a systematic review

OBJECTIVE

To evaluate the effects of Ramadan fasting on hematological data in athletes through a systematic appraisal of the literature.

DESIGN

Systematic review Data sources: The entire content of two databases, PubMed/MEDLINE and Web of Science Eligibility criteria for selecting studies: Ramadanrelated measurements of any hematological indices in athletes were considered. Both single-group pre-post with and without a control group studies conducted in athletes and published in English language before December 31, 2018 were included. Study appraisal: The methodological quality of the studies identified was assessed using 'QualSyst'.

RESULTS

Of nine selected articles, eight were of moderate quality and only one was of strong quality. The main problem to date has been a lack of appropriate controls. Compared to before Ramadan, hematocrit and hemoglobin values increased in three studies, decreased in one study and did not change in one study during Ramadan fasting. Another study reported increased hematocrit and a puzzling decrease of hemoglobin during as compared to before Ramadan fasting. In most studies, blood platelet counts and the limited number of immune function used to date remainedunchanged.

CONCLUSIONS

All reported changes in hematological indices remained within the normal reference range of the laboratory. Therefore, regular training can continue safely during Ramadan fasting from a hematological view point.

Effects of Ramadan fasting on physical performances in soccer players: a systematic review

OBJECTIVE

To evaluate the effects of Ramadan fasting on physical performance measures in soccer players through a systematic appraisal of the literature.

DESIGN

Systematic review Data sources: The entire content of two databases, PubMed/MEDLINE and Web of Science. Eligibility criteria for selecting studies: Both singlegroup, pre-post and crossover design studies published in any language before March 15, 2019 were included. Assessments of physical performance were accepted for analysis. study appraisal: The methodological quality of the included studies was assessed using 'QualSyst'.

RESULTS

Of 18 selected articles, 16 were generally of strong quality and the remaining studies (n=2) were rated as moderate, although most lacked significant details about the Ramadan fasting. Most studies showed that Ramadan fasting did not impair short-term maximal performances in soccer players (i.e., vertical jump, sprint performance, maximal voluntary contraction, hand grip, agility performance). During the 30-s Wingate test, the repeated sprint exercise (RSE) tasks, and the long-duration incremental and non-incremental exercises, most studies reported some negative effects of Ramadan fasting even when the training load was maintained. For the soccer specific skills and test with ball, most studies reported that there was no significant negative effects of the fasting month on performance when the training load was maintained or slightly reduced during the Ramadan.

CONCLUSIONS

The continuance of training during Ramadan fasting, with maintained training load, has no negative effects on short-term maximal performances and soccer specific skills and test with ball. However, performances of the 30-s Wingate test, the RSE tasks, and the long-duration incremental and non-incremental exercises were significantly impaired during Ramadan fasting even when the training load was maintained.

P955Assessment of coronary and myocardial reperfusion as well as left ventricular infarct size and function following streptokinase administration immediately after Primary coronary intervention

Background

Reperfusion injury might be considered a consequence of insufficient myocardial perfusion (MP) due to microthrombi (MT) embolization into the microcirculation. Streptokinase (SK) a fibrinolytic agent, if injected into the culprit artery immediately after primary percutaneous coronary intervention (PPCI) might tackle and dissolve these MT resulting in better MP and function.

Methods

Sixty four patients presenting within 24 hours by their first ST elevation myocardial infarction, underwent PPCI, then equally divided into 2 groups; G1 received 250 kU of intracoronary SK (ICSK) vs saline in G2. Successful coronary perfusion was defined as corrected TIMI frame count (cTFC) <28 frames, and successful MP as TIMI myocardial blush grade (TMBG) 3. Evaluation of left ventricular (LV) function was done by comparing the baseline LV global longitudinal strain (GLS) before and 1-month after PPCI. Assessment of infarct size was done by measuring peak CK-MB, CK-MB area under the curve and ST segment resolution (STR) 90 min after PPCI.

Results

Thirty minutes after ICSK, cTFC (fig) was significantly lower (P≤0.05), while TMBG (fig) was significantly higher (P≤0.02) in G1 vs G2. Peak CK-MB, CK-MB area under the curve were significantly lower (P≤0.015 & P≤0.001 respectively) while STR≥70%was significantly higher in G1 (P≤0.045). Multivariate logistic regression analysis showed that the likelihood of achieving successful MP post-PPCI is associated with ICSK administration [OR=0.123, 95% CI (0.02–0.75), P≤0.024] and total ischemic time (ROC curve). Multivariate linear regression analysis showed that each of, immediate ICSK administration post-PPCI and TMBG were independent predictors for LV GLS improvement after one month. No significant difference in bleeding risk between G1&2 (p=1).

Conclusion

ICSK given immediately after primary PCI was an independent predictor of successful coronary and myocardial reperfusion. It significantly led to reduction of infarct size and improvement of LV GLS.

Comparison of 2- and 3-Minute Inter-Repetition Rest Periods on Maximal Jerk Technique and Power Maintenance

Purpose: The aim of this study was to examine the effect of 3- vs. 2-minute inter maximal-repetition rest period (IMRRP) on maintaining jerk technical efficiency and power production during two successive maximal repetitions of Clean & Jerk (C&J). Methods: In a randomized, within subject, repeated measures design, nine elite-weightlifters (age: 24.4 ± 3.6 years, body mass: 77.2 ± 7.1 kg, height 176.0 ± 6.4 cm and 1RM C&J: 170.0 ± 5.0 kg) performed 2-separate testing sessions using 2 (IMRRP-2) and 3 (IMRRP-3) -minute IMRRP, while barbell kinematics and kinetics and joint kinematics were recorded. Results: Statistical analysis showed that one minute longer IMRRP enhanced the maintenance of optimal jerk technique evidenced by reducing declines in peak vertical barbell displacement (2.74%; p = .03), peak barbell velocity (2.89%; p = .03), and peak knee (1.61%; p = .03) and hip extensions (1.59%; p = .03) during the drive phase of the jerk. Additionally, IMRRP-3 led to maintaining optimal lifting strategy by reducing the increase in horizontal displacement during the descending (3.85%; p = .04) and ascending (5.42%; p = .02) phases. Increasing IMRRP from 2min to 3min was also shown to enhance kinetic variables evidenced by prompting higher peak vGRF (2.01%; p = .04) and power (2.55%; p = .04). Conclusion: To better identify an athlete's maximal jerk technique and power maintenance, the results of this study suggest 3min as more appropriate IMRRP during successive C&J at 100% 1RM.

Effect of napping opportunity at different times of day on vigilance and shuttle run performance

The aim of the present study was to examine the effect of a nap opportunity during the daytime realized at different times of day on physical and mental performance. Eighteen physically active males (age: 20.5 ± 3.0 years, height: 175.3 ± 5.9 cm, body-mass: 70.0 ± 8.6 kg) were tested under four experimental conditions: no-nap condition, nap at 13h00, nap at 14h00 and nap at 15h00. All nap durations were of 25-min and all tests were performed at 17h00. They performed a 5-m shuttle run test, which generated measures of the highest distance (HD) and total distance (TD). The rating of perceived exertion (RPE) was recorded after each of the six sprints in the 5-m shuttle run test. Vigilance was measured using a digit cancellation test. The results showed that TD at 17h00 was 4% greater after a nap at 14h00 than in the no-nap condition (+28 m, p < .05) or after the nap at 13h00 (+29 m, p < .05). HD was 8% higher (+9 m, p < .001) after a nap at 14h00 than in the no-nap condition and 7% higher after nap at 15h00 than in the no-nap condition (+7 m, p < .05). In addition, HD was 6% higher after nap at 14h00 (+7 m, p < .01) and 5% higher after nap at 15h00 (+9 m, p < .01) than HD after a nap at 13h00. Napping at 13h00 had no effect on physical performance at 17h00. No significant differences were observed between RPE and vigilance scores in the nap and no-nap conditions. In conclusion, napping for 25 min at 14h00 and 15h00 produces meaningful improvements in responses during repeated short-term maximal exercise tests performed at 17h00. Napping at 13h00 does not. Vigilance, as measured using a digit cancellation test, and RPE scores are not influenced by any of the nap opportunities.

Independent and Combined Effects of All-Out Sprint and Low-Intensity Continuous Exercise on Plasma Oxidative Stress Biomarkers in Trained Judokas

The purpose of this study was to assess oxidative stress biomarkers prior to and following different forms of exercise. Ten elite male judokas (age: 18.1 ± 1.7 years, athletic experience: 6 years with a training frequency of 6 Judo-sessions/week) performed three cycle ergometry sessions comprising a 30 s Wingate test (MAX), 30 min at 60% maximal-aerobic-power-output (LOW) or these two exercise protocols combined (COMBINED) in a repeated-measures design. Venous blood-samples were collected before, and 0(P0), 5(P5), 10(P10) and 20(P20) min after each exercise protocol and assessed for malondialdehyde concentration ([MDA]), glutathione peroxidase (GPX), superoxide dismutase (SOD) and glutathione reductase (GR) content, and total-antioxidant-status (TAS). Plasma [MDA] was found to be increased above baseline at P0 and P5 in the MAX, LOW and COMBINED conditions (p < 0.05), but was greater at P10 and P20 in the LOW condition compared to MAX and COMBINED conditions (p < 0.05). Blood GPX and SOD content increased above baseline at P0 in MAX and COMBINED and at P5 in LOW (p < 0.05), with GR content being similar between groups at P0 and P5 (p > 0.05). 20 min post-exercise, GPX, SOD, GR content and TAS were lower in the MAX compared to the LOW and COMBINED conditions (p < 0.05). In conclusion, the findings from this study reveal that redox-related biomarkers exhibited divergent response dynamics following different forms of exercise, which might have implications for understanding the mechanisms of exercise-induced skeletal muscle fatigue and adaptive remodeling.

Nap Opportunity During the Daytime Affects Performance and Perceived Exertion in 5-m Shuttle Run Test

Purpose

To compare the effect of different durations of nap opportunity during the daytime on repeated high-intensity short-duration performance and rating of perceived exertion (RPE).

Methods

Seventeen physically active men (age: 21.3 ± 3.4 years, height: 176.7 ± 5.9 cm, body mass: 71.8 ± 10.2 kg) performed a 5 m shuttle run test [to determine best distance (BD), total distance (TD), and fatigue index (FI)] under four conditions: a 25 min nap opportunity (N25), a 35 min nap opportunity (N35), a 45 min nap opportunity (N45), and control condition (no-nap) (N0). The sleep quality of each nap opportunity was evaluated using a scale ranging from 0 "no sleep" to 10 "uninterrupted, deep sleep throughout." The four conditions were performed in a random order. RPE was recorded after each repetition of the 5 m shuttle run test and the mean score was calculated.

Results

BD increased after N25 (+6%) and N45 (+9%) compared to N0 (p < 0.05) and was significantly higher after N45 compared to N35 (p < 0.05). Compared to N0, the three nap opportunity durations enhanced TD (p < 0.05) with greater enhancement after N45 compared to N25 (+8% vs. +3%) and N35 (+8% vs. +3%). For FI, no-significant differences were observed between the three nap opportunity durations and N0. The mean RPE score was significantly higher after N25 (+20%) and N0 (+19%) compared to N45 (p < 0.05). All participants were able to fall asleep during each nap condition with a sleep quality score of 6.9 ± 1.0, 7.0 ± 0.7, and 7.1 ± 0.8 for N25, N35, and N45.

Conclusion

A nap opportunity during the daytime was beneficial for physical performance and perceived exertion with the N45 being the most effective for improving performance and reducing fatigue during the 5 m shuttle run test. The implication of the present study is that athletes might benefit from a nap opportunity of 25, 35 or 45 min before practice or before a competition.

Observing Ramadan and sleep-wake patterns in athletes: a systematic review, meta-analysis and meta-regression

Objective

To evaluate the effect of observing Ramadan on athletes’ sleep patterns.

Design

Systematic review and meta-analysis.

Data sources

The entire content of PubMed/MEDLINE and Web of Science.

Eligibility criteria for selecting studies

Single-group, prepost and cross-over design studies conducted in athletes aged ≥18 years, training at least twice a week and published in English before 12 July 2018 were included. Studies assessing sleep quantity, quality, daytime sleepiness and/or daily naps based on objective or subjective methods were deemed eligible.

Study appraisal

The methodological quality was assessed using ‘QualSyst’.

Results

Of 13 selected articles, 7 were of strong quality, 3 were moderate and 3 were weak. 11 studies evaluated total sleep time (TST); this decreased during Ramadan in 4 studies, increased in 1 and remained unchanged in 6. Pooled TST findings indicated a moderate effect size (− 0.97, SE=0.37, 95% CI −1.69 to −0.25, t=−2.64, p=0.01) with significant heterogeneity but no publication bias. Meta-regressions showed no effects of study year, age, sample size, type of sport or competition level, but there were effects of country (with France and Tunisia being the most affected countries and Turkey the least affected, Q=32.14, p<0.0001) and study design (Q=7.74, p=0.02). Four studies measured self-reported sleep quality and it decreased in three studies. One study of sleep architecture reported more frequent waking and more light sleep during Ramadan. Daily nap duration was increased in two studies, but daytime sleepiness remained unchanged in four studies.

Conclusion

When athletes continue to train at least two times/week while observing Ramadan, TST is decreased compared with athletes’ baseline levels.

Acute Effects of an "Energy Drink" on Short-Term Maximal Performance, Reaction Times, Psychological and Physiological Parameters: Insights from a Randomized Double-Blind, Placebo-Controlled, Counterbalanced Crossover Trial

The current study examined the relationships between the effects of consuming a caffeine-containing “energy drink” upon (i) short-term maximal performance, (ii) reaction times, and (iii) psychological factors (i.e., mood state, ratings of perceived exertion (RPE), and affective load) and on physiological parameters (i.e., blood pressure and blood glucose). A randomized, double-blind, placebo-controlled, counterbalanced crossover design was implemented in this study. Nineteen male physical-education students (age: 21.2 ± 1.2 years; height: 1.76 ± 0.08 m; body-mass: 76.6 ± 12.6 kg) performed two test sessions: after drinking the “Red Bull’ beverage (RB) and after drinking a placebo (PL). One hour after ingestion of each drink, resting blood glucose and blood pressure were measured and the participants completed the Profile of Mood States questionnaire. Then, after a 5-min warm-up, simple visual reaction time and handgrip force were measured, and the 30-s Wingate test was performed. Immediately after these tests, the RPE, blood glucose, and blood pressure were measured, and the affective load was calculated. Differences between treatments were assessed using two-way repeated measures analyses of variance and paired t-tests, as appropriate. Relationships between the test variables were assessed using Bland–Altman correlations. Significant (i) improvements in peak and mean power output, handgrip force, pre- and post-exercise blood glucose, blood pressure, and vigor and (ii) reductions in reaction times, depression, confusion, fatigue, anger, anxiety, RPE, and affective load scores were observed after RB compared to PL. There were significant correlations of (i) physical performances and reaction times with (ii) RPE, affective load, and pre- and post-exercise blood glucose levels. Gains in peak and mean power were significantly correlated with reductions in fatigue, anxiety (peak power only), and anger (mean power only). The reduction of reaction times was significantly correlated with decreases in confusion and anger and with increases in vigor. Handgrip force and reaction times were significantly correlated with pre- and post-exercise blood pressures. We conclude that RB ingestion has a positive effect on physical performance and reaction times. This effect is related to ergogenic responses in both psychological (i.e., RPE, affective load, and mood state) and physiological (i.e., blood glucose and blood pressure) domains.

Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children

BACKGROUND

Musculoskeletal pain (MSP) is a public health problem among school-adolescents. This study aimed to identify the prevalence, risk factors and consequences of neck, shoulders and low-back pain among school-adolescents.

STUDY DESIGN

A cross-sectional study.

METHODS

School-adolescents aged from 12 to 18 years between October 2017 and February 2018 in South of Tunisia were recruited. Eligible participants were randomly selected and were asked to respond a four-section questionnaire. Factors independently associated with MSP were determined through multivariate logistic regression analysis.

RESULTS

Among 1221 enrolled subjects, shoulders, low-back and neck pain were reported in 43%, 35.8% and 32%, respectively. Multivariate analysis showed that independent risk factors of neck pain were female gender (Adjusted odds ratio AOR=1.55; P=0.002), using computer ≥4 hours/week (AOR=1.50; P=0.010), too low desk (AOR=2.30; P<0.001) and carrying schoolbag ≥60 minutes (AOR=1.58; P=0.008). Female gender (AOR=3.30; P<0.001), BMI ≥25 Kg/m2 (AOR=1.6; P=0.018), playing videogames ≥2 hours/day (AOR=2.37; P<0.001) and schoolbag weight to body weight ≥10% (AOR=1.46; P=0.026) were independently associated with shoulders pain. For low back-pain, independent risk factors were high-school grade (AOR=2.70; P<0.001), playing videogames ≥2 hours/day (AOR=1.83; P<0.001), watching TV≥12 hours/week (AOR=1.5; P=0.016), too low seat backrest (AOR=1.4; P=0.005) and too far seat-to-black (board) distance (AOR=1.5; P=0.041). School-adolescents consumed drugs for MSP in 19.5%, had sleep disturbance in 34% and aggressive behaviors in 22.8%.

CONCLUSIONS

The prevalence of MSP was substantially high among school-adolescents and their associated risk factors included sociodemographic factors, leisure activities and classroom furniture. An ergonomic specific and behavior-based school program is urgently needed.

Relationship between biomarkers of muscle damage and redox status in response to a weightlifting training session: effect of time-of-day

The aims of the present study were to: (1) investigate the effect of a weightlifting training session and time-of-day (TOD) upon biological parameters (i.e., oral temperature, hematological, C-reactive protein (CRP), and oxidative stress) and (2) assess their possible link with muscle damage responses. Nine weightlifters (21 ± 0.5 years) performed, in a randomized order, three Olympic-Weightlifting sessions (i.e., at 08:00, 14:00, and 18:00). Blood samples were collected at rest, 3 min and 48 h after each training session. Between pre- and post-training session, ANOVA showed significant increases in oxidative stress markers at the three TODs (p < 0.01) and significant increases for creatine kinase (CK) and lactate dehydrogenase (LDH) only at 08:00 and 18:00 (p < 0.05). At rest, the results showed a significant diurnal variation for the majority of the selected parameters except for malondialdehyde (MDA), total bilirubin, and CRP with higher values observed at 18:00 (p < 0.05). After the training session, given the higher rate of increase during the morning session, these diurnal variations persisted for temperature and WBC (p < 0.01) and were suppressed for CK, LDH, uric acid (UA), catalase, and glutathione peroxidase. The main significant correlations (p < 0.001) were observed between: (1) CK and MDA (r = 0.6) and CK and UA (r = 0.66 and r = 0.82) during the morning and evening training sessions; (2) CK and CRP only during the morning session (r = 0.5); and (3) CRP and WBC during the three training sessions (r = 0.8). In conclusion, the present findings: (1) confirm that the muscle damage responses could be induced by a high level of oxidative stress and (2) suggest to avoid scheduling training sessions in the morning given the higher muscle damage, inflammatory, and oxidative responses at this TOD.

Diurnal Variation of Short-Term Repetitive Maximal Performance and Psychological Variables in Elite Judo Athletes

Objectives: The aim of this study was to examine the effect of time of day on short-term repetitive maximal performance and psychological variables in elite judo athletes. Methods: Fourteen Tunisian elite male judokas (age: 21 ± 1 years, height:172 ± 7 cm, body-mass: 70.0 ± 8.1 kg) performed a repeated shuttle sprint and jump ability (RSSJA) test (6 m × 2 m × 12.5 m every 25-s incorporating one countermovement jump (CMJ) between sprints) in the morning (7:00 a.m.) and afternoon (5:00 p.m.). Psychological variables (Profile of mood states (POMS-f) and Hooper questionnaires) were assessed before and ratings of perceived exertion (RPE) immediately after the RSSJA. Results: Sprint times (p > 0.05) of the six repetition, fatigue index of sprints (p > 0.05) as well as mean (p > 0.05) jump height and fatigue index (p > 0.05) of CMJ did not differ between morning and afternoon. No differences were observed between the two times-of-day for anxiety, anger, confusion, depression, fatigue, interpersonal relationship, sleep, and muscle soreness (p > 0.05). Jump height in CMJ 3 and 4 (p < 0.05) and RPE (p < 0.05) and vigor (p < 0.01) scores were higher in the afternoon compared to the morning. Stress was higher in the morning compared to the afternoon (p < 0.01). Conclusion: In contrast to previous research, repeated sprint running performance and mood states of the tested elite athletes showed no-strong dependency of time-of-day of testing. A possible explanation can be the habituation of the judo athletes to work out early in the morning.

Incidence and risk factors of peripheral venous catheter-related adverse events in cardiology department of a Tunisian university hospital: A prospective observational study

AIM

The purpose of our study was to determine the incidence and risk factors of Peripheral Venous Catheter-Related Adverse Events (PVCAEs) in a cardiology department of a university hospital.

PATIENTS AND METHODS

We carried out a prospective observational study from Mars 2017 to May 2017 in the cardiology department of the University Hospital of Farhat Hached in Sousse, Tunisia. During this period, we actively followed-up all inserted PVCs (every 12hours) from insertion up to 48hours after removal. Regression analyses were applied and significance limits were set at P<0.05.

RESULTS

Data were analysed for 210 PVCs (794 PVC-days) in 148 patients. The incidence of PVCAEs was 33.33% with density of incidence of 8.81/1000 PVC-days. PVCAEs were mainly pain (50%) and mechanical events (31.42%). Infections accounted for 11.42%. The most frequent mechanical PVCAEs, was haematoma (15.71%). Multivariate analysis revealed as independent factors for the occurrence of PVCAEs: the hydro electrolytic nature of the injected product (OR=13.42, P<10-3), the medicinal nature of the injected product (OR=5.08, P=0.003), bad cutaneous state (OR=8.08, P=0.003), admission during nightshift (OR=3.76; P=0.014) and advanced age (OR=1.04, P=0.042).

CONCLUSION

Multicenter studies would be very useful to better analyze risk factors associated with PVCAEs.

Effect of 2- vs. 3-Minute Interrepetition Rest Period on Maximal Clean Technique and Performance

Ammar, A, Riemann, BL, Abdelkarim, O, Driss, T, and Hökelmann, A. Effect of 2- vs. 3-minute interrepetition rest period on maximal clean technique and performance. J Strength Cond Res 34(9): 2548-2556, 2020-Currently, it is widely accepted that adopting a long rest period (3-5 minutes) during maximal strength and power exercise is of importance in reducing acute fatigue and maintaining power and technique proficiency. However, despite the fact that weightlifting is an example of maximal strength exercise, only 2 minutes are officially allowed when athletes attempt 2 successive lifts. The purpose of this study was to compare 3- vs. 2-minute intermaximal repetition rest periods (IMRRPs) on performance, rate of perceived exertion (RPE), technical efficiency, and power production during 2 successive maximal repetitions of clean & jerk (C&J). Nine elite weightlifters (age: 24.4 ± 3.6 years, body mass: 77.2 ± 7.1 kg, height 176.0 ± 6.4 cm, and 1 repetition maximum C&J: 170.0 ± 5.0 kg) performed 2 separate testing sessions using 2-minute IMRRP (IMRRP-2) and 3-minute IMRRP (IMRRP-3), in a randomized order, while barbell kinematics and kinetics were recorded. Results showed that the longer IMRRP-3 minutes led to the maintenance of clean technique (from the first to the second repetition) evidenced by a 1.86% lower decline in peak vertical displacement (p = 0.03) and attenuation of increased peak horizontal displacements with a 1.74% (p = 0.03) less backward movement during the first pull, a 3.89% (p = 0.008) less forward movement during the second pull, and a 4.7% (p = 0.005) less backward movement during the catch phase. In addition, attenuation of peak velocity (2.22%; p = 0.02), peak vertical ground reaction force (1.70%; p = 0.03), and peak power (2.14%; p = 0.02) declines were shown using IMRRP-3 compared with IMRRP-2. Increasing IMRRP from 2 to 3 minutes was also shown to decrease RPE values (8.02%; p = 0.008) and to enhance supramaximal C&J performance (1.55%; p = 0.003). The results of this study suggest 3 minutes to be the most advantageous IMRRP in terms of maintaining technical efficiency, power output, reducing fatigue perception, and enhancing performance in elite weightlifters.

Effect of adding midazolam to bupivacaine during rectus sheath block: a randomised controlled trial

BACKGROUND

Various adjuvants have been tried to improve quality and increase duration of local anaesthetics during various nerve blocks. We aimed to evaluate the effect of adding midazolam to bupivacaine on rectus sheath (RS) block in patients undergoing umbilical or epigastric hernia repair.

METHODS

In all, 60 adult patients were divided into two equal groups, each group included 30 patients. Group I received 20 ml of bupivacaine hydrochloride 0.25% + midazolam 50 μg/kg in 2 ml saline 0.9% (Midazolam group, n = 30), whereas Group II received 20 ml of bupivacaine hydrochloride 0.25% + 2 ml saline (Control group, n = 30) for RS block on each side. The primary outcome was post-operative 48 h morphine consumption, whereas secondary outcomes included analgesia duration, post-operative pain, as evaluated by visual analogue scale (VAS) for pain scoring at 1, 2, 6, 12, 24 and 48 h post-operatively, reported post-operative nausea and or vomiting (PONV), somnolence or any adverse drug reactions.

RESULTS

The current study showed that addition of midazolam to bupivacaine for RS blockade provided good analgesia as evidenced by a statistically significant less morphine consumption in the post-operative 48 h [11.2 (5.3-18.3) vs. 25.9 (15.2-31.0) mg, P = 0.002], longer duration of analgesia, lower VAS during post-operative 48 h, lower incidence of PONV, somnolence and pruritus.

CONCLUSION

Midazolam addition to bupivacaine for RS blockade provided adjuvant analgesia as supported by less morphine consumption, longer duration of analgesia, and lower VAS score.

Kinetic and kinematic patterns during high intensity clean movement: searching for optimal load

The aim of the present study was to investigate loading effects on kinematic and kinetic variables among elite-weightlifters in order to identify an optimal training load to maximize power production for clean-movement. Nine elite-weightlifter (age: 24 ± 4years, body-mass: 77 ± 6.5kg, height: 176 ± 6.1cm and 1RM clean: 170 ± 5kg) performed 2 separate repetitions of the clean using 85, 90, 95% and 100%, in a randomized order, while standing on a force platform and being recorded using 3D-capture-system. Differences in kinematics (barbell displacement, velocity and acceleration) and kinetics (power, vertical ground reaction force (vGRF), rate of force development (RFD), and work) across the loads were statistically assessed. Results revealed significant load effects for the majority of the studied parameters (p < 0.01) and showed that typical bar-displacement, greatest bar-velocity and peak-power were achieved at 85 and 90% 1RM (p < 0.001). Additionally greater average power was shown for 90 and 95% (p < 0.01) and greater work and vGRF were shown for 90, 95 and 100% than 85% 1RM (p < 0.05). Load had no significant effect on peak-vGRF and peak-RFD (p > 0.05). The results of this study, suggest 90% 1RM to be the most advantageous load to train explosive-force and to enhance power-outputs while maintaining technical efficiency in elite-weightlifters.

Acute and delayed responses of steroidal hormones, blood lactate and biomarkers of muscle damage after a resistance training session: time-of-day effects

BACKGROUND

The present study aimed to investigate the effect of time-of-days (TOD) on some biochemical and hormonal responses after resistance training sessions.

METHODS

Ten trained subjects (22±2 years) performed, in randomized order, three resistance-training-sessions at 7 a.m., 1 p.m. and 5 p.m. Each training-session included six upper and lower body resistance exercises with 3×10 repetitions. Blood lactate (Lac), creatine kinase (CK), lactate dehydrogenase (LDH), cortisol (C) and testosterone (T) were collected at rest, 3 min and 48 h after each-session.

RESULTS

At rest, steroidal hormones were higher in the morning compared to the evening (P<0.01), whereas, no significant TOD effect on Lac, CK or LDH was observed. 3min after training, whatever the TOD, Lac, CK and T increased significantly (P<0.001). However, a significant decrease in C and a significant increase of T/C ratio were registered only after morning training. 3 min and even 48 h after training, the diurnal variations (i.e., morning to evening) of CK and C have been altered with higher early evening values of CK and lower one of C; whereas, T, Lac and LDH conserved their resting diurnal variation. Additionally, 48 h after the morning session, CK and T/C ratio remained elevated compared to the baseline levels.

CONCLUSIONS

In conclusion, resistance exercises soliciting both lower and upper limbs seems to alter the diurnal variation of CK and C, to enhance the morning anabolism/catabolism status and to produce more favorable environment for muscular adaptation up to 48 h post-training.

Estimating genetic potential of biofuel forest hardwoods to withstand metal toxicity in industrial effluent under dry tropical conditions

Biofuel tree species are recognized as a promising alternative source of fuel to conventional forms. Additionally, these tree species are also effective in accumulating toxic heavy metals present in some industrial effluents. In developing countries such as Pakistan, the use of biofuel tree species is gaining popularity not only for harvesting economical and environmentally friendly biofuel, but also to sequester poisonous heavy metals from industrial wastewater. This study was aimed at evaluating the genetic potential of two biofuel species, namely, Jatropha curcas and Pongamia pinnata, to grow when irrigated with industrial effluent from the Pak-Arab Fertilizer Factory Multan, Southern Punjab, Pakistan. The growth performances of one-year-old seedlings of both species were compared in soil with adverse physiochemical properties. It was found that J. curcas was better able to withstand the toxicity of the heavy metals present in the fertilizer factory effluent. J. curcas showed maximum gain in height, diameter, and biomass production in soil irrigated with 75% concentrated industrial effluent. In contrast, P. pinnata showed a significant reduction in growth in soil irrigated with more than 50% concentrated industrial effluent, indicating that this species is less tolerant to higher toxicity levels of industrial effluent. This study identifies J. curcas as a promising biofuel tree species that can be grown using industrial wastewater.

Temporal specificity of training: intra-day effects on biochemical responses and Olympic-Weightlifting performances

The aim of this study was to investigate the performance of an Olympic-Weightlifting session training at three times of the day on the performance related to biochemical responses. Nine weightlifters (21 ± 0.5 years) performed, in randomised order, on three Olympic-Weightlifting training (snatch, clean and jerk) sessions (08:00 a.m., 02:00 p. m., 06:00 p. m.). Blood samples were collected: before, 3 min and 48 h after each training session. Haematological parameters and markers of muscle injury were assessed. Resting oral temperature and rating of perceived exertion (RPE) were also assessed during each session. ANOVA showed that the performance was better (P < 0.001) at 02:00 p. m. with a less RPE (P < 0.01) compared to the morning and the evening sessions while there was higher (P < 0.05) oral temperature at 06:00 p. m. versus 08:00 a.m. and 02:00 p. m. Muscle damage changed immediately (without significant effect after 48 h) after the training sessions with lower values ​​in the evening compared to the morning. In conclusion, the afternoon training is more effective than morning or evening sessions for weightlifters. Therefore, coaches and weightlifters should be advised to schedule their training session in the afternoon hour.

Specialty choices of medical students and house officers in Karachi, Pakistan

Unerstanding patterns of career choices inmedicine is importnat for educators and policy-makers to plan the supply of specialists. This study analysed the career choices made by medical students and house officers in 2 private and 2 public medical schools in Karachi, Pakistan. An anonymous, self-administered and gynaecology were the 4 highest ranked specialties, with internal medicine ranked top as both the 1st and 2nd choice. Internal medicine was the 1st choice for significantly more students in public than private medical colleges (22.2% versus 1l4.9%). Students from private medical institutions chose a wider range of specialties than those from publicly-funded colleges. A high proportion of medical students and graduates in Karachi favour the same medical specialties, which may lead to saturation in those areas of specialization.

Human monoclonal antibodies targeting carbonic anhydrase IX for the molecular imaging of hypoxic regions in solid tumours

Background:

Hypoxia, which is commonly observed in areas of primary tumours and of metastases, influences response to treatment. However, its characterisation has so far mainly been restricted to the ex vivo analysis of tumour sections using monoclonal antibodies specific to carbonic anhydrase IX (CA IX) or by pimonidazole staining, after the intravenous administration of this 2-nitroimidazole compound in experimental animal models.

Methods:

In this study, we describe the generation of high-affinity human monoclonal antibodies (A3 and CC7) specific to human CA IX, using phage technology.

Results:

These antibodies were able to stain CA IX ex vivo and to target the cognate antigen in vivo. In one of the two animal models of colorectal cancer studied (LS174T), CA IX imaging closely matched pimonidazole staining, with a preferential staining of tumour areas characterised by little vascularity and low perfusion. In contrast, in a second animal model (SW1222), distinct staining patterns were observed for pimonidazole and CA IX targeting. We observed a complementary pattern of tumour regions targeted in vivo by the clinical-stage vascular-targeting antibody L19 and the anti-CA IX antibody A3, indicating that a homogenous pattern of in vivo tumour targeting could be achieved by a combination of the two antibodies.

Conclusion:

The new human anti-CA IX antibodies are expected to be non-immunogenic in patients with cancer and may serve as broadly applicable reagents for the non-invasive imaging of hypoxia and for pharmacodelivery applications.

Improvement of the etodolac purity test by reversed phase high-performance liquid chromatography

The resolution of etodolac by reversed phase HPLC applied in the European Pharmacopeia (EP) was found to be greatly affected by using methanol as the injection solvent and the system of gradient elution, which leads to peak broadening as well as poor separation of etodolac from the impurities such as 2-(7-ethylindol-3-yl) ethanol respectively. Changing the type of injection solvent (methanol) by the mobile phase, which is a mixture of methanol, buffer (KH2PO4, PH = 7), and acetonitril as well as monitoring the gradient program (increasing the polarity) leads to enhance the selectivity and efficiency of the analysis of etodolac by eliminating the peak broadening and markedly improving the separation of etodolac from 2-(7-ethylindol-3-yl) ethanol. The method was validated by parameters such as selectivity, repeatability, and intermediate precision.

Neuropeptide Y facilitates activity-based-anorexia

The hypothesis that treatment with neuropeptide Y (NPY) can increase running activity and decrease food intake and body weight was tested. Female rats with a running wheel lost more weight than sedentary rats and ran progressively more as the availability of food was gradually reduced. When food was available for only 1h/day, the rats lost control over body weight. Correlatively, the level of NPY mRNA was increased in the hypothalamic arcuate nucleus. This phenomenon, activity-based-anorexia, was enhanced by intracerebroventricular infusion of NPY in rats which had food available during 2h/day. By contrast, NPY stimulated food intake but not wheel running in rats which had food available continuously. These findings are inconsistent with the prevailing theory of the role of the hypothalamus in the regulation of body weight according to which food intake is a homeostatic process controlled by "orexigenic" and "anorexigenic" neural networks. However, the finding that treatment with NPY, generally considered an "orexigen", can increase physical activity and decrease food intake and cause a loss of body weight is in line with the clinical observation that patients with anorexia nervosa are physically hyperactive and eat only little food despite having depleted body fat and up-regulated hypothalamic "orexigenic" peptides.