Metabolism and exretion of 3-hydroxyphenyltrimethylammonium and neostigmine

1. Carbon-14 labelled 3-hydroxyphenyltrimethylammonium (3-OH PTMA), an active metabolite of neostigmine, has been given to rats by intramuscular injection and its excretion, distribution and metabolism have been studied.2. A method is described for the separation and estimation of free and conjugated 3-OH PTMA in urine and liver.3. In the first hour, about 20% of a dose is excreted in the urine as free 3-OH PTMA and thereafter the rate of excretion of glucuronide conjugate exceeds that of free 3-OH PTMA. In 24 hr 76.8% of the dose is excreted in urine mainly as the conjugate.4. The peak concentration of radioactivity in blood occurs within 30 min and in liver within 1 hr after administration. More than 90% of the radioactivity in liver occurs as the glucuronide conjugate. Relatively high concentrations of radioactivity were found in liver and heart.5. In the hen 3-OH PTMA is rapidly excreted by renal tubular secretion.6. Experiments with carbon-14 labelled neostigmine show that up to 1 hr mainly unchanged neostigmine is excreted in urine; thereafter increasing amounts of free 3-OH PTMA and its glucuronide conjugate are excreted.7. It is concluded that the duration of action of neostigmine is determined by its rapid renal excretion and by its metabolism to the glucuronide conjugate of 3-OH PTMA.

The Psychological Well-Being of University Students amidst COVID-19 Pandemic: Scoping review, systematic review and meta-analysis

This review aimed to summarise the current evidence relating to university students' psychological well-being amidst the COVID-19 pandemic. A scoping review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, was first conducted to determine if the evidence can be systematically reviewed and meta-analysed. The search was performed via Google Scholar, MEDLINE/PubMed, Science Direct, Scopus and Web of Science. A total of 90 original articles were selected for the scoping review. Meta-analysis of a total of 46,284 cases revealed an overall pooled prevalence rate of 29.1% (95% confidence interval [CI]: 20.9-39.0; K = 9, N = 22357) for anxiety symptoms and 23.2% (95% CI: 15.7-32.9; K = 12, N = 23927) for depression symptoms. This data revealed that COVID-19 had a significant impact on university students' psychological well-being.

The excretion and metabolism of oral 14C-pyridostigmine in the rat

1. Pyridostigmine labelled with carbon-14 in the methyl group of the quaternary nitrogen has been used to investigate the excretion and metabolism of the drug after administration of single doses (500 mug) to the rat by stomach tube.2. Pyridostigmine is slowly excreted in the urine; the maximum excretion occurs between 1-3 hr after administration. In 24 hr 42% of the dose is excreted in urine and 38.4% is present in faeces and intestinal contents.3. The peak concentration of radioactivity in liver and blood occurs about 2 hr after administration.4. About 75% of the radioactivity in urine is present as unchanged pyridostigmine, the remainder as metabolite.5. The results are compared with those previously obtained after oral administration of neostigmine.6. It is concluded that after oral administration the absorption of pyridostigmine is greater and the metabolism substantially less than that of neostigmine.

Physiotherapists' knowledge and the implementation of COVID-19 infection prevention and control measures

BACKGROUND

Physiotherapists are required to recognize their role in managing patients with Coronavirus Disease-19 (COVID-19), and to adopt preventive measures to limit transmission of the disease.

OBJECTIVE

The aim of this study was to assess the perception, knowledge, and application of the preventive measures taken by physiotherapists in managing issues with confirmed or suspected patients suffering from COVID-19.

METHODS

A self-administered survey comprising 15 questions was divided into four sections related to precautions when interacting with patients with COVID-19: (1) knowledge of the physiotherapy role, (2) knowledge of preventive measures to limit transmission of the virus, (3) practicing these measures, and (4) managing patients with COVID-19.

RESULTS

A total of 456 physiotherapists from 139 countries participated in the study. Most physiotherapists were knowledgeable regarding their role in the management of COVID-19 patients (M = 94.3%; SD = 15.4) and the management of potential COVID-19 patients (M = 84.5%; SD = 20.1). The rating of knowledge and practices of preventive measures to limit transmission of COVID-19 were lower (M = 74.3%; SD = 25.7, and M = 62.5%; SD = 31.3, respectively). Participants from the European region (M = 83; SD = 15.8) had a higher score than participants from the Asia Western Pacific region (M = 78; SD = 18.49; P = 0.01).

CONCLUSIONS

Physiotherapists are highly knowledgeable about their role in managing COVID-19 patients. Most of them are adopting preventive measures to limit the transmission of the disease. Yet, physiotherapists are required to enroll in medical education, training and infection control workshops and courses to remain updated with the recent advances in such fields.

The current implementation of Oslo Sports Trauma Research Center cycling injury prevention exercises among male elite cyclists in the Gulf Cooperation Council

Background/purpose

Cyclists are expected to present with sport-related injuries. The Oslo Sports Trauma Research Center provided exercises for preventing the most common injuries in cycling. We aimed to survey the compliance with Oslo Sports Trauma Research Center exercises among cyclists in the Gulf Cooperation Council countries. It is expected that most cyclists in the Gulf Cooperation Council countries are implementing these exercises as part of their warm-up sessions.

Methods

This cross-sectional online survey collected the participants’ demographic characteristics (country, age, and sex) and assessed their compliance with the programme.

Results

Four-hundred and twenty-three cyclists responded, of which 52% were aged 20–29 years. The pelvic control exercise was the most implemented (56%), followed by the elephant and isolated pelvic rotation exercises (54%); the single-leg pelvic rotation exercise was the least implemented (46%). The implementation rate did not differ significantly according to age or country. Saudi Arabia and Kuwait reported the highest mean implementation scores, while the United Arab Emirates reported the lowest

Conclusions

The implementation rate of Oslo Sports Trauma Research Center exercises was low among cyclists in the Gulf Cooperation Council countries. There is a need to increase awareness between players, programme deliverers, and policymakers and educate them about the importance of implementing such programmes in injury reduction.

The effectiveness of the Copenhagen adduction exercise on improving eccentric hip adduction strength among soccer players with groin injury: a randomized controlled trial

INTRODUCTION

Groin injuries are common in soccer players and often involve adductor muscle strains. The Copenhagen Adduction Exercise (CAE) is a targeted intervention whose effectiveness in rehabilitation for these injuries warrants investigation.

OBJECTIVE

To investigate the impact of a rehabilitation program, which includes the CAE, on eccentric hip adduction (EHAD) strength, hip joint range of motion (ROM), self-reported disability, and pain among soccer players with adductor-related groin pain. It was hypothesized that the addition of CAE to the rehabilitation program would yield greater improvements.

METHODS

Employing a randomized controlled trial with a two-group parallel design, thirty male soccer players with a mean age of 26.4 ± 3.9 years were randomized into an intervention group (IG) including CAE (n = 15) and a control group (CG) without CAE (n = 15), based on a power analysis to ensure 80% power to detect significant differences. Both groups engaged in their respective rehabilitation programs twice a week for eight weeks. The primary outcome measured was EHAD strength, while secondary outcomes included hip joint ROM, self-reported disability measured by the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain levels.

RESULTS

Significant improvements within groups were observed across all measures (p < 0.001). The IG demonstrated a greater increase in EHAD strength (Mean Difference [MD] = 0.49 Nm/kg, 95% Confidence Interval [CI] [0.31, 0.66]), a more pronounced reduction in pain (MD = -1.60, 95% CI [-2.18, -1.02]), and betterment in all HAGOS subscale scores compared to the CG. There were no significant between-group differences in hip joint ROM.

CONCLUSION

Incorporating the CAE into rehabilitation programs significantly improves EHAD strength, decreases pain scores, and reduces self-reported disability in soccer players with adductor-related groin pain.

REGISTRATION

ClinicalTrials.gov identifier: NCT05589623.

The Effect of Combining Plyometrics Exercises and Balance Exercises in Improving Dynamic Balance among Female College Athletes: A Randomized Controlled Trial

INTRODUCTION

Plyometrics and balance exercises have been shown to reduce lower limb injury incidence. The effects of combining these exercises on dynamic balance have not been investigated.

OBJECTIVE

This study aimed to evaluate the effect of plyometrics and balance exercises and a combination of both exercises on postural stability among female athletes compared to those who did not perform any specific exercise (control).

DESIGN

Randomized controlled trial.

SETTING

Sports Medicine Laboratory.

PARTICIPANTS

Two hundred female athletes aged 21.9±2.4 years were randomly assigned to a plyometrics exercises group (n = 50), a balance exercises group (n = 50), a combination of both exercises group (n = 50), or a control group (n = 50). One hundred seventy-nine female college athletes completed the study.

INTERVENTIONS

Plyometrics exercises, balance exercises and a combination of both exercises.

OUTCOME MEASURES

Limits of stability, which was assessed using the Biodex Stability System to assess the performance of the dynamic balance. It was measured pre and post-intervention after six weeks.

RESULTS

There were no differences in baseline data between groups (p = .557). All groups showed significant improvements in limits of stability (p < .001). The most marked improvement in the limits of stability was shown in the combination group compared to the control group (MD = 4.1 %, 95% CI [2.8, 5.3], p < .001).

CONCLUSIONS

Combining plyometrics and balance exercises significantly increases the dynamic balance performance post-intervention among female athletes compared to the control group. This article is protected by copyright. All rights reserved.

Combining the Copenhagen Adduction Exercise and Nordic Hamstring Exercise Improves Dynamic Balance Among Male Athletes: A Randomized Controlled Trial

BACKGROUND

Copenhagen adduction exercise (CAE) and Nordic hamstring exercise (NHE) reduce the incidence of groin and hamstring injuries. Efficient dynamic balance can improve motor performance and reduce the risk of injuries in athletes. However, the effects of these exercises on dynamic balance have not been investigated.

HYPOTHESIS

CAE and NHE, as well as a combination of both exercises, would improve dynamic balance among amateur male athletes.

STUDY DESIGN

Randomized controlled trial.

LEVEL OF EVIDENCE

Level 1.

METHODS

A total of 200 male athletes aged 21.9 ± 2.4 years were included in the study and randomly assigned to 4 groups: CAE group (n = 50), NHE group (n = 50), CAE and NHE group (n = 50), and a control group (n = 50). A total of 177 male athletes completed the study. The primary outcome measure was the limit of stability (LoS), which was measured using the Biodex Stability System to assess the performance of the dynamic balance. The LoS of the athletes' performance was measured pre- and postintervention after 6 weeks.

RESULTS

The LoS significantly improved in all treatment groups, including CAE (44.5% ± 5.3%), NHE (43.2% ± 5.3%), and CAE + NHE (48.4% ± 5.1%) groups when compared with the control group (28.3% ± 4.8%) after 6 weeks (all Ps < 0.01). The improvement of LoS was significantly greater in the CAE + NHE group compared with other groups (CAE, NHE, and control groups).

CONCLUSION

There was a significant increase in dynamic balance performance postintervention among male athletes. CAE and NHE may improve injury prevention programs.

CLINICAL RELEVANCE

The results of this study provide evidence for athlete trainers and coaches to consider including the CAE and NHE as components of injury prevention programs to improve balance capacity and performance in athletes. Such improvements in balance may prevent injury risk and decrease absenteeism and injury-related financial burdens.

Effectiveness of Injury Prevention Programs With Core Muscle Strengthening Exercises to Reduce the Incidence of Hamstring Injury Among Soccer Players: A Systematic Review and Meta-Analysis

CONTEXT

Muscles in the hamstring group are frequently injured in sporting activities. Injury prevention programs (IPPs), including eccentric training of the hamstrings, have proven to be of great value in decreasing the injury rate of hamstring muscles.

OBJECTIVE

To examine the effectiveness of IPPs that include core muscle strengthening exercises (CMSEs) in reducing hamstring injury rates.

DATA SOURCES

This systematic review with meta-analysis was based upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was conducted for relevant studies published from 1985 to 2021 using the following databases: Cochrane Library, MEDLINE, AMED, PubMed, Web of Science, and Physiotherapy Evidence Database (PEDro).

STUDY SELECTION

The initial electronic search found 2694 randomized controlled trials (RCTs). After removing duplicate entries, 1374 articles were screened by their titles and abstracts, and 53 full-text records were assessed, of which 43 were excluded. The remaining 10 articles were reviewed in detail, from which 5 studies met our inclusion criteria and were included in the current meta-analysis.

STUDY DESIGN

Systematic review and meta-analysis of RCTs.

LEVEL OF EVIDENCE

Level 1a.

DATA EXTRACTION

Two researchers independently completed the abstract review and performed full-text reviews. A third reviewer was consulted to reach a consensus if any discrepancies were noted. Details were recorded about the participants, methodological aspects, eligibility criteria, intervention data, and outcome measures, including age; number of subjects in the intervention/control group; number of injuries in each group; and the duration, frequency, and intensity of the training conducted in the intervention.

RESULTS

The pooled results of 4728 players and 379,102 exposure hours showed 47% hamstring injury reduction per 1000 h of exposure in the intervention group compared with the control group with an injury risk ratio of 0.53 (95% CI [0.28, 0.98], P = 0.04).

CONCLUSION

The results indicate that CMSEs incorporated with IPPs reduce susceptibility and risk of hamstring injuries in soccer players.

Ischemic and Bleeding Profile of Patients on Dual Antiplatelet Therapy beyond 1 Year of Index Acute Coronary Syndrome / Percutaneous Intervention

Dual antiplatelet treatment (DAPT) is the cornerstone of the management and prophylaxis of acute coronary syndrome (ACS). However, the associated risk of bleeding with the usage of DAPT and risk of thrombosis with stoppage of the drug makes it a challenging task to take appropriate decisions regarding the choice and duration of DAPT. The present study is aimed to tackle these challenges and to analyze whether prolonged dual antiplatelet therapy carries more risk of bleeding or a higher risk of thrombosis is present with discontinuation of the same.

MATERIAL

In this study, a total of 235 cases of confirmed myocardial infarction, unstable angina, or those who underwent percutaneous intervention were included. After 1 year, the number of patients on DAPT, the type of antiplatelets they were using were observed, their ischemic risk was calculated using DAPT score, and bleeding risk was calculated using PRECISE-DAPT score. Bleeding events were assessed using BARC classification.

OBSERVATION

Out of 235 patients, the majority of the patients were males (78.7%). Only 7.2% of the patients had bleeding since the start of the drugs. The majority (5% out of 7.2%) of bleeding episodes were clinically insignificant. 163 (69%) patients were on Dual antiplatelet therapy after 1 year. Out of which 115 were appropriately taking DAPT as per their DAPT score. Patients with high bleeding risk (PRECISE DAPT score ≥25) were 89, out of which 38 (53.2%) patients were taking SAPT, appropriate for their bleeding risk. While 112 (68.7%) were taking prolonged DAPT, appropriate for PRECISE-DAPT risk.

CONCLUSION

The majority of patients remained on DAPT following discharge for more than 1 year after ACS. This suggests that treating physicians prioritizes ischemic risk reduction over bleeding risk in patients with ACS, according to the patient's risk profile.