Doping in sports among Malaysian universities athlete: survey of the knowledge, beliefs, and perception during Malaysian universities games in Kuala Lumpur 2014.

BACKGROUND: Doping in young athletes at present is on escalation. A few doping cases involving athletes from South East Asia (SEA) countries have been reported. The objective of this study is to determine current perceived doping and antidoping climate in Malaysia through an exploration of doping-related knowledge, perception and beliefs among the university athletes. METHODS: A survey was conducted during the Malaysian Universities Games in Kuala Lumpur 2014. A total of 614 athletes completed the questionnaires on perception, specific knowledge, environment, behavior and beliefs towards doping. RESULTS: From this survey, we found that their knowledge about doping and antidoping was poor, they have misguided beliefs and perception about doping, and their environment seems to be favorable for performance enhancing substances usage in the future. We grouped the athletes based on their doping's environment into ultraclean, potential and high-risk group; and the results showed that they have a significant relationship with their knowledge, beliefs and perception about doping in sports, P<0.001. About 1.5-1.8% of the studied athletes have positive behavior towards doping practice; doping use, χ2 =24.6(2) P<0.001 and doping willingness, χ2 =17.15(2) P<0.001. CONCLUSIONS: Doping behavior and doping risks in this region are still under-studied. Hence, we recommended that every South East Asia countries would identify the potential risks of doping among their young athletes, and collectively collaborating in managing doping issues involving this region. Special attention should be given to doping environment as it has negative influences on athletes behavior towards doping.

Modifiable Factors Associated With Survival After Out-of-Hospital Cardiac Arrest in the Pan-Asian Resuscitation Outcomes Study.

STUDY OBJECTIVE: The study aims to identify modifiable factors associated with improved out-of-hospital cardiac arrest survival among communities in the Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network: Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand, and the United Arab Emirates (Dubai). METHODS: This was a prospective, international, multicenter cohort study of out-of-hospital cardiac arrest in the Asia-Pacific. Arrests caused by trauma, patients who were not transported by emergency medical services (EMS), and pediatric out-of-hospital cardiac arrest cases (<18 years) were excluded from the analysis. Modifiable out-of-hospital factors (bystander cardiopulmonary resuscitation [CPR] and defibrillation, out-of-hospital defibrillation, advanced airway, and drug administration) were compared for all out-of-hospital cardiac arrest patients presenting to EMS and participating hospitals. The primary outcome measure was survival to hospital discharge or 30 days of hospitalization (if not discharged). We used multilevel mixed-effects logistic regression models to identify factors independently associated with out-of-hospital cardiac arrest survival, accounting for clustering within each community. RESULTS: Of 66,780 out-of-hospital cardiac arrest cases reported between January 2009 and December 2012, we included 56,765 in the analysis. In the adjusted model, modifiable factors associated with improved out-of-hospital cardiac arrest outcomes included bystander CPR (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.31 to 1.55), response time less than or equal to 8 minutes (OR 1.52; 95% CI 1.35 to 1.71), and out-of-hospital defibrillation (OR 2.31; 95% CI 1.96 to 2.72). Out-of-hospital advanced airway (OR 0.73; 95% CI 0.67 to 0.80) was negatively associated with out-of-hospital cardiac arrest survival. CONCLUSION: In the PAROS cohort, bystander CPR, out-of-hospital defibrillation, and response time less than or equal to 8 minutes were positively associated with increased out-of-hospital cardiac arrest survival, whereas out-of-hospital advanced airway was associated with decreased out-of-hospital cardiac arrest survival. Developing EMS systems should focus on basic life support interventions in out-of-hospital cardiac arrest resuscitation.

Does injection flow rate have an impact on arterial phase image degradation in liver MRI? A comparison of gadoxetic acid versus gadobutrol.

AIM: To evaluate retrospectively the impact of injection flow rate on arterial phase image degradation in liver magnetic resonance imaging (MRI) with gadoxetic acid (Gd-EOB-DTPA) compared to gadobutrol. MATERIALS AND METHODS: Two hundred consecutive patients who had undergone liver MRI were enrolled in this Health Insurance Portability and Accountability Act (HIPAA)-compliant institutional review board (IRB)-approved study and were divided into three groups. Group 1 (50 patients) and 2 (50 patients) had undergone MRI performed with gadoxetic acid (fixed 10 ml) at flow rate of 1 and 2 ml/s, respectively. Group 3 (100 patients) had undergone MRI performed with gadobutrol (0.1 mmol/kg) at 1 ml/s. Precontrast and post-contrast (arterial, portal venous, and hepatic venous phases) image degradation was assessed by two blinded independent readers using a four-point rating scale. The numbers of patients with arterial phase image degradation were compared using the Fisher exact test among the three groups. RESULTS: The incidence of arterial phase image degradation was 12% (6/50) in group 1 and 16% (8/50) in group 2 for both readers, 6% (6/100) for reader 1 and 5% (5/100) for reader 2 in group 3. Group 2 had a higher incidence of arterial phase image degradation when compared with group 3 for reader 2 (p=0.032). Severe arterial phase image degradation, resulting in non-diagnostic image quality, occurred in 4% (2/50) of patients when performed with gadoxetic acid administration at 2 ml/s and 2% (1/50) at 1 ml/s. CONCLUSION: A slower injection flow rate has a trend to reduce the incidence and severity of arterial phase image degradation during liver MRI with gadoxetic acid when compared to gadobutrol.

A promising solution to enhance the sensocompatibility of biosensors in continuous glucose monitoring systems.

BACKGROUND: Continuous glucose monitors (CGMs) measure glucose in real time, making it possible to improve glycemic control. A promising technique involves glucose sensors implanted in subcutaneous tissue measuring glucose concentration in interstitial fluid. A major drawback of this technique is sensor bioinstability, which can lead to unpredictable drift and reproducibility. The bioinstability is partly due to sensor design but is also affected by naturally occurring subcutaneous inflammations. Applying a nonbiofouling coating to the sensor membrane could be a means to enhancing sensocompatibility. METHODS: This study evaluates the suitability of a polyethylene-glycol-based coating on sensors in CGMs. Methods used include cross hatch, wet paper rub, paper double rub, bending, hydrophilicity, protein adsorption, bio-compatibility, hemocompatibility, and glucose/oxygen permeability testing. RESULTS: Results demonstrate that coating homogeneity, adhesion, integrity, and scratch resistance are good. The coating repels lysozyme and bovine serum albumin, and only a low level of fibrin and blood platelet adsorption to the coating was recorded when testing in whole human blood. Cytotoxicity, irritation, sensitization, and hemolysis were assessed, and levels suggested good biocompatibility of the coating in subcutaneous tissue. Finally, it was shown that the coating can be applied to cellulose acetate membranes of different porosity without changing their permeability for glucose and oxygen. CONCLUSIONS: These results suggest that the mechanical properties of the coating are sufficient for the given application, that the coating is effective in preventing protein adsorption and blood clot formation on the sensor surface, and that the coating can be applied to membranes without hindering their glucose and oxygen transport.

A randomized controlled trial of patient-controlled analgesia compared with boluses of analgesia for the control of acute traumatic pain in the emergency department.

BACKGROUND: The use of patient-controlled analgesia (PCA) has been reported to provide effective pain relief, often resulting in less opioid consumption, and is associated with greater patient satisfaction when it is compared to other techniques of analgesia delivery. OBJECTIVES: This study was done to compare the effectiveness of pain relief and patient satisfaction between PCA and the conventional method of administering boluses of analgesia for acute pain of traumatic origin in the Emergency Department (ED). METHODS: Study patients were randomized into two groups after being given a bolus of morphine. The PCA group was then given morphine via the PCA system, whereas the control group was given the conventional boluses of morphine via titration method. Pain levels were measured using the visual analogue scale at intervals of 0, 15, 30, 45, 60, 90, and 120 min. Any adverse events were also noted. Finally, within 24 h, these patients completed questionnaires regarding their experience with regard to the pain relief they experienced. RESULTS: The PCA group experienced faster and greater pain relief. No life-threatening events were encountered. The satisfaction questionnaire revealed that the PCA group was more satisfied using the PCA method of pain relief than those receiving standard boluses for delivery of analgesia. CONCLUSION: PCA provides more effective pain relief and more patient satisfaction when compared to the conventional method of titrated bolus intravenous injection for the relief of traumatic pain in the ED setting.

The use of end-tidal carbon dioxide monitoring in patients with hypotension in the emergency department.

BACKGROUND: The aim of this study was to determine the usefulness of end tidal carbon dioxide (ETCO2) monitoring in hypotensive shock patients presenting to the ED. METHODS: This was a prospective observational study in a tertiary ED. One hundred three adults in shock with hypotension presenting to the ED were recruited into the study. They were grouped according to different types of shock, hypovolemic, cardiogenic, septic and others. Vital signs and ETCO2 were measured on presentation and at 30-min intervals up to 120 min. Blood gases and serum lactate levels were obtained on arrival. All patients were managed according to standard protocols and treatment regimes. Patient survival up to hospital admission and at 30 days was recorded. RESULTS: Mean ETCO2 for all patients on arrival was 29.07 ± 9.96 mmHg. Average ETCO2 for patients in hypovolemic, cardiogenic and septic shock was 29.64 ± 11.49, 28.60 ± 9.87 and 27.81 ± 7.39 mmHg, respectively. ETCO2 on arrival was positively correlated with systolic and diastolic BP, MAP, bicarbonate, base excess and lactate when analyzed in all shock patients. Early ETCO2 measurements were found to be significantly lower in patients who did not survive to hospital admission (p = 0.005). All patients who had ETCO2 ≤ 12mmHg died in the ED. However, normal ETCO2 does not ensure patient survival. CONCLUSION: The use of ETCO2 in the ED has great potential to be used as a method of non-invasive monitoring of patients in shock.

Bone-anchored hearing aids and chronic pain: a long-term complication and a cause for elective implant removal.

OBJECTIVES: To report a case series of elective removal of bone-anchored hearing aid implants, and reasons for removal. DESIGN: Retrospective review of a prospectively collected database. SETTING: Two tertiary referral centres in the Manchester area: Manchester Royal Infirmary and Salford Royal University Hospital. PARTICIPANTS: A series of 499 adults and children who had undergone a total of 602 implant insertions (1984-2008). MAIN OUTCOME MEASURES: Implant removal rates, and reasons. RESULTS: Twenty-seven of the 602 implants (4.5 per cent) required removal. Of these, 12 were due to pain (2.0 per cent), seven to persistent infection (1.2 per cent), three to failure of osseointegration (0.5 per cent), three to trauma (0.5 per cent) and two to other reasons (0.4 per cent). CONCLUSION: Chronic implant site pain represents the main reason why implants are removed electively, and affects 2 per cent of all implants. This complication has important medico-legal implications and should be discussed when obtaining informed consent for implantation.

The use of propofol for procedural sedation and analgesia in the emergency department: a comparison with midazolam.

INTRODUCTION: This study aimed to determine the effectiveness of propofol as an alternative agent for procedural sedation and analgesia (PSA) in the emergency department (ED) and to make a comparison between two different sedative (propofol vs midazolam) drugs used in combination with fentanyl. OBJECTIVES: To compare outcomes between a combination of fentanyl and propofol with fentanyl and midazolam in patients during and after PSA. METHODOLOGY: A randomised single blinded control trial carried out in the ED of a university hospital. 40 patients were randomly allocated equally into two groups: group A, 20 subjects received intravenous fentanyl 3 µg/kg as a bolus dose and a titration maximum bolus dose of propofol 1 mg/kg followed by a maximum titration top-up of 0.5 mg/kg if needed; group B, 20 subjects received intravenous fentanyl 3 µg/kg as a bolus dose and a titration maximum bolus dose of midazolam 0.1 mg/kg and a maximum titration top-up of 0.1 mg/kg if needed. The target sedation level was a Ramsay score of 3 or 4. Outcomes included the presence of any adverse events related to PSA and time to discharge. The Mann-Whitney U test was used to compare the two groups. RESULTS: None of the patients developed any significant adverse events during and after procedures. The mean length of stay in the propofol and midazolam groups was 29.25 (11.03) and 71.75 (60.64) min, respectively (p<0.001). CONCLUSION: Both propofol and midazolam given at the recommended doses were equally safe and effective for PSA in the ED. The propofol group was discharged much earlier than to the midazolam group.

Compromised chorionic villous vascularization in idiopathic second trimester fetal loss.

BACKGROUND: For normal fetal growth and development a well-developed chorionic villous vascularization is essential. AIM: The aim of this study is to investigate whether idiopathic second trimester fetal loss is associated with an underdeveloped chorionic villous vascularization. METHODS: 38 placentas after late miscarriage, classified as idiopathic fetal loss (IFL, n=16) or as fetal loss due to intrauterine infection (IUI, n=22) were collected. After CD34 immunohistochemical staining the villous stromal area, number of villous vessels, vascular area and vascular area density (central, peripheral and total) were measured in randomly selected immature intermediate villi. RESULTS: The mean gestational age was 19+4 weeks for the IFL group and 20+6 weeks for the IUI group. After controlling for gestational age, we found no differences in fetal weight, placental weight, villous stromal area, number of vessels and central vascular features. The mean peripheral vascular area and peripheral vascular area density were, after adjusting for gestational age, reduced in the IFL group. CONCLUSION: Idiopathic second trimester fetal loss is associated with a reduced peripheral chorionic villous vascularization. We hypothesize that in these cases, placentation is already disturbed in first trimester of pregnancy, leading to a reduced materno-fetal interface in second trimester, thus to early postplacental fetal hypoxia and fetal death.

Techniques used for assessing the sense of smell.

Assessment of the sense of smell is a challenging clinical investigation. Although a wide range of tests are available, many are modifications of tests designed more than 20 years ago. This article describes the smell tests that are available, and consider smell assessment after nasal surgery.

Metagenomic analysis of two enhanced biological phosphorus removal (EBPR) sludge communities.

Enhanced biological phosphorus removal (EBPR) is one of the best-studied microbially mediated industrial processes because of its ecological and economic relevance. Despite this, it is not well understood at the metabolic level. Here we present a metagenomic analysis of two lab-scale EBPR sludges dominated by the uncultured bacterium, "Candidatus Accumulibacter phosphatis." The analysis sheds light on several controversies in EBPR metabolic models and provides hypotheses explaining the dominance of A. phosphatis in this habitat, its lifestyle outside EBPR and probable cultivation requirements. Comparison of the same species from different EBPR sludges highlights recent evolutionary dynamics in the A. phosphatis genome that could be linked to mechanisms for environmental adaptation. In spite of an apparent lack of phylogenetic overlap in the flanking communities of the two sludges studied, common functional themes were found, at least one of them complementary to the inferred metabolism of the dominant organism. The present study provides a much needed blueprint for a systems-level understanding of EBPR and illustrates that metagenomics enables detailed, often novel, insights into even well-studied biological systems.