Effects of a Two-Month Exercise Training Program on Concurrent Non-Opiate Substance Use in Opioid-Dependent Patients during Substitution Treatment

BACKGROUND

This randomized controlled trial aimed to evaluate the effects of a two-month exercise intervention on the concurrent non-opiate substance use (alcohol, cocaine, cannabis, and benzodiazepines) in opioid users during their medication treatment.

METHODS

Ninety opioid users (41 females) in methadone and buprenorphine medication treatment were randomly divided into four groups: (a) buprenorphine experimental (BEX; n = 26, aged 41.9 ± 6.1 yrs); (b) buprenorphine control (BCON; n = 25, aged 41.9 ± 5.6 yrs); (c) methadone experimental (MEX; n = 20, aged 46.7 ± 6.6 yrs); and (d) methadone control (MCON; n = 19, aged 46.1 ± 7.5 yrs). The experimental groups (BEX and MEX) followed an aerobic exercise training program on a treadmill for 20 min at 70% HRmax, 3 days/week for 8 weeks. Socio-demographic, anthropometric, and clinical characteristics, as well as non-opioid drug use in days and quantity per week, were assessed before and after the intervention period.

RESULTS

Following the exercise training, the weekly non-opioid substance consumption (days) decreased (p < 0.05) in both exercise groups and was lower in BEX compared to MEX, while no differences were observed (p > 0.05) between the control groups (BCON vs. MCON) or compared to their baseline levels. Similarly, the daily amount of non-opiate substance intake was reduced (p < 0.05) post-training in BEX and MEX, whereas it did not differ (p > 0.05) in BCON and MCON compared to the baseline.

CONCLUSIONS

The two-month exercise intervention reduced the non-opioid drug use in both the methadone and buprenorphine substitution groups compared to the controls, suggesting that aerobic exercise training may be an effective strategy for treating patients with OUDs.

Dietary Intake of Soccer Players before, during and after an Official Game: Influence of Competition Level and Playing Position

Physical demands in soccer differ according to league level and playing position and may influence nutritional requirements. This study examined the effect of competition level and playing position on dietary intake in male soccer players (SP). Diet was weighed and recorded by 123 SP for 3 days; before, on the day, and the day after an official match. SP in the Super League (SL, n = 33) division reported higher (p < 0.05) average three-day energy (195 ± 36 kJ/kg), carbohydrate (6.0 ± 1.1 g/kg), and protein (2.2 ± 0.5 g/kg) intakes compared to the intakes reported by SP in the 2nd (n = 30) (energy: 159 ± 31 kJ/kg; carbohydrate: 4.6 ± 1.2 g/kg; protein: 1.9 ± 0.4 g/kg), 3rd (n = 30) (energy: 153 ± 34 kJ/kg; carbohydrate: 4.5 ± 1.2 g/kg; protein: 1.7 ± 0.4 g/kg), and 4th (n = 30) (energy: 152 ± 36 kJ/kg; carbohydrate: 4.2 ± 1.2 g/kg; protein: 1.7 ± 0.5 g/kg) national leagues (mean ± SD). Furthermore, when data were analyzed by playing position (pooled data), wide midfielders reported higher (p < 0.05) energy (183 ± 33 kJ/kg), carbohydrate (5.4 ± 1.2 g/kg), and fat (1.5 ± 0.4 g/kg) intakes compared to central defenders (energy: 147 ± 37 kJ/kg; carbohydrate: 4.1 ± 1.1 g/kg; fat: 1.2 ± 0.4 g/kg). The dietary intake of SP may differ according to the playing position and competition level, possibly due to different metabolic demands in training and competition.

Effect of a 36-Week Supervised Exercise Training Program on Physical and Cognitive Function in Older Patients With Dementia

BACKGROUND/AIM

To investigate the effects of an exercise training program on physical and cognitive function in older patients with dementia.

PATIENTS AND METHODS

Thirty-eight patients with early-middle dementia (31 females and seven males), aged 80.6±6.9 years, residents in an Elderly Care Unit, either completed a 36-week structured exercise program (Intervention Group, IG; n=19), or received the usual medical care (Control Group, CG; n=19). Before and after the 36-week intervention, cognitive function was evaluated in both groups by Mini-Mental State Examination (MMSE) and depression by Geriatric Depression Scale (GDS); physical function was assessed using handgrip test, Timed Up to Go (TUG), Berg Balance Scale (BBS) and Chair-Stand Test (CST), and daily living functionality by Functional Rating Scale for Symptoms of Dementia (FRSSD).

RESULTS

As a result of exercise intervention, participants scored better in all functional and cognitive test assessments compared to the control group, as reflected by absolute and relative (%) differences in all metrics after the 36-week exercise program (p<0.001).

CONCLUSION

A 36-week supervised exercise training program was found to result in significant improvements in physical and cognitive function of elderly patients in early to middle stages of dementia at an Elderly Care Unit. The promising results of this study shed more light on the adaptability of elderly patients with early and mild dementia to long-term exercise training and verified the feasibility of applying such programs in this clinical population.

Vaccination coverage of primary care providers against seasonal influenza, tetanus, pneumococcal pneumonia and herpes zoster: A cross-sectional study in Greece

Introduction

Primary care providers' (PCPs) compliance to self-immunization is important for their protection and the protection of their colleagues and patients and has been associated with the coverage of the general public. In this study, we aim to investigate the vaccination coverage of PCPs.

Methods

A questionnaire-based cross-sectional survey was conducted among physicians, nurses and pharmacists employed in public or private primary care settings in Greece. Demographic and occupational characteristics as well as vaccination coverage data for influenza, tetanus, pneumococcal pneumonia and herpes zoster were collected. Statistical significance was set at 0.05.

Results

In total, 748 (61.7% response rate) PCPs participated. Vaccination rates were 66.4% (496/747) for influenza (2019/2020 flu season), 62.9% (469/746) for tetanus (10-year Td or Tdap booster dose), 70% (14/20) for pneumococcal pneumonia (≥ 1 dose of PPSV23 or PCV13) and 12.3% (10/81) for herpes zoster. Multiple logistic regression revealed that nurses had significantly lower probability of being vaccinated against influenza [odds ratio (OR) = 0.25; 95% confidence interval (CI) = 0.14-0.45] and pharmacists had significantly lower probability of being vaccinated against both influenza (OR = 0.44; 95% CI = 0.31-0.62) and influenza & tetanus (OR = 0.52; 95% CI = 0.37-0.73) compared to physicians. Older age (>40 years) was an independent risk factor for not receiving a tetanus vaccine (40-49 vs. 19-39; OR = 0.42; 95% CI = 0.28-0.63, over 50 years old vs. 19-39; OR = 0.54; 95% CI = 0.36-0.79).

Conclusions

The results revealed suboptimal vaccination rates among health providers who are in the frontline of adult immunization. Individualized and targeted measures to improve their vaccination coverage and indirectly the vaccination coverage of their patients, are therefore required.

The Effect of High-Intensity Interval Training on Mitochondrial-Associated Indices in Overweight and Obese Adults: A Systematic Review and Meta-Analysis

BACKGROUND

Obesity is a significant health problem with an increasing incidence, causing a low-grade systemic inflammatory state and being implicated in various chronic diseases. Moreover, obesity has been shown to cause mitochondrial dysfunction through oxidative stress and inflammation, eventually affecting energy metabolism. However, high-intensity interval training (HIIT) can improve mitochondrial efficiency through exercise-induced mitochondrial adaptations. This systematic review and meta-analysis aims to examine the potential effects of HIIT on mitochondrial-associated indices in obese and overweight adults.

METHODS

PubMed, Scopus, and Web of Science databases were searched.

RESULTS

Twenty-eight eligible studies were included, involving 530 participants. HIIT was found to significantly improve the activity of citrate synthase (CS), cytochrome C (COX-IV), beta-hydroxyacyl CoA-dehydrogenase (β-HAD), Complexes I-V as well as VO2max in overweight and obese individuals, whereas no significant changes were shown in PGC-1α and SIRT1. Interestingly, subgroup analyses revealed that CS, COX-IV, β-HAD, and Complexes I-V activity exhibited a significant improvement only in the healthy subgroup.

CONCLUSIONS

Overall, HIIT can be utilized to enhance mitochondrial-associated indices in overweight and obese individuals. However, this improvement may be health status dependent.

The Effects of a Short-Term Combined Exercise Program on Liver Steatosis Indices and the Lipidemic and Glycemic Profile in NAFLD Individuals: A Pilot Study

Non-alcoholic fatty liver disease (NAFLD) is a very common liver disease associated with obesity, unhealthy diet, and lack of physical exercise. Short-term aerobic or resistance exercise has been shown to result in reduced liver fat in patients with NAFLD; however, the impact of the combination of these types of exercise has received less attention. This study investigated the effect of a short-term (7 days) concurrent exercise training program performed daily on liver steatosis indices, as well as the glycemic and lipidemic profile of overweight/obese sedentary volunteers. Twenty adult patients (age: 47.3 ± 12.3 yrs, body mass index: 32.4 ± 3.4 kg/m2) with NAFLD, detected by ultrasound and hematological indices, participated in the study. Pre- and post-exercise intervention assessment included body weight (BW), waist circumference (WC), hip/waist ratio (H/W), Homeostasis Model Assessment Insulin Resistance (HOMA-IR), blood lipids, and steatosis indices. Fatty Liver Index, Lipid Accumulation Index, WC, H/W, triglycerides, and total cholesterol were improved (p < 0.05) post-exercise, while no differences (p > 0.05) were observed in BW, HOMA-IR, HDL, LDL, Hepatic Steatosis Index, and Framingham Steatosis Index compared to pre-exercise values. It is concluded that a 7-day combined exercise program can have beneficial effects on hepatic steatosis and central adiposity indices, independently of weight loss, in patients with NAFLD.

Young Artistic Gymnasts Drink Ad Libitum Only Half of Their Fluid Lost during Training, but More Fluid Intake Does Not Influence Performance

To examine the effect of the fluid balance on and performance in young artistic gymnasts during training under ad libitum and prescribed fluid intake conditions, eleven males (12.3 ± 2.6 years, mean ± SD) performed two 3 h identical training sessions. Participants ingested, in a random order, water equivalent to either 50% (LV) or 150% (HV) of their fluid loss. After the 3 h training, the gymnasts performed program routines on three apparatuses. The pre-exercise urine specific gravity (USG) was similar between conditions (LV: 1.018 ± 0.007 vs. HV: 1.015 ± 0.007; p = 0.09), while the post-exercise USG was lower in the HV condition (LV: 1.017 ± 0.006 vs. HV: 1.002 ± 0.003; p < 0.001). Fluid loss corresponding to percentage of body mass was higher in the LV condition (1.2 ± 0.5%) compared to the HV condition (0.4 ± 0.8%) (p = 0.02); however, the sums of the score performances were not different (LV: 26.17 ± 2.04 vs. HV: 26.05 ± 2.00; p = 0.57). Ingesting fluid equivalent to about 50% of the fluid lost, which was the amount that was drunk ad libitum during training, maintained short-term hydration levels and avoided excessive dehydration in artistic preadolescent and adolescent gymnasts. A higher amount of fluid, equivalent to about 1.5 times the fluid loss, did not provide an additional performance benefit.

Effects of Exercise and Physical Activity Levels on Childhood Cancer: An Umbrella Review

Patients and survivors of childhood cancer experience adverse effects related to the disease and its treatment. These adverse effects are associated with both physiological and psychological health. Exercise helps manage the side effects and improve the health outcomes. The objective of this umbrella review is to search the current literature in the context of exercise and physical activity as complementary interventions on pediatric cancer and to provide comprehensive information about the derived health outcomes. A literature search was conducted on the Cochrane, PubMed, and Embase databases for systematic reviews published up to January 2023. Moreover, a hand search of reference lists was performed. We included participants under 19 years of age at diagnosis of any type of childhood cancer, without restriction on the type or phase of treatment, who participated in exercise interventions. The results showed a beneficial impact on fatigue, muscle strength, aerobic capacity, activity and participation levels, psychosocial health, cardiovascular/cardiorespiratory fitness, physical function, bone mineral density, and brain volume and structure, with limited and not serious adverse effects. These findings documented that exercise interventions had a positive effect on many physiological and psychological health outcomes in pediatric cancer patients and survivors.

The Role of Physical Exercise in Opioid Substitution Therapy: Mechanisms of Sequential Effects

It is generally accepted that chronic opioid use is associated with structural and functional changes in the human brain that lead to an enhancement of impulsive behavior for immediate satisfaction. Interestingly, in recent years, physical exercise interventions have been used as an adjunctive treatment for patients with opioid use disorders (OUDs). Indeed, exercise has positive effects on both the biological and psychosocial basis of addiction, modifying neural circuits such as the reward, inhibition, and stress systems, and thus causing behavioral changes. This review focuses on the possible mechanisms that contribute to the beneficial effects of exercise on the treatment of OUDs, with emphasis placed on the description of a sequential consolidation of these mechanisms. Exercise is thought to act initially as a factor of internal activation and self-regulation and eventually as a factor of commitment. This approach suggests a sequential (temporal) consolidation of the functions of exercise in favor of gradual disengagement from addiction. Particularly, the sequence in which the exercise-induced mechanisms are consolidated follows the pattern of internal activation-self-regulation-commitment, eventually resulting in stimulation of the endocannabinoid and endogenous opioid systems. Additionally, this is accompanied by modification of molecular and behavioral aspects of opioid addiction. Overall, the neurobiological actions of exercise in combination with certain psychological mechanisms appear to promote its beneficial effects. Given the positive effects of exercise on both physical and mental health, exercise prescription is recommended as a complement to conventional therapy for patients on opioid maintenance treatment.

Impact of supervised aerobic exercise on clinical physiological and mental parameters of people living with HIV: a systematic review and meta-analyses of randomized controlled trials

Background: The benefits derived from supervised aerobic exercise in people living with human immunofeficiency virus- HIV (PLWH) have not yet been clearly identified.Objective: To evaluate the impact of supervised aerobic exercise on immunological, cardiorespiratory, pulmonary, hemodynamic and mental parameters of PLWH.Methods: A systematic review was carried out in accordance to PRISMA guidelines. PubMed, Physiotherapy Evidence Database (PEDro) and Cochrane Central Register of Controlled Trials (CENTRAL) were screened up to August 2021, for the identification of English written randomized trials, with participants aged 18 years and older, at any stage of the disease, with or without co-morbidities. The risk of bias assessment was conducted according to the Cochrane Collaboration's tool for assessing risk of bias. Meta- analyses were conducted using continuous, inverse variance, random-effects model.Results: Ten studies were suitable for meta-analysis based on inclusion criteria. Supervised aerobic exercise appeared to have beneficial effects on depressive symptoms [mean difference (MD)= -4.18 (confidence interval (CI)= (-6.55)-(-1.81), Z = 3.46, p = 0.0005, I²=0%, n = 2], forced expiratory volume in 1 sec [MD = 0.70, CI = 0.39-1.00, Z = 4.41, p < 0.0001, I²=0%, n = 2], and on the maximum oxygen uptake [MD = 1.38, CI = -0.02-2.78, Z = 1.94, p = 0.05, I²=94%, n = 4] of PLWH. No exercise effect was found for CD4 T-cell count (p = 0.16, n = 5), systolic blood pressure (p = 0.91, n = 2) and diastolic blood pressure (p = 0.72, n = 2).Conclusions: Supervised continuous aerobic exercise may improve lung function, depressive symptomatology and aerobic capacity of PLWH, however, the small number of available studies and the high heterogeneity concerning VO2max demonstrate the need for more research in this area.

Pre-Exercise Maltodextrin Ingestion and Transient Hypoglycemia in Cycling and Running

This study examined the phenomenon of transient hypoglycemia and metabolic responses to pre-exercise carbohydrate (CHO) maltodextrin ingestion in cycling and running on the same individuals. Eleven active males cycled or ran for 30 min at 80% maximal heart rate (HRmax) after ingestion of either 1g/kg body mass maltodextrin (CHO-Cycle and CHO-Run respectively) or placebo (PL-Cycle and PL-Run) solutions. Fluids were ingested 30min before exercise in a double-blind and random manner. Blood glucose and serum insulin were higher before exercise in CHO (mean CHO-Cycle+CHO-Run) (Glucose: 7.4 ± 0.3 mmol·l^-1; Insulin: 59 ± 10 mU·l^-1) compared to placebo (mean PL-Cycle+PL-Run) (Glucose: 4.7 ± 0.1 mmol·l^-1; Insulin: 8 ± 1 mU·l^-1) (p<0.01), but no differences were observed during exercise among the 4 conditions. Mean blood glucose did not drop below 4.1 mmol·l^-1 in any trial. However, six volunteers in CHO-Cycle and seven in CHO-Run experienced blood glucose concentration ≤ 3.5 mmol·l^-1 at 20min of exercise and similar degree of transient hypoglycemia in both exercise modes. No association was found between insulin response to maltodextrin ingestion and drop in blood glucose during exercise. Blood lactate increased with exercise more in cycling compared to running, and plasma free fatty acids (FFA) concentrations were higher in placebo compared to CHO irrespective of exercise mode (p<0.01). The ingestion of maltodextrin 30min before exercise at about 80% HRmax produced similar glucose and insulin responses in cycling and running in active males. Lactate was higher in cycling, whereas maltodextrin reduced FFA concentrations independently of exercise mode.

The effects of exercise on VO2peak, quality of life and hospitalization in heart failure patients: A systematic review with meta-analyses

Exercise training has become one of the most fundamental components of cardiac rehabilitation. This systematic review with meta-analyses has the objective to determine the effectiveness of exercise on selected cardiac rehabilitation outcomes, i.e. peak oxygen consumption (VO₂peak), hospitalization and quality of life (QOL) of patients with heart failure. PubMed, EMBASE, and Cochrane Library were searched up to May 2019 to identify randomized controlled trials comparing exercise training to usual care. Overall, 131 trials were included with a total of 9,761 patients, the majority of whom were males (74%), predominantly with reduced ejection fraction and NYHA class ranging from II to III. There was a significant improvement in VO₂peak in the exercise group compared to non-exercise control group (mean difference: 2.98 mL/kg/ min, 95% CI: 2.52-3.43, p < 0.001; 84 RCTs, n = 3,690 patients). Exercise training was also beneficial for the patients' QOL. The QOL meta-analysis included 5,786 patients and showed a clinically significant improvement of QOL following exercise (-0.82, 95% CI: -1.02 to -0.62; p = 0.00001; I² = 91%). Hospitalization incidence of heart failure patients was also lower in the exercise compared to control group (fixed-effect Odds Ratio: 0.56, 95% CI: 0.42-0.75, p < 0.0001; 26 trials, 4,664 participants). Exercise-based rehabilitation improves V0₂peak and QOL and reduces the incidence of hospitalization of heart failure patients.

Effect of a Carbohydrate-Electrolyte Solution on Fluid Balance and Performance at a Thermoneutral Environment in International-Level Fencers

Chryssanthopoulos, C, Tsolakis, C, Bottoms, L, Toubekis, A, Zacharogiannis, E, Pafili, Z, and Maridaki, M. Effect of a carbohydrate-electrolyte solution on fluid balance and performance at a thermoneutral environment in international-level fencers. J Strength Cond Res 34(1): 152-161, 2020-The purpose of the study was to examine a possible effect of a carbohydrate-electrolyte (CHO-E) solution on fluid balance and performance in fencing at a thermoneutral environment. Sixteen fencers performed two 120-minute training sessions separated by 7-14 days under similar environmental conditions (temperature: 20.3° C and humidity: 45-47%). Each session consisted of 60-minute conditioning exercises followed by 10 bouts of 3 minutes against the same opponent with 3-minute interval between each bout. Participants ingested at regular intervals either a 6% CHO-E solution or an artificially sweetened water (PL) in a counterbalanced order. No difference was observed between conditions in the heart rate responses, perceived exertion, changes in plasma volume, urine specific gravity, number of bouts won or lost, or points for and against. Considerable variability was observed in body mass changes that revealed significant differences at the time level (i.e., pre- vs. post-exercise) (F1,15 = 9.31, p = 0.008, η = 0.38), whereas no difference was found between conditions (i.e., CHO-E vs. PL) (F1,15 = 0.43, p = 0.52, η = 0.03) and conditions × time interaction (F1,15 = 3.57, p = 0.078, η = 0.19). Fluid loss was not significantly different between conditions (p = 0.08, d = 0.47). The blood glucose level was higher (p < 0.01) after exercise in CHO-E, whereas the blood lactate level was similar between conditions. In conclusion, the CHO-E solution was as effective as the artificially sweetened water in terms of fluid balance and fencing performance at a thermoneutral environment. Because of large individual variability, fencers should monitor their fluid intake and body fluid loss in training and competition.

Time Course of Oxidative Stress, Inflammation, and Muscle Damage Markers for 5 Days After a Soccer Match: Effects of Sex and Playing Position

Souglis, A, Bogdanis, GC, Chryssanthopoulos, C, Apostolidis, N, and Geladas, ND. Time course of oxidative stress, inflammation and muscle damage markers for 5 days after a soccer match: Effects of sex and playing position. J Strength Cond Res 32(7): 2045-2054, 2018-This study examined the influence of sex and playing position on the time course of selected oxidative stress, inflammation, and muscle damage markers after an official soccer match. Sixty professional soccer players (30 men and 30 women) were divided into 3 groups, according to their playing position: defenders, midfielders, and attackers. Each group consisted of 10 male and 10 female players. Sixty healthy volunteers (30 men and 30 women) served as control. Blood samples were taken before and after the match and daily for 5 days after the match. Analysis of variance revealed different responses over time between sex and playing positions, as shown by the 3-way interaction, for creatine kinase (CK), protein carbonyls (PCs), catalase, fibrinogen, uric acid (UA), lactate dehydrogenase, reduced glutathione, C-reactive protein, and interleukin 6 (p < 0.01). Male players had higher values compared with women of the same playing position, for all oxidative, inflammatory, and muscle damage indices (p < 0.01). Also, in both sexes, midfielders had higher peaks in all indices compared with defenders (p < 0.05). Five days after the game CK and UA concentrations had not returned to pregame levels in any exercise group, whereas PCs were still elevated in male midfielders and attackers (p < 0.05). These results show that sex and playing position influence the time course of selected oxidative stress, inflammation, and muscle damage markers after an official soccer game. This information should be taken into account by practitioners for the design of training programs after match play.

Carbohydrate mouth rinse does not affect performance during a 60-min running race in women

This study examined the effect of carbohydrate mouth rinsing on endurance running performance in women. Fifteen female recreational endurance runners, who used no oral contraceptives, ran two races of 1-h duration on an indoor track (216-m length) at 18:00 h after an 8-h fast with a 7-days interval between races, corresponding to the 3^rd-10th day of each premenopausal runner's menstrual cycle, or any day for the postmenopausal runners. In a double-blind random order, participants rinsed their mouth with 25 ml of either a 6.4% carbohydrate (RCHO) or a placebo solution (RP). No fluid was ingested during exercise. Serum 17β-Εstradiol (P = 0.59) and Progesterone (P = 0.35) did not differ between treatments. There was no difference in 1-hour running performance (RCHO: 10,621.88 ± 205.98 m vs. RP: 10,454.00 ± 206.64 m; t = 1.784, P = 0.096). Furthermore, the mean percentage effect (±99%CI) of RCHO relative to RP, 1.67% (-1.1% to 4.4%), and Cohen's effect size (d = 0.21) support a trivial outcome of RCHO for total distance covered. In conclusion, carbohydrate mouth rinsing did not improve 60-min track running performance in female recreational runners competing in a low ovarian hormone condition, after an 8-h fast and when no fluid was ingested during exercise.

Glycemic Index of Two Different Fried Potato Varieties Cultivated Under Organic Fertilization Conditions

This study identified the glycemic index (GI) of two different commercially available varieties of potatoes, Lady Rosetta (LR) and Spunta (S), cultivated under organic fertilization conditions and fried in extra virgin olive oil. Eight healthy males 26 ± 1.5 years of age, 84.7 ± 3.2 Kg body mass and 19.2 ± 1.5% of body fat participated (mean ± SE). Volunteers consumed in a random order 50 g of anhydrous glucose in 300 ml of water (G), or 50 g of available carbohydrate of sliced and fried LR or S twice. Blood glucose was measured enzymatically from capillary blood samples before food consumption and at 15, 30, 45, 60, 90 and 120 min postprandially. Each meal was prepared and consumed in the morning after a 12-hour overnight fast, whereas diet and physical activity were controlled. For the calculation of GI the mean blood glucose values of the two trials (i.e. 1st and 2nd time) in each potato variety (i.e. LR or S) were considered. The incremental area under the blood glucose-time curve (IAUC) was used according to trapezoidal rule for the determination of GI. The IAUC was 5504 ± 1173 mg.min/dl and 4012 ± 911 mg.min/dl whereas the GI was 114 ± 15 and 83 ± 12 in LR and S respectively. However, these differences were not significant (IAUC: p= 0.21 and GI: p=0.20). Fried potato slices in extra virgin olive oil derived from LR and S potato varieties cultivated under organic fertilization conditions possess similar GI in healthy male volunteers.

Skeletal muscle glycogen concentration and metabolic responses following a high glycaemic carbohydrate breakfast

The purpose of this study was to examine the influence of a carbohydrate-rich meal on post-prandial metabolic responses and skeletal muscle glycogen concentration. After an overnight fast, eight male recreational/club endurance runners ingested a carbohydrate (CHO) meal (2.5 g CHO x kg(-1) body mass) and biopsies were obtained from the vastus lateralis muscle before and 3 h after the meal. Ingestion of the meal resulted in a 10.6 +/- 2.5% (P < 0.05) increase in muscle glycogen concentration (pre-meal vs post-meal: 314.0 +/- 33.9 vs 347.3 +/- 31.3 mmol x kg(-1) dry weight). Three hours after ingestion, mean serum insulin concentrations had not returned to pre-feeding values (0 min vs 180 min: 45 +/- 4 vs 143 +/- 21 pmol x l(-1)). On a separate occasion, six similar individuals ingested the meal or fasted for a further 3 h during which time expired air samples were collected to estimate the amount of carbohydrate oxidized over the 3 h post-prandial period. It was estimated that about 20% of the carbohydrate consumed was converted into muscle glycogen, and about 12 % was oxidized. We conclude that a meal providing 2.5 g CHO x kg(-1) body mass can increase muscle glycogen stores 3 h after ingestion. However, an estimated 67% of the carbohydrate ingested was unaccounted for and this may have been stored as liver glycogen and/or still be in the gastrointestinal tract.

The effect of a high carbohydrate meal on endurance running capacity

This study examined the effects of a pre-exercise meal and a carbohydrate-electrolyte solution on endurance running capacity. Ten men performed 3 treadmill runs at 70% VO2max to exhaustion after consuming (a) a carbohydrate meal 3 h before exercise and a carbohydrate-electrolyte solution during exercise (M + C); or (b) the carbohydrate meal 3 h before exercise and water during exercise (M + W); or (c) a liquid placebo 3 h before exercise and water during exercise (P + W). Exercise time was longer in M + C (125.1 +/- 5.3 min; mean +/- SE) and M + W (111.9 +/- 5.6 min) compared with P + W (102.9 +/- 7.9 min; p < .01 and p < .05, respectively), and longer in M + C compared with M + W (p < .05). Serum insulin concentration at the start of exercise and carbohydrate oxidation rates during the first hour of exercise were higher, whereas plasma FFA concentrations throughout exercise were lower in M + W and M + C than in P + W (p < .01). A carbohydrate meal before exercise at 70% VO2max improved endurance running capacity; however, the combination of the meal and a carbohydrate-electrolyte solution during exercise further improved endurance running capacity.

Influence of a carbohydrate-electrolyte solution ingested during running on muscle glycogen utilisation in fed humans

This study investigated whether the ingestion of a carbohydrate-electrolyte solution during running would influence muscle glycogen utilisation in subjects who had consumed a carbohydrate meal 3 hours before exercise. Eight men completed two 60-min treadmill runs at 70% VO(2)max. Before each run they consumed a carbohydrate meal (183 +/- 7 g) 3 hours before exercise and either 1) a carbohydrate-electrolyte solution during the run (46 +/- 1 g) (M+C), or 2) water during the run (M + W). Biopsy samples were obtained from the vastus lateralis muscle at rest and after 60 min of running. Serum insulin concentrations were higher (p < 0.01) in both trials at the start of exercise compared with fasting values, whereas blood glucose concentrations were higher (p < 0.01) after 60 min of running in the M+C trial. Pre-exercise muscle glycogen concentrations were similar in both trials (M+C: 321.9 +/- 27.2 vs M+W: 338.8 +/- 32.8 mmol x kg x dry weight (-1) [dw]; NS). There was no difference in the amount of glycogen used during exercise (M+C: 96.1 +/- 22.1 vs M+W: 77.9 +/- 11.7 mmol x kg x dw (-1); NS). In conclusion, a carbohydrate-electrolyte solution ingested during treadmill running at 70 % VO(2)max does not influence muscle glycogen use during the first hour of exercise when a carbohydrate meal is consumed 3 hours before exercise.

Fatal disseminated intravascular coagulation caused by Mycoplasma pneumoniae

We report fatal disseminated intravascular coagulation caused by Mycoplasma pneumoniae infection in a 7-year-old white boy. The diagnosis was based on relevant clinical material, absence of any other infections, a 4-fold rise in titer of complement fixation for M. pneumoniae and open lung biopsy findings. We discuss the association between M. pneumoniae and autoimmune mechanism.

Pre-exercise carbohydrate meal and endurance running capacity when carbohydrates are ingested during exercise

This study examined whether combining a pre-exercise carbohydrate meal with the ingestion of a carbohydrate-electrolyte solution during exercise is better in improving endurance running capacity than a carbohydrate-electrolyte solution alone. Ten men completed three treadmill runs at 70% VO2max to exhaustion. They consumed 1.) a carbohydrate meal three hours before exercise and a carbohydrate-electrolyte solution during exercise (M + C), or 2.) a liquid placebo three hours before exercise and the carbohydrate-electrolyte solution during exercise (P + C), or 3.) a placebo three hours before exercise and placebo during exercise (P + P). When the meal was consumed (M + C) serum insulin concentrations were higher at the start of exercise, and carbohydrate oxidation rates were higher during the first 60 min of exercise compared with the values found in the P + C and P + P trials (p < 0.01). Exercise time was longer in the M + C (147.4+/-9.6 min) compared with the P + C (125.3+/-7 min) (p < 0.01). Also, exercise time was longer in M + C and P + C compared with the P + P (115.1+/-7.6 min) (p < 0.01 and p < 0.05 respectively). These results indicate that the combination of a pre-exercise carbohydrate meal and a carbohydrate-electrolyte solution further improves endurance running capacity than the carbohydrate-electrolyte solution alone.

Comparison between carbohydrate feedings before and during exercise on running performance during a 30-km treadmill time trial

The purpose of this study was to compare the effects of a carbohydrate-electrolyte solution, ingested during exercise, with the effects of a preexercise carbohydrate meal on endurance running performance. Ten endurance-trained males completed two 30-km treadmill runs. In one trial subjects consumed a placebo solution 4 hr before exercise and a carbohydrate-electrolyte solution immediately before exercise and every 5 km (C). In the other trial, subjects consumed a 4-hr preexercise high-carbohydrate meal and water immediately before exercise and every 5 km (M). Performance times were identical for M and C, and there was no difference in the self-selected speeds. Oxygen uptake, heart rates, perceived rate of exertion, and respiratory exchange ratios were also similar. However, blood glucose concentration was higher in C during the first 20 km of the 30-km run. In M, blood glucose concentration was maintained above 4.5 mmol.L-1 throughout exercise. Thus, the two conditions produced the same 30-km treadmill running performance time.

The influence of pre-exercise glucose ingestion on endurance running capacity

Drinking a concentrated glucose solution less than 1 h before the start of prolonged submaximal exercise has been reported to reduce endurance capacity during cycling. The purpose of this study was to re-examine the influence of pre-exercise ingestion of a concentrated glucose solution on endurance running capacity. Nine recreational runners (five men and four women) ran to exhaustion on a level treadmill, at speeds equivalent to 70% VO2max, on two occasions separated by at least 1 week. The runners ingested either a solution containing 75 g of glucose in 300 ml of water (G trial), or 300 ml of sweetened water (P trial) 30 min before each trial. As a consequence, the blood glucose concentrations were 55% higher at the beginning of the G trial compared with those recorded for the P trial (G trial, mean(s.e.) blood glucose = 6.3(0.7) mmol l-1 versus P trial, mean(s.e.) blood glucose = 4.1(0.3) mmol l-1; P < 0.01). Nevertheless, there were no differences in the running times to exhaustion between the two trials (G trial, mean(s.e.) 133.79(11.0) min versus P trial, mean(s.e.) 121.16(8.1) min). The results of this study show that ingesting a 25% glucose solution 30 min before exercise does not reduce the endurance capacity of recreational runners when the exercise intensity is equivalent to 70% VO2max.

A comparative study on aztreonam, ceftazidime and amikacin in the treatment of complicated urinary tract infections

In a prospective, randomized trial, aztreonam (1 g intravenously or intramuscularly, twice daily) was compared with ceftazidime (1 g intravenously or intramuscularly, twice daily) and amikacin (500 mg intravenously or intramuscularly, twice daily) in 76 patients aged 24 to 84 years (mean, 59.7 years) with complicated urinary tract infections. Initial pathogens included Escherichia coli (47.5%), Pseudomonas aeruginosa (22.5%), Klebsiella spp. (9%), Proteus spp. (7.5%) and Enterobacter spp (6%). In four patients initial urine cultures yielded more than one organism. All pathogens were sensitive to the three study drugs. Including performance of 4- to 6-week follow-up cultures, eradication of the pathogens occurred in 72% of patients treated with aztreonam, in 74% of those treated with ceftazidime and in 71% treated with amikacin (p greater than 0.05). Clinical success was observed in 84% of patients treated with aztreonam, in 82% of those treated with ceftazidime and in 85% treated with amikacin (p greater than 0.05). All drugs were well tolerated. It is concluded that aztreonam, ceftazidime and amikacin are equally effective and safe for the treatment of complicated urinary tract infections due to susceptible organisms.

The determination of the eosinophil count: comparison of two techniques

The total eosinophil count obtained by use of the standard hemacytometer is considered by several investigators to be the most reliable method for the determination of the circulating eosinophil levels in the blood because it is believed to be less subject to error than the calculated eosinophil count obtained with Wright stained blood smears from the differential count. We compared the two techniques in outpatients as well as inpatients with and without allergies (total of 514 patients). Our results demonstrate that the eosinophil count by the two methods are similar.

Cardiopulmonary responses of asthmatic children to strenuous exercise. Effect of theophylline

The purpose of the study were to investigate the cardiopulmonary adaptations of asthmatic children to physical exercise and to evaluate the effects of theophylline. Two groups of children were evaluated. Eight asthmatic children participated in two exercise sessions. Half of the patients received theophylline in predetermined doses during the first session and half prior to the second session. Seventeen normal children matched for age, height, and weight served as controls. Various cardiorespiratory parameters were measured every 2 minutes during exercise and prior to termination of maximal physical effort. The results indicate that children with chronic asthma reach the range of predicted maximal aerobic capacity for their age. Theophylline increases the endurance of asthmatic children to maximal physical efforts without improving the cardiorespiratory parameters that were measured. The use of theophylline in therapeutic doses appears safe under conditions of vigorous exercise.

Epidemiologic observations in idiopathic pulmonary hemosiderosis

We did an epidemiologic survey of 30 children in whom idiopathic pulmonary hemosiderosis was diagnosed. Eighteen patients had died; 12 patients were still living. The majority of the cases were diagnosed in between 1962 and 1971, mainly in the spring and fall. Eighty percent of the patient lived in villages, whereas only 30% of the total population resided in the same type of rural area. Only one (5%) of the deceased children lived in the city, whereas four (33%) of the living children were city dwellers. The socioeconomic conditions were poor, and in 50% of the cases continuous exposure to highly toxic insecticides was elicited by history and investigation of housing conditions. The incidence of newly diagnosed cases decreased with the improvement of living conditions and the prohibition of the use of certain insecticides. We believe that environmental factors, perhaps insecticides, may cause idiopathic pulmonary hemosiderosis in genetically predisposed persons. An epidemiologic history and genetic investigation should be included in the evaluation of patients with any disease when the cause is obscure.

Prognostic criteria in idiopathic pulmonary hemosiderosis in children

An epidemiologic survey was undertaken of 30 children in whom idiopathic pulmonary hemosiderosis (IPH) had been identified. In determining the prognostic significance of various parameters, a clinical severity score was used. This included the year of onset of IPH, fever, difficulty in breathing, the severity of the anemia, the roentgenographic findings and therapeutic modalities such as transfusions, administration of steroids, antibiotic treatment and splenectomy. Eighteen patients had died. The results of this investigation suggest that: (1) The severity of the disease at its onset does not determine the survival; (2) Females survived longer; (3) Young age of the patients at the onset of IPH seems to carry a less favorable prognosis; (4) The common therapeutic modalities in use have not proved to be beneficial. We believe that some environmental insult to the developing lung in genetically predisposed persons may contribute to a higher morbidity in the younger patients.

Assessment of acute asthma in the emergency room: evaluation of compliance and combined drug therapy

Thirty-three chronic asthmatic children and adolescents on predetermined doses of theophylline preparations who arrived at the Emergency Room with an acute episode of wheezing were evaluated to determine compliance, and if therapeutic plasma theophylline levels (PTLs) facilitate the effectiveness of epinephrine. Patients were divided into three groups based on the requirement of one, two, or three doses of epinephrine. In the total group of patient visits, only 25% took the theophylline preparations as prescribed. The poor responders group requiring three injections of epinephrine was characterized by the lowest compliance and the highest unacceptable PTLs. It appears that therapeutic PTLs enhance the response to epinephrine. The evaluation of compliance in case of epinephrine failure is recommended.

Listeria meningitis in an immunocompetent child

We report a case of Listeria monocytogenes meningitis in an apparently healthy 3-year-old boy. This is the first case reported in English literature where adequate evaluation of immune status did not reveal an immunologic defect. The patient is in the age group least affected by an opportunistic organism and has been living in a district known for a high incidence of Listeria in livestock. The epidemiologic implication of this observation is discussed.

Quantitative effect of theophylline anhydrous on exercise-induced asthma after maximal physical effort

The quantitative effects of theophylline anhydrous upon exercise-induced asthma (EIA) were evaluated in asthmatic children. Theophylline inhibits EIA after maximal physical effort, increases tolerance to exercise and exerts a greater inhibitory effect upon larger than smaller airways. Its inhibitory effect seems not to be related to plasma theophylline levels.

An assessment of cardiorespiratory adjustments of asthmatic adults to exercise

The cardiorespiratory adjustments of asthmatic adults to submaximal and maximal workloads were investigated. Cardiorespiratory variables were measured every 2 min during exercise and at the end of maximal physical effort. Exercise-induced asthma (EIA) occurred in all asthmatic subjects while normal subjects maintained normal spirometry. The results suggest that asthmatic adults have no cardiac reserve or oxygen delivery limitations. They work under less efficient ventilatory conditions at submaximal workloads and have a significantly lower functional work capacity. The high degree of correlation between preexercise maximal midexpiratory flow rate (MMF) and maximum O2 consumption (max Vo2) suggests that the smaller airways contribute significantly to the observed abnormalities. We recommend that evaluation of antiasthmatic medications in exercise-induced asthma should take into consideration their effect upon smaller airways and cardiorespiratory variables.