Cannabis in sport: anti-doping perspective

Since 2004, when the World Anti-Doping Agency assumed the responsibility for establishing and maintaining the list of prohibited substances and methods in sport (i.e. the Prohibited List), cannabinoids have been prohibited in all sports during competition. The basis for this prohibition can be found in the World Anti-Doping Code, which defines the three criteria used to consider banning a substance. In this context, we discuss the potential of cannabis to enhance sports performance, the risk it poses to the athlete's health and its violation of the spirit of sport. Although these compounds are prohibited in-competition only, we explain why the pharmacokinetics of their main psychoactive compound, Δ(9)-tetrahydrocannabinol, may complicate the results management of adverse analytical findings. Passive inhalation does not appear to be a plausible explanation for a positive test. Although the prohibition of cannabinoids in sports is one of the most controversial issues in anti-doping, in this review we stress the reasons behind this prohibition, with strong emphasis on the evolving knowledge of cannabinoid pharmacology.     

Physical activity in the prevention of cardiovascular disease: an epidemiological perspective

This review of the epidemiological evidence regarding physical activity and cardiovascular disease (CVD) provides substantial evidence from many different populations that leisure time physical activity is associated with reduced risk of coronary heart disease (CHD) and cardiovascular mortality in both men and women and in middle-aged and older individuals. Physical activity appears to be a critical factor in both primary and secondary prevention of CHD. The studies indicate a dose-response relationship between overall physical activity and CVD, which is linear at least up to a certain level of activity. Prospective studies suggest that physical activity is also associated with reduced risk of stroke. The mechanisms underlying the protective effect of physical activity on CVD are still unclear. In recent years. the view that physical activity has to be vigorous to achieve a reduction in risk of CHD has been questioned. Overall, the evidence points to the benefit of continued regular moderate physical activity which does not need to be strenuous or prolonged and includes daily leisure activities such as walking or gardening which are readily attainable by large sections of the population. Taking up regular light or moderate physical activity in middle or older age confers significant benefit for CVD and all-cause mortality.     

Tug of war: introduction to the sport and an epidemiological injury study among elite pullers

The objective of this study was to describe injury patterns among elite tug of war athletes, using a survey method. The setting was the World Tug of War (TOW) Championships in 1998. All 990 male and female athletes asked to participate. Demographic data, participation history, and injury history during TOW, including injury number and type, were collected. A total of 252 (187 males and 65 females) athletes completed the survey (25% response rate). Although males had been competing longer than females (9.3 +/- 6.9 years vs. 6.5 +/- 5.0 years, t-test, P < 0.005), the percentage of males (64/187 = 32%) and females (24/65 = 37%) females reporting TOW injuries was similar. Strains and sprains comprised over half of all injuries, and the back (42%), shoulder-upper limb (23%), and knee (17%) were most commonly injured. Injury patterns were similar among males and females. Elite TOW athletes represent a diverse age range (15-55 years) of males and females who have competed for 5-10 years. About one-third will have suffered past TOW-related injuries, typically involving sprains or strains of the low back, shoulder girdle-upper extremity, and knee. The possibility of an increased injury rate among female TOW athletes warrants further study. Considerations for future research are discussed.     

Imaging in epilepsy: a paediatric perspective

Assessment of a child with epilepsy involves a number of key stages, the most crucial being clinical evaluation where the presence of seizure activity and seizure type is identified. Subsequent imaging is not required in all children. In those selected for further investigation, imaging techniques are broadly divided into structural and functional studies. MRI currently provides the best structural data, with nuclear medicine and specialized MR techniques giving supportive functional information. CT now has a much diminished role. This review highlights the role of different imaging modalities in the investigation of childhood epilepsy, as well as some of the practicalities of imaging children, and areas where recent advances have been made. It is hoped that the overview and information provided will help both the specialist and the general radiologist make informed decisions regarding how to best image a child with epilepsy.     

Preparticipation examination (screening): practical issues as determined by sport: a United Kingdom perspective.

OBJECTIVES: Pre-participation examination, screening and health surveillance are part of the job specification for many roles within Sports Medicine. The type and scope of this activity varies enormously, with little consensus as to best evidence-based practice. The purpose of this work was to explore and understand the practical approaches to pre-participation examination, screening and health surveillance in two contrasting sport scenarios. DATA SOURCE: Team physicians for British Triathlon and Manchester United Football Club. DATA SYNTHESIS/METHODS: Information was gathered under the headings: why screen, screening objectives, practical issues and constraints? RESULTS: The systems evolved within these two sports reflect their respective opportunities and constraints. Different systems, each with merit, have evolved with some generalizable concepts across sport. CONCLUSIONS: A perfect system for pre-participation examination, screening and health surveillance across all sport does not exist, however, within specific sport scenarios examples of good practice are demonstrated.     

A physiotherapy perspective of musculoskeletal imaging in sport

This paper presents a physiotherapy perspective on the role that imaging is now playing in the diagnosis and management of musculoskeletal and sporting injuries. Although the Royal College of Radiologists and the UK Chartered Society of Physiotherapy were founded in the latter part of the nineteenth century, it is 100 years later that developments in the UK NHS have led to increased roles for non-medical healthcare professionals and allied health professionals, such as physiotherapists, in an extended clinical role. Physiotherapists, perhaps because of their knowledge of clinical and applied anatomy, have keenly taken up the opportunities offered to request and interpret imaging in its various forms; the most commonly available are plain radiography, musculoskeletal ultrasound and MRI. This has meant taking formal courses under the auspices of universities with mentorship and tutoring within the clinical setting, which are part of a continuing professional development. The ability to request several forms of imaging has enhanced physiotherapy practice and has increased the appreciation of the responsibilities which accompany this new role.     

The ethics of blood testing as an element of doping control in sport

Sport authorities continue to confront a variety of perplexing issues as they attempt to address effectively and efficiently the problems posed by doping. The emergence of the phenomena of blood doping and the administration of erythropoietin have added to the challenges faced by doping control authorities. Some sport organizations have introduced blood tests in an attempt to deal with these issues despite the absence of any effective test for the detection of the administration of homologous blood products or eythropoietin. A number of ethical issues are raised by such developments. Even in the presence of an effective test it is suggested that the decision to implement a specific testing approach can be reached by considering the wishes of a hypothetical "Fair Competitor" and an analysis of the costs involved. In this respect the Fair Competitor assumes in the sport community the role that the "reasonable person" occupies in law, permitting an analysis of a proposed course of action. In making any decision regarding the implementation of any test, a Fair Competitor would be guided by considerations of the postulated advantage and incidence of a doping technique, the likelihood of false positive and negative results, the risk of unwanted consequences of a testing process, and a concern that a specific test not accelerate the likelihood of the use of other doping methods. This approach is applied to a consideration of the appropriateness of blood testing in sport. It is concluded, using such an analysis, that in their present state of development, blood tests should not be implemented. It is recognized that certain sport authorities currently use blood tests to exclude competitors whose blood values exceed certain predetermined levels on the grounds of concerns regarding health and safety. Screening of this kind is beyond the purview of this discussion.     

Eye injuries in sport: an increasing problem.

A prospective study of ocular injuries sustained during sport, was performed from January to June 1987. A total of 84 eye injuries were seen. Of these, 23 were severe enough to necessitate admission to hospital. These latter accounted for one quarter of all severe eye injuries during this period. Racquet sports caused 42% of the injuries, and 57% of the hospital admissions, including two penetrating injuries. The importance of sport in causing eye trauma is increasing. It is crucial to encourage safer play, including the wearing of adequate eye protection.     

Radiographic features of paediatric pneumocystis pneumonia -- a historical perspective

AIM: To determine differences between the plain radiographic features of paediatric pneumocystis pneumonia (PCP) recorded before the emergence of human immunodeficiency virus (HIV) in 1982 and those documented in the HIV era. To establish differences in the radiographic features of PCP documented in HIV-infected children in developed and developing countries. METHOD: A Medline search of articles was conducted from 1950 to 2006, using the terms "pneumocystis pneumonia in children" and "chest radiographic features" or "bilateral opacification" or "lobar consolidation" or "asymmetrical opacification" or "pneumatocoeles" or "cavities" or "pneumothorax" or "pneumomediastinum" or "pleural effusion" or "mediastinal adenopathy" or "nodules" or "normal chest radiography". Appropriate articles were retrieved, radiological data extracted, reference lists examined and hand searches of referenced articles conducted. RESULTS: Diffuse bilateral "ground-glass" or alveolar pulmonary opacification, which may show some asymmetry, has been consistently documented as the commonest radiographic finding in childhood PCP throughout the period under review. The less common radiological features of PCP in children are similar to those in adults. In developed countries, PCP-related pulmonary air cysts have been reported at an earlier age in HIV-infected children, compared with uninfected children. PCP-related air cysts, pneumothorax, and pneumomediastinum have been reported in children in developed but not in developing countries. CONCLUSION: The radiological features of paediatric PCP documented before the HIV epidemic are similar to those recorded in the HIV era. Further study of the determinants of the uncommon radiographic features in children is warranted.     

Metatarsalgia: an ultrasound perspective

Research on metatarsophalangeal joint instability and the plantar plate was conducted from May 2002 to May 2006. Along with plantar plate tears, we found a range of pathologies. This is a pictorial review of our experience.     

Rape: an Asian perspective

Rape is one of the fastest growing violent crimes in many parts of the world. Rape laws have been amended in most countries in an attempt to cope with the proliferation of this crime. Even though the legal definition of rape and the procedural laws have been amended, rape remains a serious problem in both the developed and developing nations. In some countries the offence of rape carries severe punishment sometimes even the death sentence. In many jurisdictions the term 'sexual penetration' is being used instead of 'sexual intercourse'. Sexual penetration includes sexual intercourse, anal intercourse, cunnilingus, fellatio or any other intrusions involving any part of a human body or of any object into the genital or anal opening of a person's body. In many countries rape and other sexual offences have been replaced with a series of gender neutral and graded offences with appropriate punishments. Medical examination can provide independent, scientific, corroborative evidence that may be of value to the court in arriving at a judgement. Doctors should have a clear understanding of different rape laws in order to apprectiate the various issues involved. Special knowledge, skill and experience are essential to conduct a good-quality medical examination. There is a dearth of trained forensic physicians in many Asian countries. However, managing a rape victim (survivor) goes for beyond proving the case in a court of law. There should be an adequate rehabilitation programme available to the victims to help them cope.     

Jaundice: an internist's perspective

Jaundice may result from a pathophysiologic abnormality in the uptake, transport, conjugation, or excretion of bilirubin. The pathogenesis of this disease is always difficult to determine, but studies such as abdominal ultrasonography, percutaneous transhepatic cholangiography, and endoscopic retrograde cholangiopancreatography have facilitated diagnosis.     

Muscle dysfunction versus wear and tear as a cause of exercise related osteoarthritis: an epidemiological update

There are two main hypotheses for the cause of exercise related osteoarthritis: wear and tear of the articular cartilage and muscle dysfunction. This is a review of the clinical literature to see which hypothesis has the greatest support. Clinical studies support the muscle dysfunction hypothesis over the wear and tear hypothesis.     

Pivot shift as an outcome measure for ACL reconstruction: a systematic review

Purpose  

To identify and evaluate the evidence for the pivot shift test as an outcome measure following ACL reconstruction. Achieving rotatory control of the knee post anterior cruciate ligament (ACL) reconstruction has been shown to increase patient satisfaction, decrease functional instability and potentially delay the development of osteoarthritis. The pivot shift is able to assess this rotatory component of knee laxity and appears to have the potential to become a benchmark in gauging the success of ACL surgery. Multiple confounding factors and discrepancies in performing the maneuver itself however put its usefulness in question. Thus, the literature was reviewed to assess whether the pivot shift was able to correlate with final functional outcomes.