Central Stimulation Research Articles

Factors associated with caffeine intake among undergraduates: a cross-sectional study from Palestine

BackgroundCaffeine is one of the world’s most frequently consumed central nervous system stimulants. Moderate caffeine intake has beneficial health effects, while increased caffeine intake may have harmful effects in the human body. Existing literature indicated that undergraduates consume caffeine excessively. Till this date, little is known about the consumption pattern of caffeine among Palestinian undergraduates. Therefore, the current study aimed to estimate the percentage of caffeine consumption among Palestinian undergraduates, to assess their caffeine daily intake, and to identify factors associated with unsafe caffeine consumption.MethodsA cross-sectional study was conducted in Palestine between March and May 2022. Undergraduates were recruited by random sampling after a personal invitation. Undergraduates aged between 18 and 25 were included in the study, while those who were taking medications, had medical conditions affecting the data collection process, and had incomplete responses were excluded from the study. Caffeine consumption was assessed using a semi-quantitative food frequency questionnaire (FFQ) developed by the research team. The content validity of the FFQ was done by three reviewers. Also, a questionnaire was used to collect data related to sociodemographic characteristics, medical history, lifestyle habits, sleeping quality, physical activity, and psychological status. Data were analyzed through the descriptive statistics and inferential statistics (Chi-square test, Mann-Whitney test, and Kruskal-Wallis H test).ResultsThe final analysis included 486 undergraduates with a mean age of 20.1 ± 1.48 years. The majority of the undergraduates were female (65.0%) and single (89.5%). The sample was distributed almost equally between the first (26.3%), second (23.0%), third (22.8%), and fourth (18.7%) academic years, and only 44 undergraduates (9.1%) were in their fifth year. The vast majority of university students (96.5%) consumed caffeinated products, with coffee ranking first place. Nearly half of the participants (32.7%) exceeded the safe levels of caffeine consumption. Males, smokers, poor physical activity, higher Sleep Hygiene Index (SHI) scores, and greater anxiety, stress, and depression scores had significantly higher rates of unsafe caffeine intake than their peers (p < 0.05). The total caffeine consumption was significantly associated with gender, low household income, smoking status, physical activity level, SHI score, as well as anxiety (p < 0.05).ConclusionCaffeine consumption in the studied sample was significantly high and exceeded the safe levels. The current study revealed that unsafe caffeine consumption was more common among males, smokers, and physically active individuals. Caffeine intake was also linked to poor-quality sleep and higher psychological concerns. Therefore, educational programs are recommended to increase awareness of the adverse effects of high caffeine intake.

The effects of contralateral limb cross-education training on post-surgical rehabilitation outcomes in patients with anterior cruciate ligament reconstruction: a randomized controlled trial

ObjectiveThis study examines whether cross-education training of the healthy limb promotes cross-transfer through central nervous system stimulation, enhancing the function, kinematic parameters, dynamic balance, and plantar pressure of the affected knee joint in patients recovering from postoperative anterior cruciate ligament reconstruction (ACLR).MethodsForty anterior cruciate ligament reconstruction (ACLR) patients, 5–6 weeks postoperatively, were included and randomly assigned to either an experimental group (n = 20) or a control group (n = 20). The experimental group participated in six weeks of cross-education (CE) training in addition to conventional rehabilitation, while the control group received only conventional rehabilitation. Assessment outcomes included knee function (Lysholm score, joint mobility, and surface electromyographic characteristics of the rectus femoris muscle), kinematic parameters (stride length, stride speed, and stride width), dynamic balance (gait line length, single-support line length, and medial-lateral displacements), and plantar pressure (forefoot, midfoot, and hindfoot pressures). The effect of CE training on postoperative ACLR rehabilitation was comprehensively assessed by comparing the pre- and post-intervention changes within each group and the differences between the groups.ResultsBefore the intervention, no statistically significant differences were observed between the two groups across all measured parameters (P > 0.05). Following the intervention, significant improvements in knee function, kinematic parameters, balance function, and plantar pressure were observed in both groups, with the experimental group showing significantly more significant improvements (P < 0.05). The Lysholm score, range of motion (ROM), and surface electromyographic activity of the rectus femoris muscle were significantly higher in the experimental group compared to the control group (P < 0.01). Among kinematic parameters, the experimental group demonstrated a significant increase in stride length and reduced stride width, whereas differences in stride speed were not statistically significant (P > 0.05). Regarding balance function, the experimental group exhibited significantly longer gait and single-support line lengths, significantly reducing medial-lateral displacement (P < 0.05). Analysis of plantar pressure revealed significant improvements in forefoot and hindfoot pressures in the experimental group, with a particularly notable increase in hindfoot pressure (P < 0.05). However, changes in midfoot pressure were not statistically significant (P > 0.05).ConclusionCE training markedly enhanced knee function, kinematic metrics, dynamic stability, and plantar pressure in postoperative ACLR patients providing initial evidence for the prospective utilization of CE theory in rehabilitation. Nonetheless, the fundamental mechanics of its effects remain ambiguous, and variables such as individual differences and neuromuscular adaptation processes may affect training results. Future studies should examine its long-term impacts and uncover potential neuromuscular pathways to establish a solid scientific basis for improving postoperative rehabilitation procedures.

White matter connections within the central sulcus subserving the somato-cognitive action network.

The somato-cognitive action network (SCAN) consists of three nodes interspersed within Penfield's motor effector regions. The configuration of the somato-cognitive action network nodes resembles the one of the 'plis de passage' of the central sulcus: small gyri bridging the precentral and postcentral gyri. Thus, we hypothesize that these may provide a structural substrate of the somato-cognitive action network. Here, using microdissections of sixteen human hemispheres, we consistently identified a chain of three distinct plis de passage with increased underlying white matter, in locations analogous to the somato-cognitive action network nodes. We mapped localizations of plis de passage into standard stereotactic space to seed fMRI connectivity across 9,000 resting-state fMRI scans, which demonstrated the connectivity of these sites with the somato-cognitive action network. Intraoperative recordings during direct electrical central sulcus stimulation further identified inter-effector regions corresponding to plis de passage locations. This work provides a critical step towards improved understanding of the somato-cognitive action network in both structural and functional terms. Further, our work has the potential to guide the development of refined motor cortex stimulation techniques for treating brain disorders, and operative resective techniques for complex surgery of the motor cortex.

Qualitative Analysis of Symptoms from the Central Thalamic Deep Brain Stimulation Trial for Traumatic Brain Injury

Qualitative Analysis of Symptoms from the Central Thalamic Deep Brain Stimulation Trial for Traumatic Brain Injury

Pediatric Attention-Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder: Analyzing National Treatment Trends.

This study investigated how a disruptive mood dysregulation disorder (DMDD) diagnosis influences treatment selection and sequencing in children with attention-deficit/hyperactivity disorder (ADHD). This multicenter, population-based, retrospective cohort study analyzed data from TriNetX Research Network (June 2013 through July 2024). Youth with ADHD (without DMDD) formed the control cohort (n=631 295). Youth with ADHD+DMDD (n=24 723) formed the study cohort. Odds ratios (ORs) and relative risks were calculated to analyze associations. Compared with controls, ADHD+DMDD cohort was more likely to be composed of non-Hispanic ethnicity and exhibited higher rates of psychiatric comorbidities, inpatient and emergency service utilization, and billed psychotherapy (ORs range 1.25-6.95). Youth with ADHD+DMDD were more likely to receive ADHD medications (ORs range 1.55-4.80), as well as antidepressants, mood stabilizers, and antipsychotics (ORs range 5.05-13.16). Hispanic youth with DMDD utilized more psychotropics but less psychotherapy, while White youth used all services more. Before the use of non-ADHD medications for aggression, only 25% of ADHD+DMDD youth had a therapy code, and around 11% showed evidence of optimization of ADHD medication. After a DMDD diagnosis, treatment rates for other psychotropics increased more than those for central nervous system stimulants. In youth with ADHD, a DMDD diagnosis is associated with increases in the spectrum of pharmacological and nonpharmacological treatments deployed with patterns varying by race and ethnicity. Antipsychotic and mood stabilizer prescriptions increased most prominently, often before receiving psychotherapy services or efforts to optimize ADHD medication. Future research should address disparities in DMDD treatment patterns and identify the optimal treatment sequences for DMDD.

Effect of Capromorelin on Appetite and Weight Gain of Domestic Pigeons (Columba livia domestica).

Weight loss and decreased appetite are commonly encountered sequela of disease and stress in avian patients. However, there is currently minimal information in the veterinary literature regarding appetite stimulation in birds. Capromorelin is a potent agonist of the growth hormone secretagogue receptor and increases food consumption via direct stimulation of the hunger centers of the hypothalamus. It is US Food and Drug Administration approved for use as an appetite stimulant in dogs (Canis lupus familiaris) and has also been shown to increase food consumption in New Zealand white rabbits (Oryctolagus cuniculus), domestic cats (Felis catus), and chickens (Gallus gallus domesticus). Twenty adult domestic pigeons (Columba livia domestica), housed in groups of 5, were involved in a randomized controlled study to investigate the effect of capromorelin on appetite and weight gain. Each group of pigeons was randomly assigned to receive either oral water (control) or capromorelin (treatment). The birds were individually weighed and given either oral water (control) or capromorelin at 12 mg/kg once daily for the duration of the 6-day study period. Total food consumed was recorded in grams per cage each day, and pigeons given capromorelin consumed 38% more food than those in the control group. Pigeons given capromorelin gained significantly more weight (2.5% gain) over the course of the study period compared with controls (0.7% loss, P = 0.004). No adverse side effects were noted in any birds. Capromorelin shows promise as an appetite stimulant in pigeons, and further investigation into its use in other avian species is warranted.

Optimization of an analytical method based on the use of zwitterionic- phosphorylcholine -HILIC column for the determination of multiple polar emerging contaminants in reclaimed water.

The aim of this study was to optimize a Liquid Chromatography Mass Spectrometry (LC-MS) method using a zwitterionic phosphorylcholine HILIC column for the determination of several Persistent and Mobile Organic Contaminants (PMOC) in wastewater samples. An experimental design approach was implemented to both better understand the retention mechanisms of several polar compounds and to find the optimal operating conditions for their detection and quantification. Eleven PMOCs, with logDpH=7 ranging from -5.27 to 0.24, were considered, including pesticides, artificial sweeteners, pharmaceuticals, and central nervous system stimulants. Key chromatographic variables-such as the initial percentage of the organic mobile phase, temperature, flow rate, gradient time, acid percentage, and the type and concentration of two different salts- were studied to assess their influence on peak areas, retention times and separation efficiency. The results indicated buffer type, flow rate, and initial percentage of organic mobile phase as the most influential factors affecting retention, though the effects were closely related to the chemical and physicochemical properties of the analytes. The optimized instrumental method demonstrated acceptable figures of merit, with recoveries ranging from 49 % to 100 % for all analytes (except taurine, which may require a different experimental preprocessing step). The method also showed satisfactory precision (repeatability of the entire experimental procedure), in terms of Relative Standard Deviation (RSD %), which was <10 % for all analytes. The developed method was successfully applied to the analysis of reclaimed water samples collected in six wastewater treatment plants in two regions of northern Italy. All target ECs were detected and quantified, except for clenbuterol, terbutaline, acesulfame K and 2,4-dichlorophenoxyacetic acid, which were below the detection limit.

Efficacy of oral modafinil on accelerating consciousness recovery in adult patients with moderate to severe acute traumatic brain injury admitted to intensive care unit: a randomized double-blind clinical trial.

Traumatic Brain Injury (TBI) is a leading cause of hospitalization and disability in young and middle-aged adults. This study aims to survey the efficacy of oral modafinil, a low-side-effect central nervous system stimulant, in the enhancement of consciousness recovery in moderate to severe TBI patients in the ICUs of a referral trauma center. All ICU patients meeting inclusion criteria between April 2021 and April 2023 were screened. Eligible patients had a motor Glasgow Coma Score(GCS) of 4 or 5 and did not receive continuous intravenous sedatives within 24 h before screening. They were randomly assigned to receive 200mg of enteral modafinil or placebo daily for 7 days. Motor GCS and total GCS scores, ICU/hospital stay duration, mechanical ventilation requirement, tracheal tube removal time, and tracheostomy needs were recorded. Among the included 85 eligible patients, there was no significant difference between the modafinil and placebo groups in the median days between the intervention and the time of a 2-unit increase in total GCS (P = 0.25) or a 1-unit increase in motor GCS (P-value = 0.31). The group assignment also had no impact on the mean GCS (P-value = 0.533) and mean motor GCS (P-value = 0.167) over time. The only significant difference was in the proportion of patients with an increase in total GCS by 2 units, which was 54% for the modafinil vs. 32% for the placebo group (P-value = 0.04), and an increase in motor GCS by 1 unit, with 56% in the modafinil vs. 34% in the placebo group (P-value = 0.04). The administration of modafinil appears to be safe and beneficial for patients with severe TBI during their stay in the ICU.

Drug detection in oral fluid and urine after single therapeutic doses of dexamphetamine, lisdexamphetamine, and methylphenidate in healthy volunteers.

Dexamphetamine, lisdexamphetamine, and methylphenidate are central stimulant drugs widely used to treat Attention-deficit/hyperactivity disorder (ADHD), but poor adherence may lead to treatment failure and the drugs are also subject to misuse and diversion. Drug analysis in oral fluid may thus be useful for monitoring adherence and misuse. We measured drug concentrations in oral fluid and urine after controlled dosing to investigate detection windows and evaluate the chosen cut-offs. Healthy volunteers ingested single oral doses of 10 mg dexamphetamine (n=11), 30 mg lisdexamphetamine (n=11), or 20 mg methylphenidate (n=10), after which they collected parallel oral fluid and urine samples every 8 hours for 4-6 days. Amphetamine (analytical cut-off, oral fluid: 1.5 ng/mL; urine: 50 ng/mL), methylphenidate (oral fluid: 0.06 ng/mL), and ritalinic acid (urine: 500 ng/mL) were analyzed using fully validated chromatographic methods. The median time from ingestion to the last detection in oral fluid was 67 ± 4.9 (lisdexamphetamine) and 69 ± 8.8 (dexamphetamine) hours for amphetamine and 36 ± 2.5 hours for methylphenidate. This was comparable to urine (77 ± 5.1 hours for lisdexamphetamine, 78 ± 4.5 hours for dexamphetamine, 41 ± 2.4 hours for ritalinic acid). The inter-individual variability in detection times was large, probably in part due to pH-dependent disposition. Using a logistic regression approach, we found similar detection rates as a function of time since intake in urine and oral fluid with the chosen cut-offs, with a high degree of probability for detection at least 24 hours after intake of a low therapeutic dose. This demonstrates the usefulness of oral fluid as a test matrix to assess adherence to ADHD medications, provided the analytical method is sensitive, requiring a cut-off as low as 0.1 ng/mL for methylphenidate. Detection windows similar to those in urine may be achieved for amphetamine and methylphenidate in oral fluid.

Cocaine Induced Necrotic Penile Ulcer

Cocaine is a strong central nervous system stimulant that is highly addictive with a wide potential for abuse as a recreational drug. The use of cocaine in an estimated 3 million Texans and 560 million Americans, has led to a growing health care hazard with many detrimental effects.

Cognitive Enhancers Consumption: Prevalence, Knowledge, and Determinants of Use Among Medical Students in Egypt, Sudan, and Jordan

Background Cognitive Enhancers (CE) are central nervous system stimulant substances known to improve cognitive functions. Due to high-perceived stress and academic pressure, CEs are becoming increasingly popular among medical students. As a result, they are more likely to misuse these substances. Objectives This study aims to estimate the prevalence of CE consumption, compare the prevalence between countries and genders, and identify characteristics associated with CE consumption among students at medical schools in Egypt, Sudan, and Jordan. Method A population-based survey study was conducted among medical students from Egypt, Sudan, and Jordan. An online self-reported questionnaire was used to collect data. Frequencies and percentages were calculated to represent participant distribution across categories. Chi-square was used for categorical variables comparisons. All tests were two-tailed, considering p < 0.05 statistically significant. Demographic characteristics, reasons for use, types of CE used, and side effects were compared by country and gender. Results A total sample of 1399 participated in the questionnaire, most of whom were females 824 (58.9%). Overall, 1236 (88.3%) were CE consumers, and 163 (11.7%) were non-consumers. Of the respondents who used CE, 814 (58.2%) reported using them daily. There was a statistically significant difference between the consumption of CE and the source of acquisition, nationality, and residence status regarding gender. Conclusions Our findings suggest that CE use is increasing among medical students in Egypt, Sudan, and Jordan. Efficient support, stress management programs, and awareness symposia may help reduce the misuse of these substances. Future longitudinal studies are still required.

Methylphenidate abuse and misuse in patients affected with a psychiatric disorder and a substance use disorder: a systematic review.

Methylphenidate (MPH), a central nervous system stimulant primarily prescribed for attention-deficit/hyperactivity disorder (ADHD), has seen increasing rates of misuse and abuse, particularly in patients with dual diagnosis (co-occurring psychiatric disorders and substance use disorders/SUDs). The heightened risk of dependence and adverse effects in these vulnerable populations warrants a systematic review to assess the prevalence and pattern of abuse/misuse of MPH among patients within this population and to understand potential risk factors, patterns of misuse, and outcomes, including the impact on psychiatric symptoms and overall mental health, the effects on SUD (e.g., exacerbation or mitigation of symptoms), and the incidence of adverse events and complications (e.g., cardiovascular issues, psychological effects). A systematic review was conducted in August-September 2024 using both PubMed and Scopus databases. The following search strategy was used: TITLE-ABS-KEY (methylphenidate OR Ritalin OR Concerta) AND TITLE-ABS-KEY (abuse OR misuse OR dependency OR addiction) AND TITLE-ABS-KEY (dual diagnosis OR comorbid psychiatric disorder OR psychiatric disorder AND substance use disorder). The systematic review was structured in accordance with the PRISMA guidelines and identified studies were assessed by title/abstract and full text screening against eligibility criteria. A total of 12 studies were selected for analysis after screening for relevance, quality, and adherence to inclusion criteria. Findings indicated that individuals with psychiatric disorders, particularly conduct disorder (N=593/1551 individuals), mood disorder (N=90/1551 individuals), anxiety disorder (N=66/1551 individuals), personality disorder (N=44/1551 individuals) and major depression disorder (N=40/1551 individuals), were more likely to misuse MPH. Co-occurring SUD, especially involving Alcohol Use Disorder (N=475/1551 individuals), Cannabis Use Disorder (N=371/1551 individuals), Nicotine Use Disorder (N=343/1551 individuals), Cocaine Use Disorder (N=68/1551 individuals), significantly elevated the risk. Misuse often involved higher doses than prescribed (N=84/1551 individuals) or using non-oral routes of administration (N=20/1551 individuals; e.g., snorting). Adverse outcomes included heightened risk of gastrointestinal events (N=201/1551 individuals), cardiovascular events (N=108/1551 individuals), psychosis (N=69/1551 individuals), and exacerbation of psychiatric symptoms (N=1082/1551 individuals). MPH misuse and abuse are significant concerns in patients with psychiatric disorders and SUD. Risk factors include impulsivity, history of substance abuse, and access to prescription stimulants. Integrated therapeutic approaches and stricter prescription monitoring are recommended to mitigate misuse risks. https://www.crd.york.ac.uk/prospero/, identifier CRD42024576724.

Somatosensory integration in robot-assisted motor restoration post-stroke.

Disruption of somatosensorimotor integration (SMI) after stroke is a significant obstacle to achieving precise motor restoration. Integrating somatosensory input into motor relearning to reconstruct SMI is critical during stroke rehabilitation. However, current robotic approaches focus primarily on precise control of repetitive movements and rarely effectively engage and modulate somatosensory responses, which impedes motor rehabilitation that relies on SMI. This article discusses how to effectively regulate somatosensory feedback from target muscles through peripheral and central neuromodulatory stimulations based on quantitatively measured somatosensory responses in real time during robot-assisted rehabilitation after stroke. Further development of standardized recording protocols and diagnostic databases of quantitative neuroimaging features in response to post-stroke somatosensory stimulations for real-time precise detection, and optimized combinations of peripheral somatosensory stimulations with robot assistance and central nervous neuromodulation are needed to enhance the recruitment of targeted ascending neuromuscular pathways in robot-assisted training, aiming to achieve precise muscle control and integrated somatosensorimotor functions, thereby improving long-term neurorehabilitation after stroke.

Abstract 304: Increased Stroke Severity and Mortality in Methamphetamine Users: A Propensity‐Matched Analysis

Introduction Methamphetamine (meth) is a highly addictive central nervous system stimulant that has been associated with an increased risk of cerebrovascular disease, particularly among younger individuals. Frequent methamphetamine use, defined as meth use exceeding 100 days annually in the United States, has increased by 66% from 2015 to 2019 and represents a growing concern among young patients. This study aims to compare the severity of stroke presentation between methamphetamine users and non‐users by employing propensity score analysis to account for confounding variables. Methods We conducted a retrospective review of consecutive stroke patients who presented to a Comprehensive Stroke Hospital between January 2023 and August 2024 with a definitive diagnosis of ischemic or hemorrhagic stroke. Baseline demographics, clinical presentation, and inpatient mortality were recorded. Patients in the methamphetamine stroke group were matched with non‐methamphetamine stroke patients based on age, gender, hypertension, diabetes mellitus, atrial fibrillation, and hyperlipidemia using propensity score analysis. Statistical analysis was performed using the T‐Test or Mann‐Whitney U‐Test where appropriate. Results Our study included 53 patients with a mean age of 56 (83% ischemic, 17% hemorrhagic) diagnosed with methamphetamine‐related stroke, who were matched to 200 non‐methamphetamine stroke patients with a mean age of 64 (88% ischemic, 12% hemorrhagic) during the study period. The average NIHSS score for meth‐positive patients was higher than that of the meth‐negative group (9.7 vs. 6.5; p=0.05). Meth‐positive patients also had higher white blood cell (WBC) (10 vs 9.3 p=0.03) and neutrophil (7.5 vs. 7.2 p=0.02) counts on presentation. The inpatient mortality rate for meth‐positive patients was significantly higher as well (13.2 vs. 9.5; p=0.02). Conclusion Methamphetamine use among stroke patients is associated with increased stroke severity, WBC count upon presentation, and a higher in‐hospital mortality rate. Future research should investigate the underlying mechanisms that contribute to this increased severity and the implications for treatment outcomes.

L-DOPA for the prevention and acceleration of the reversal of neurogenic dystrophic damage to internal organs

This review presents experimental and clinical studies of the effects of the levorotatory isomer of dihydroxyphenylalanine (l-DOPA) on the development and reversal of neurogenic dystrophic changes (neurogenic dystrophy) in the heart, stomach, liver, and pancreas. These changes were induced by stimulation of the reflexogenic zones such as the aortic arch and pyloroduodenal area in rats and rabbits, by tonsillar stimulation in rabbits, by 3-hour electrical stimulation and immobilization in rats, and by central electrical stimulation of the posterior hypothalamus in rabbits. Protective effects of l-DOPA were identified at doses of 30, 50, and 300 mg/kg in terms of the development of biochemical and morphological manifestations of neurogenic dystrophy in the studied organs, including a significant decrease in norepinephrine and creatine phosphate levels and an increase in lactic acid level. The use of l-DOPA during the repair phase accelerated the recovery of adrenergic mediation, energy metabolism, and the resolution of dystrophic morphological manifestations, in particular, hemorrhagic erosions of the gastric mucosa. In clinical settings, preoperative medication of patients with l-DOPA (5 mg/kg) for 3 days before mitral commissurotomy prevented the development of postoperative heart failure. In patients with peptic ulcer disease, the administration of l-DOPA during the early remission phase accelerated the healing of ulcers in the stomach and duodenal wall.

Heptaminol hair testing to highlight octodrine contamination in supplements, responsible for a doping adverse analytical finding

Octodrine, also known as dimethylhexylamine (DMHA), is a central nervous stimulant. When ingested by humans, octodrine is rapidly metabolized to heptaminol, the main compound present in the blood. Due to their stimulant activities, octodrine and its metabolite are specified substances in section S6b “specified stimulants” of the World Anti-Doping Agency (WADA) Prohibited List, prohibited in competition. But in some cases, they can be responsible for an adverse analytical finding (AAF) following contamination, with a low concentration in the urine. In such cases, a hair test can distinguish doping from contamination according to the concentration measured, or the absence of the target drug. However, no data are available in the literature. The aim of this study was to develop a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantification of octodrine and heptaminol in hair, and to apply it to an athlete with an AAF with heptaminol (141 and 136 ng/mL in urine samples A and B after correction for specific gravity) and octodrine (16 ng/mL, not given by the WADA laboratory in sample A as being below the minimum request level of 50 ng/mL).All the supplements taken by the athlete were analysed, and pubic hair (black, 1.5–2 cm long, no head hair available) and toenail clippings (0.1 cm) were sampled two months after AAF. A supplement was identified as the source of contamination, containing octodrine at a concentration range 16–34 µg/g. The athlete had taken 13 g daily (0.2–0.4 mg octodrine) for 20 days prior to the AAF (total dose 4–8 mg). His pubic hair and toenail clippings contained only heptaminol (30 pg/mg and 3 pg/mg, respectively). A controlled study was carried out on a volunteer who took a single 13 g dose of the contaminated supplement (single dose of octodrine 0.2–0.4 mg). His urine was positive for both compounds, with concentrations very close to those of the athlete on the day of the AAF after the same delay between intake and sampling (around 4 h). One month later, his head hair and pubic hair showed only heptaminol at 2 and 3 pg/mg, respectively, and toenail clippings were totally negative for both compounds. The contamination was accepted by the WADA commission, but the athlete was still banned for 9 months for having consumed supplements purchased on the internet.

Chocolate toxicosis in pets

Chocolate ingestion is very common in pets, particularly dogs, but has also been reported in other animals including cats and rabbits. Most cases occur around Christmas and Easter, when large amounts of chocolate are often present in the home in the form of chocolate bars, snacks, confectionery, Easter eggs and chocolate figurines. Chocolate-covered raisins, nuts and coffee beans present an additional toxicological hazard in dogs. The type of chocolate is defined in law by the percentage of cocoa solids, with dark (plain) chocolate containing more than milk chocolate. The main toxic component of chocolate is theobromine, a methylxanthine, although caffeine, another methylxanthine, is also present. These cause central nervous system stimulation with cardiac and respiratory hyperactivity. Signs include gastrointestinal effects, excitability, hyperactivity, tachycardia, tremors, hypertension and hyperthermia. Signs of toxicosis generally occur within a few hours of ingestion. The mainstays of treatment are decontamination and supportive care with rehydration, control of central nervous system stimulation and arrhythmias as required. Most pets recover fully, and death is uncommon; however, prognosis is more guarded in pets with seizures or arrhythmias.

To Caffeinate or Not to Caffeinate? The Dilemma in Neonatal Apnea Management

Caffeine, a widely used central nervous system stimulant, has emerged as the most commonly used therapeutic agent for managing apnea of prematurity in neonates over the last decade. Despite the evidence favoring caffeine, there are several controversies with the use of caffeine in neonates. Several studies have shown that caffeine significantly decreases cerebral blood flow velocity, impacting cerebral oxygenation and tissue oxygenation index. Higher doses of caffeine have raised safety concerns, with reports of increased incidence of cerebellar hemorrhage and adverse neurological outcomes in preterm infants. The duration of caffeine therapy remains a conundrum, with no consensus guidelines available. Neonatal units differ in their approaches to discontinuing caffeine therapy and discharging babies based on apnea-free intervals. The documentation and monitoring protocols for apnea vary across units, raising concerns about the accuracy of clinical recommendations. This article aims to unfold the complexities surrounding caffeine therapy in neonatal care, highlighting the potential concerns of using caffeine, especially in higher doses, while acknowledging the existing benefits for managing apnea of prematurity. We call on medical professionals to conduct more thorough research and controlled trials to understand better how to use caffeine effectively for premature babies for improving neonatal outcomes.

The Top 5 Can't-Miss Sport Supplements.

Background/Objectives: Sports supplements have become popular among fitness enthusiasts for enhancing the adaptive response to exercise. This review analyzes five of the most effective ergogenic aids: creatine, beta-alanine, nitrates, caffeine, and protein. Methods: We conducted a narrative review of the literature with a focus on the sport supplements with the most robust evidence for efficacy and safety. Results: Creatine, one of the most studied ergogenic aids, increases phosphocreatine stores in skeletal muscles, improving ATP production during high-intensity exercises like sprinting and weightlifting. Studies show creatine supplementation enhances skeletal muscle mass, strength/power, and muscular endurance. The typical dosage is 3-5 g per day and is safe for long-term use. Beta-alanine, when combined with the amino acid histidine, elevates intramuscular carnosine, which acts as a buffer in skeletal muscles and delays fatigue during high-intensity exercise by neutralizing hydrogen ions. Individuals usually take 2-6 g daily in divided doses to minimize paresthesia. Research shows significant performance improvements in activities lasting 1-4 min. Nitrates, found in beetroot juice, enhance aerobic performance by increasing oxygen delivery to muscles, enhancing endurance, and reducing oxygen cost during exercise. The recommended dosage is approximately 500 milligrams taken 2-3 h before exercise. Caffeine, a central nervous system stimulant, reduces perceived pain while enhancing focus and alertness. Effective doses range from 3 to 6 milligrams per kilogram of body weight, typically consumed an hour before exercise. Protein supplementation supports muscle repair, growth, and recovery, especially after resistance training. The recommended intake for exercise-trained men and women varies depending on their specific goals. Concluions: In summary, creatine, beta-alanine, nitrates, caffeine, and protein are the best ergogenic aids, with strong evidence supporting their efficacy and safety.

A Review on Validated RP-HPLC Method for the Simultaneous Estimation of Serdexmethylphenidate and Dexmethylphenidate in Bulk and Pharmaceutical Dosage Form

An ADHD medication called Azstarys was approved by the FDA in March 2021.Because it combined serdexmethylphenidate and dexmethylphenidate for the first time, it is unique. Treatment for Attention Deficit Hyperactivity Disorder (ADHD) begins with a prodrug called serdexmethylphenidate. CNS stimulants include serdexmethylphenidate. People six years of age and older with attention deficit hyperactivity disorder (ADHD) are taken serdexmethylphenidate, a prodrug of dexmethylphenidate, in addition to dexmethylphenidate. Serdexmethylphenidate is a prodrug of the central nervous system stimulant dexmethylphenidate. It alters neurotransmission in the central nervous system by increasing extracellular dopamine and norepinephrine numbers.3[11] As a central nervous system stimulant, serdexmethylphenidate carries a risk of usage, addiction, and abuse that should be monitored. In addition, patients need to be assessed. The accuracy, precision, linearity, robustness, limits of detection and quantitation, system adaptability, robustness, and other factors can all be used to validate the RP-HPLC technology.