Clin Med
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Athletes have always sought to outperform their competitors and regrettably some have resorted to misuse of drugs or doping to achieve this. Stimulants were taken by the first Olympic athletes to be disqualified in 1972. Although undetectable until 1975, from the 1950s androgenic anabolic steroids were administered for increased strength and power followed in the 1990s by erythropoietin for enhanced endurance. ⋯ When the International Olympic Committee (IOC) prohibited beta blockers (beneficial in shooting), diuretics (assist weight classified athletes) and glucocorticosteroids, some athletes with genuine medical conditions were denied legitimate medical therapy. To overcome this, in 1992 the IOC introduced a system known now as Therapeutic Use Exemption (TUE). This paper discusses Olympic athletes who have been known to dope at past Games and some medical indications and pitfalls in the TUE process.
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Practice Guideline
Assessment and management of alcohol dependence and withdrawal in the acute hospital: concise guidance.
Alcohol dependence is common among patients attending acute hospitals. It can be the major reason for attendance or a significant cofactor. Assessment of these patients in the acute setting can be challenging owing to the multidisciplinary approach required. ⋯ For this reason, assessment of dependence and prevention and management of acute alcohol withdrawal are often suboptimal. There is little existing guidance on how to manage this patient population, especially in non-specialist settings. With recently published National Institute for Health and Clinical Excellence (NICE) guidance on the management of dependence and withdrawal, now is the perfect time to produce concise guidelines in the hope that a more succinct suite of guidance can reach a larger audience.
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Sudden cardiac death in an athlete is a rare and heartrending event, often occurring in the absence of warning symptoms. The causes of sudden cardiac death in athletes are age dependent and demonstrate a degree of geographical variation. Pre-participation screening is recommended by both the European Society of Cardiology and the American Heart Association although there is no consensus regarding the utilisation of an electrocardiogram. This article will review the aetiology of sudden cardiac death and will present the evidence for pre-participation screening.
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Infliximab is a biological agent that is licensed for the treatment of severe Crohn's disease. The annual cost of infliximab treatment is approximately pound 16,456 (excl VAT). In May 2010, the National Institute for Health and Clinical Excellence (NICE) recommended that patients should receive biological agents as a planned course of treatment only until treatment failure or until 12 months after the start of treatment, whichever is shorter. ⋯ Four patients were in deep clinical remission and discontinued infliximab. Implementation of the NICE recommendations on the use of infliximab in Crohn's disease is likely to be challenging in the face of significant resistance from patients who have an understandable fear of relapse. It might be more appropriate to discuss treatment withdrawal when high-quality evidence is available to support this management option.