A synopsis of the adverse analytical and atypical findings between 2005 and 2011 from the Doping Control Laboratory of Athens in Greece.

This article concerns the analysis of the Adverse Analytical Findings (AAFs) and the appropriate alterations made during the period 2005-2011, so that the Doping Control Laboratory of Athens (DCLA) obeys the updated World Anti-Doping Agency (WADA) List of Prohibited Substances. The % AAFs of the DCLA was compared with those of WADA-Accredited Laboratories. In 2008, the term Atypical Finding was introduced by the WADA representing a reported but inconclusive result. A characteristic example is when a testosterone-to-epitestosterone ratio is >4 followed by a negative gas chromatography/combustion/isotope ratio mass spectrometry result. In a total of about 30,000 athlete samples, 136 athletes were found with an increased testosterone/epitestosterone ratio and 43 with tetrahydrocannabinol metabolite (THCCOOH) of 427 reported AAFs. Twenty-one athletes in total were found positive with methylhexaneamine, the 11 found after a batch of 1000 samples was reprocessed. Besides, there were AAFs below their Minimum Required Performance Level (MRPL). The increasing need for higher detectability imposed new apparatus, e.g., liquid chromatography/quadrupole/time-of-flight mass spectrometry, whereas that for lowering the capital costs and reporting times led to the unification of the screening method which includes stimulants, diuretics, anabolics and other substances.

Stabilization of human urine doping control samples: a current opinion.

Transportation of doping control urine samples from the collection sites to the World Anti-doping Agency (WADA) Accredited Laboratories is conducted under ambient temperatures. When sample delivery is not immediate, microbial contamination of urine, especially in summer, is a common phenomenon that may affect sample integrity and may result in misinterpretation of analytical data. Furthermore, the possibility of intentional contamination of sports samples during collection with proteolytic enzymes, masking the abuse of prohibited proteins such as erythropoietin (EPO) and peptide hormones, is a practice that has already been reported. Consequently, stabilization of urine samples with a suitable method in a way that protects samples' integrity is important. Currently, no stabilization method is applied in the sample collection equipment system in order to prevent degradation of urine compounds. The present work is an overview of a study, funded by WADA, on degradation and stabilization aspects of sports urine samples against the above threats of degradation. Extensive method development resulted in the creation of a mixture of chemical agents for the stabilization of urine. Evaluation of results demonstrated that the stabilization mixture could stabilize endogenous steroids, recombinant EPO, and human chorionic gonadotropin in almost the entire range of the experimental conditions tested.

Stabilization of human urine doping control samples: IV. Human chorionic gonadotropin.

The presence of proteolytic enzymes in urine samples, coming from exogenous or endogenous sources, enhances the cleavage of human chorionic gonadotropin (hCG). Moreover, elevated temperatures occurring occasionally during the delayed transportation of sport urine samples, favor the nicking of the hCG molecule. The aim of the current study, funded by the World Anti-Doping Agency (WADA), was the application of a stabilization mixture in athletes' urine samples to chemically inactivate proteolytic enzymes coming from exogenous or endogenous sources so as to prevent the degradation of hCG. The stabilization mixture applied, already tested for the stabilization of endogenous steroids and recombinant erythropoietin (rEPO), was a combination of antibiotics, antimycotic substances, and protease inhibitors. Incubation experiments were conducted in the presence or absence of the stabilization mixture in urine aliquots spiked with six proteases (first series of experiments) and one microorganism associated with urinary tract infections (UTI) (second series of experiments). Intact hCG levels were evaluated by using the EIAgen Total hCG kit. In the first series of experiments, hCG levels were reduced in the untreated aliquots following incubation at 37 degrees C. The addition of the chemical stabilization mixture prevented degradation of hCG induced by four of the proteases applied. In the second series of experiments, no significant difference was found in urine inoculated with E. coli, between aliquots treated with chemical mixture and the untreated aliquots. The addition of the proposed chemical stabilization mixture improves the quality of athletes' urine samples against possible deterioration due to high temperatures or attempts of proteolytic manipulation.

The burden of incidental findings in clinical practice in a tertiary care center.

BACKGROUND: To evaluate the prevalence and clinical burden of serendipitously discovered abnormalities in hospitalized patients, unrelated to their presenting symptoms and physical signs. METHODS: A total of 478 patients consecutively admitted in the Department of Medicine were enrolled in the study. In the end of first diagnostic work-up, the previously undetected imaging or endoscopic asymptomatic abnormalities termed as incidental findings (IFs) were recorded and some of them were further investigated. RESULTS: One hundred thirty eight (28.8%) patients had IFs. The most common IFs were located in the kidney and genitourinary system followed by liver and gallbladder. The most common method of detection of IFs was ultrasonography (US) of the abdomen. The patients with IFs compared with those without, were older (P=0.007), had no previous hospitalizations (P<0.001) and stayed longer in the hospital (P<0.001). The 25 (18.1%) patients with IFs were not evaluated further. One hundred seventy seven IFs discovered in 113 patients were further evaluated by medical specialists and additional tests were performed if warranted. In the end of the diagnostic work-up, in a total of 113 patients with IFs, 78.7% had insignificant and 21.2% potentially significant IFs. The latter group had higher rate of IFs compared with the former group, usually more than 3 (P=0.017). CONCLUSIONS: IFs were prevalent in a hospital population. Hospitalized patients with IFs were more than 60 years old and had no previous hospitalization. A large number of IFs were potentially significant deserving further clinical management.