The diagnostic value and accuracy of ultrasound in diagnosing hydatidiform mole: A systematic review and meta-analysis of the literature.

INTRODUCTION: Hydatidiform moles are the most common type of gestational trophoblastic disease. Internationally the incidence of hydatidiform moles is 1-2:1000 pregnancies. Early detection of women with hydatidiform moles is preferential, as these women are at a higher risk of developing other gestational trophoblastic disease. Despite Ultrasound being the most common modality used to diagnose hydatidiform moles, its diagnostic value and accuracy throughout all trimesters remains uncertain. Thus, the aim of this review was to explore and evaluate the diagnostic value and accuracy of Ultrasound in diagnosing hydatidiform mole throughout all trimesters of pregnancy. METHODS: The databases MEDLINE and CINAHL were searched between 2004 and 2021. Included studies were quality assessed using the Mixed Methods Appraisal Tool. RESULTS: A total of 8 studies were included. The narrative synthesis identified four themes: Misdiagnosis, Complete and Partial molar pregnancy, Operator dependency and Gestational age. The meta-analysis highlighted although the sensitivity of ultrasound for diagnosing hydatidiform moles is relatively low at 52.2%, the specificity was high at 92.6%. CONCLUSION: While histological examination remains the gold standard for detecting hydatidiform moles, our review made evident that ultrasound is a beneficial diagnostic tool in the detection of Hydatidiform moles, especially alongside other diagnostic investigations. This review has highlighted and collated the main barriers and facilitators to diagnosing hydatidiform moles using ultrasound. IMPLICATION FOR PRACTICE: Findings suggest that although sonographic detection of hydatidiform moles remains a diagnostic challenge, seeking a second opinion or repeating scans before making a final diagnosis should be embedded into clinical practice.

Vitamin E supplementation, exercise and lipid peroxidation in human participants.

The theoretical benefits of using antioxidant vitamin supplements to quench oxygen free radicals appear large. The major function of vitamin E is to work as a chain-breaking antioxidant in a fat soluble environment so as to protect polyunsaturated fatty acids within membrane phospholipids and in plasma lipoproteins. The purpose of this critical review was to determine whether vitamin E supplementation decreases exercise-induced lipid peroxidation in humans. If vitamin E alone is ineffective, researchers can turn their efforts to other individual antioxidants or combinations. Using the search words "vitamin E", "exercise", "lipid peroxidation" and "antioxidant", all relevant studies since 1985 were identified through a computer search using Pub Med and Sport Discuss databases. Additional articles were reviewed from the reference list of the retrieved articles. Nine vitamin E studies met the criteria of using human participants in an experimental design. Studies were analyzed to determine the strength of evidence regarding the efficacy of vitamin E supplementation. Strength of evidence was based on: (1) number of participants, (2) intensity of the exercise test, (3) type of research design, (4) other controls, (5) the biomarker of lipid peroxidation, (6) the timing of the biomarker measurement, (7) measurement of vitamin E status and (8) correction for plasma volume change. Overall, the six studies showing no effect of vitamin E supplementation had a much higher total score (67) in comparison to the three studies showing positive effects (38). Although limitations have plagued much of the research, vitamin E supplementation does not appear to decrease exercise-induced lipid peroxidation in humans.

The incidence of hematuria in middle distance track running.

The purpose of this study was to establish if middle distance track athletes experience hematuria during their competitive season interval workouts and, if so, what type of workout based on intensity and distance was most associated with hematuria. During a 4-week observational period, athletes (n = 10) underwent reagent strip urinalysis before and after their twice weekly interval sessions. Positive samples for hematuria were analyzed microscopically to accurately determine red blood cell (RBC) loss. Seventy-one individual interval workouts were observed, of which 32 cases of hematuria were reported. Nine cases of hematuria exhibited >100 RBC per High Power Field (Hpf). Furthermore, 90% of the athletes experienced post-workout hematuria at least once. The highest incidence of hematuria was observed after workouts run at 110% of VO(2peak) over short (600-1,500 m) to moderate (1,501-3,000 m) distances. All post-exercise cases of hematuria resolved within 2 hr of recovery.

The effects of magnesium supplementation on exercise performance.

PURPOSE: To determine the effects of magnesium (Mg2+) supplementation on performance and recovery in physically active women using the sensitive and recently advanced measure of ionic Mg2+ (iMg). METHODS: Participants (N = 121) were screened for [iMg] in plasma, with 44 (36.4%) exhibiting [iMg] below the normal range of 0.53-0.67 mmol.L-1 (4). Thirty-two subjects (21 +/- 3 yr) representing a broad range of [iMg] (0.54 +/- 0.04 mmol.L-1) completed the main 14-wk study. At baseline, participants submitted to a resting blood pressure measurement, and they completed both an anaerobic treadmill test and an incremental (aerobic) treadmill test. For the latter, values for workload, oxygen uptake, and heart rate were obtained at both anaerobic threshold and maximal effort. Blood samples for iMg, total serum Mg2+ (TMg), erythrocyte Mg2+ (EMg), Ca2+, K+, Na+, hemoglobin, hematocrit, lactate, and glucose were also collected pretest, and 4, 10, 30 min, and 24 h posttest. Subjects received 212 mg.d-1 Mg oxide or placebo in a double-blind fashion and were retested after 4 wk. After a 6-wk washout period, the testing was repeated with a treatment crossover. RESULTS: Ionic Mg2+ increased with Mg2+ treatment versus placebo (P < 0.05); however, performance and recovery indices were not significantly affected. CONCLUSION: Four weeks of 212 mg.d-1 Mg oxide supplementation improves resting [iMg] levels but not performance or recovery in physically active women.

The effects of magnesium supplementation on exercise performance.

OBJECTIVES: Magnesium (Mg) status, although difficult to assess, is suspected to be marginal in many individuals, especially athletes, and this has led to the common use of Mg supplements. The purpose of this article is to critique research that has addressed Mg supplementation in athletes. DATA SOURCES: The primary database was Medline, which was searched for English articles from 1966 to June 1999 using the words "magnesium" and "supplementation." STUDY SELECTION: Only experimental studies dealing with human subjects, Mg supplementation, and exercise performance were critiqued (n = 12). DATA EXTRACTION: Quality of critiqued articles was based on 1) use of cross-over designs, 2) how and if Mg status was assessed, 3) whether treatment was solely Mg supplementation, 4) duration of supplementation, 5) subject number, and 6) degree of experimental control. Articles were classified into "no effect" and "positive effect," and also were examined in regard to the type of performance outcome (strength, anaerobic-lactacid, and aerobic). DATA SYNTHESIS: Mg is a cofactor to over 325 enzymatic reactions, and a deficiency of the mineral therefore has many physiological and exercise performance implications. Low dietary intakes, as found in many female athletes, coupled with increased urinary losses with exercise, may eventually lead to an Mg deficiency. Strength of evidence favors those studies finding no effect of Mg supplementation, regardless of whether the performance outcome was strength, anaerobic-lactacid, or aerobic. Analysis was confounded due to: 1) variable exercise modes, intensities, and durations, 2) variable training states and ages of subjects, 3) subject selection favoring males and gender differences has not been probed, 4) Mg dosage has ranged from 1 day to 3 months and from 116 mg/day to 500 mg/day, 5) multivitamins/minerals have been ingested with the Mg, 6) with one exception, Mg status was either not reported or reliant on total Mg (TMg), 7) lack of a cross-over design, 8) only one study made note of controlling exercise prior to exercise testing and blood assay, and 9) typical Mg intake measured was only measured in three of the studies. CONCLUSIONS: Most evidence indicates no effect of Mg supplementation on performance (strength, anaerobic-lactacid, and aerobic). When only peak treadmill speed during a VO2 max test is examined, the strength of evidence is equivocal. Trained subjects appear to benefit less than untrained subjects, but this observation requires further study. Little research has focused on physically active females who may be at the highest risk for Mg deficiency. Research has been confounded by numerous factors.

The efficacy of SPORT as a dietary supplement on performance and recovery in trained athletes.

This study investigated the efficacy of SPORT (a popular dietary supplement) in improving performance and assisting recovery in 9 trained athletes. In a double-blind, crossover experiment, subjects ran at workloads of 60 and 80% of peak oxygen uptake (Peak VO2) for 5 min each with 5 min recovery after each bout and at 100% Peak VO2 until exhaustion. Two capsules of either SPORT or a gelatin placebo were administered 1 hr prior to exercise and immediately after each workload. Heart rate (HR) and blood lactate (BLa) were measured at 1 hr prior to exercise, immediately after the 100% exercise bout and at 5, 10, 20, and 45 min during recovery. No significant differences between treatments on HR and BLa measures at any of the 6 time periods, or on subjects' time to exhaustion were found. Under the conditions of this experimental design, SPORT had no beneficial effects on performance or recovery in trained athletes.

The effect of exercise intensity on hematuria in healthy male runners.

The purpose of this study were: (1) to establish the prevalence of exercise-induced hematuria in a group of otherwise healthy male runners (n = 70), and (2) to investigate the role of exercise intensity in those runners who exhibited exercise-related hematuria (n = 10) by evaluating the effect of running and cycling at high and low intensities. The identified and recruited subjects participated in four different exercise protocols: (1) a 60-min treadmill run (RUN) at 90% of anaerobic threshold (Th(ae)), (2) a 60-min leg cycle ergometer ride (BIKE) at 90% of Th(ae), (3) a 3x400-m sprint (SPRINT), each followed by 4 min of rest or light walking, and (4) 3x60-Wingate leg cycle ergometry tests, each followed by 4 min of rest or light cycling. The study employed a 3x4 (time by protocol) within-subjects design and dependent variables were measured before exercise, 4 min after, and 1 h after exercise, and included measurements of hematuria, proteinuria, urinary pH, serum haptoglobin concentration, serum creatine phosphokinase activity, plasma lactate concentration, and hemoglobin. The 400-m sprint at maximal effort significantly increased both hematuria and proteinuria (P<0.01). Post-exercise hematuria for the SPRINT protocol was significantly different than that for the BIKE (P<0.01) and RUN (P<0.01) protocols. Due to the significant increase in hematuria and proteinuria following the SPRINT protocol, it was concluded that exercise-related changes in renal function were associated with weight-bearing exercise intensity rather than non-weight-bearing exercise duration.

Sport-related hematuria: a review.

OBJECTIVE: To present an overview and models of the potential causes and implications of sport-related hematuria in an athletic population as provided by a literature review. DATA SOURCES: A total of 64 published scientific articles have been utilized to provide a review of sport-related hematuria. STUDY SELECTION: Reviewed studies were selected on the basis that they provided informative findings about the possible mechanisms of sport-related hematuria attributed to exercise duration and intensity. These studies used both normal adult and athletic populations. DATA EXTRACTION: A review of the literature on the potential mechanisms of sport-related hematuria led to the classification of these mechanisms as either exercise duration related or exercise intensity related. DATA SYNTHESIS: Research has revealed an increased prevalence of hematuria in athletes. The mechanisms responsible may be traced to different sources or a combination thereof. Many explanations have been directed toward a potential cause; foot-strike hemolysis, renal ischemia, hypoxic damage to the kidney, the release of a hemolyzing factor, bladder and/or kidney trauma, nonsteroidal anti-inflammatory drugs, dehydration, increased circulation rate, myoglobinuria release, and the peroxidation of red blood cells. These mechanisms are presented in two models depicting the influence of either exercise intensity or exercise duration on sport-related hematuria. CONCLUSIONS: Athletes, coaches, and sports medicine professionals should be aware of this condition because frequent high-intensity and/or long-duration workouts and competitions may promote the symptoms. Repeated red blood cell loss through the urine may be a contributing factor toward promoting anemic conditions in competitive athletes. Recognition of the potential mechanisms can spare the time and expense of invasive testing.

Effects of iron supplementation and discontinuation on serum copper, zinc, calcium, and magnesium levels in women.

The purpose of this study was: 1) to establish the prevalence of depleted iron stores, iron deficiency, and low serum levels for copper, zinc, calcium, and magnesium in a healthy female population; and 2) to examine the effects of iron supplementation and discontinuation on the serum levels of the above minerals. One hundred eleven healthy women between the ages of 18 and 40 yr reported for fasted morning blood sampling for iron, copper, zinc, calcium, and magnesium status. Forty-five subjects were either iron-deficient as defined by a hemoglobin level below 120 g.l-1 (four subjects) or iron deplete as defined by a serum ferritin value below 20 micrograms.l-1 (43 subjects). Two subjects fit both criteria. This subgroup continued with the study and were prescribed a normal therapeutic iron dose (320 mg elemental iron per day, taken as two Slow-Fe tablets.d-1 for a period of 12 wk). The subjects then discontinued the iron supplementation for a further 12 wk. The response of the various blood minerals was monitored at 6-wk intervals. Twenty-five subjects completed the full 24-wk treatment. The main conclusions to be made from this study were that: 1) For this sample population of women, iron depletion was quite common (39%), although low hemoglobin values (< 120 g.l-1) were only seen in 3.6%. No subjects fell below the criteria for low serum copper levels (< 13.3 mumol.l-1) nor low serum magnesium levels (< 0.6 mmol.l-1). Seven subjects (6.5%) fell below the criteria for low serum zinc levels (< 11.5 mumol.l-1) while two subjects (1.8%) were below the criteria for low serum calcium levels (< 2.20 mmol.l-1). 2) Therapeutic oral iron supplementation was successful in raising mean serum ferritin values from 15.9 micrograms.l-1 to 36.5 micrograms.l-1 but was not associated with decrements in serum copper or calcium levels. 3) The treatment did not significantly effect serum zinc and magnesium levels during the supplementation period, but a downward trend continued through the discontinuation phase so that at 18 and 24 wk serum zinc and magnesium levels were significantly lower than baseline. 4) Oral contraceptive use was associated with elevated serum copper and ferritin values and lowered serum magnesium levels.

The effects of prelatent/latent iron deficiency on physical work capacity.

In order to examine the effects of mild iron deficiency on physical work capacity, 40 prelatent iron-deficient female endurance runners were studied before and after 8 wk of supplementation with either oral iron (320 mg ferrous sulfate) or a matching placebo. Subjects underwent the following physical work capacity tests: the Wingate cycle ergometer test, the anaerobic speed test, the ventilatory threshold, VO2max, and maximal treadmill velocity during the VO2max test. Muscle biopsy samples pre- and post-treatment were obtained from 17 of the subjects, and these were assayed for citrate synthase and cytoplasmic alpha-glycerophosphate dehydrogenase activity. Subjects were randomly assigned to one of the treatment groups, and a double-blind method of administration of the supplements was used. The differences in improvement scores between the two groups on the work capacity and enzyme activity variables were statistically nonsignificant (P greater than 0.05). Serum ferritin values rose from a mean of 12.4 +/- 4.5 to 37.7 +/- 19.7 ng.ml-1 for the experimental group and from 12.2 +/- 4.3 to 17.2 +/- 8.9 ng.ml-1 for the controls (P = 0.0025), whereas hemoglobin levels remained fairly constant for both groups (P = 0.6). Eight weeks of iron supplementation to prelatent/latent iron-deficient, physically active females did not significantly enhance work capacity. Within the limitations of this study, the presence of a serum ferritin below 20 ng.ml-1 does not pose a significant handicap to physical work capacity.

Iron status in athletes. An update.

As more studies are done on the iron status of athletes, the significance of apparent iron deficiency remains controversial. Do observed changes in iron status in athletes indicate an actual iron deficiency or a physiological response to exercise? Iron replacement would clearly be indicated if an iron deficiency was present but would not be necessary or effective if the observed changes were simply a physiological response. There is agreement that serum ferritin and haemoglobin decrease with some exercise conditions and that some indicators of haemolysis, such as serum haptoglobin and bilirubin, change in response to exercise. Expansion of plasma volume and the shift of iron storage from bone marrow to the liver could support the claim that the apparent reduced iron status parameters occurring with exercise are misleading. Countering this concept are studies in athletes which demonstrate dietary iron intake deficiencies and blood loss in the gastrointestinal and urinary tract. Iron deficiency is common in the general population, particularly in women. Therefore, continued monitoring of iron status in athletes appears justified in the face of present knowledge. Replacement therapy, when iron deficiency is apparent, is recommended.