Sports medicine pt.1

Question 1

What are things to consider when it comes to amateur vs professional sports doping

Answer 1

• In amateur sports the main things to consider are health safe guard and fairness of competition.
• While in professionals sports it is important to consider health safe guard and fairness of competition, and worker’s rights as these are professionals (with sport being their profession).

Question 2

What is doping defined as?

Answer 2

According to the world anti-doping code (updated every year with what drugs can be/can’t be used in athletic competitions) released by world anti-doping agency, it is defined as the occurrence of one or more of the antidoping rule violations set forth in Article 2.1 through Article 2.11 of the Code

Question 3

How many rules are there in in article 2 of the world anti-doping code?

Answer 3

11 rules

Question 4

Which article is the most violated in competitive sports in the world anti-doping code?

Answer 4

• The article that is most violated is the one regarding use of banned substances (2.2)
• 2.2 Use or Attempted Use by an Athlete of a Prohibited Substance or a Prohibited Method.
  So if someone finds prohibited drugs in your possession, it is considered doping (even if they
  weren’t used).

Question 5

What are prohibited substances and methods divided into?

Answer 5

The list is divided into 3 groups: those prohibited at all times (in- and out- of competitions), those prohibited during competition, and those prohibited only in particular sports.

Question 6

What are substances prohibited at all times?

Answer 6

S0 – non approved substances
* S1 – anabolic agents – this is the most important class and includes, for example, anabolic androgenic steroids. This class includes those that are made for animal consumption.
* S2 – peptide hormones, growth factors, related substances, and mimetics.
* S3 – ß-2 agonists – due to their anabolic effect.
* S4 – hormone and metabolic modulators
* S5 – diuretics and masking agents – they are taken in order to evade being found by anti doping analyses, and to lower weight before a weigh-in in fighting sports.

Question 7

What are methods prohibited at all times?

Answer 7

• • M1 – manipulation of blood and blood components – for example autologous or homologous transfusions.
• • M2 - chemical and physical manipulation – there are chemical that can increase oxygen release, among those intravenous and/or injections of more than 100 ml/12h of physiological
    solutions, unless there’s a medical reason.

Question 8

What are substances and methods prohibited during competition?

Answer 8

• This list includes mostly stimulants like amphetamines and cocaine
• This list also contains
  cannabinoids, which are not known to increase performance but are still banned since the idea
  that an athlete is using it is bad for the image of the world of sports.
• Glucocorticoids are also
  banned, but sometimes they must be used to treat some symptoms of allergy, back pain, asthma, etc… even though – it cannot be used in-competition

Question 9

What are substances prohibited in specific sports?

Answer 9

• ß-blockers are prohibited in sports such as archery, golf, golf, shooting, etc. as they increase the diastolic time, which allows for better accuracy as the athlete is not affected by the tremors of
  the systoles as much.
• In this case you have to think about older athletes that might be competing in these sports and are hypertensive (therefore requiring administration of ß-blockers).

Question 10

What are the top sports in which anti-doping rules violations (ADRV) were seen?

Answer 10

The top sports in which there were ADRVs are (in order): athletics, bodybuilding, cycling, weightlifting, football

Question 11

Top 5 countries in which there were ADRV

Answer 11

The top 10 countries in which there were ADRVs: Italy, France, USA, Australia, Belgium

Question 12

What are adverse analytical findings?

Answer 12

These are cases in which a prohibited substance was found but it was not clear whether it was used for a therapeutic purpose or not (keep in mind sometimes the dose alone can make the
difference).

Question 13

What were the top substances identified as adverse analytical findings?

Answer 13

• The top substances identified as AAFs were: anabolic steroids, diuretics + other masking agents, stimulants, hormone and metabolic modulators, glucocorticoids
• The most detected stimulant in this class is methylphenidate, which is used to treat ADHD both in children and adults. Other stimulants include amphetamines and cocaine

Question 14

Cases in which banned substances are allowed in a competitive athlete

Answer 14

• Athlete has a medical condition which requires the drug, must be analyzed by the committee and approve it
• Keep in mind that if for example an athlete is diagnosed with hypertension and is prescribed diuretics in order to decongest and lower Bp then a request for such exception would be denied
  as there are non-diuretic anti-hypertensive alternatives. Insulin on the other hand is likely to be
  approved.

Question 15

What is the most effective drug that boosts sport performance?

Answer 15

Anabolic agents (e.g. androgens, GH)

Question 16

Endogenous drugs vs exogenous drugs in doping samples frequency

Answer 16

Endogenous drugs such as testosterone are rarely found in doping test compared to exogenous drugs because it is easily recognised as doping(obvious and difficult to hide), if found in the
urine/blood sample.

Question 17

What are side effects of steroids?

Answer 17

• Liver changes malignancies
• Problems of fertility in both genders (masculinization in women is quite typical)
• Cardiovascular side effects

Question 18

What are cardiovascular effects of anabolic steroids?

Answer 18

• Hypertrophy of the heart
• MI, stroke, sudden death
• Toxic effect on myocardial cells
• Increased coronary artery atherosclerosis (lowering of HDL cholesterol which is protective)
• Some develop dilated cardiomyopathy where reduced ejection fraction is observed and reduced systolic contraction as demonstrated by low fractional shortening.

Question 19

Pathways that anabolic steroids lead to heart problems

Answer 19

• Anabolic steroids can lead to heart problems through different pathways of myocardial injury.
• In fact, accelerated atherosclerosis, myocardial hypertrophy, fibrosis, impaired vascular reactivity due to mineral corticoids reducing nitric oxide and vasospasm, and thrombophilia all
  lead to ischemia, infarction and arrhythmias by electrolyte imbalance(Ca, Phosphate and potassium) triggered by steroids as well as fibrosis

Question 20

Risk of MI after stopping anabolic steroids

Answer 20

It is important to remember that the risk of MI remains to be high for several months even after cessation of the steroids use.

Question 21

Ways blood and blood components are manipulated and what is it used for

Answer 21

• Blood transfusions
• Erythropoietin
• High altitude training (physiological adaptation to hypoxia, increase in EPO (legal)
• Hypobaric-hypoxic tents/altitude tents (pumps out oxygen and you sleep in it, adaptation to hypoxia, increase in EPO (not legal everywhere e.g. italy)
  These increase aerobic capacity (VO2 max) since they increase the aerobic power (increase in hemoglobin which increases oxygen carrying capacity)

Question 22

Adverse effects of blood transfusions and EPO

Answer 22

increased hematocrit and viscosity, polycythemia, higher blood pressure, thrombophilia, increased iron stores (iron accumulation in the liver and endocrine glands, testes). These subjects are more at risk of blood clots potentially leading to cerebral ischemia etc

Question 23

Amphetamine effect and side effects

Answer 23

• Amphetamines increase the attention, concentration and mood; and decrease the feeling of fatigue
  and pain, and they reduce hunger so are useful in sports where you need a low weight (cyclists, runners).
• The most important side effect is the rise in temperature and also peripheral vasoconstriction which leads to heat-strokes
• Other cardiovascular effects are tachycardia, hypertensive and increase
  in myocardial contractility. These 3 points mean that the myocardium demands more oxygens so if you have any problem in the coronary arteries this will cause ischemia or MI leading to
  arrythmia etc. In subjects with heart problems (myocardial hypertrophy, congenital arrhythmias) it can cause sudden death.
• Acute adverse effects: agitation, insomnia, rhabdomyolysis, arrhythmias, chest pain, hypertensive crisis, cerebrovascular accidents.

Question 24

What is a newer way of doping and give an example

Answer 24

• Gene doping
• The Belgian blue cattle is a
  cow in which the myostatin gene was artificially removed so that this cow only has only lean mass
• Some people use the same method in athletes of various sports. It is possible that athelets, especially in countries where doping is more common(Russia, Poland etc..), use this kind
• This method is similar to how it works in COVID vaccine where virus is used to produce beneficial
  proteins.

Question 25

Side effects of cocaine

Answer 25

• For what concerns the CNS, the main side effects are: hyperthermia, behavioral disturbances, and cerebrovascular accidents
• In the respiratory system we can see respiratory arrest and pneumothorax.
• The most frequent ones, however, are the cardiovascular seide
  effects
• If you have a young patient arriving in the emergency department that presents with chest pain and discomfort you should immediately think of cocaine as it is the leading cause of MI among young people
• Moreover, cocaine can cause: coronary artery vasoconstriction (focal
  spasm or generalized), left ventricle hypertrophy which can be seen with typical contraction bands, prothrombotic and/or atherogenic effects, or have a direct toxic effect on myocardiocytes because of mixture of cocaine and alcohol
• Cocaine brings you a high mood,
  that leads to drinking alcohol which alternatively causes a low mood which then triggers another intake of the cocaine
• Cocaethylene is formed by the liver when cocaine and ethanol coexist in the blood which is really toxic to the myocardium, liver and bones.