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Role of carbohydrate in central fatigue: a systematic review

Khong TK, Selvanayagam VS, Sidhu SK, Yusof A

Scand J Med Sci Sports, 2017 Apr;27(4):376-384.
PMID: 27714855 DOI: 10.1111/sms.12754

Carbohydrate (CHO) depletion is linked to neuromuscular fatigue during exercise. While its role at peripheral level is relatively well understood, less is known about its impact centrally. The aim of this systematic review was to critically analyze the effects of CHO on central fatigue (CF) assessed by various neurophysiological techniques. Four databases were searched using PRISMA guidelines through February 2016. The inclusion criteria were: CHO as intervention against a placebo control, fatigue induced by prolonged exercise and assessed using neurophysiological measures [voluntary activation (VA), superimposed twitch (SIT), M-wave, electromyography], alongside maximal voluntary contraction (MVC). Seven papers were reviewed, where exercise duration lasted between 115 and 180 min. CHO improved exercise performance in three studies, whereby two of them attributed it to CF via attenuation of VA and SIT reductions, while the other indicated peripheral involvement via attenuation of M-wave reduction. Although a few studies suggest that CHO attenuates CF, data on its direct effects on neurophysiological outcome measures are limited and mixed. Generally, measures employed in these studies were inadequate to conclude central contribution to fatigue. Factors including the techniques used and the lack of controls render additional confounding factors to make definitive deductions. Future studies should employ consistent techniques and appropriate neurophysiological controls to distinguish CHO effect at central level. The use of pharmacological intervention should be incorporated to elucidate involvement of central mechanisms.
Fulltext Eye movements are made to the centre of gravity of texture-defined targets

Sidhu SK, Allen HA, Keeble DRT

Vision Res, 2023 Sep;210:108264.
PMID: 37276684 DOI: 10.1016/j.visres.2023.108264

Saccadic localisation of targets of various properties has been extensively studied, but rarely for texture-defined figures. In this paper, three experiments that investigate the way information from a texture target is processed in order to provide a signal for eye movement control are presented. Participants made saccades to target regions embedded in a background structure, and the saccade landing position and latency were measured. The textures comprised line elements, with orientations of the lines configured to form the figure and ground. Various orientation profile configurations (Block, Blur, and Cornsweet), were used in order to measure the role of edge profiles in driving eye movements and producing salience. We found that in all cases the visual system is in fact able to effectively segregate a texture figure from the ground in order to accurately plan a saccade to the target-figure. While saccadic latency was the highest for the Blur profile, the mean saccadic landing position was mostly unaffected by the various profiles (Experiment 1). More specifically, we showed that saccades were directed to the centre-of-gravity of the target (Experiment 2). We also found that figures with information of orientation contrast at both the edge and centre of figure (i.e. Block) produced the highest level of saliency in attracting eye movements (Experiment 3). Overall, the results show that saccades are planned on the representation of the whole target shape rather than a local salient region based on orientation contrast cues, and that the various texture profiles were important only to the extent that they affected the time to programme a saccade.
Factors affecting clean intermittent catheterization compliance among children and adolescents with neurogenic bladder due to spina bifida and caudal regression syndrome

Sidhu SK, M Yusof MS, Woo SY, Nagappan P

J Pediatr Urol, 2024 Feb 15.
PMID: 38413297 DOI: 10.1016/j.jpurol.2024.02.009

INTRODUCTION: Children and adolescents with neurogenic bladder often need clean intermittent catheterization (CIC) over a long period. Our study aimed to identify factors that affect CIC compliance and to determine if CIC compliance affected short-term urological outcomes among patients in Malaysia.
STUDY DESIGN: 50 patients aged 2-18 years who perform CIC were included in this cohort study. Patient compliance with CIC was evaluated using the validated Intermittent Catheterization Adherence Scale (ICAS). CIC difficulties were assessed using the validated Intermittent Catheterization Difficulty Questionnaire (ICDQ). Data was obtained on patients' co-morbidity, caregiver factors, socio-economic factors, CIC technique, access to catheters and facilities, urinary tract infections, incontinence, urology tests and treatment. Statistical analysis was performed.
RESULTS: Mean age was 6.68 ± 4.34 years. 32 (64%) patients commenced CIC within the first month of life. Mean daily CIC frequency was 4.70 ± 1.33.30 (60%) participants showed strong adherence to CIC. 39 (78%) participants were able to catheterize with no or minor difficulties. Pain (6, 12%), transient blocking sensation (6.12%), and urinary incontinence (3, 6%) were the predominant difficulties encountered. CIC performed by caregiver was associated with improved adherence compared to patient self-catheterization (p = 0.039). The mean age of participants who self-catheterized was 10.7 ± 3.7 years. Strong adherence was also observed among patients who purchased their own CIC catheters (p = 0.007). Participants with lower ICDQ score were more likely to be compliant with CIC (p = 0.007). CIC adherence was not affected by patient's age, gender, co-morbidity, mobility, caregiver factors, socio-economic factors, and age at initiation of CIC. There was no significant association between CIC adherence and febrile urinary tract infections, upper tract deterioration, and bladder stones at 6 months follow-up.
DISCUSSION: There is lower CIC adherence when a child begins to self-catheterize and healthcare providers should be alert during this period of transition. Though most patients with spina bifida have decreased urethral sensation, some patients do experience significant pain during CIC which may impact their compliance. These patients would need a review of their catheterization techniques to improve adherence. The limitations of our study are its modest sample size from a single center and short study period. Our study provides insights into the feasibility of instituting CIC in developing countries.
CONCLUSION: Strong CIC adherence was observed among patients who were catheterized by their caregiver, purchased their own CIC catheters, and encountered minimal difficulties during catheterization. CIC adherence had no effect on short-term urological outcomes.

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