METHODS: A self-administrated online Google form survey was carried out between February 2021 and April 2021. Five thousand eight hundred forty-five participants who regularly exercise and aged ≥18 years responded to the questionnaire. The questionnaire was distributed through social media platforms and included five sections: demographic, training characters, knowledge, practice, and attitude.
RESULTS: The participants mean age was 27.4 ± 8.6 years. Males represented 58.2 % of participants. 75.3% of the study participants had not used either hormones or supplements, and about 19% used supplements only. The mean percent score for knowledge, practice, and attitude were 39.3 ± 30.5, 1.1 ± 9.5, and 21.3 ± 23.8, respectively. Level of knowledge was higher among participants who worked in the medical field or as sports coaches. The practice was higher among male participants. The most commonly used anabolic hormones and nutritional supplements were steroids and proteins with bodybuilding being the most common purpose. Internet was the main source of information and pharmacy was the main source for procuring these substances. There was a significant decrease in proteins, carbohydrates, and sports drinks used during the COVID-19 lockdown compared to before the COVID-19 lockdown, while a statistically significant increase in vitamins used during the COVID-19 lockdown compared to before COVID-19 lockdown.
DISCUSSION: In the MENA region, there has been an increase in the use of anabolic hormones and nutritional supplements. Most of the population has low knowledge of the harmful effect of uncontrolled, uninformed and unmonitored use of these substances Therefore, increasing the awareness level of participants and sports coaches should be a priority to limit the unsupervised use of hormones and supplements.
METHODS: Patients enrolled in the PROGRESS registry were evaluated for use of vasopressor and LDC (equivalent or lesser potency to hydrocortisone 50 mg six-hourly plus 50 microg 9-alpha-fludrocortisone) for treatment of severe sepsis at any time in intensive care units (ICUs). Baseline characteristics and hospital mortality were analyzed, and logistic regression techniques used to develop propensity score and outcome models adjusted for baseline imbalances between groups.
RESULTS: A total of 8,968 patients with severe sepsis and sufficient data for analysis were studied. A total of 79.8% (7,160/8,968) of patients received vasopressors, and 34.0% (3,051/8,968) of patients received LDC. Regional use of LDC was highest in Europe (51.1%) and lowest in Asia (21.6%). Country use was highest in Brazil (62.9%) and lowest in Malaysia (9.0%). A total of 14.2% of patients on LDC were not receiving any vasopressor therapy. LDC patients were older, had more co-morbidities and higher disease severity scores. Patients receiving LDC spent longer in ICU than patients who did not (median of 12 versus 8 days; P <0.001). Overall hospital mortality rates were greater in the LDC than in the non-LDC group (58.0% versus 43.0%; P <0.001). After adjusting for baseline imbalances, in all mortality models (with vasopressor use), a consistent association remained between LDC and hospital mortality (odds ratios varying from 1.30 to 1.47).
CONCLUSIONS: Widespread use of LDC for the treatment of severe sepsis with significant regional and country variation exists. In this study, 14.2% of patients received LDC despite the absence of evidence of shock. Hospital mortality was higher in the LDC group and remained higher after adjustment for key determinates of mortality.