scholarly journals Managing the combined consequences of COVID-19 infection and lock-down policies on athletes: narrative review and guidelines proposal for a safe return to sport

2020 ◽  
Vol 6 (1) ◽  
pp. e000849
Author(s):  
Jean-Bernard Fabre ◽  
Laurent Grelot ◽  
William Vanbiervielt ◽  
Julien Mazerie ◽  
Raphael Manca ◽  
...  
Keyword(s):  
Sports Medicine ◽  
Acute Myocarditis ◽  
Multiorgan Failure ◽  
Clinical Manifestations ◽  
Return To Sport ◽  
Disease Spread ◽  
Cardiac Complications ◽  
Professional Soccer ◽  
Physical Abilities ◽  
Fitness And Health

COVID-19 pandemic is a global health matter. The disease spread rapidly across the globe and brought the world of sports to an unprecedented stoppage. Usual symptoms of the disease are fever, cough, myalgia, fatigue, slight dyspnoea, sore throat and headache. In more severe cases, dyspnoea, hypoxaemia, respiratory failure, shock and multiorgan failure occur. This appears to be a self-limiting phenomenon related to individuals with coexisting medical conditions, such as hypertension, diabetes and cardiovascular disorders. Nevertheless, cases have been reported in professional soccer players in extremely good fitness condition, demonstrating that athletes are not spared by the disease. Despite COVID-19 clinical manifestations are mainly respiratory, major cardiac complications are being reported, leading to acute myocarditis. One difficulty is that symptoms of COVID-19 vary among individuals, with athletes being affected with no apparent sign of the disease. This could be a real danger for amateur or professional athletes when returning to their usual training and thus to play. Another threat is that the lock-down policies did not allow most athletes to follow their usual training routines. There is thus a need for a careful approach by the sports medicine community to ensure safety of all athletes before they return to sport. Here, we propose evaluation guidelines of fitness and health of athletes to (1) reduce any lethal risk of practice, especially myocarditis and sudden cardiac death; (2) evaluate the combined consequences of the disease and detraining on the physical abilities and biological profile of athletes; and (3) monitor postinfection fatigue symptoms.

scholarly journals Clinically suspected myocarditis complicating dengue shock syndrome: a case report and literature review of cardiac complication in dengue-affected pediatric patient

2021 ◽  
Vol 16 (4) ◽  
pp. 304-308
Author(s):  
Dita Aulia Rachmi ◽  
Drastis Mahardiana ◽  
Eka Prasetya Budi Mulia ◽  
Agus Subagjo
Keyword(s):  
Pediatric Patient ◽  
Acute Myocarditis ◽  
Sinus Bradycardia ◽  
Sinus Node ◽  
Clinical Manifestations ◽  
Dengue Shock Syndrome ◽  
Atropine Sulfate ◽  
Cardiac Complication ◽  
Cardiac Complications ◽  
Pubmed Search

We report a case of dengue shock syndrome complicated by clinically suspected acute myocarditis in pediatric patient at a limited-resources hospital in a rural area and review the literature. A 12-year-old boy who experienced dengue shock syndrome developed bradycardia on day 7th of illness. His electrocardiogram during the bradycardia showed sinus bradycardia with a rate of 50 beats per minute. Atropine sulfate and dobutamine, alongside supportive management, were administered. The patient recovered 4 days later. We found a total of seven articles involving pediatric patient with dengue illness and cardiac complications by PubMed search. Clinical manifestations of cardiac involvement in pediatric patient with dengue varied and were mostly transient from tachy-bradyarrhythmia, sinus node dysfunction, low blood pressure, decreased ejection fraction, lower cardiac output, and increased cardiac enzyme. Transient cardiac abnormality can be an important presentation, and physician should have high awareness of cardiac complication in dengue-affected pediatric patients to manage them accordingly.

scholarly journals Pathobiology of A/Chicken/Hong Kong/220/97 (H5N1) Avian Influenza Virus in Seven Gallinaceous Species

2001 ◽  
Vol 38 (2) ◽  
pp. 149-164 ◽  
Author(s):  
L. E. L. Perkins ◽  
D. E. Swayne
Keyword(s):  
Hong Kong ◽  
Avian Influenza ◽  
Pulmonary Edema ◽  
Multiorgan Failure ◽  
Clinical Manifestations ◽  
Highly Pathogenic ◽  
H5n1 Avian Influenza Virus ◽  
Multiple Organs ◽  
H5n1 Avian Influenza ◽  
Virus Localization

Direct bird-to-human transmission, with the production of severe respiratory disease and human mortality, is unique to the Hong Kong-origin H5N1 highly pathogenic avian influenza (HPAI) virus, which was originally isolated from a disease outbreak in chickens. The pathobiology of the A/chicken/Hong Kong/ 220/97 (H5N1) (HK/220) HPAI virus was investigated in chickens, turkeys, Japanese and Bobwhite quail, guinea fowl, pheasants, and partridges, where it produced 75-100% mortality within 10 days. Depression, mucoid diarrhea, and neurologic dysfunction were common clinical manifestations of disease. Grossly, the most severe and consistent lesions included splenomegaly, pulmonary edema and congestion, and hemorrhages in enteric lymphoid areas, on serosal surfaces, and in skeletal muscle. Histologic lesions were observed in multiple organs and were characterized by exudation, hemorrhage, necrosis, inflammation, or a combination of these features. The lung, heart, brain, spleen, and adrenal glands were the most consistently affected, and viral antigen was most often detected by immunohistochemistry in the parenchyma of these organs. The pathogenesis of infection with the HK/220 HPAI virus in these species was twofold. Early mortality occurring at 1-2 days postinoculation (DPI) corresponded to severe pulmonary edema and congestion and virus localization within the vascular endothelium. Mortality occurring after 2 DPI was related to systemic biochemical imbalance, multiorgan failure, or a combination of these factors. The pathobiologic features were analogous to those experimentally induced with other HPAI viruses in domestic poultry.

scholarly journals Medical retirement from sport after concussions

2018 ◽  
Vol 8 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Cecilia Davis-Hayes ◽  
David R. Baker ◽  
Thomas S. Bottiglieri ◽  
William N. Levine ◽  
Natasha Desai ◽  
...  
Keyword(s):  
Sports Medicine ◽  
Comprehensive Evaluation ◽  
Treatment Algorithm ◽  
Return To Sport ◽  
Real Patient ◽  
Patient Centered ◽  
Concussion Management ◽  
Injury Threshold ◽  
History Of ◽  
Concussion Recovery

Purpose of reviewIn patients with a considerable history of sports-related concussion, the decision of when to discontinue participation in sports due to medical concerns including neurologic disorders has potentially life-altering consequences, especially for young athletes, and merits a comprehensive evaluation involving nuanced discussion. Few resources exist to aid the sports medicine provider.Recent findingsIn this narrative review, we describe 10 prototypical vignettes based upon the authors' collective experience in concussion management and propose an algorithm to help clinicians navigate retirement discussions. Issues for consideration include absolute and relative contraindications to return to sport, ranging from clinical or radiographic evidence of lasting neurologic injury to prolonged concussion recovery periods or reduced injury threshold to patient-centered factors including personal identity through sport, financial motivations, and navigating uncertainty in the context of long-term risks.SummaryThe authors propose a novel treatment algorithm based on real patient cases to guide medical retirement decisions after concussion in sport.

scholarly journals Sports Medicine Considerations During the COVID-19 Pandemic

2020 ◽  
pp. 036354652097518
Author(s):  
Mary K. Mulcahey ◽  
Arianna L. Gianakos ◽  
Angela Mercurio ◽  
Scott Rodeo ◽  
Karen M. Sutton
Keyword(s):  
Best Practices ◽  
Sports Medicine ◽  
Return To Sport ◽  
Well Being ◽  
Return To Sports ◽  
The Novel ◽  
Current Disruption ◽  
Novel Coronavirus ◽  
Health And Well Being ◽  
Sports Activities

The outbreak of the novel coronavirus (COVID-19) has resulted in upward of 14 million confirmed cases and >597,000 deaths worldwide as of July 19, 2020. The current disruption in sports activities caused by COVID-19 presents a challenge to physicians, coaches, and trainers in discerning best practices for a safe return to sport. There is a distinct need to develop and adopt consistent measures for resumption of sports activities, including training and competition, in a way that places the health and well-being of athletes at the forefront while also protecting coaches, allied staff, and spectators. This article provides an overview of the effects of COVID-19 in the athletic population and presents considerations for training during the pandemic, as well as guidelines for return to sports as restrictions are lifted.

scholarly journals Psychometric Analysis and Effectiveness of the Psychological Readiness of Injured Athlete to Return to Sport (PRIA-RS) Questionnaire on Injured Soccer Players

2020 ◽  
Vol 17 (5) ◽  
pp. 1536
Author(s):  
Pedro Gómez-Piqueras ◽  
Clare Ardern ◽  
Alejandro Prieto-Ayuso ◽  
Francisco Javier Robles-Palazón ◽  
Antonio Cejudo ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Return To Sport ◽  
Professional Sports ◽  
Soccer Players ◽  
Measurement Properties ◽  
Psychometric Analysis ◽  
Decision Making Process ◽  
Difficult Decision ◽  
Professional Soccer ◽  
Patient Reported

The decision-making process about when an athlete may safely return to training and competition after an injury is a difficult decision. Safe return to training and competition is characterised by physical and psychological readiness to return to the sport. The objectives of this study are (1) to assess the measurement properties of the Psychological Readiness of Injured Athlete to Return to Sport questionnaire (PRIA-RS), and (2) to analyse the effectiveness which the PRIA-RS questionnaire possesses when applied during four consecutive seasons on professional soccer players. One hundred and nine male soccer players from the Albacete Soccer Club (Spain) were involved during four consecutive seasons for the current study: 2012–2013, 2013–2014, 2014–2015 and 2015–2016. Psychometric analysis (validity, reliability, internal consistency and effectiveness) and external psychometric analysis (evaluating measures of patient-reported outcomes (EMPRO)) were confirmed and supported. The main results of the study reveal that the psychometric properties of this questionnaire are optimum for their application in a professional sports context.

scholarly journals Current Practices in the Treatment of Syndesmotic Injuries: A Global Perspective

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0011
Author(s):  
Jonathan Bartolomei ◽  
Shanthan C. Challa ◽  
Kenneth J. Hunt ◽  
Daniel K. Moon
Keyword(s):  
North American ◽  
Sports Medicine ◽  
Return To Sport ◽  
High Impact ◽  
Optimal Treatment ◽  
Return To Play ◽  
Considerable Variability ◽  
Flexible Devices ◽  
Fixation Devices ◽  
Rehabilitation Protocols

Category: Ankle; Sports Introduction/Purpose: There exists little consensus regarding optimal treatment protocols for syndesmotic injuries. Orthopedic clinicians have implemented a variety of treatment strategies, ranging from immobilization to screw fixation to new flexible fixation devices. While the body of literature is growing with regard to both the biomechanics and clinical outcomes for various constructs and rehabilitation protocols, there is little consensus on the optimal treatment and return to sport strategy for these injuries. We endeavored to assess current approaches to syndesmotic injuries by orthopedic foot and ankle specialists around the world in six athlete scenarios with increasing degrees of injury. Commensurate with the lack of available data to guide treatments, we hypothesize that there will be great variability in the treatment and management of syndesmotic injuries. Methods: A REDcap survey was created with 27 questions, including respondent demographics, indications for treatment of syndesmotic injuries, preferred treatment, preferred technique for repairing the syndesmosis, and post-operative management. Respondents were asked to choose their preferred fixation device and post-operative return to play protocols in six different athlete scenarios (moderate impact, high impact, and very high impact and each with/without complete deltoid injury). The survey was disseminated among the memberships of 18 North American and International medical societies. Society members were surveyed via three emails distributed two weeks apart. Frequencies and percentages were calculated for all categorical responses. Results: A total of 596 providers responded to the survey, including 337 American surgeons and 259 members of various international societies. There was a 70% survey completion rate with a wide geographic distribution among respondents. Flexible devices were the preferred fixation construct (48%), followed by screws (27%), hybrid fixation (19%) and other (6%). There was a higher preference for flexible devices among sports medicine trained providers (58%) relative to non-sports medicine trained providers (44%). 62% of respondents noted that their rehabilitation protocols would not change for each athlete scenario. Considerable variability was present in anticipated full return to sport, ranging from immediately following injury to six months post-op. 33% stated that they would repair the deltoid ‘greater than 50%’ of the time if injured. Conclusion: There is a wide variety of indications and treatment constructs employed by orthopedic surgeons for athletes with ligamentous syndesmotic injuries requiring fixation. Although flexible fixation devices are the preferred choice among all respondents, there was considerable variability in device choices. Fellowship training also appears to affect the preferred fixation method. There was no overall difference between device preference between North American and International respondents (Fig1). There also exists substantial variability in expected return to play for every athlete scenario. The diversity in approaches and post-operative recommendations underscores the need for evidence-based guidelines regarding the management of syndesmotic injuries.

scholarly journals Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients

2004 ◽  
Vol 17 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Sascha Mann ◽  
Michael Schütze ◽  
Steffen Sola ◽  
Jürgen Piek
Keyword(s):  
Surgical Treatment ◽  
Spinal Deformity ◽  
Multiorgan Failure ◽  
Vertebral Osteomyelitis ◽  
Clinical Manifestations ◽  
Neurological Deficits ◽  
Causative Organism ◽  
Delay In Diagnosis ◽  
Pyogenic Spondylodiscitis ◽  
Antibiotic Drugs

Object Pyogenic vertebral osteomyelitis is of special interest to neurosurgeons because it often results in acute neurological deterioration and requires a combination of adequate surgical and conservative treatment. The aim of the current study was to evaluate the strategy of a primary surgical approach to this disease. Methods A group of 24 patients with the clinical and radiological signs of acute pyogenic spondylodiscitis was prospectively followed from 1998 to 2004. Of these, 20 had underlying diseases such as diabetes mellitus, chronic alcoholism, and liver cirrhosis. The main causative organism was Staphylococcus aureus. Most infections were localized in the thoracic or lumbar spine (10 cases each); 15 infections were associated with epidural abscesses. Because of a delay in diagnosis, 13 patients presented with neurological deficits on admission. Patients with a complete or rapidly progressing neurological deficit underwent immediate surgery. In patients with minor or no deficits or in a stable neurological condition, surgery was delayed for 3 to 5 days. This group was treated with immobilization and intravenous antibiotic drugs before surgery. Surgical procedures included ventral, dorsal, and combined approaches in one- or two-stage operations. Antibiotic treatment included the use of broad-spectrum antibiotic drugs delivered intravenously for at least 10 days, followed by orally administered antibiotics for 3 months. Twenty patients were independent on follow-up review, 15 with no or minor handicaps. Severe septicemia and multiorgan failure developed in two patients, and these two died of their disease. Major complications were mainly due to long-term antibiotic therapy. Conclusions Surgical treatment is the modality of choice in patients with acute spinal osteomyelitis. It is especially indicated in patients with progressive or severe neurological deficits and spinal deformity. In experienced hands, surgery is safe and offers the advantages of spinal cord decompression, immediate mobilization, and correction of spinal deformity. The decision whether an anterior or posterior approach should be used must be made on an individual basis.

scholarly journals The Evolving Approach to Treating Syndesmotic Injuries in the Elite Athlete: An International Perspective

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0040
Author(s):  
Jonathan Bartolomei ◽  
Kenneth Hunt ◽  
Shanthan Challa
Keyword(s):  
Sports Medicine ◽  
Return To Sport ◽  
High Impact ◽  
Optimal Treatment ◽  
Return To Play ◽  
Considerable Variability ◽  
Fixation Device ◽  
Flexible Devices ◽  
Fixation Devices ◽  
Rehabilitation Protocols

Objectives: There exists little consensus regarding optimal treatment protocols for syndesmotic injuries. Orthopaedic clinicians have implemented a variety of treatment strategies, ranging from immobilization to screw fixation to new flexible fixation devices. While the body of literature is growing with regard to both the biomechanics and clinical outcomes for various constructs and rehabilitation protocols, there is little consensus on the optimal treatment and return to sport strategy for these injuries. We endeavored to assess current approaches to syndesmotic injures by orthopedic foot and ankle specialists around the world in 6 athlete scenarios with increasing degree of injury. Commensurate with the lack of available data to guide treatments, we hypothesize that there will be great variability in the treatment and management of syndesmotic injuries. Methods: A REDcap survey was created with 27 questions, including respondent demographics, indications for treatment of syndesmotic injuries, preferred treatment, preferred technique for repairing the syndesmosis and post-operative management. Respondents were asked to choose their preferred fixation device and post-operative return to play protocols in six different athlete scenarios (moderate impact, high impact and very high impact and each with/without complete deltoid injury). The survey was disseminated among the memberships of 18 North American and International medical societies. Society members were surveyed via three emails disseminated 2 weeks apart. Frequencies and percentages were calculated for all categorical responses. Results: A total of 596 providers responded to the survey, including 337 American surgeons and 259 members of various international societies. There was a 70% survey completion rate with a wide geographic distribution among respondents. Flexible devices were the preferred fixation construct (48%), followed by screws (27%), hybrid fixation (19%) and other (6%). There was a higher preference for flexible devices among sports medicine trained providers (58%) relative to non-sports medicine trained providers (44%). 62% of respondents noted that their rehabilitation protocols would not change for each athlete scenario. Considerable variability was present in anticipated full return to sport, ranging from immediately following injury to 6 months post-op (Fig 1). 33% stated that they would repair the deltoid ‘greater than 50%’ of the time if injured. Conclusion: There is a wide variety of indications and treatment constructs employed by orthopaedic surgeons for athletes with ligamentous syndesmotic injuries requiring fixation. Although, flexible fixation devices are the preferred among all respondents but there was a considerable variability in device choices. Fellowship training also appears to affect the preferred fixation device choice. There also exists substantial variability in expected return to play for every athlete scenario (Fig 1). The diversity in approaches and post-operative recommendations underscores the need for evidence-based guidelines regarding management of syndesmotic injuries.

Autoimmune Disease (AD) in Patients with Myelodysplastic Syndrome (MDS): A Retrospective Single Institution Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4736-4736
Author(s):  
Jeyanthi Ramanarayanan ◽  
Alan N. Baer ◽  
Minoo Battiwalla ◽  
Laurie A. Ford ◽  
Meir Wetzler ◽  
...  
Keyword(s):  
Autoimmune Disease ◽  
Lupus Erythematosus ◽  
Systemic Vasculitis ◽  
Multiorgan Failure ◽  
Clinical Manifestations ◽  
Response To Therapy ◽  
Entire Cohort ◽  
Double Stranded Dna ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Autoimmune disease (AD) can manifest uncommonly either at the time of diagnosis of MDS or during its course. When present, AD generally responds to immunosuppressive therapies, but cytopenias and immunosuppression associated with MDS compromise delivery of these therapies. Few studies have investigated the impact of co-existing AD on the course and outcome of patients with MDS. Our objective was to evaluate the clinical manifestations, laboratory characteristics, response to therapy and survival of MDS patients with AD. Records of patients evaluated at Roswell Park Cancer Institute with pathologically demonstrated MDS between 1993 and 2003 (n=277) were reviewed and patients with evidence of AD were identified. Patients with laboratory abnormalities without disease manifestations were excluded, as were patients with therapy-related MDS following treatment for AD. 13 patients (4%) were identified with co-existing MDS and AD. The initial presentation was AD in 6 (46%) and MDS in 4 (31%), while 3 patients (23%) had near-simultaneous diagnoses of both conditions. The spectrum of AD in these patients included systemic vasculitis in 3 patients, systemic lupus erythematosus in two and rheumatoid arthritis, temporal arteritis, cryoglobulinemia, aphthous stomatitis, pyoderma gangrenosum, inflammatory bowel disease, erythema nodosum and Evans syndrome in one patient each. Anti-double stranded DNA (levels ≥ 40.0 u/ml; normal range 0.0–3.5u/ml), ANA (≥1:160), cold agglutinins, low C3 and elevated ESR (≥100mm/hr) were the serological abnormalities detected at the time of AD diagnosis. Eleven of 13 patients were female, and median age at diagnosis of MDS was 65 years, while the entire cohort was 44% female (p=0.005) and had a median age of 71 yrs at diagnosis. FAB subtypes were RA (n=7), RAEB (n=3), CMMoL (n=2) and RARS (n=1). Cytogenetics were normal in 5 patients; abnormalities in the other 8 patients included −7, +8, and del(5q). The median survival of patients from diagnosis of MDS was 48 months and the survival from diagnosis of AD was 46 months. Known causes of death in 6 patients included sepsis, intracranial hemorrhage, lung cancer and transplant-associated multiorgan failure. Based on this study, AD occurs in 4% of MDS patients, predominantly affects female patients, and has heterogeneous clinical manifestations.The pathobiologic implication of the occurrence of AD at the same time or after the diagnosis of MDS is that the dysplastic clone might be responsible for the induction of immune dysregulation.

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