Vaccination status of COVID-19 patients followed up in the ICU in a country with heterologous vaccination policy: A multicenter national study in Turkey.

OBJECTIVE: Vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-2) prevents the development of serious diseases has been shown in many studies. However, the effect of vaccination on outcomes in COVID-19 patients requiring intensive care is not clear. METHODS: This is a retrospective multicenter study conducted in 17 intensive care unit (ICU) in Turkey between January 1, 2021, and December 31, 2021. Patients aged 18 years and older who were diagnosed with COVID-19 and followed in ICU were included in the study. Patients who have never been vaccinated and patients who have been vaccinated with a single dose were considered unvaccinated. Logistic regression models were fit for the two outcomes (28-day mortality and in-hospital mortality). RESULTS: A total of 2968 patients were included final analysis. The most of patients followed in the ICU during the study period were unvaccinated (58.5%). Vaccinated patients were older, had higher Charlson comorbidity index (CCI), and had higher APACHE-2 scores than unvaccinated patients. Risk for 28-day mortality and in-hospital mortality was similar in across the year both vaccinated and unvaccinated patients. However, risk for in-hospital mortality and 28-day mortality was higher in the unvaccinated patients in quarter 4 adjusted for gender and CCI (OR: 1.45, 95% CI: 1.06-1.99 and OR: 1.42, 95% CI: 1.03-1.96, respectively) compared to the vaccinated group. CONCLUSION: Despite effective vaccination, fully vaccinated patients may be admitted to ICU because of disease severity. Unvaccinated patients were younger and had fewer comorbid conditions. Unvaccinated patients have an increased risk of 28-day mortality when adjusted for gender and CCI.

Effect of two eccentric hamstring exercises on muscle architectural characteristics assessed with diffusion tensor MRI.

OBJECTIVES: To evaluate the effect of a Nordic hamstring exercise or Diver hamstring exercise intervention on biceps femoris long head, semitendinosus and semimembranosus muscle's fascicle length and orientation through diffusion tensor imaging (DTI) with magnetic resonance imaging. METHODS: In this three-arm, single-center, randomized controlled trial, injury-free male basketball players were randomly assigned to a Nordic, Diver hamstring exercise intervention or control group. The primary outcome was the DTI-derived fascicle length and orientation of muscles over 12 weeks. RESULTS: Fifty-three participants were included for analysis (mean age 22 ± 7 years). Fascicle length in the semitendinosus over 12 weeks significantly increased in the Nordic-group (mean [M]: 20.8 mm, 95% confidence interval [95% CI]: 7.8 to 33.8) compared with the Control-group (M: 0.9 mm, 95% CI: -7.1 to 8.9), mean between-groups difference: 19.9 mm, 95% CI: 1.9 to 37.9, p = 0.026. Fascicle orientation in the biceps femoris long head over 12 weeks significantly decreased in the Diver-group (mean: -2.6°, 95% CI: -4.1 to -1.0) compared with the Control-group (mean: -0.2°, 95% CI: -1.4 to 1.0), mean between-groups difference: -2.4°, 95% CI: -4.7 to -0.1, p = 0.039. CONCLUSION: The Nordic hamstring exercise intervention did significantly increase the fascicle length of the semitendinosus and the Diver hamstring exercise intervention did significantly change the orientation of fascicles of the biceps femoris long head. As both exercises are complementary to each other, the combination is relevant for preventing hamstring injuries.

Effectiveness of an e-health tennis-specific injury prevention programme: randomised controlled trial in adult recreational tennis players.

BACKGROUND: Despite reported injury rates of up to 3 per 1000 hours exposure, there are no evidence-based prevention programmes in tennis. PURPOSE: To evaluate the effectiveness of an e-health prevention programme for reducing tennis injury prevalence. STUDY DESIGN: Two-arm, researcher-blinded randomised controlled trial. METHODS: Adult tennis players of all playing levels were randomised in an unsupervised programme lasting 12 weeks (TennisReady group or control group). The primary outcome was the overall injury prevalence over a 16-week period, measured at 2 weekly intervals with the Oslo Sports and Trauma Research Centre questionnaire. Estimates for the primary outcome and associated 95% CIs were obtained using generalised estimating equation models. Secondary outcome scores included prevalence of substantial injuries, overall incidence, adherence and time-loss injuries. RESULTS: A total of 579 (83%) (TennisReady n=286, control n=293) participants were included in the primary analysis. The mean injury prevalence was 37% (95% CI 33% to 42%) in the TennisReady vs 38% (95% CI 34% to 42%) in the control group (adjusted p-value 0.93). The prevalence of substantial injuries was 11% (95% CI 9% to 14%) in the TennisReady vs 12% (95% CI 9% to 15%) in the control group (p value of 0.79). Analysis of the secondary outcome scores showed no difference between groups. The mean prevalence rates between high (8%) and low (92%) adherent groups were 32% (95% CI 23% to 44%) and 37% (95% CI 33% to 42%), respectively (p value 0.36). CONCLUSION: Providing an unsupervised e-health tennis-specific exercise programme did not reduce the injury rates and should not be implemented. TRIAL REGISTRATION NUMBER: NTR6443.

Effect of VDR and TLR2 gene variants on the clinical course of patients with COVID-19 disease.

The coronavirus disease 2019 (COVID-19) pandemic, which has caused a major global health crisis, primarily targets the upper and lower respiratory tract. But infected individuals may experience different clinical symptoms, ranging from asymptomatic to critical. The vitamin D receptor (VDR) and Toll-like receptor 2 (TLR2) polymorphisms play a role in the immune response. This study aimed to evaluate the effect of VDR Bsml (rs1544410) and TLR2 23bp indel variants on the clinical status of Turkish patients with COVID-19 disease. A total of 312 people, including 106 intensive care unit (ICU) patients, 103 symptomatic hospitalized patients, and 103 healthy controls, were included in the study. The VDR BsmI and TLR2 23bp indel were genotyped using polymerase chain reaction and/or restriction fragment length fraction methods. The VDR BsmI b/b genotype and b allele were higher in symptomatic patients compared to the healthy control group (p = 0.035). The VDR BsmI B/B and B/b genotype distribution did not differ between ICU patients and both symptomatic patients and controls (p > 0.05). We found that B/B:B/b+b/b and B/B+B/b:b/b were significantly different in symptomatic patients compared to controls (p = 0.033 and p = 0.041, respectively). The VDR BsmI b/b genotype distribution was found to be lower in deceased patients than in living patients (p = 0.023). There was no significant difference between the groups in terms of TLR2 23bp indel genotype and allele distribution (p > 0.05). Our study results suggest that the VDR BsmI b allele may have a role in COVID-19 patients with symptomatic findings. These data need to be repeated in different ethnic and larger sample groups.

Percutaneous closure of an iatrogenic ventricular septal defect associated with transcatheter aortic valve implantation.

An 81-year-old man who had dyspnea was admitted to our hospital with a diagnosis of severe aortic stenosis. A transcatheter aortic valve implantation was successfully performed with a 29 mm Edwards Sapien XT valve using a transfemoral access. After the procedure, the echocardiography showed a restrictive ventricular septal defect (VSD) in the membranous septum. As the patient had no symptoms, it was decided to follow him up conservatively. However, he was readmitted within three weeks with symptoms suggestive of biventricular failure. A control echocardiography revealed a membranous VSD, 8 mm in size, right chambers dilatation with moderate tricuspid regurgitation, and systolic pulmonary artery pressure of 60 mm Hg. The previously deployed aortic valve was normal in function. The decision to perform a percutaneous VSD closure was made. The defect was then closed with a 10 mm muscular VSD occluder. During and after the procedure, there was no dysfunction in the bioprosthetic aortic valve. At the one-year follow-up, the patient was still asymptomatic.

Can Gastric Volume be Accurately Estimated by Ultrasound?

OBJECTIVE: Knowing the degree of gastric fullness is critical in determining the potential risk of pulmonary aspiration prior to urgent or elective intubation. This study aims to investigate the role of ultrasound in predicting the gastric volume accurately. METHODS: 176 patients who underwent upper gastric endoscopy after 12-hour fasting were examined by gastric US. The patients were ran- domly divided into 6 groups according to the volume of ingested semifluid meal: (1) empty stomach (no volume), (2) 50 mL, (3) 100 mL, (4) 200 mL, (5) 300 mL, and (6) 400 mL. Antral cross-sectional area (CSA) was measured by US after each ingestion. RESULTS: We found a strong linear correlation between antral CSA and gastric volume up to 200 mL. The diagnostic performance of ultra- sound was found to be more powerful in the supine position than in the right lateral position. A new mathematical model was established to predict gastric volume. The threshold value for antral cross-sectional area at risk of pulmonary aspiration was determined as 3.1 cm2 by sonographic measurement. CONCLUSION: Ultrasonography could be preferred to gastric endoscopy or scintigraphy in terms of non-invasiveness and easiness, although it still merits further investigation.

Prevalence of mental health symptoms among male and female Australian professional footballers.

OBJECTIVE: Determining the prevalence of mental health symptoms (MHS) among Australian professional footballers compared with former players. A secondary aim was to assess whether MHS were associated with recent injury and psychological resilience. METHODS: This cross-sectional study included 149 male (mean age: 24 years) and 132 female (mean age: 23 years) Australian A-League and W-League professional footballers (study group) and 81 former male footballers (control group, mean age: 39 years) for analysis. MHS and psychological resilience were assessed through validated questionnaires. Severe injuries were assessed through a single question. The adjusted Wald method was used to assess the primary aim. Logistic regression analyses was used to assess the secondary aim. RESULTS: The most prevalent MHS among active footballers and former footballers was sport-related psychological distress (63%) and alcohol misuse (69%), respectively. Global psychological distress, sleep disturbance, alcohol misuse and substance misuse were significantly lower among active male footballers than among former players. Increased psychological resilience among active male footballers was associated with a decrease in symptoms of sport-related and global psychological distress, anxiety and depression of 9%, 14%, 23% and 20%, respectively. Increased psychological resilience among female players was associated with 10% decrease in symptoms of depression. Problem gambling and sleep disturbance was associated with injury in the previous 6 months among active male and female footballers, respectively. CONCLUSIONS: MHS are prevalent among active and former professional footballers. Higher level of psychological resilience is associated with decreased reporting of MHS. Severe injury is associated with problem gambling and sleep disturbance.

The Impact of Intravenous Fluid Therapy on Acid-Base Status of Critically Ill Adults: A Stewart Approach-Based Perspective.

One of the most important tasks of physicians working in intensive care units (ICUs) is to arrange intravenous fluid therapy. The primary indications of the need for intravenous fluid therapy in ICUs are in cases of resuscitation, maintenance, or replacement, but we also load intravenous fluid for purposes such as fluid creep (including drug dilution and keeping venous lines patent) as well as nutrition. However, in doing so, some facts are ignored or overlooked, resulting in an acid-base disturbance. Regardless of the type and content of the fluid entering the body through an intravenous route, it may impair the acid-base balance depending on the rate, volume, and duration of the administration. The mechanism involved in acid-base disturbances induced by intravenous fluid therapy is easier to understand with the help of the physical-chemical approach proposed by Canadian physiologist, Peter Stewart. It is possible to establish a quantitative link between fluid therapy and acid-base disturbance using the Stewart principles. However, it is not possible to accomplish this with the traditional approach; moreover, it may not be noticed sometimes due to the normalization of pH or standard base excess induced by compensatory mechanisms. The clinical significance of fluid-induced acid-base disturbances has not been completely clarified yet. Nevertheless, as fluid therapy may be the cause of unexplained acid-base disorders that may lead to confusion and elicit unnecessary investigation, more attention must be paid to understand this issue. Therefore, the aim of this paper is to address the effects of different types of fluid therapies on acid-base balance using the simplified perspective of Stewart principles. Overall, the paper intends to help recognize fluid-induced acid-base disturbance through bedside evaluation and choose an appropriate fluid by considering the acid-base status of a patient.

Disturbed remodeling and delayed fracture healing in pediatric pycnodysostosis patients.

Pycnodysostosis is an autosomal recessive disease caused by a gene mutation leading cathepsin K deficiency. Pathological fractures of the long bones are common, but guidelines on fracture treatment in these patients are still lacking. We have treated 5 fractures in 2 pediatric pycnodysostosis patients. We hypothesize that pycnodysostosis patients have an incomplete remodeling process in fracture healing because of cathepsin K deficiency. Therefore, to minimize the role of endochondral bone formation (indirect) after a fracture, it seems prudent to strive for direct bone healing (intramembranous) instead of indirect bone healing. Open reduction with internal fixation should be the goal.

Impact of concussion and severe musculoskeletal injuries on the onset of mental health symptoms in male professional rugby players: a 12-month study.

OBJECTIVE: This study explored the association between concussion or musculoskeletal injuries, and the onset of mental health symptoms (MHS) in male professional rugby players over a 12-month period. METHODS: Observational prospective cohort study with three measurements over a follow-up period of 12 months. At baseline, 573 participants provided informed consent. A total of 327 male professional rugby players (62% forwards, 38% backs) completed all follow-up assessments at baseline, 6 months and 12 months. The mean (±SD) age, height and weight of the participants at baseline was 25.9 (±4.4) years, 184.9 (±8.7) cm and 101.5 (±14.6) kg, respectively. Number of musculoskeletal injuries and number of confirmed concussions were assessed through single questions. Symptoms of distress, anxiety/depression, sleep disturbance, adverse alcohol use and eating disorders were assessed using validated questionnaires. RESULTS: Professional rugby players who sustained a concussion within 12 months of baseline were more likely to develop MHS with ORs ranging from 1.5 (95% CI 1.0 to 2.1) for distress to 2.0 (1.2 to 3.6) for adverse alcohol use. Players who sustained a severe injury within 12 months of baseline were more likely to develop symptoms anxiety/depression with an OR of 1.5 (1.1 to 2.0). There was no significant association in both groups for other MHS. CONCLUSIONS: Rugby players who sustained concussion or severe injuries are up to two times more likely to develop symptoms of distress, adverse alcohol use or anxiety/depression.

The "sequence of prevention" for musculoskeletal injuries among adult recreational footballers: A systematic review of the scientific literature.

OBJECTIVE: To gather epidemiological information related to all steps of Van Mechelen's "sequence of prevention" for musculoskeletal injuries among adult recreational football players. METHODS: A systematic review of the scientific literature was conducted in Medline via Pubmed. Therefore, two highly sensitive search strategies based on three groups of keywords (and related search terms) were used. RESULTS: In total, 33 relevant original studies were included in our systematic review. The results of our systematic review showed that the incidence of musculoskeletal injuries among recreational adult football players ranged from 9.6 to 15.8 injuries per 1000 exposure hours. These injuries are especially located in the ankle, knee, groin and hamstring, being associated with previous injury and match exposure. The FIFA11 + injury prevention programme and the Nordic Hamstring Exercise (NHE) were found to be effective for the reduction or prevention of musculoskeletal injuries among adult recreational football players. CONCLUSIONS: Our systematic review showed that musculoskeletal injuries are common among recreational adult football players, while effective preventive programmes are available. Further studies should focus on the identification and understanding of the key factors responsible for the optimal adoption, implementation and maintenance of these measures.

Exposure to physical and psychosocial stressors in relation to symptoms of common mental disorders among European professional football referees: a prospective cohort study.

OBJECTIVES: The study aim was to explore the association of physical and psychosocial stressors (severe injuries, surgeries, recent life events, social support) with one-season onset of symptoms of common mental disorders (CMDs) among European professional football referees. METHODS: An observational prospective cohort study over a follow-up period of one season (2015-2016) was conducted among professional football referees from Belgium, Finland, France, Germany, Norway, Russia, Scotland and Sweden. Based on physical and psychosocial stressors as well as symptoms of CMD, an electronic questionnaire in English and French was set up and distributed by eight football federations involved. RESULTS: The prevalence of symptoms of CMD ranged from 5.9% for distress to 19.2% for eating disorders. A higher number of severe injuries and a lower degree of satisfaction about social support were significantly related to the occurrence of symptoms of CMD with an OR of 2.63 and an OR of 1.10, respectively. CONCLUSION: A higher number of severe injuries and a lower degree on satisfaction about social support were found to be significantly associated with the onset of symptoms of CMD among European professional football referees. Referees suffering from severe injuries were nearly three times more likely to report symptoms of anxiety and depression. Referees who reported a low satisfaction of social support were significantly more likely to report symptoms of eating disorder.

The 'Sequence of Prevention' for musculoskeletal injuries among recreational basketballers: a systematic review of the scientific literature.

OBJECTIVE: Currently, there is no overview of the incidence and (basketball-specific) risk factors of musculoskeletal injuries among recreational basketball players, nor any insight into the effect of preventive measures on the incidence of basketball injuries. This study aimed to gather systematically the scientific evidence on the incidence, prevalence, aetiology and preventive measures for musculoskeletal injuries among recreational basketball players. METHODS: Highly sensitive search strategies were built based on three groups of keywords (and related search terms). Two electronic databases were searched, namely Medline (biomedical literature) via Pubmed, and SPORTDiscus (sports and sports medicine literature) via EBSCOhost. RESULTS: The incidence of musculoskeletal injuries among recreational basketball players ranged from 0.0047 injuries per 1,000 athlete-exposures (AE) for dental injuries to 10.1 injuries per 1000 AE for overall injuries during match play. Significant risk factors for injuries were defending, postural sway, high vertical ground reaction force during jumping and weight >75 kg. All prevention studies have shown to have a significant effect on reducing the risk of injury ranging from an odds ratio (95% confidence interval (CI)) of 0.175 (0.049-0.626) for training injuries and a relative risk (95% CI) of 0.83 (0.57-1.19) achieved with FIFA 11+ prevention exercises and sport-specific balance training, relatively. CONCLUSION: In order to gain insight in the aetiology of basketball-specific injuries and consequently facilitate the development of preventive strategies, more high quality basketball-specific and injury-specific studies among recreational basketball players are needed.

Symptoms of common mental disorders and related stressors in Danish professional football and handball.

The aim of the study was twofold, namely (i) to determine the prevalence of symptoms of common mental disorders (CMDs) among current and retired professional football and handball players and (ii) to explore the relationship of psychosocial stressors with the outcome measures under study. A total of 1155 players were enrolled in an observational study based on a cross-sectional design. Questionnaires based on validated scales were set up and distributed among current and retired professional football and handball players by the Danish football and handball players' union. In professional football, the highest prevalence (4 weeks) of symptoms of CMDs was 18% and 19% for anxiety/depression among current and retired players, respectively. In professional handball, the highest prevalence (4 weeks) of symptoms of CMDs was 26% and 16% for anxiety/depression among current and retired players, respectively. For both the current and retired professional football and handball players, a higher number of severe injuries and recent adverse life events (LE) were related to the presence of symptoms of CMD. Players exposed to severe injuries and/or recent adverse LE were 20-50% times more likely to report symptoms of CMD. The results suggest that it is possible to recognize the population of professional athletes that are more likely to develop symptoms of CMD. This could create the opportunity to intervene preventively on athletes that suffered from severe injury and/or recent adverse LE that could lead to a faster and safer recovery and psychological readiness to return to play.

Providing interoperability of eHealth communities through peer-to-peer networks.

Providing an interoperability infrastructure for Electronic Healthcare Records (EHRs) is on the agenda of many national and regional eHealth initiatives. Two important integration profiles have been specified for this purpose, namely, the "Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing (XDS)" and the "IHE Cross Community Access (XCA)." IHE XDS describes how to share EHRs in a community of healthcare enterprises and IHE XCA describes how EHRs are shared across communities. However, the current version of the IHE XCA integration profile does not address some of the important challenges of cross-community exchange environments. The first challenge is scalability. If every community that joins the network needs to connect to every other community, i.e., a pure peer-to-peer network, this solution will not scale. Furthermore, each community may use a different coding vocabulary for the same metadata attribute, in which case, the target community cannot interpret the query involving such an attribute. Yet another important challenge is that each community may (and typically will) have a different patient identifier domain. Querying for the patient identifiers in the target community using patient demographic data may create patient privacy concerns. In this paper, we address each of these challenges and show how they can be handled effectively in a superpeer-based peer-to-peer architecture.

Achieving clinical statement interoperability using R-MIM and archetype-based semantic transformations.

Effective use of electronic healthcare records (EHRs) has the potential to positively influence both the quality and the cost of health care. Consequently, sharing patient's EHRs is becoming a global priority in the healthcare information technology domain. This paper addresses the interoperability of EHR structure and content. It describes how two different EHR standards derived from the same reference information model (RIM) can be mapped to each other by using archetypes, refined message information model (R-MIM) derivations, and semantic tools. It is also demonstrated that well-defined R-MIM derivation rules help tracing the class properties back to their origins when the R-MIMs of two EHR standards are derived from the same RIM. Using well-defined rules also enable finding equivalences in the properties of the source and target EHRs. Yet an R-MIM still defines the concepts at the generic level. Archetypes (or templates), on the other hand, constrain an R-MIM to domain-specific concepts, and hence, provide finer granularity semantics. Therefore, while mapping clinical statements between EHRs, we also make use of the archetype semantics. Derivation statements are inferred from the Web Ontology Language definitions of the RIM, the R-MIMs, and the archetypes. Finally, we show how to transform Health Level Seven clinical statement instances to EHRcom clinical statement instances and vice versa by using the generated mapping definitions.