Investigation of the knowledge of South African high school rugby coaches on concussion and the return-to-play protocol.

Background: Coaches are pivotal in the management of concussed players. Assessing the knowledge of high school rugby coaches with regard to concussion management will enable relevant future education on this topic to be covered. Objectives: To investigate the knowledge of South African high school rugby coaches on concussion symptom recognition, knowledge and stepwise return-to-play (RTP) protocols. Methods: A cross-sectional descriptive study involving 143 first team, high school rugby coaches was completed via an electronic questionnaire. Independent variables included coach demographics, qualifications, experience, BokSmart accreditation, and school size. Dependent variables included knowledge scores on concussion symptoms, general concussion knowledge, stepwise RTP and Maddocks questions. Relationships between total scores for different demographic groupings were established using non-parametric techniques. Results: The coaches had high general, symptom and overall concussion knowledge scores (77% - 80%) in contrast with low RTP scores (62%) and very low Maddocks questions knowledge scores (26%). The 35-44-year age group received top scores for symptom recognition (p=0.034) and total concussion knowledge (p=0.041). Larger category school coaches (p=0.008) and BokSmart accredited coaches (p=0.041) outperformed all other coaches in general concussion knowledge and total knowledge, respectively. However, respondents were not familiar with emotional symptoms or the importance of cognitive rest after a concussion. Educational programmes were the most popular knowledge source for coaches. Conclusion: In general, coaches presented with good general concussion knowledge but lesser expertise on emotional symptoms, cognitive rest and RTP management. Modifiable predictors of knowledge included the expansion of BokSmart accreditation, focussing information sessions on smaller rugby size schools and the education of coaches younger than 35 years or older than 45 years of age.

World netball cardiac screening guidelines.

Sudden cardiac adverse events remain an area of concern in sport. The precise risk for netball athletes is unknown but the annual incidence of sudden cardiac death in sports is reported at 0.5-2 cases in 100 000 young competitive athletes between the ages of 12-35 years. Cardiac screening in the sport and exercise medicine context aims at identifying pathologies associated with catastrophic events when combined with physical activity. There is an ongoing debate relating to the standardisation of the pre-participatory medical assessment (PPMA). World Netball (WN) commissioned a cardiac screening policy (13 March 2022). The minimum PPMA recommended by World Netball is a history, physical examination, and a resting 12-lead electrocardiogram (ECG). ECGs should be interpreted in accordance with athlete-specific ECG interpretation criteria. Expansion of sports cardiology experience and infrastructure, in combination with universal emergency response planning for sudden cardiac arrest, is intended to safeguard athlete health and player welfare in WN.

The congested International Match Calendar in football: views of 1055 professional male players.

BACKGROUND: The International Match Calendar congestion affects players recovery. The views of a worldwide cohort of professional football players is shared in this communication. METHODS: A cross-sectional observational study recruited players through Fédération Internationale des Associations de Footballeurs Professionnel's national members. An electronic survey was shared in English, French, Italian and Spanish with 1055 players consenting and completing it anonymously in November 2021. RESULTS: A total of 42% of respondents believe back-to-back matches should be limited to three. Most respondents (69%) felt off or in season breaks are infringed by clubs or national teams and 83% believe regulations should protect them. A total of 55% of players believed they sustained one or more injuries due to the overload and it has affected 52% of respondents' mental state. CONCLUSION: The congested International Match Calendar poses a risk to professional footballers physical and mental health. Poor recovery between matches may affect player availability and performance. Players should be represented by active players when International Match Calendar scheduling decisions are made. Administrators should seek medical guidance regarding the effects of overload on performance prior to making decisions. This study allows the opportunity for a larger national team player sample to be studied.

Safety and efficacy of inclisiran in South African patients at high cardiovascular risk: A subanalysis of the ORION phase III clinical trials.

BACKGROUND: Inclisiran significantly reduced low-density lipoprotein cholesterol (LDL-C) in individuals with heterozygous familial hypercholesterolaemia, established atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk equivalents (type 2 diabetes, familial hypercholesterolaemia or a 10-year risk of a cardiovascular event ≥20%) in the ORION phase III clinical trials. Infrequent dosing at days 1, 90, 270 and 450 resulted in a mean LDL-C reduction of ~50%. A total of 298 participants from South Africa (SA) were enrolled. Local data are needed to support the use of inclisiran in the SA population, potentially addressing an unmet need for additional LDL-C-lowering therapies. Objectives. To analyse the ORION phase III trial data to assess the efficacy and safety of inclisiran in SA participants. Methods. ORION-9, 10 and 11 were randomised, double-blind, phase III trials. Participants were receiving maximally tolerated statins with or without other lipid-lowering therapies (excluding protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors). Participants were randomised 1:1 to inclisiran sodium 300 mg/284 mg (free acid) or placebo administered at days 1, 90, 270 and 450. The co-primary endpoints were the LDL-C percentage change from baseline to day 510 and the time-averaged percentage change in LDL-C from baseline after day 90 up to day 540. Key secondary endpoints included the absolute change in LDL-C from baseline to day 510, the time-averaged absolute change from baseline after day 90 up to day 540, and changes in other lipids and lipoproteins. Results. The mean age of the participants was 58.6 years (56% male). The mean LDL-C level at baseline was 3.6 mmol/L. At day 510, inclisiran reduced LDL-C levels by 54.2% compared with placebo (95% confidence interval (CI) -61.3 - -47.2; p<0.0001). The corresponding time-averaged reduction in LDL-C was 52.8% (95% CI -57.9 - -47.8; p<0.0001). Treatment-emergent adverse events at the injection site were more common with inclisiran compared with placebo (10.1% v. 0.7%); however, all were mild or moderate in nature and none were persistent. Conclusion. Inclisiran, given in addition to maximally tolerated standard lipid-lowering therapy, is effective and safe and results in robust reductions in LDL-C in SA patients at high cardiovascular risk.

Year of the face mask: do's and don'ts during exercise.

The COVID-19 pandemic causes widespread anxiety and uncertainty regarding disease transmission. In many countries people are obliged to wear a face mask in public spaces. Individuals involved in sports participation at any level need to make informed decisions on wearing a face mask during exercise. Currently there is no scientific evidence on what to advise regarding the safety of wearing a face mask during exercise, or what type of mask to use. This short report aims to answer these questions in a structured and practical way.

Implications of COVID-19 for resumption of sport in South Africa: A South African Sports Medicine Association (SASMA) position statement - Part 1.

The significant impact of the coronavirus disease 2019 (COVID-19) pandemic has extended to sport with the cessation of nearly all professional and non-professional events globally. Recreational parks and fitness centres have also closed. A challenge remains to get athletes back to participation in the safest way, balancing the protection of their health while curbing the societal transmission of the virus. With this Position Statement, the South African Sports Medicine Association (SASMA) aims to guide return-to-sport as safely as possible, in an evidence-based manner, given that COVID-19 is a new illness and new information from experts in various fields continues to emerge. Clinical considerations are briefly described, focusing on a return-to-sport strategy, including education, preparation of the environment, risk stratification of sports and participants, and the practical implementation of these guidelines. The management of the potentially exposed or infected athlete is further highlighted. It is important that persons charged with managing athletes' return-to-sport in any environment must be up-to-date with local and international trends, transmission rates, regulations and sport-specific rule changes that might develop as sport resumes. Additionally, such information should be applied in a sports-specific manner, considering individual athlete's and team needs and be consistent with national legislation.

Implications of COVID-19 for resumption of sport in South Africa: A South African Sports Medicine Association (SASMA) position statement - Part 2.

The lockdown regulations due to the coronavirus pandemic (COVID-19) that broke out towards the end of 2019 and continued to spread throughout most countries in the world had a negative effect on the sporting community. The South African government eased the lockdown rules to Level 1 from 21 September 2020. In Part 2 of this Position Statement of the South African Sports Medicine Association (SASMA), the authors address the position regarding the safe return to sports for athletes who were infected by the virus. An update on clinical manifestations and multi-organ involvement, testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), prolonged positive real time polymerase chain reaction (RT-PCR) and the role of quantitative real time polymerase chain reaction (RT-qPCR) in informing return to sports, grading of disease severity, individualised management of infected athletes and graduated return to play guidelines (GRTP) is provided. The authors also share thoughts on athletes with disabilities, immunisation, the using of masks during exercise and utilising biologically safe environments (BSE). Finally the SASMA Guidelines for Safe RTP in Level 1 lockdown during SARS-Cov-2 are introduced.

State of the ART: clinical efficacy and improved quality of life in the public antiretroviral therapy program, Free State province, South Africa.

The South African public-sector antiretroviral treatment (ART) program has yielded promising early results. To extend and reinforce these preliminary findings, we undertook a detailed assessment of the clinical efficacy and outcomes over two years of ART. The primary objective was to assess the clinical outcomes and adverse effects of two years of ART, while identifying the possible effects of baseline health and patient characteristics. A secondary objective was to address the interplay between positive and negative outcomes (clinical benefits versus adverse effects) in terms of the patients' physical and emotional quality of life (QoL). Clinical outcome, baseline characteristics, health status, and physical and emotional QoL scores were determined from clinical files and interviews with 268 patients enrolled in the Free State ART program at three time points (6, 12, and 24 months of ART). Age, sex, education, and baseline health (CD4 cell count and viral load) were all independently associated with the ART outcome in the early stages of treatment, but their impact diminished as the treatment progressed. The number of patients classified as treatment successes increased over the first two years of ART, whereas the proportion of patients experiencing adverse effects diminished. Importantly, our findings show that ART had strong and stable positive effects on physical and emotional QoL. These favorable results demonstrate that a well-managed public-sector ART program can be very successful within a high-HIV-prevalence resource-limited setting. This finding emphasizes the need to adopt treatment scale-up as a key policy priority, while at the same time ensuring that the highest standards of healthcare provision are maintained. Healthcare services should also target vulnerable groups (males, less-educated patients, those with low baseline CD4 cell counts, and high baseline viral loads) who are most likely to experience treatment failure.

Factors influencing treatment default among tuberculosis patients in a high burden province of South Africa.

OBJECTIVE: To determine and describe the factors influencing treatment default of tuberculosis (TB) patients in the Free State Province of South Africa. METHODS: A retrospective records review of pulmonary TB cases captured in the ETR.Net electronic TB register between 2003 and 2012 was performed. Subjects were >15 years of age and had a recorded pre-treatment smear result. The demographic and clinical characteristics of defaulters were described. Multivariate logistic regression analysis was used to determine factors associated with treatment default. The odds ratios (OR) together with their corresponding 95% confidence intervals (CI) were estimated. Statistical significance was considered at 0.05. RESULTS: A total of 7980 out of 110 349 (7.2%) cases defaulted treatment. Significantly higher proportions of cases were male (8.3% vs. female: 5.8%; p<0.001), <25 years old (9.1% vs. 25-34 years: 8.7%; 35-44 years: 7.0%; 45-54 years: 5.2%; 55-64 years: 4.4%; >64 years: 3.9%; p<0.001), undergoing TB retreatment (11.0% vs. new cases: 6.3%; p<0.001), had a negative pre-treatment sputum smear result (7.8% vs. positive smear results: 7.1%; p<0.001), were in the first 2 months of treatment (95.5% vs. >2 months: 4.8%; p<0.001), and had unknown HIV status (7.8% vs. HIV-positive: 7.0% and HIV-negative: 5.7%; p<0.001). After controlling for potential confounders, multivariate analysis revealed a two-fold increased risk of defaulting treatment when being retreated compared to being treated for the first time for TB (adjusted OR (AOR) 2.0, 95% CI 1.85-2.25). Female cases were 40% less likely to default treatment compared to their male counterparts (AOR 0.6, 95% CI 0.51-0.71). Treatment default was less likely among cases >24 years old compared to younger cases (25-34 years: AOR 0.8, 95% CI 0.77-0.87; 35-44 years: AOR 0.6, 95% CI 0.50-0.64; 45-54 years: AOR 0.4, 95% CI 0.32-0.49; 55-64 years: AOR 0.3, 95% CI 0.21-0.43; >64 years: AOR 0.3, 95% CI 0.19-0.35). Co-infected cases receiving antiretroviral therapy (ART) were 40% less likely to default TB treatment relative to those whose ART status was unknown (AOR 0.6, 95% CI 0.46-0.57). CONCLUSIONS: Salient factors influence TB patient treatment default in the Free State Province. Therefore, the strengthening of clinical and programmatic interventions for patients at high risk of treatment default is recommended. In particular, ART provision to co-infected cases facilitates TB treatment adherence and outcomes.

Clinical and bacteriologic efficacy of telithromycin in patients with bacteremic community-acquired pneumonia.

This retrospective analysis was performed to determine the clinical and bacteriologic efficacy of the ketolide antibacterial telithromycin in patients with community-acquired pneumonia (CAP) with pneumococcal bacteremia. Patients 13 years old with radiologically confirmed CAP and a positive blood culture for Streptococcus pneumoniae at screening were analyzed from eight multicenter Phase III/IV clinical trials. In four open-label, non-comparative studies, patients received telithromycin 800 mg once daily for 7-10 days. In four randomized, controlled, double-blind, comparative studies, patients received telithromycin 800 mg once daily for 5-10 days or a comparator antimicrobial (amoxicillin 1000 mg three times daily, clarithromycin 500 mg twice daily, or trovafloxacin 200 mg once daily) for 7-10 days. In total, 118 patients (telithromycin, 94/1061 [8.9%]; comparator, 24/244 [9.8%]) had documented pneumococcal bacteremia. Those who were treated with telithromycin achieved a clinical cure rate of 90.2% (74/82, per-protocol population); S. pneumoniae was eradicated in 77/82 (93.9%) bacteremic patients who received telithromycin and 15/19 (78.9%) comparator-treated patients. Clinical cure was also observed among telithromycin-treated bacteremic patients who were infected with penicillin- or erythromycin-resistant strains of S. pneumoniae (5/7 and 8/10, respectively). In conclusion, telithromycin achieves high clinical and bacteriologic cure rates in CAP patients with pneumococcal bacteremia.

Acute obturator internus muscle strain in a rugby player: a case report.

A 28-year-old male rugby player presented with severe onset of right hip pain when he fell awkward after a ruck during an international match. A rare case of an acute strain of the obturator internus muscle, a deep muscle of the hip joint, is reported, which resolved completely after a period of rest and intense active physical therapy.

Telithromycin in the treatment of community-acquired pneumonia: a pooled analysis.

The efficacy of telithromycin has been assessed in six Phase III studies involving adults with mild to moderate community-acquired pneumonia (CAP) with a degree of severity compatible with oral therapy. Patients received telithromycin 800 mg once daily for 7-10 days in three open-label studies (n=870) and three randomized, double-blind, comparator-controlled studies (n=503). Comparator antibacterials were amoxicillin 1000 mg three-times daily, clarithromycin 500 mg twice daily and trovafloxacin 200 mg once daily. Clinical and bacteriological outcomes were assessed 7-14 days post-therapy. Among telithromycin-treated patients, per-protocol clinical cure rates were 93.1 and 91.0% for the open-label and comparative studies, respectively. Telithromycin treatment was as effective as the comparator agents. High eradication and clinical cure rates were observed for infections caused by key pathogens: Streptococcus pneumoniae including isolates resistant to penicillin G and/or erythromycin A (95.4%), Haemophilus influenzae (89.5%) and Moraxella catarrhalis (90%). Telithromycin was also highly effective in patients with infections caused by atypical and/or intracellular pathogens and those at increased risk of morbidity. Telithromycin was generally well tolerated. Telithromycin 800 mg once daily for 7-10 days offers a convenient and well-tolerated first-line oral therapy for the empirical treatment of mild to moderate CAP.

Influence of aging treatment on the bacterial quality of South African springbok (Antidorcas marsupialis marsupialis) wholesale cuts.

The left sides of 20 springbok carcasses were aged with the skin on (treatment 1), while the right sides were aged without the skin (treatment 2). Another 20 carcasses were skinned, halved and cut into wholesale cuts. The loin and leg cuts from the right sides were deboned before vacuum packaging (treatment 3), while the loin and leg cuts from the left sides were vacuum packed with the bone in (treatment 4). All the carcass sides (36 h post mortem) and vacuum packed cuts (36 h post mortem) were aged for either 2, 5, 12 and 19 days respectively (ca. 0 degrees C). The examined groups of bacteria indicate that, for an ageing period of 12 days or less, vacuum packaging does not have an advantage over the hung in air method. However, when considering an extended ageing period ( > 12 days) vacuum packaging ensures that spoilage bacteria are inhibited and that the Enterobacteriaceae group of bacteria do not increase (ca. 0 degrees C), while the results clearly show that this is not the case with the hung in air ageing treatments (1 and 2).

Short-term effects of two fusarium toxins, diacetoxyscirpenol and neosolaniol monoacetate, in male Wistar rats.

This study compared the pathological and haematological effects of neosolaniol monoacetate in male Wistar rats with those of diacetoxyscirpenol, a highly toxic trichothecene mycotoxin. Both toxins caused statistically significant decreases in erythrocyte counts and increased the proportion of larger platelets compared to controls when dosed at 1 mg/kg body weight three times/wk for up to 5 wk. Lesions caused by treatment with either toxin at this dosage level were mild and were seen--mainly after 2-4 wk--in the actively dividing cells of the thymus, spleen, lymph nodes and bone marrow. Reduced severity or disappearance of the lesions was noted towards the end of the treatment period. The type and severity of the toxic effects of neosolaniol monoacetate appeared to be similar to those of diacetoxyscirpenol.

Uterine artery embolization for symptomatic fibroids.

OBJECTIVES: The aim of this study was to introduce uterine artery embolization (UAE) as an effective and safe treatment option in patients with symptomatic fibroids. METHODS: Sixty-one patients underwent UAE with a 3- and 12-month follow-up. RESULTS: The procedure was well tolerated in all patients with the following symptoms improving: heavy bleeding [90% (95% CI 80.21%; 95.4%)]; dysmenorrhea [median -4 (95% CI -5; -4)]; feeling of a mass [74% (95% CI 57.9%; 85.8%)]; abdomino-pelvic discomfort [88% (95% CI 75.5%; 94.9%)]; and deep dyspareunia [90% (95% CI 71.1%; 97.3%)]. Uterine volume decreased by a median difference of 188 cm(3) (95% CI 146.5; 236), which related to a median % reduction of 37.7% (95% CI 32.4%; 45%) at 12-month follow-up. Most (91%) patients were satisfied with the procedure and only minor complications occurred. CONCLUSIONS: Uterine artery embolization can be performed effectively and safely at centers with the necessary expertise and can be used with success in Africa.

The suitability of a rolled BHK21 monolayer system for the production of vaccines against the SAT types of foot-and-mouth disease virus. I. Adaptation of virus isolates to the system, immunogen yields achieved and assessment of subtype cross reactivity.

In an examination of 34 southern African SAT-type foot-and-mouth disease viruses, all but 1 attained satisfactory levels of infectivity within 6 passages in rolled BHK21 monolayer cell cultures. However, there were marked differences between adapted viruses with respect to the mass of immunogen (146S material) produced. Several isolates which consistently produced levels greater than or equal to 2 micrograms/ml were identified. In cross neutralization tests using post-vaccinal sera, SAT-1 and SAT-2 isolates showed considerable diversity and none of the viruses tested would be expected to produce a broad-spectrum response if incorporated into a vaccine. On the other hand, when 2 of the SAT-2 isolates were incorporated into the same vaccine a distinctly broader response resulted.

A "Youth Multi-function Centre" in the Free State: an alternative to clinic-based HIV/AIDS prevention and care.

The youth are especially vulnerable to the HIV/AIDS epidemic in South Africa. In the Free State (second highest incidence of HIV/AIDS among the provinces), the Welkom-Goldfields area may for various reasons be singled out as a high risk area for HIV/AIDS which should receive priority attention in attempts to combat the disease. It is suggested that a Youth Multi-function Centre would place youth reproductive health care in the broader development and life skills arena--where it could be thought to rightfully belong. The objectives of the paper are to depict the rationale for a Youth Multi-function Centre, to broadly conceptualise a Youth Multi-function Centre, and to report on the process and methodology followed in an attempt to actually establish such a centre in Thabong/Welkom.

Efficacy of telithromycin in community-acquired pneumonia caused by pneumococci with reduced susceptibility to penicillin and/or erythromycin.

BACKGROUND: The efficacy of oral telithromycin was assessed in patients with community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae with reduced susceptibility to penicillin and/or erythromycin. METHODS: Patients with CAP who had received telithromycin 800 mg once daily for 5 or 7-10 days (n = 2,289) in eight phase III clinical trials, or telithromycin 800 mg once daily for 7 days (n = 50) in a phase II study were included in this pooled analysis. Patients with S. pneumoniae as the cause of infection were identified, with particular focus on those infected with strains with reduced susceptibility to penicillin (intermediate, minimal inhibitory concentration (MIC) 0.12-1.0 mg/l; resistant, MIC >or=2.0 mg/l) and/or resistance to erythromycin (MIC >or=1.0 mg/l). Per-protocol clinical and bacteriological outcomes were assessed 7-14 days post-therapy in the phase III studies, and at 7-21 days post-therapy or at the end of therapy in the phase II study. RESULTS: Of the 327 telithromycin-treated patients with S. pneumoniae infection, 61 (19%) were infected with strains with reduced susceptibility to penicillin and/or erythromycin. Clinical cure and bacterial eradication rates in these patients were 91.8% (56/61) and 93.4% (57/61), respectively. Corresponding clinical cure and bacterial eradication rates overall for all isolates of pneumococci were 94.5% (309/327) and 96.0% (314/327), respectively. All isolates with reduced susceptibility to penicillin and/or erythromycin were susceptible to telithromycin (MIC

A polydiagnostic approach to the differences in the symptoms of schizophrenia in different cultural and ethnic populations.

This study evaluates the pathoplastic influences of ethnicity and culture on the symptoms of schizophrenia. A sample of 113 schizophrenics was evaluated using the Present State Examination (PSE) and Landmark's Manual for the Assessment of Schizophrenia. The subjects were 57 coloured and 56 black individuals. Six different tribes of Bantu, Negroid and Khoisan origin and with different language and cultural backgrounds were represented among the black subjects. Core symptoms remained basically the same in two groups, but the content of positive symptoms was found to be influenced by culture. However, no statistically significant differences in the presentation of negative symptoms were found in terms of quantity, but there were qualitative differences between the ethnic groups.

Efficacy and tolerability of once-daily telithromycin compared with high-dose amoxicillin for treatment of community-acquired pneumonia.

BACKGROUND: This randomized, double-blind study compared the efficacy and tolerability of the new ketolide antimicrobial telithromycin with that of high-dose amoxicillin in the treatment of community-acquired pneumonia (CAP). PATIENTS AND METHODS: Adult patients (n = 404), with signs and symptoms of CAP and radiologic confirmation were randomized to receive telithromycin 800 mg once daily (n = 199) or amoxicillin 1,000 mg three times a day (n = 205) for 10 days. Clinical and bacteriologic outcomes were assessed at post-therapy test-of-cure (days 17-24) and late post therapy (days 31-36). RESULTS: The clinical cure rate for telithromycin-treated patients (per protocol) pst therapy (days 17-24) was 141/149 (94.6%) and compared well with that for amoxicillin (137/152 (90.1%)). Subset analysis of patients (per protocol) showed high clinical cure rates for patients aged >/= 65 years (telithromycin 21/24, 87.5%; amoxicillin 22/29, 75.9%); those with documented pneumococcal bacteremia (telithromycin 10/10, 100%; amoxicillin 7/9, 77.8%); and patients with a Fine score >/= III (telithromycin 31/34, 91.2%; amoxicillin 38/47, 80.9%). Bacterial eradication rates were comparable between treatments (telithromycin 42/48, 87.5%; amoxicillin 39/45, 86.7%), with 22/23 vs 18/21 Streptococcus pneumoniae strains 9/12 vs 11/13 Haemophilus influenzae strains and all Moraxella catarrhalis isolates (five and three patients, respectively) eradicated at the test-of-cure visit. Both treatments were generally well tolerated. CONCLUSION: Telithromycin 800 mg once daily is a convenient, optimal-spectrum, first-line treatment for CAP in adults, at least as effective and well tolerated as high-dose amoxicillin.