Exploring Choke Holds in Brazilian Jiujitsu Athletes: A Demographic Study.

Introduction Brazilian jiujitsu is a relatively new sport that has grown exponentially in popularity along with the growth of the Ultimate Fighting Championship (UFC). In jiujitsu, there are a variety of submissions with a choke hold being one of the most popular. There is a subset of athletes in jiujitsu who believes chokes are safe. However, there have been case reports of relatively young athletes suffering strokes secondary to internal carotid or vertebral artery dissections after being placed in choke holds. There have been manuscripts describing the injury profile in jiujitsu, but none mention stroke or dissections. This study evaluated how frequently chokes happen in jiujitsu and if athletes have ever experienced symptoms consistent with cervical artery dissection (CAD). Additionally, this study aimed to describe the training frequency and baseline demographics of jiujitsu athletes. Methods A survey was distributed throughout social media platforms which asked both quantitative and qualitative questions regarding athlete training. The survey consisted of 28 questions which collected largely baseline grappling information about the participants such as how long they trained, how often they spar, favorite submission, how frequently they are choked, etc. This data was then analyzed using odds ratio and one sample t-test to evaluate for statistical differences. Results A total of 521 participants were included in the analysis. The participants were mostly male (84.7%), trained for four years, four times per week; 99.8% (520) participated in sparring, with an average age of 37; and 55.7% (290) have experienced symptoms consistent with CAD. Descriptive statistics revealed that individuals who were 37 years of age or younger were more likely to experience symptoms consistent with CAD (odds ratio: 1.5337 (95% confidence interval (CI): 1.0827-2.1727). Athletes that were 37 years of age or younger have been training for fewer years (4.7 years vs 8.8 years) but train more days per week (4.03 times per week vs 3.76 time per week), drill for a longer amount of time (46.8 minutes per class vs 38.3 minutes per class), attend longer classes (81.12 minutes vs 72.3 minutes), and train for a longer period of time per week (338.5 minutes vs 274.6 minutes) than athletes over 37 years. All previously mentioned variables were analyzed using a one sample t-test and were significant at the α = 0.05 level. The lone qualitative question regarding the term "train brain" revealed that of those who experienced it, 84.1% (58) described it as a cognitive/physical impairing event. Conclusion Jiujitsu athletes train multiple times per week and are frequently exposed to choke holds. There is no literature to examine the long-term effects of these chokes on the athlete's cervical vasculature. Additional studies should be conducted to evaluate the effects of the repetitive stress placed on these vessels.

Convalescent Plasma for Preventing Critical Illness in COVID-19: a Phase 2 Trial and Immune Profile.

The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an unprecedented event requiring frequent adaptation to changing clinical circumstances. Convalescent immune plasma (CIP) is a promising treatment that can be mobilized rapidly in a pandemic setting. We tested whether administration of SARS-CoV-2 CIP at hospital admission could reduce the rate of ICU transfer or 28-day mortality or alter levels of specific antibody responses before and after CIP infusion. In a single-arm phase II study, patients >18 years-old with respiratory symptoms with confirmed COVID-19 infection who were admitted to a non-ICU bed were administered two units of CIP within 72 h of admission. Levels of SARS-CoV-2 detected by PCR in the respiratory tract and circulating anti-SARS-CoV-2 antibody titers were sequentially measured before and after CIP transfusion. Twenty-nine patients were transfused high titer CIP and 48 contemporaneous comparable controls were identified. All classes of antibodies to the three SARS-CoV-2 target proteins were significantly increased at days 7 and 14 post-transfusion compared with baseline (P < 0.01). Anti-nucleocapsid IgA levels were reduced at day 28, suggesting that the initial rise may have been due to the contribution of CIP. The groups were well-balanced, without statistically significant differences in demographics or co-morbidities or use of remdesivir or dexamethasone. In participants transfused with CIP, the rate of ICU transfer was 13.8% compared to 27.1% for controls with a hazard ratio 0.506 (95% CI 0.165-1.554), and 28-day mortality was 6.9% compared to 10.4% for controls, hazard ratio 0.640 (95% CI 0.124-3.298). IMPORTANCE Transfusion of high-titer CIP to non-critically ill patients early after admission with COVID-19 respiratory disease was associated with significantly increased anti-SARS-CoV-2 specific antibodies (compared to baseline) and a non-significant reduction in ICU transfer and death (compared to controls). This prospective phase II trial provides a suggestion that the antiviral effects of CIP from early in the COVID-19 pandemic may delay progression to critical illness and death in specific patient populations. This study informs the optimal timing and potential population of use for CIP in COVID-19, particularly in settings without access to other interventions, or in planning for future coronavirus pandemics.

Convalescent plasma for preventing critical illness in COVID-19: A phase 2 trial and immune profile.

RATIONALE: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an unprecedented event requiring rapid adaptation to changing clinical circumstances. Convalescent immune plasma (CIP) is a promising treatment that can be mobilized rapidly in a pandemic setting. OBJECTIVES: We tested whether administration of SARS-CoV-2 CIP at hospital admission could reduce the rate of ICU transfer or 28 day mortality. METHODS: In a single-arm phase II study, patients >18 years-old with respiratory symptoms documented with COVID-19 infection who were admitted to a non-ICU bed were administered two units of CIP within 72 hours of admission. Detection of respiratory tract SARS-CoV-2 by polymerase chain reaction and circulating anti-SARS-CoV-2 antibody titers were measured before and at time points after CIP transfusion. MEASUREMENTS AND MAIN RESULTS: Twenty-nine patients were transfused CIP and forty-eight contemporaneous controls were identified with comparable baseline characteristics. Levels of anti-SARS-CoV-2 IgG, IgM, and IgA anti-spike, anti-receptor-binding domain, and anti-nucleocapsid significantly increased from baseline to post-transfusion for all proteins tested. In patients transfused with CIP, the rate of ICU transfer was 13.8% compared to 27.1% for controls with a hazard ratio 0.506 (95% CI 0.165-1.554), and 28-day mortality was 6.9% compared to 10.4% for controls, hazard ratio 0.640 (95% CI 0.124-3.298). CONCLUSIONS: Transfusion of high-titer CIP to patients early after admission with COVID-19 respiratory disease was associated with reduced ICU transfer and 28-day mortality but was not statistically significant. Follow up randomized trials may inform the use of CIP for COVID-19 or future coronavirus pandemics.