Epidemiology of injuries in male and female youth football players:A systematic review and meta-analysis

Background:To conduct a systematic review and meta-analysis of epidemiological data of injuries in male and female youth football players.Methods:Searches were performed in MEDLINE/PubMed,Web of Science,Cochrane Library,and SPORTDiscus databases.Studies were considered if they reported injury incidence rate in male and female youth(≤19 years old)football players.Two reviewers(FJRP and ALV)extracted data and assessed trial quality using the Strengthening the Reporting of Observational Studies in Epidemiology(STROBE)statement and the Newcastle Ottawa Scale.The Grading of Recommendations Assessment,Development,and Evaluation approach determined the quality of evidence.Studies were combined using a Poisson random effects regression model.Results:Forty-three studies were included.The overall incidence rate was 5.70 injuries/1000 h in males and 6.77 injuries/1000 h in females.Match injury incidence(14.43 injuries/1000 h in males and 14.97 injuries/1000 h in females)was significantly higher than training injury incidence(2.77 injuries/1000 h in males and 2.62 injuries/1000 h in females).The lower extremity had the highest incidence rate in both sexes.The most common type of injury was muscle/tendon for males and joint/ligament for females.Minimal injuries were the most common in both sexes.The incidence rate of injuries increased with advances in chronological age in males.Elite male players presented higher match injury incidence than sub-elite players.In females,there was a paucity of data for comparison across age groups and levels of play.Conclusion:The high injury incidence rates and sex differences identified for the most common location and type of injury reinforce the need for implementing different targeted injury-risk mitigation strategies in male and female youth football players.

Sudden Death in Sports: Case Report and Review of an Ongoing Problem

Background: Both competitive and recreational sports are considered a positive practice that is good for human health and quality of life, so it is difficult to understand how young, energetic and apparently healthy people can die while playing their usual sports. When these events occur in elite athletes during monitored events, they normally receive considerable media attention. Objective: To describe the case of sudden death in a young professional athlete who was successfully aided and resuscitated outside our hospital, and to review the literature about sudden death in sports. Materials and Method: We searched for Sudden Death (according to the International Classification of Diseases (ICD-9 and ICD-10)) in our hospital but found no other relevant cases. We performed a literature search on the state of the art in sudden death (Google Scholar, PubMed, LILACS, Scielo and the Revista Española de Cardiología). Results: Although we observed that the prevalence of sudden death is not very high, it still represents a potentially avoidable event. An adequate medical examination prior to regular sporting practice can decrease the incidence of sudden death in athletes under the age of 35. Data available in the literature support medical check-ups that include history-taking, physical examination and electrocardiogram. The findings of this evaluation may also prompt further assessment (electrocardiograph, ergometry). Conclusions: We could not identify standard, obligatory guidelines for screening possible heart diseases causing cardiorespiratory failure and sudden death. As a measure for primary prevention, we propose a protocol for reducing the risk of sudden death in athletes.

Occupational determinants of continued smoking during pregnancy. INMA Valencia cohort study

To describe the smoking habits of the mothers participating in the INMA (INfancia y Medio Ambiente or Childhood and the Environment) cohort of Valencia and to determine which occupational factors are associated with smoking cessation during pregnancy. Cohort study comprising 855 pregnant women from Health Service Areas 6 and 7 was set up in the Autonomous Region of Valencia, Spain. Data on smoking and smoking cessation during pregnancy, and on sociodemographic and work related variables were collected through structured questionnaires at the first and third trimester of pregnancy. Multivariate logistic regression models were constructed to assess factors related to smoking at the beginning of the pregnancy and to continued smoking. 787 women followed in the project and completed all the data. Among them 40.9% smoked at the beginning of pregnancy and 56.2% continued until gestational week 32. Time and effort spent on housework was associated with smoking at the beginning of pregnancy while stress in the workplace related variables contributed to both the prevalence of smoking at the beginning of the pregnancy and the persistence in the habit throughout pregnancy. We found a high prevalence of smoking among the pregnant mothers. Both, conditions in the workplace, as well as the burden of housework were found to be risk factors for smoking and not quitting during pregnancy. These factors should be taken into account when developing health programs designed to encourage the incorporation of healthy habits into the lives of pregnant women.

Design and Evaluation of a Vision-Based UI for People with Large Cognitive-Motor Disabilities

Recovering from multiple traumatic brain injury (TBI) is a very difficult task, depending on the severity of the lesions, the affected parts of the brain and the level of damage (locomotor, cognitive or sensory). Although there are some software platforms to help these patients to recover part of the lost capacity, the variety of existing lesions and the different degree to which they affect the patient, do not allow the generalization of the appropriate treatments and tools in each case. The aim of this work is to design and evaluate a machine vision-based UI (User Interface) allowing patients with a high level of injury to interact with a computer. This UI will be a tool for the therapy they follow and a way to communicate with their environment. The interface provides a set of specific activities, developed in collaboration with the multidisciplinary team that is currently evaluating each patient, to be used as a part of the therapy they receive. The system has been successfully tested with two patients whose degree of disability prevents them from using other types of platforms.

Health Seek: A Deep Learning-Based Intelligent System to Aid Medical Diagnosis

Medical diagnosis is one of the most tedious and complex processes that healthcare personnel face in their day-to-day life. To establish an adequate treatment, it is essential to carry out a correct and early evaluation of each patient. Occasionally, given the number of tests that need to be performed, this evaluation process can require a significant amount of time, and can negatively affect the patient’s recovery. The objective of this work is the development of a new software that, using Artificial Intelligence (AI), offers the healthcare professional support in the process of diagnosing the patient, as well as preventing the probability of suffering a certain disease, based on test information analytics and demographic information available. The system allows storing multiple models based on Deep Learning (DL), previously trained for the diagnosis of different diseases. These models allow predictions to be made based on available medical information. As a use case, one of these models has been successfully tested in diagnosing stroke events.

Post-Hospital Syndrome and Hyponatremia

Introduction: Post-hospital syndrome (PHS) is defined as a period of vulnerability during the first 30 days after a patient is discharged from hospital, in which multiple factors come into play. Hyponatremia is the most frequent hydroelectrolytic disorder in hospitalized patients and may be related to the appearance of PHS. Objective: The objective is to estimate the prevalence of PHS that is assessed as the rate of readmissions in the first 30 days after discharge, in patients with hyponatremia. Material and Methods: It is a descriptive observational study of patients with hyponatremia who were discharged from 1 September 2010 to 2 February 2020 at the Internal Medicine Service of the Hospital University of San Juan (Alicante, Spain). Results: Of the 25 included patients, 5 (20%) were readmitted within a month of discharge, after a mean of 11.4 days (standard deviation [SD] 5.1). The overall mortality of the study was 20% (n = 5), with one case of death in the first 30 days post-hospitalization (4%). In 12 patients (48%) the origin of the hyponatremia was undetermined. The most frequently recorded etiology for the condition was pharmacological (n = 7, 28%), and there was pronounced variability in its clinical and laboratory study. The most widely used corrective measure was drug withdrawal, in 16 patients (64%). Water intake restriction was the most common treatment after discharge (5 patients, 20%), followed by urea (2 patients, 8%), while tolvaptan was not used. Conclusion: Hyponatremia may be the cause of PHS, which could increase the rate of early readmission. Hyponatremia is an underdiagnosed and undertreated entity, so it is necessary to apply an appropriate system to optimize its management and, in future studies, to assess its impact on PHS.

Caregiver Burden in the Management of Frail Elderly Patients with Diabetes in Internal Medicine

Aim: Advanced age and fragility often lead to dependence, making caregiver assistance necessary for performing the activities of daily living. Patients with diabetes are characterized by an elevated presence of comorbidities and subsequent frailty—a relevant consideration when making decisions regarding treatment goals. Health professionals may overlook the caregiver experience when assessing the circumstances surrounding frail elderly patients with diabetes, but this factor can have a large impact on relevant caregiver and patient outcomes. Methods: An observational, retrospective study was carried out to assess the impact of improved management in diabetes on caregiver burden. We assessed patients’ performance of activities of daily living using the Barthel scale. Our primary outcome was caregiver burden, as assessed using the Zarit scale. Results: At baseline, 81.4% of the caregivers reported severe overburden (>55 points on the Zarit scale). At three months, the proportion of caregivers reporting this level of burden had dropped to 76.7% and remained stable at six months (77.1%). In contrast, 8.5% of the caregivers reported moderate overburden (47 to 55 points) at baseline, compared to 13.3% at three months and 12.5% at six. The proportion of caregivers reporting no overburden (Conclusions: Caregiver burden remained persistently high, decreasing only slightly after six months.

Effects of exercise-based cardiac rehabilitation on inflammatory biomarkers in patients with cardiovascular disease:a systematic review with meta-analysis

Background:Evidence supports the anti-inflammatory effect of exercise-based cardiac rehabilitation(CR)in patients with cardiovascular disease(CVD).Nonetheless,the influence of training variables on the effects of exercise training is debateable.Therefore,this systematic review with meta-analysis aims to i)estimate the effects of exercise-based CR on the circulating levels of inflammatory biomarkers in patients with CVD based on the type of exercise,and ii)analyse the influence of other potential moderator variables.Methods:Electronic searches were performed in PubMed,Scopus,and Web of Science databases up to October 2022.A random-effects models of standardised mean difference(SMD)were used.Subgroup analyses and meta-regressions were used to carry out heterogeneity analyses.Results:Aerobic exercise diminished the levels of C-reactive protein compared with the control group in patients with CVD(SMD+=-0.33[95%CI=-0.47,-0.20),as well as the levels of tumor necrosis factor-alfa exclusively in patients with chronic heart failure(SMD+=-0.38[95%CI=-0.59,-0.17]).Moreover,heterogeneity analyses showed that the effect of aerobic exercise on vascular cell adhesion molecule-1 is higher in studies that carried out a CR programme based exclusively on exercise,as well as in studies that performed a shorter intervention period or carried out a lower number of exercise sessions(P≤0.05).Conclusion:Our findings support the anti-inflammatory effect of aerobic exercise in patients with CVD.The low number of studies testing interventions using resistance or combined exercise precludes a definitive answer about their anti-inflammatory effects in this patient population.

Corneal collagen cross-linking epithelium-on vs. epithelium-off: a systematic review and meta-analysis

Background The purpose of the study was to determine the advantages and disadvantages of epi-on corneal cross-linking(CXL)techniques compared with standard epi-off CXL.Methods We searched MEDLINE and EMBASE for randomized controlled trials(RCTs)and non-randomized studies of interventions(NRSIs)and we evaluated the selected papers according to the Cochrane risk of bias tool.We considered,as primary outcomes,average Kmax flattening,changes in uncorrected and corrected distance visual acuity(UDVA and CDVA);as secondary outcomes,we considered changes in pachymetry values and endothelial cell density(ECD).We also investigated adverse events related to the treatments and treatment failure.Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference(MD)with 95%confidence interval(CI)as the effect size.Results A total of 15 studies were included and among these 15 trials,9 were RCTs and 6 were NRSIs,but only 4 studies showed no high risk of bias and were included in this meta-analysis.Our analysis revealed significant postoperative differences in CDVA(MD=0.07;95%CI 0.04 to 0.10;P<0.001),and no significative differences in UDVA,Kmax,central corneal thickness(CCT)and ECD(P>0.05).Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing(P=0.035)and persistent stromal haze(P=0.026).Conclusion Epi-on CXL is as effective as epi-off CXL.Except for a higher significant improvement in CDVA with current epi-on protocols,our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual,topographic,pachymetric,and endothelial parameters.Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.

Retinal image quality with multifocal, EDoF, and accommodative intraocular lenses as studied by pyramidal aberrometry

BackgroundTo study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function (PSF) Strehl ratio using a pyramidal wavefront sensor (PWS)-based aberrometer.MethodsThis study included 194 eyes implanted with: (a) 19 AcrySof SA60AT (control group);(b) 19 Miniwell;(c) 24 LENTIS Mplus LS-313 MF30;(d) 33 LENTIS Mplus LS-313 MF15;(e) 17 AkkoLens Lumina;(f) 31 AT LISA Tri 839MP;(g) 20 Precizon Presbyopic;(h) 20 AcrySof IQ PanOptix;(i) 11 Tecnis Eyhance. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root mean square (RMS), low-order aberration (LOA) and high-order aberration (HOA) RMS measured by PWS aberrometer.ResultsAT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0- and 4.0-mm pupil size (0.52 ± 0.14 and 0.31 ± 0.10;P < 0.05), followed by SA60AT (0.41 ± 0.11 and 0.28 ± 0.07) and PanOptix (0.4 ± 0.07 and 0.26 ± 0.04). AT LISA Tri was found to provide a significantly better retinal image quality than PanOptix at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.004). Mplus MF15 was found to be significantly better than Mplus MF30 at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.002). Total RMS, LOA RMS, HOA RMS, PSF Strehl ratio and PSFw2 varied significantly between the studied groups (P < 0.001).ConclusionsFar distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens. AT LISA Tri, SA60AT and PanOptix showed the highest values of far distance retinal image quality, while the lowest PSFw2 Strehl ratios were displayed by Miniwell, Mplus MF30 and Precizon Presbyopic.

Retinal image quality with multifocal,EDoF,and accommodative intraocular lenses as studied by pyramidal aberrometry

Background:To study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function(PSF)Strehl ratio using a pyramidal wavefront sensor(PWS)-based aberrometer.Methods:This study included 194 eyes implanted with:(a)19 AcrySof SA60AT(control group);(b)19 Miniwell;(c)24 LENTIS Mplus LS-313 MF30;(d)33 LENTIS Mplus LS-313 MF15;(e)17 AkkoLens Lumina;(f)31 AT LISA Tri 839MP;(g)20 Precizon Presbyopic;(h)20 AcrySof IQ PanOptix;(i)11 Tecnis Eyhance.Main outcome measures were PSF Strehl ratio,PSF Strehl ratio excluding second-order aberrations(PSFw2),total root mean square(RMS),low-order aberration(LOA)and high-order aberration(HOA)RMS measured by PWS aberrometer.Results:AT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0-and 4.0-mm pupil size(0.52±0.14 and 0.31±0.10;P<0.05),followed by SA60AT(0.41±0.11 and 0.28±0.07)and PanOptix(0.4±0.07 and 0.26±0.04).AT LISA Tri was found to provide a significantly better retinal image quality than PanOptix at both 3.0 mm(P<0.0001)and 4.0 mm(P=0.004).Mplus MF15 was found to be significantly better than Mplus MF30 at both 3.0 mm(P<0.0001)and 4.0 mm(P=0.002).Total RMS,LOA RMS,HOA RMS,PSF Strehl ratio and PSFw2 varied significantly between the studied groups(P<0.001).Conclusions:Far distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens.AT LISA Tri,SA60AT and PanOptix showed the highest values of far distance retinal image quality,while the lowest PSFw2 Strehl ratios were displayed by Miniwell,Mplus MF30 and Precizon Presbyopic.

Corneal collagen cross‑linking epithelium‑on vs.epithelium‑off:a systematic review and meta‑analysis

Background:The purpose of the study was to determine the advantages and disadvantages of epi-on corneal crosslinking(CXL)techniques compared with standard epi-off CXL.Methods:We searched MEDLINE and EMBASE for randomized controlled trials(RCTs)and non-randomized studies of interventions(NRSIs)and we evaluated the selected papers according to the Cochrane risk of bias tool.We considered,as primary outcomes,average Kmax flattening,changes in uncorrected and corrected distance visual acuity(UDVA and CDVA);as secondary outcomes,we considered changes in pachymetry values and endothelial cell density(ECD).We also investigated adverse events related to the treatments and treatment failure.Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference(MD)with 95%confidence interval(CI)as the effect size.Results:A total of 15 studies were included and among these 15 trials,9 were RCTs and 6 were NRSIs,but only 4 studies showed no high risk of bias and were included in this meta-analysis.Our analysis revealed significant postoperative differences in CDVA(MD=0.07;95%CI 0.04 to 0.10;P<0.001),and no significative differences in UDVA,Kmax,central corneal thickness(CCT)and ECD(P>0.05).Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing(P=0.035)and persistent stromal haze(P=0.026).Conclusion:Epi-on CXL is as effective as epi-off CXL.Except for a higher significant improvement in CDVA with current epi-on protocols,our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual,topographic,pachymetric,and endothelial parameters.Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.