Scientific Rationale for a Bottom-Up Approach to Target the Host Response in Order to Try and Reduce the Numbers Presenting With Adult Respiratory Distress Syndrome Associated With COVID-19. Is There a Role for Statins and COX-2 Inhibitors in the Prevention and Early Treatment of the Disease?

The inflammatory response to and the subsequent development of Adult Respiratory Distress Syndrome (ARDS) is considered to underpin COVID-19 pathogenesis. With a developing world catastrophe, we need to examine our known therapeutic stocks, to assess suitability for prevention and/or treatment of this pro-inflammatory virus. Analyzing commonly available and inexpensive immunomodulatory and anti-inflammatory medications to assess their possible effectiveness in improving the host response to COVID-19, this paper recommends the following: (1) optimize current health-cease (reduce) smoking, ensure adequate hypertension and diabetes control, continue exercising; (2) start on an HMG CoA reductase inhibitor "statin" for its immunomodulatory and anti-inflammatory properties, which may reduce the mortality associated with ARDS; and (3) consider using Diclofenac (or other COX-2 inhibition medications) for its anti-inflammatory and virus toxicity properties.

Influence of type and duration of training on the presence of an abnormal ECG in high-performance athletes.

Objective: To undertake an ECG in high level athletes to determine the morphology of the ECG and to assess the influences on the ECG of the amount of time in a high-performance programme and the type of sport played.

Design: Cross-sectional cohort study.

Setting: High-performance sports programme.

Applying physical science principles to mid-substance Achilles tendinopathy and the relationship to eccentric lengthening exercises.

Mid-substance Achilles tendinopathy is common in the active population. Eccentric (lengthening) exercises are known to be effective in alleviating the clinical condition. To better understand mid-substance Achilles tendinopathy and the response to lengthening exercises physical science principles of elasticity are applied.

Deducing a mechanism of all musculoskeletal injuries.

Background: The mechanism of musculoskeletal (MSK) injuries is not well understood. This research applies principles of elastic motion to the anatomy and movement patterns of MSK structures. From this an insight into the application and timing of forces on MSK structures can be established and the mechanism/s of injury derived.

Lower back injuries in rowing national level compared to international level rowers.

Background: Rowing injuries are common, with lower back injuries having the highest incidence.

Objectives: This study was to investigate the major rowing injuries seen at a single high performance rowing sports program over a 5 years training period and establish if any relationship exists between these injuries and the level of competition that the rower is partaking in.

Patients And Methods: All rowers at the South Australian Sports Institute (SASI) programs were designated as being either international or national level rowers.

Analysis of the Three Most Prevalent Injuries in Australian Football Demonstrates a Season to Season Association Between Groin/Hip/Osteitis Pubis Injuries With ACL Knee Injuries.

Background: Injuries are common in contact sports like Australian football. The Australian Football League (AFL) has developed an extensive injury surveillance database that can be used for epidemiological studies.

Objectives: The purpose of this study is to identify any association between the three most prevalent injuries in the AFL.

Physical principles demonstrate that the biceps femoris muscle relative to the other hamstring muscles exerts the most force: implications for hamstring muscle strain injuries.

Of the hamstring muscle group the biceps femoris muscle is the most commonly injured muscle in sports requiring interval sprinting. The reason for this observation is unknown. The objective of this study was to calculate the forces of all three hamstring muscles, relative to each other, during a lengthening contraction to assess for any differences that may help explain the biceps femoris predilection for injury during interval sprinting.

Chronic Achilles tendinopathy treated with eccentric stretching program.

Background: This study assessed the efficacy of a modified eccentric heel-drop program (reduced time and increased duration of stretch) in treating chronic Achilles tendinopathy.

Methods: Athletes with at least 12 weeks of symptoms diagnosed clinically as chronic Achilles tendinopathy were enrolled in the study. The only treatment recommended was a 6-week eccentric stretching regimen, with each stretch being maintained for at least 15 seconds.

Bone biopsy of the parasymphyseal pubic bone region in athletes with chronic groin injury demonstrates new woven bone formation consistent with a diagnosis of pubic bone stress injury.

Background: There is little scientific evidence available regarding the pathologic basis for chronic groin injury in athletes, a known difficult clinical problem.

Hypothesis: Histological analysis of the superior pubic ramus in athletes with diagnosed chronic groin injury may reveal the nature of the pathologic process.

Study Design: Case series; Level of evidence, 4.

Hip joint range of motion restriction precedes athletic chronic groin injury.

Although a restricted hip range of motion has been previously associated with chronic groin injury the temporal course of this association remains unclear. Accordingly the purpose of this prospective cohort study was to report preliminary findings examining whether hip joint range of motion restriction is associated with subsequent onset of athletic chronic groin injury. End-range internal and external hip joint range of motion was determined in 29 elite Australian football players, without previous history of groin injury.

Outcome of conservative management of athletic chronic groin injury diagnosed as pubic bone stress injury.

Background: Little data exist on the results of treatment for sports-related chronic groin injury.

Hypothesis: Sports-related chronic groin injury treated with a conservative (rest) program results in a satisfactory outcome.

Study Design: Case series; Level of evidence, 4.

Assessment of physical examination and magnetic resonance imaging findings of hamstring injury as predictors for recurrent injury.

Study Design: Prospective cohort study.

Objective: To examine clinical and magnetic resonance imaging (MRI) features of hamstring muscle injury to determine if any are predictive for recurrent injury.

Background: Hamstring muscle strain injury and subsequent recurrent injury are common.

Assessment of player performance following return to sport after hamstring muscle strain injury.

Objective: To determine if there is any decrease in playing performance of athletes following return to sport after recovery from hamstring muscle strain injury.

Design: Prospective cohort study.

Participants: One professional Australian football team over two playing seasons.

6. Doctor on the sidelines.

Effectively managing on-field emergencies is the most important role of the doctor on the sidelines. Pre-event preparation is essential and should include a formulated plan for dealing with emergencies and access to emergency equipment such as a stretcher and a bag and mask. Game day injuries should be assessed by adhering as closely as possible to a normal clinical consultation, with a proper history and examination being performed for all injuries.

Are systemic emboli reduced in computer-assisted knee surgery?: A prospective, randomised, clinical trial.

We undertook a prospective, randomised study using a non-invasive transcranial Doppler device to evaluate cranial embolisation in computer-assisted navigated total knee arthroplasty (n = 14) and compared this with a standard conventional surgical technique using intramedullary alignment guides (n = 10). All patients were selected randomly without the knowledge of the patient, anaesthetists (before the onset of the procedure) and ward staff. The operations were performed by a single surgeon at one hospital using a uniform surgical approach, instrumentation, technique and release sequence.

Return to play following muscle strains.

Objective: To assess return to play strategies following muscle strains with the desired outcomes of decreased competition play lost and minimized risk for recurrent injury.

Methods: Literature review of previous studies that examine return to play criteria for the commonly seen muscle strain injuries in sport.

Results: There have been no studies directly comparing different return to play approaches.

Blood loss after total knee replacement: effects of computer-assisted surgery.

We carried out a prospective randomised study to evaluate the blood loss in 60 patients having a total knee arthroplasty and divided randomly into two equal groups, one having a computer-assisted procedure and the other a standard operation. The surgery was carried out by a single surgeon at one institution using a uniform approach. The only variable in the groups was the use of intramedullary femoral and tibial alignment jigs in the standard group and single tracker pins of the imageless navigation system in the tibia and femur in the navigated group.

The effect of sports specific training on reducing the incidence of hamstring injuries in professional Australian Rules football players.

Objectives: To assess in a single team of Australian Rules football players the effect of a specific intervention program on the incidence and consequence of hamstring muscle strain injuries.

Method: A prospective study was performed with a single team being followed for four playing seasons for hamstring injury. Magnetic resonance imaging was used to confirm the diagnosis of hamstring muscle injury.

Hip joint range of motion reduction in sports-related chronic groin injury diagnosed as pubic bone stress injury.

Traumatic osteitis pubis is a non-specific entity that relates to chronic groin injury and has recently been described as being akin to a pubic bone stress injury. It is uncertain whether or not reduction of hip joint range of motion occurs in traumatic osteitis pubis. The purpose of this study was to establish whether there is a reduction of hip range of motion in athletes who have chronic groin injury diagnosed as pubic bone stress injury.

Groin pain in footballers: the association between preseason clinical and pubic bone magnetic resonance imaging findings and athlete outcome.

Background: Groin pain and tenderness are common in athletes from a variety of codes of football, but little attention has been directed to the influence of magnetic resonance imaging and such clinical findings on athlete participation.

Hypothesis: Preseason groin pain, tenderness, and magnetic resonance imaging findings such as pubic bone marrow edema are associated with restricted training capacity and missed games.

Study Design: Cohort study; Level of evidence, 2.

Description of pain provocation tests used for the diagnosis of sports-related chronic groin pain: relationship of tests to defined clinical (pain and tenderness) and MRI (pubic bone marrow oedema) criteria.

The clinical assessment of groin pain in athletes is difficult, with the lack of specific clinical tests being in part responsible. Three pain provocation tests used in the diagnosis of chronic groin pain are described and their relationship to defined clinical and MRI criteria has been assessed. Eighty-nine Australian Rules football players with and without groin symptoms underwent clinical examination followed by history.

Diagnostic and prognostic value of clinical findings in 83 athletes with posterior thigh injury: comparison of clinical findings with magnetic resonance imaging documentation of hamstring muscle strain.

Background: Little is known about the clinical features of posterior thigh injuries and their contribution to accurate diagnosis and prognostic assessment of hamstring muscle strain injury.

Hypotheses: The clinical features of posterior thigh injury can be used to diagnose hamstring muscle strain and to predict duration of absence from competition.

Study Design: Prospective clinical study.