Elevated international normalised ratios correlate with severity of injury and outcome

Background. Haemorrhagic shock is the leading cause of preventable early deaths from trauma. Acute coagulopathy on admission to a trauma unit is associated with worse outcomes. The relationship of haemorrhage to early mortality remains consistent regardless of mechanism of injury. Haemorrhage and haemorrhagic shock are increasingly amenable to interventions that result in reductions in morbidity and mortality.Objectives. To assess the prevalence of coagulopathy in patients admitted to the level 1 trauma unit at Inkosi Albert Luthuli Central Hospital, Durban, South Africa, and correlate it with in-hospital mortality.Methods. A retrospective analysis of the first 1 000 patients admitted to the trauma unit during the years 2007 - 2011 was performed. The admission international normalised ratios (INRs) were correlated with Injury Severity Scores (ISSs) and in-hospital mortality. A multivariable Poisson model with robust standard errors was used to assess the relationship between coagulopathy and mortality after adjustment for the confounding influence of age and gender. The data were analysed using the R statistics program.Results. Of the 1 000 patients, 752 were male. There were 261 admissions directly from the scene and 739 inter-hospital transfers (nonscene). The mean INRs among survivors for all, scene and non-scene patients were 1.33, 1.30 and 1.34, respectively, and those among non-survivors 1.92, 2.01 and 1.88, respectively (p<0.001). The overall prevalence of coagulopathy was 48.7%, 46.9% in scene patients and 49.2% in non-scene patients. The mortality rate of scene patients with abnormal INR levels was 41.1% (adjusted relative risk (aRR) 3.59, 95% confidence interval (CI) 2.11 - 6.44; p<0.001) v. 25.1% for non-scene patients (aRR 1.67, 95% CI 1.15 - 2.05; p=0.004) (p=0.001).Conclusions. There was a high prevalence of coagulopathy in our study. Raised admission INRs were associated with worse outcomes. There was a direct correlation between the INR and the ISS. INRs may offer predictive capabilities in resource-depleted environments where the ISS is not routinely calculated. Early recognition of acute coagulopathy may help reduce morbidity and mortality

The lateral batting backlift technique: is it a contributing factor to success for professional cricket players at the highest level?

   Background: This study aimed primarily to investigate the lateral batting backlift technique (LBBT) among semi-professional, professional and current international cricket players. A key question was to investigate whether this technique is a factor that contributes to success for cricket players at the highest levels of the game.  Methods: The participants in this study’s sample (n = 130) were South African semi-professional players (SP) (n = 69), professional players (PP) (n = 49) and South African international professional players (SAI) (n = 12). Biomechanical and video analyses were performed on all the participating groups. Classifiers were utilised to identify the batting backlift technique type (BBTT) employed by all batsmen. All statistics and wagon wheels (scoring areas of the batsmen on a cricket field) were sourced online. A Pearson’s Chi-squared test, Student T-test, one-way analysis of variance and T-test were performed in this study. All analyses were performed using R (R Core Team) at a significance level of α = 0.05.  Results: This study found that a LBBT is more common at the highest levels of batsmanship with batsmen at the various levels of cricket having percentages of the LBBT as follows: SP = 37%; PP = 38%; SAI = 75%; p = 0.001. There was also a noticeably higher difference in the highest scores and career averages between all groups of players, as well as batsmen who either use a straight batting backlift technique (SBBT) or a LBBT. This study also found that SAI batsmen who used the LBBT were more proficient at scoring runs in various areas around the cricket field (according to the wagon wheel analysis).  Conclusion: This study found that a LBBT is a contributing factor for success regarding players wanting to play cricket at the highest levels. Cricket coaches should also pay attention to the direction of the backlift with players, especially when correlating it to various scoring areas on the cricket field. Further in-depth research is required to fully investigate the change in batting backlift techniques among cricket players over a long-term period.&nbsp

Elevated international normalised ratios correlate with severity of injury and outcome

Background. Haemorrhagic shock is the leading cause of preventable early deaths from trauma. Acute coagulopathy on admission to a trauma unit is associated with worse outcomes. The relationship of haemorrhage to early mortality remains consistent regardless of mechanism of injury. Haemorrhage and haemorrhagic shock are increasingly amenable to interventions that result in reductions in morbidity and mortality.Objectives. To assess the prevalence of coagulopathy in patients admitted to the level 1 trauma unit at Inkosi Albert Luthuli Central Hospital, Durban, South Africa, and correlate it with in-hospital mortality.Methods. A retrospective analysis of the first 1 000 patients admitted to the trauma unit during the years 2007 - 2011 was performed. The admission international normalised ratios (INRs) were correlated with Injury Severity Scores (ISSs) and in-hospital mortality. A multivariable Poisson model with robust standard errors was used to assess the relationship between coagulopathy and mortality after adjustment for the confounding influence of age and gender. The data were analysed using the R statistics program.Results.Of the 1 000 patients, 752 were male. There were 261 admissions directly from the scene and 739 inter-hospital transfers (non scene). The mean INRs among survivors for all, scene and non-scene patients were 1.33, 1.30 and 1.34, respectively, and those among non-survivors 1.92, 2.01 and 1.88, respectively (p<0.001). The overall prevalence of coagulopathy was 48.7%, 46.9% in scene patients and 49.2% in non-scene patients. The mortality rate of scene patients with abnormal INR levels was 41.1% (adjusted relative risk (aRR) 3.59, 95% confidence interval (CI) 2.11 - 6.44; p<0.001) v. 25.1% for non-scene patients (aRR 1.67, 95% CI 1.15 - 2.05; p=0.004) (p=0.001).Conclusions. There was a high prevalence of coagulopathy in our study. Raised admission INRs were associated with worse outcomes. There was a direct correlation between the INR and the ISS. INRs may offer predictive capabilities in resource-depleted environments where the ISS is not routinely calculated. Early recognition of acute coagulopathy may help reduce morbidity and mortality

A 12-week primary prevention programme and its effect on health outcomes (the Sweet Hearts biokinetics pilot study)

Background: The prevalence of non-communicable diseases (NCDs) and physical inactivity are concerning within the South African population. To address these concerns, the ‘Strategic Plan for Prevention and Control of NCDs 2013-2017’ was developed. In response to this plan, a 12-week pilot biokinetics community health programme, Sweet Hearts, was initiated. Methods: This study is a prospective pilot study evaluating the feasibility and effectiveness of the intervention. Twenty- five individuals participated in the intervention. Ten participants performed a battery of physiological tests pre and post intervention and 5 participants completed an email-based survey post intervention. The setting of the study was Tramway Football Club, Southfield, Cape Town, South Africa. The Sweet Hearts intervention was designed to promote physical activity and healthy nutritional habits in those who participated. A total of 27 exercise sessions consisting of cardiovascular, resistance and flexibility training were conducted. Brief-behavioural counselling was integrated into exercise sessions. Results: The intervention group had a high attrition rate with >50% of participants not presenting for post-intervention testing. Results were evident despite a limited sample size. There were significant improvements in health outcome measures among participants who did attend all testing sessions. These improvements included: an increase in Global Physical Activity Questionnaire (GPAQ) score (p = 0.03), 12- minute walk distance (p = 0.01), sit-to-stand test repetitions (p = 0.001), and a decrease in waist circumference (p = 0.01). Improvements were also noted in self-reported eating restraint (p = 0.03). Five main themes were structured into post intervention surveys: 1) enjoyment of the intervention, 2) benefits of the intervention, 3) obstacles affecting adherence, 4) future improvements to the intervention, and 5) state of non-communicable diseases in South Africa. Conclusion: The results of the Sweet Hearts intervention demonstrate the difficulty and importance of maintaining adherence to a community health intervention. The favourable results of the small sample size demonstrate the potential benefit of biokinetics-based programmes in the public health sector; and provide proof of concept for the dedication of resources towards health promotion within a community setting.

B Cells Migrate into Remote Brain Areas and Support Neurogenesis and Functional Recovery after Focal Stroke in Mice

Lymphocytes infiltrate the stroke core and penumbra and often exacerbate cellular injury. B cells, however, are lymphocytes that do not contribute to acute pathology but can support recovery. B cell adoptive transfer to mice reduced infarct volumes 3 and 7 d after transient middle cerebral artery occlusion (tMCAo), independent of changing immune populations in recipient mice. Testing a direct neurotrophic effect, B cells cocultured with mixed cortical cells protected neurons and maintained dendritic arborization after oxygen-glucose deprivation. Whole-brain volumetric serial two-photon tomography (STPT) and a custom-developed image analysis pipeline visualized and quantified poststroke B cell diapedesis throughout the brain, including remote areas supporting functional recovery. Stroke induced significant bilateral B cell diapedesis into remote brain regions regulating motor and cognitive functions and neurogenesis (e.g., dentate gyrus, hypothalamus, olfactory areas, cerebellum) in the whole-brain datasets. To confirm a mechanistic role for B cells in functional recovery, rituximab was given to human CD20+ (hCD20+) transgenic mice to continuously deplete hCD20+-expressing B cells following tMCAo. These mice experienced delayed motor recovery, impaired spatial memory, and increased anxiety through 8 wk poststroke compared to wild type (WT) littermates also receiving rituximab. B cell depletion reduced stroke-induced hippocampal neurogenesis and cell survival. Thus, B cell diapedesis occurred in areas remote to the infarct that mediated motor and cognitive recovery. Understanding the role of B cells in neuronal health and disease-based plasticity is critical for developing effective immune-based therapies for protection against diseases that involve recruitment of peripheral immune cells into the injured brain

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Relationship between selected body composition components and self-efficacy among 12-14-year-old rural adolescents in the Eastern Cape Province of South Africa

Adolescence is a crucial developmental stage of growing and development. This stage is characterised by physiological and psychological changes, such as changes in body composition and self-efficacy. The aim of this study was to investigate the relationship between certain body composition components and self-efficacy among 12- to 14-year-old rural boys (n=49) and girls (n=43). The anthropometrical measurements included body mass, body stature, three skinfold sites, waist and hip circumferences and were used to determine Body Mass Index (BMI), fat percentages and waist-to-hip ratio (WHR). The Self-Efficacy Questionnaire for Children (SEQ-C) was used to measure general self-efficacy. Descriptive statistics and the Pearson product-moment practical correlation for analysis of data was performed. Only girls presented significantly high practical correlations between BMI and emotional self-efficacy (r=0.33, p=0.02), total self-efficacy and WHR (r=0.44, p=0.00), social self-efficacy and WHR (r=0.39, p=0.01), and emotional self-efficacy and WHR (r=0.33, p=0.02). The boys presented significant and positive practical correlations between social self-efficacy and body mass (r=0.31, p=0.02) and body stature (r=0.39, p=0.00). The findings seem to suggest that the practical correlations between body composition and self-efficacy could be specific to certain cultures and specific countries. Keywords: Self-efficacy; Body composition; Rural children; Body Mass Index; Fat percentage; Waist-to-hip ratio