Efficacy of Coronavirus Disease (COVID-19) Safety Protocol at the 2021 Wrestling European Olympic Games Qualifier Organized in Budapest = A koronavírus-járvány (COVID-19) biztonsági protokolljának hatékonysága a 2021-es olimpiai játékok európai kvalifikációs birkózóversenyén, Budapesten

Bevezetés és cél: A COVID-19 világjárvány számos nehézséget okoz a többnapos nemzetközi sportesemények szervezésében. Ennek oka - részben - a sportolók közötti szoros fizikai kapcsolat, amely köztudottan elősegíti a vírus terjedését, még az egyéni sportágakban, például a birkózásban is. Ezért a birkózóselejtezőn rendkívül fontos volt a betegség szűrésének bevezetése, és a fertőzött résztvevők kizárása (majd elkülönítése). Az orvosi csapat és a COVID-marsallok együtt dolgoztak egy szűrési protokoll kidolgozásán, és céljuk volt, hogy a verseny során teszteljék annak hatékonyságát. Anyag és módszerek: A versenyen 37 ország 281 versenyzője vett részt. A Magyarországra való belépés kritériuma a polimeráz láncreakció (PCR) negatív tesztje, járványügyi és tüneti negativitás volt 72 órán belül. Antigén gyorsteszteket (ART) és szükség esetén újratesztelést is végeztünk. Kiutazáskor negatív PCR-teszt, vagy a karanténidőszak lejárta után kiállított igazolás volt szükséges. Eredmények: Összesen 1287 PCR-tesztet és 1250 gyorstesztet végeztünk. Érkezéskor 21 PCR-pozitív (1,4%) személy volt, akiket karanténba helyeztek. Az induláskor 6 PCR-teszt volt pozitív (0,47%). Az akkreditációkor elvégzett ART tesztek közül egy volt pozitív. Következtetés: Az egészségügyi személyzet sikeres protokollt dolgozott ki a COVID-19 szűrésére és a résztvevők izolálására, amit az induláskor tapasztalt nagyon alacsony pozitivitás is jelez. Így ez a protokoll alkalmazható többnapos nemzetközi sportesemények szervezésénél. Introduction and Aim: The pandemic Covid-19 imposes several difficulties to organize multi-day international sports events. This is - in part - due to the close physical contact among the athletes, known to promote the spread of virus, even in individual sports, such as wrestling. Thus, at the Wrestling Qualifier it was of utmost importance to introduce screening for the disease and exclude infected participants (and then isolate them). The medical team and the COVID Marshals worked together on developing a screening protocol and aimed to test the efficacy during this competition. Material and Methods: The event was attended by 281 competitors from 37 countries. The criteria to enter Hungary were a negative polymerase chain reaction (PCR) test, epidemiological and symptomatic negativity within 72 hours. We also performed Antigen rapid tests (ART, chromatographic immunoassay) and retesting if necessary. Upon departure a negative PCR test or a certificate issued after the end of the quarantine period was required. Results: In total, 1,287 PCR tests and 1,250 rapid tests were performed. At arrival, there were 21 PCR positive (1.4%) individuals, and they were quarantined. At the departure 6 PCR tests were positive (0.47%). One of the ARTs performed at the accreditation was positive. Conclusion: The medical staff has developed a successful protocol to screen for Covid-19 and isolate participants as indicated by the very low positivity for Covid-19 at departure. Thus such protocol can be used for organizing multi-day international sports events

Monitoring of skeletal muscle ischemia using near infrared spectroscopy

Early diagnosis of acute limb muscle ischemia (LMI) is essential in order to avoid serious, irreversible local and systemic complications resulting in loss of the limb or even death. To date, techniques for monitoring LMI are limited by lack of a feasible and reliable monitoring method. Purpose: The main purposes of this thesis were to examine the feasibility and convergent validity of conventional and wireless near infrared spectroscopy (NIRS) for continuous monitoring of skeletal muscle oxygenation and hemodynamics during transient and long-term LMI and to investigate the predictive value of NIRS-derived data for evaluation of limb muscle oxidative changes during tourniquet-induced LMI. Methods: Following a complete literature review (Chapter 2), forearm muscle oxygenation and hemodynamics were studied in 10 healthy subjects using wireless NIRS instrumentation during isometric muscle contraction and tourniquet-induced LMI (Chapter 3). In Chapter 4, changes in NIRS-derived leg muscle oxygenation and hemodynamics, in conjunction with muscle oxidative changes, following tourniquet-induced LMI were investigated in 17 patients undergoing surgery for ankle fracture. In Chapter 5, the effect of electromagnetic interference (EMI) from 3 commonly used surgical instruments on NIRS signals were investigated using a mathematical method of signal analysis. Results: Chapter 2: No validated monitoring method for early detection of acute LMI was revealed. Chapters 3-4: Wireless and conventional NIRS data were consistent with muscle ischemia and reperfusion. Chapter 4: An average of 43.2±14.6 minutes of tourniquet-induced ischemia led to a 172.3±145.7% (range: 10.7-363.3%) increase in muscle protein oxidation (P<0.0005). Changes in NIRS-derived muscle oxygenated and total-hemoglobin were both negatively correlated, while reoxygenation-rate was positively correlated (P<0.05) to muscle protein oxidation. Chapter 5: EMI from 3 OR instruments was found to have no effect on NIRS signals (P<0.01). Conclusions: NIRS is a feasible method for continuous monitoring of limb muscle oxygenation and hemodynamics during transient and long-term tourniquet-induced ischemia. Tourniquet-induced LMI of 21-74 minutes leads to oxidative muscle damage. A significant negative association between the extent of tourniquet-induced oxidative damage and changes in NIRS-derived local muscle oxygenated blood volume was found. EMI of commonly used orthopedic surgical instruments does not affect NIRS signals.Medicine, Faculty ofMedicine, Department ofExperimental Medicine, Division ofGraduat

Near-Infrared Spectroscopic Screening for Bladder Disease in Africa: Training Rural Clinic Staff to Collect Data of Diagnostic Quality

Background. While near-infrared spectroscopy (NIRS) has recognized relevance for developing countries, biomedical applications are rare. This reflects the cost and complexity of NIRS and the convention of comprehensive training for accurate data collection. In an international initiative using transcutaneous NIRS to screen for bladder disease in Africa, we evaluated if interactive training enabled clinic staff to collect data accurately. Methods. Workshop training in a Ugandan medical clinic on NIRS monitoring theory; bladder physiology and chromophore changes occurring with disease; device orientation; device positioning over the bladder, monitoring subjects during voiding; and saving/uploading data. Participation in patient screening followed with observation, assistance, and then data collection. Evaluation comprised conduct of serial independent screenings with analysis if saved files were of diagnostic quality. Results. 10 individuals attended 1-hour workshops and then 0.5–3.0 hours of screening. Five then felt able to conduct screening independently and all collected data were of diagnostic quality (>5 consecutive patients); all had participated in screening for >1.5 hours (6+ subjects); less participation allowed competent assistance but not consistent adherence to the monitoring protocol. Conclusion. A simplified NIRS system, small-group theory/orientation workshops, and >I.5 hours of 1 : 1 training during screening enabled clinic staff in Africa to collect accurate NIRS data

Optical Monitoring of Breathing Patterns and Tissue Oxygenation: A Potential Application in COVID-19 Screening and Monitoring

The worldwide outbreak of the novel Coronavirus (COVID-19) has highlighted the need for a screening and monitoring system for infectious respiratory diseases in the acute and chronic phase. The purpose of this study was to examine the feasibility of using a wearable near-infrared spectroscopy (NIRS) sensor to collect respiratory signals and distinguish between normal and simulated pathological breathing. Twenty-one healthy adults participated in an experiment that examined five separate breathing conditions. Respiratory signals were collected with a continuous-wave NIRS sensor (PortaLite, Artinis Medical Systems) affixed over the sternal manubrium. Following a three-minute baseline, participants began five minutes of imposed difficult breathing using a respiratory trainer. After a five minute recovery period, participants began five minutes of imposed rapid and shallow breathing. The study concluded with five additional minutes of regular breathing. NIRS signals were analyzed using a machine learning model to distinguish between normal and simulated pathological breathing. Three features: breathing interval, breathing depth, and O2Hb signal amplitude were extracted from the NIRS data and, when used together, resulted in a weighted average accuracy of 0.87. This study demonstrated that a wearable NIRS sensor can monitor respiratory patterns continuously and non-invasively and we identified three respiratory features that can distinguish between normal and simulated pathological breathing