Ivermectin exposures reported to the Poisons Information Helpline in South Africa during the COVID-19 pandemic.

BACKGROUND: Ivermectin is an antiparasitic drug that has shown in vitro activity against COVID­19. Clinical studies supporting ivermectin for COVID­19 prevention and treatment are conflicting, with important limitations. Public support for ivermectin is significant, with extensive off-label use despite the conflicting views on its efficacy. Ivermectin tablets and injectable formulations are not registered in South Africa for human use by the South African Health Products Regulatory Authority. The National Department of Health does not currently recommend the use of ivermectin for COVID­19. OBJECTIVES: To describe cases of ivermectin exposure reported to the Poisons Information Helpline of the Western Cape (PIHWC) before and after publication of the drug's in vitro activity against SARS-CoV-2. METHODS: In a retrospective review, ivermectin-related calls reported to the PIHWC from 1 June 2015 to 30 June 2020 (period 1) were compared with calls received from 1 July 2020 to 31 July 2021 (period 2), dichotomised according to the first publication indicating ivermectin activity against SARS-CoV-2. RESULTS: Seventy-one cases were screened, and 65 were included for analysis; 19 cases were reported during period 1 and 46 during period 2. During period 2, 25 ivermectin cases (54.3%) were related to COVID­19 use. Of these, 24 cases (52.2%) involved veterinary preparations, 3 (6.5%) human preparations and 19 (41.3%) unknown preparations. Fourteen cases (73.7%) during period 1 and 30 (65.2%) during period 2 were reported to be symptomatic. The most common organ systems involved were the central nervous (n=26 cases; 40.0%), gastrointestinal (n=18; 27.7%), ocular (n=9; 13.8%) and dermatological (n=5; 7.7%) systems. CONCLUSION: Ivermectin-related exposure calls increased during study period 2, probably as a result of ivermectin being used as preventive and definitive therapy for COVID­19 in the absence of robust evidence on efficacy, dosing recommendations or appropriate formulations.

Bleeding and thrombosis outcomes in hospitalised COVID-19 patients on low-molecular-weight heparin and antiplatelet therapy.

BACKGROUND: An increased incidence of thromboembolic events in hospitalised COVID­19 patients has been demonstrated despite the use of low-molecular-weight heparin (LMWH). Antiplatelet therapy prior to admission and early in the disease course has been hypothesised to be protective against thrombosis. OBJECTIVES: To describe the bleeding and thrombosis outcomes in hospitalised patients with confirmed COVID­19 receiving LMWH, with and without concomitant antiplatelet therapy. Secondary objectives were to explore predictors of bleeding and thrombosis outcomes, and dosing practices of antiplatelet therapy and LMWH. METHODS: We conducted a descriptive, cross-sectional study of bleeding and thrombosis outcomes at Tygerberg Academic Hospital, Cape Town, South Africa, during the first COVID­19 wave, in 808 hospitalised patients with confirmed COVID­19 receiving LMWH with and without concomitant antiplatelet therapy. Multivariate logistic regression analysis was performed if predictors were deemed statistically and clinically significant. RESULTS: Patients receiving both LMWH and antiplatelet therapy had similar bleeding outcomes compared with patients only receiving LMWH (odds ratio (OR) 1.5; 95% confidence interval (CI) 0.6 - 4.0). Patients receiving both LMWH and antiplatelet therapy had increased odds of developing thrombosis compared with patients only receiving LMWH (OR 4.8; 95% CI 2.1 - 10.7). CONCLUSION: The bleeding risk in COVID­19 patients receiving both LMWH and antiplatelet therapy was not significantly increased. A potentially higher risk of thrombosis in patients receiving LMWH and antiplatelet therapy was observed. However, this could reflect confounding by indication. Randomised studies are required to further evaluate the use of antiplatelet therapy to treat hospitalised patients with COVID­19.

Bleeding and thrombosis outcomes in hospitalised COVID-19 patients on low-molecular-weight heparin and antiplatelet therapy

Background. An increased incidence of thromboembolic events in hospitalised COVID­19 patients has been demonstrated despite the use of low-molecular-weight heparin (LMWH). Antiplatelet therapy prior to admission and early in the disease course has been hypothesised to be protective against thrombosis.Objectives. To describe the bleeding and thrombosis outcomes in hospitalised patients with confirmed COVID­19 receiving LMWH, with and without concomitant antiplatelet therapy. Secondary objectives were to explore predictors of bleeding and thrombosis outcomes, and dosing practices of antiplatelet therapy and LMWH.Methods. We conducted a descriptive, cross-sectional study of bleeding and thrombosis outcomes at Tygerberg Academic Hospital, Cape Town, South Africa, during the first COVID­19 wave, in 808 hospitalised patients with confirmed COVID­19 receiving LMWH with and without concomitant antiplatelet therapy. Multivariate logistic regression analysis was performed if predictors were deemed statistically and clinically significant.Results. Patients receiving both LMWH and antiplatelet therapy had similar bleeding outcomes compared with patients only receiving LMWH (odds ratio (OR) 1.5; 95% confidence interval (CI) 0.6 - 4.0). Patients receiving both LMWH and antiplatelet therapy had increased odds of developing thrombosis compared with patients only receiving LMWH (OR 4.8; 95% CI 2.1 - 10.7).Conclusion. The bleeding risk in COVID­19 patients receiving both LMWH and antiplatelet therapy was not significantly increased. A potentially higher risk of thrombosis in patients receiving LMWH and antiplatelet therapy was observed. However, this could reflect confounding by indication. Randomised studies are required to further evaluate the use of antiplatelet therapy to treat hospitalised patients with COVID­19.

Boomslang (Dispholidus typus) envenomation in a patient on warfarin therapy.

The venom of the boomslang (Dispholidus typus) has potent effects on the coagulation system. It is known to produce a venom-induced consumptive coagulopathy (VICC) through the proposed activation of clotting factor II (prothrombin), factor X, and possibly factor IX. Warfarin, an anticoagulant medication, decreases the circulating vitamin K-dependent clotting factors II, VII, IX and X. We report a unique case of a boomslang bite in a patient on warfarin therapy. During the patient's hospital stay he developed abnormal clotting profiles indicating an underlying VICC, but without major bleeding. He received monovalent antivenom and recovered with no complications. We discuss two possible outcomes of a boomslang bite in a patient on warfarin therapy, exploring the underlying pathophysiology that could lead to the presentation of a reduced risk of overall bleeding or, alternatively, that the bleeding could be compounded and exacerbated. It is possible that in our case the anticoagulant effect of warfarin was wholly obscured by the VICC of the boomslang venom. The composition of the snake venom may have been a contributory factor in the reduced clinical bleeding observed.

Vasopressor therapy in atypical antipsychotic overdose.

Hypotension is a common presentation following an overdose of quetiapine. Adrenaline is often used as the vasopressor of choice for hypotension not responding to intravenous fluids. We present a case of quetiapine overdose with hypotension unresponsive to high-dose adrenaline. The patient was commenced on noradrenaline and made a full recovery. We highlight learning points about vasopressor therapy for atypical antipsychotic overdose. Quetiapine-induced hypotension is thought to be mediated by α1-receptor antagonism. Adrenaline is unlikely to improve blood pressure, as it is an agonist at both α- and ß-receptors. Alpha-2- and ß2-agonism can reduce sympathetic outflow and cause vasodilation, respectively, further exacerbating the hypotension. Noradrenaline is the preferred vasopressor of choice for hypotension caused by quetiapine overdose, as it has less affinity for α2- and ß2-receptors, but maintains α1-receptor agonism. Drugs with a similar mechanism of inducing hypotension should also be treated with noradrenaline as the vasopressor of choice.

Medical cannabis: What practitioners need to know.

The South African (SA) Constitutional Court recently decriminalised the private cultivation, possession and use of cannabis by adults. Cannabis contains varying amounts of the cannabinoids delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), depending on various cultivation factors. No commercial plant-derived cannabis products are currently registered by the SA Health Products Regulatory Authority (SAHPRA) for medical use. Such products are therefore unregulated, but are freely available in SA, and may be of inadequate quality and unverified composition, and not guaranteed to be safe or effective. SAHPRA has to date approved only one synthetic medical cannabis product, dronabinol. Evidence supporting benefit from medical cannabis exists for two drug-resistant childhood forms of epilepsy, Dravet syndrome and Lennox-Gastaut syndrome. Adjuvant therapy with medical cannabis can reduce seizure frequency for Lennox-Gastaut syndrome and Dravet syndrome by 18.8% and 22.8%, respectively, and may be beneficial for other rare forms of epilepsy. There is moderate evidence for chemotherapy-induced nausea and vomiting with the synthetic cannabinoids. Multiple sclerosis-associated spasticity showed a small clinical improvement in self-reported spasticity when a purified form of THC/CBD was added to existing therapy. Currently, low-level or no convincing evidence exists for the use of medical cannabis for chronic pain, sleep and weight disorders, and neuropsychiatric disorders. Cannabis is associated with a greater risk of adverse effects than active and placebo controls, and may be involved in clinically significant drug-drug interactions. The evolving regulatory and legal landscape on the use of medical cannabis will guide prescription and recreational use in the coming years.

Rendimiento de la escala CardShock en pacientes con shock cardiogénico profundo tratados con membrana de oxigenación extracorpórea venoarterial / Predictive ability of the CardShock score in patients with profound cardiogenic shock undergoing venoarterial extracorporeal membrane oxygenation support

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Current evidence for directed and supportive investigational therapies against COVID-19.

Coronavirus disease 2019 (COVID-19) is a global health crisis. There is currently a great need for effective and safe therapies directed at the disease, but no drugs are presently registered for use in COVID-19. Several directed therapies have been proposed, and most are still in clinical trials. Currently available published, peer-reviewed results mostly involve small sample sizes with study limitations restricting the interpretation of the findings. Many trials currently published also do not have a control group, limiting the interpretation of the effect of the intervention. Investigational directed therapies as well as investigational supportive therapies against COVID-19 are reviewed here. Chloroquine and hydroxychloroquine show promise as directed therapies, but current trial results are conflicting. Lopinavir/ritonavir also shows potential, but was started late in the disease course in most trials. No randomised controlled evidence is currently available for remdesivir and favipiravir. Corticosteroid use is not recommended for directed therapy against COVID-19, and the role of tocilizumab is currently unclear, based on limited evidence. Early initiation of investigational directed therapies may provide benefit in selected patients. The results from larger randomised controlled trials will clarify the place of these therapies in COVID-19 treatment.

Influencia del cambio de reglamento sobre los goles realizados en fútbol sala / Influence of change of regulation on the goals achieved in futsal

Este artículo analiza la hipótesis de que los cambios introducidos en la normativa del fútbol sala modifican su lógica interna disminuyendo los goles totales y modificando su forma de ejecución. El objetivo de estudio es analizar los goles y manera de realizarlos en una temporada anterior y posterior al cambio de reglamentación para establecer cuantitativamente cómo el cambio de reglas del 2.006 afecta al juego. Se analizaron 3.126 goles en 442 partidos, 1.771 goles en 232 partidos en la temporada 2.002-2.003 y 1.355 goles en 210 partidos en la temporada 2.013-2.014. El método utilizado fue la metodología observacional, se utilizó el programa Lince vl.2.1. Los resultados muestran una reducción estadísticamente significativa en el número de goles de una temporada a otra. En la temporada 2.002-2.003 se lograron 1.927 goles con un promedio por equipo de 120,38 ± 28,58, y en la temporada 2.013-2.014 1.355 goles con un promedio de 90,40 ± 27,72

This article analyses the hypothesis that the changes introduced in the regulation of futsal modify the inner logic of the game, what turns into a reduction of total goals and a significant variation in the form of execution. Therefore, it is set out as aim of study to analyze the goals and the way to achieve them in a previous season and in one subsequent to the change of regulation in order to establish quantitatively how the 2006 rules change has affected the game. Totally, 3126 goals were analyzed, scored in 442 matches, distributed in 1771 goals in 232 matches in season 2002-2003 and 1355 goals in 210 matches in season 2103-2014. The method used in this study was observational methodology. For the observational process, it has been used the observational software Lince vl.2.1. It has been carried out using the IBM SPSS 19.0.0 program. The results show a statistically significant reduction in the number of goals from one season to another. In season 2002-2003, 1927 goals were achieved with an average by team of 120.38±28.58, by 1355 goals in season 2013-2014 of 90.40±27.72

Análisis observacional de los goles de dos temporadas de la LNFS / Observational analysis of the goals the two seasons of the Spanish Professional Futsal League

Este estudio analiza las acciones ofensivas que terminan en gol a lo largo de las temporadas 2.012-2.013 y 2.013-2.014 en la liga de fútbol sala profesional español determinando las relaciones entre las variables anteriores que están involucrados en estas acciones. Los goles totales analizados han sido 2.449. El método utilizado fue una metodología observacional a través del programa Lince vl.2. Para el análisis estadístico se utilizó el programa IBM SPSS 19.0.0 para determinar la asociación o independencia entre las variables zona de tiro-superficie de contacto-tipo de tiro y tipo de acción-número de pases-jugadores involucrados. Los resultados muestran que la mayoría de los goles en fútbol sala se producen en jugadas rápidas de 1-2 pases con 1-2 jugadores participantes y que con defensas organizadas se requiere un mayor número de pases y la participación de 3 jugadores para encontrar líneas de pase antes de disparar con opciones de hacer gol (AU)

This article analyse the offensive actions ending goal along the seasons 2.012-2.013 and 2.013-2.014 of the Spanish professional futsal league and determine the relationships between the previous variables which are involved in these actions and influence goal. The total goals analyzed have been 2.449. The method used in this study was observational methodology. For the observational process, it has been used the observational software Lince vl.2.1. It has been carried out using the IBM SPSS 19.0.0 program to determine the association or independence between variables zone from which the shot is taken-contact surface-type of shot and type of play-number of passes-players involved. The results show with organized defenses, a bigger number of passes and the participation of 3 players touching the ball to find passing lanes before shooting with goal options are required and most of the goals in actual futsal occur in fast moves of 1-2 passes with 1 or 2 players involved in it (AU)

Modificación del volumen-intensidad como medida preventiva de lesiones en fútbol sala / Modification of volume-intensity as preventive measure in futsal injuries

A lo largo de los años se han desarrollado distintas metodologías para controlar las cargas de entrenamiento y optimizar el rendimiento. La prevención de lesiones se ha convertido en uno de los grandes objetivos del cuerpo técnico. Algunos estudios plantean que variables como el volumen de trabajo, la intensidad y la frecuencia en su realización pueden ser la clave para lograrlo. El propósito de este trabajo es analizar en qué magnitud han influido las diferentes medidas preventivas adoptadas referidas a estas variables en el plan de entrenamiento de un equipo profesional de fútbol sala y comprobar si existen diferencias con respecto a otra temporada del mismo equipo y de las mismas características. La muestra estuvo compuesta por 12 jugadores. Los resultados muestran una disminución del volumen mensual y total, del número de microciclos de mayor intensidad y del número de sesiones semanales entre la primera y la segunda temporada. Las medidas adoptadas han sido efectivas para disminuir la incidencia lesional (AU)

Over the years different methodologies have been developed to control the training loads and optimize performance. Injury prevention has become one of the major objectives of the coaching staff. Some studies suggest that variables such as workload, intensity and frequency may be important to achieving this. The purpose of this paper is to analyze the influence of the different preventive measures related to these variables in the training plan of a professional football team and see if there are differences with respect to another season of the same team and the same characteristics. The sample consisted of 12 players. The results show a decrease in the monthly volume and total volume, a decrease in the number of microcycles with greater intensity and a decrease in the number of weekly sessions in the second season. The measures have been effective in reducing the incidence of injury (AU)

Relación entre motivación, compromiso y autoconcepto en adolescentes: estudio con futbolistas / Relacao entre motivacao, compromisso e autoconceitoem futebolistas adolescentes de categorias desportivas diferentes / Relationship between motivation, commitment and selfconcept in adolescent soccer players of different sport categories

El objetivo de este trabajo fue analizar las relaciones entre motivación, compromiso deportivo y autoconcepto físico en futbolistas adolescentes de la provincia de Zaragoza en categorías Cadete (14-16 años) y Juvenil (16-18 años) así como atender a posibles diferencias entre las divisiones que las componen, más o menos competitivas. Para ello, se utilizó una muestra de 512 sujetos pertenecientes a 37 equipos de 12 clubes de la ciudad (M=16,00; DT: 1,465) a quienes se suministró la Sport Motivation Scale (Pelletier et al.,1995) validada y traducida al español por Núñez, Martín-Albo, Navarro y González (2006), Sport Commitment Questionnaire (SCQ), desarrollado por Scanlan, Simons, Carpenter, Schmidt y Keeler (1993), en una versión traducida y validada al castellano por Sousa, Torregrosa, Viladrich, Villamarín y Cruz (2007) y Physical Self-Questionnaire (C-PSQ) de Fox y Corbin (1999) utilizando una versión traducida al castellano de Moreno, Cervelló, Vera y Ruiz (2007) orientada hacia jóvenes. Los resultados mostraron diferencias significativas entre los diferentes niveles de competición así como dos perfiles conductuales; el primero caracterizado por comportamientos más autodeterminados (motivaciones intrínsecas, compromiso adquirido, diversión deportiva, oportunidades de implicación, competencia percibida, autoconfianza…) y otro, de conductas menos adaptativas (motivaciones extrínsecas, amotivación, coacciones sociales, atractivo físico…) (AU)

O objetivo deste trabalho foi analisar as relações entre motivação, compromisso desportivo e autoconceito físico em futebolistas adolescentes da província de Zaragoza nas categorias de 'Cadetes' (14 - 16 anos) (Equivalente a Iniciados e Juvenis) e 'Juveniles' (16 - 18 anos) (Equivalente a Juvenis e Juniores) assim como atender possíveis diferenças entre as divisões que as compõem, mais ou menos competitivas. Para isso, utilizou-se uma amostra de 512 sujeitos pertencentes a 37 equipas de 12 clubes da cidade (M=16,00; DT: 1,465) aos que se forneceu a Sport Motivation Scale (Pelletier et al., 1995) validada e traduzida ao espanhol por Núñez, Martín-Albo, Navarro y González (2006), Sport Commitment Questionnaire (SCQ), desenvolvido por Scanlan, Simons, Carpenter, Schmidt y Keeler (1993), numa versão traduzida ao castelhano de Moreno, Cervelló, Vera y Ruiz (2007) orientada aos jovens. Os resultados mostraram diferenças significativas entre os diferentes níveis de competição assim como dois perfis de conduta; o primeiro é caracterizado por comportamentos mais autodeterminados (motivações intrínsecas, compromisso adquirido, diversão desportiva, oportunidades de implicação, competência apercebida, autoconfiança…) e outro, de condutas menos adaptativas (motivações extrínsecas, amotivação, coações sociais, atrativo físico…) (AU)

The aim of this research was toanalyse the relationships between motivation, sport commitment and physical self-concept among adolescent footballers in the province of Zaragoza in the categories of Juniors I (14-16 years) and Juniors II (16-18 years) as well as exploring possible differences between the more or less competitive divisions. In order to carry this out, a sample of 512 subjects belonging to 37 teams of 12 clubs around the city were involved(M=16,00; SD: 1,465) and who were provided with the Sport Motivation Scale (Pelletier et al., 1995) translated into Spanish by Núñez, Martín-Albo, Navarro y González (2006), the Sport Commitment Questionnaire (SCQ), elaborated by Scanlan, Simons, Carpenter, Schmidt y Keeler (1993), in a version translated into Spanish bySousa, Torregrosa, Viladrich, Villamarín y Cruz (2007), and Fox and Corbin’s (1999) Physical Self-Questionnaire (C-PSQ), using the version of Moreno, Cervelló, Vera y Ruiz (2007) aimed at young people and translated into Spanish. The results showed significant differences among the distinct levels of competitiveness as well as two behavioural profiles: the first one characterised by more selfdetermined behaviour (intrinsic motivation, sport commitment, sport enjoyment, involvement opportunities, competence, self-confidence…) and the second one distinguished by less adaptive behaviour (extrinsic motivation, amotivation, social constraints, attractive body…) (AU)

Curva de aprendizaje y pronóstico en pacientes con shock cardiogénico refractario tratados con soporte ventricular tipo ECMO / Learning curve and prognosis in patients with refractory cardiogenic shock receiving ECMO ventricular support

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Human neuroblastoma cultures for biorobotics.

This paper introduces a new biorobotic system using human neuroblastoma cultures and centre of area learning for basic robotic guidance. Multielectrode Arrays Setups have been designed for direct culturing neural cells over silicon or glass substrates, providing the capability to stimulate and record simultaneously populations of neural cells. The main objective of this work will be to control a robot using this biological neuroprocessor and a new simple centre of area learning scheme. The final system could be applied for testing how chemicals affect the behaviour of the robot or to establish the basis for new hybrid optogenetic neuroprostheses based on stimulating optically genetic-modified neurons.