Contextual Variables Affect Running Performance in Professional Soccer Players: A Brief Report

This study aimed to investigate the effects of contextual variables on running performance in Brazilian professional soccer players. Twenty male players from one club participating in the 1st Division of the Brazilian soccer championship were analyzed during 35 matches. Global Positioning System was used to determine total distance (TD) covered, distance covered and actions in high intensity and sprinting, and the number of accelerations, and decelerations. The independent variables used were match location, match outcome, opposition ranking, change of head coach, and distance traveled to play the matches. Total distance was higher in a way than home matches (9,712 vs. 9,533 m; p ≤ 0.05), and losses than draws and wins (9,846 vs. 9,400 vs. 9,551 m; p ≤ 0.05), whereas distance in sprinting was higher in draws than losses (203 vs. 175 m; p ≤ 0.01). Changing the head coach during the season resulted in overall lower distance covered in high intensity, sprinting, high-intensity actions (p ≤ 0.01), and decelerations (p ≤ 0.05). Higher values for distance covered in sprinting and high intensity were found in matches without travel compared to those with long-travel (p ≤ 0.05). Overall, running performance was affected by the location, match outcome, change of head coach, and distance traveled during the season.

IgG4-Related Esophageal Disease Presenting as Esophagitis with Chronic Strictures

IgG4-related disease is a recently recognized autoimmune systemic disorder that has been described in various organs. The disease is characterized histologically by a dense lymphoplasmacytic infiltrate with IgG4-positive cells, storiform fibrosis, obliterative phlebitis, and can be associated with space-occupying lesions. IgG4-related disease involving the upper gastrointestinal tract is rare. We report the case of a 30-year-old female patient with a long-standing history of severe dysphagia and odynophagia. Symptoms persisted despite anti-acid therapy, and control esophagogastroduodenoscopy revealed endoscopic images consistent with a nontransposable stenosis in the proximal esophagus. An underlying autoimmune process was suspected, and topical immunosuppressants were tried to control her disease. The patient maintained disabling dysphagia secondary to chronic esophageal strictures. A diagnosis of probable IgG4-related disease was made after esophageal biopsies. Treatment attempts with topical corticosteroids was not associated with a significant improvement of the symptoms of dysphagia and odynophagia, possibly because of the chronic nature of the disease associated with a high fibrotic component. This report describes a case of IgG4-related esophageal disease presenting as chronic esophagitis with strictures. We also briefly review the main histopathological features and treatment options in IgG4-related disease.

Endoscopic necrosectomy - when the gastroenterologist faces his greatest nightmare

A 69-year-old woman with severe acute necrotizing pancreatitis underwent a CT-scan, which revealed a peripancreatic collection near the pancreatic body/tail, with heterogeneous content and gas inside, suggestive of an infected walled-off-pancreatic-necrosis (WOPN). The patient was proposed to WOPN transgastric endoscopic drainage. Due to persistence of sepsis, endoscopic necrosectomy was deemed necessary. During the fifth session, the endoscopist noted a large pulsatile vessel at the posterior wall of the collection. Given location and morphologic features, it was assumed that vessel was the splenic artery. The procedure was suspended.

Gastric antral vascular ectasia: when treatment prolongs bleeding

Gastric antral vascular ectasia (GAVE) is a common finding in endoscopic examination of patients with liver cirrhosis. Although GAVE was first described in 1953 by Rider et al. as a cause of massive gastric bleeding, its etiology is not fully understood. We herein discuss the theme of gastric hyperplastic polyps (HPs) after endoscopic band ligation (EBL) for GAVE.

Effectiveness of a Walking Football Program for Middle-Aged and Older Men With Type 2 Diabetes: Protocol for a Randomized Controlled Trial

Background

Studies on walking football have found positive effects on health; however, there are still several research gaps when applying walking football programs for patients with type 2 diabetes.

Objective

This study aims to test the effectiveness of a walking football exercise program on glycemic control and cardiovascular risk factors in middle-aged and older men with type 2 diabetes.

Methods

The study will be run as a randomized controlled trial with a 6-month duration in Portugal. Eligible participants will be randomized using a 1:1 ratio for intervention or control groups and compared using an intention-to-treat analysis. The intervention will consist of a walking football exercise program. The control group will continue with usual care in primary health care units. The primary outcome will be the mean difference in glycated hemoglobin between intervention and control groups after 6 months. Secondary outcomes include the mean differences in fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure, body mass index, waist circumference, fat-free mass, and fat mass. Additionally, secondary outcomes include the incidence of exercise-related injuries and adverse events and the walking football exercise program’s cost-utility.

Results

The study protocol is being prepared to be submitted to the Health Ethics Committee of the Northern Regional Health Administration, Portugal. After approval, participant recruitment will start in primary health care units in Porto's metropolitan area by family medicine doctors.

Conclusions

Walking football might have the potential to be effective in improving glycemic control and cardiovascular risk factors, with a low rate of exercise-related injuries and adverse events and a good cost-utility ratio. Therefore, walking football may be a sustainable intervention strategy for type 2 diabetes management.

International Registered Report Identifier (IRRID)

PRR1-10.2196/28554

Burnout in gastrenterologists: a national-level analysis

INTRODUCTION

The term burn-out or burnout, means 'burn to exhaustion', this term was first used by Herbert Freundenberg. According to Freundenberg, burnout is a 'state of physical and mental exhaustion conditioned by the individual's professional activity'. That is manifested through a set of signs and symptoms associated with physical and emotional breakdown that result from total energy exhaustion and the lack of resources or forces to 'help' others.

OBJECTIVES

Assess the occurrence of burnout in Portuguese gastroenterologists and understand how certain sociodemographic and professional variables might be associated with burnout manifestations.

MATERIAL AND METHODS

Observational descriptive, prospective and multicenter study, with analyzed data related to a sample of 52 national gastroenterologists, during the time between 5 February 2019 and 13 April 2019. An estimate of the burnout levels was carried out by the Copenhagen Burnout Inventory (CBI) questionnaire validated for the Portuguese population - CBI-PT. Possible interconnection between sociodemographic and socio-professional variables were analyzed.

RESULTS

More than half of the gastroenterologists surveyed did not experience burnout in all subscales of the CBI. On a personal level, there were 13 gastroenterologists with moderate burnout and 11 with high burnout. Regarding the work extent, 18 gastroenterologists with moderate burnout and 7 with high burnout were identified. When considering patient level, it was possible to determine 21 gastroenterologists with moderate burnout and 3 with high burnout. There were no cases of severe burnout. Physicians who developed burnout were significantly younger (p < .001), had less service time (p = .007) and less leisure time (p = .024). Doctors in internship had a higher prevalence of burnout, which might be significantly related to a higher level of professional stress (p = .016). The performance of certain examinations (varicose ligation and endoscopic capsule), working during the weekend and the involvement in medico-legal issues had revealed an association with a higher prevalence of burnout.

DISCUSSION AND CONCLUSION

A higher prevalence of burnout was identified in young gastroenterologists, doctors in the internship, those performing high amounts of techniques (upper gastrointestinal endoscopy and colonoscopy), as well as doctors working during the weekend or involvement in legal-medical issues. Therefore, it is possible to conclude that if these young doctors do not acquire tools that will allow them to deal with this problem, it is expected that this pathology will reach critical levels within gastroenterologists, and consequently have a negative impact on healthcare.

Mental health symptoms in electronic football players

Background

The escalated competitive pressure and professionalisation of esports players could predispose them to mental health symptoms. We aimed to develop a model to explore the association between distress and anxiety/depression symptoms and potential associations between adaptive or maladaptive coping strategies, sleeping disturbance, alcohol consumption and eating habits in electronic football players.

Methods

The present exploratory cross-sectional study includes the Distress Screener, General Health Questionnaire, Brief Cope, Sleep Disturbance Domain of the Patient-Reported Outcomes Measurement Information System, Alcohol Use Disorders Identification Test Consumption and a set of questions regarding eating habits. A two-step robust maximum likelihood method of the Structural Equation Modelling approach was used.

Results

Both measurement model (χ²/df=1065.04 (637), p<0.001; Tucker-Lewis Index (TLI)=0.91, Comparative Fit Index (CFI)=0.92, standardised root mean residual (SRMR)=0.07 and root mean square error of approximation (RMSEA)=0.05; 95% CI 0.043 to 0.053) and hypothesised structural model (χ²/df=1131.98 (648); p<0.001; TLI=0.90, CFI=0.91, SRMR=0.07 and RMSEA=0.05; 95% CI 0.054 to 0.06) showed an adequate fit to the data. Stress was positively related with depression and anxiety symptoms. Only anxiety symptoms were linked with coping strategies. Maladaptive coping strategies were related to sleep disturbance, alcohol consumption and poor eating habits, whereas adaptive coping strategies were associated with less sleep disturbance, reduced alcohol consumption and better eating habits.

Conclusion

An integrative approach to help electronic football players when early signs of distress are present might help avoid other mental health symptoms that interfere with players’ well-being and overall health. Additionally, adequate coping strategies to manage anxiety symptoms due to distress may help counteract potential negative consequences for lifestyle habits in electronic football players.

Portuguese Football Federation consensus statement 2020: nutrition and performance in football

Nutrition is an undeniable part of promoting health and performance among football (soccer) players. Nevertheless, nutritional strategies adopted in elite football can vary significantly depending on culture, habit and practical constraints and might not always be supported by scientific evidence. Therefore, a group of 28 Portuguese experts on sports nutrition, sports science and sports medicine sought to discuss current practices in the elite football landscape and review the existing evidence on nutritional strategies to be applied when supporting football players. Starting from understanding football's physical and physiological demands, five different moments were identified: preparing to play, match-day, recovery after matches, between matches and during injury or rehabilitation periods. When applicable, specificities of nutritional support to young athletes and female players were also addressed. The result is a set of practical recommendations that gathered consensus among involved experts, highlighting carbohydrates periodisation, hydration and conscious use of dietary supplements.

Endogenous Endophthalmitis and Liver Abscess: A Metastatic Infection or a Coincidence?

Klebsiella pneumoniae is a gram-negative pathogen that is a common cause of severe infections, including pyogenic liver abscess. Dissemination of K. pneumoniae to other organs, including the eye, is associated with significant morbidity and mortality. In the particular case of endogenous endophthalmitis (EE) by K. pneumoniae the prognosis is poor. We report the case of a middle-aged female with K. pneumoniae liver abscess. The patient developed metastatic endophthalmitis that was aggressively treated with systemic antibiotics. The liver abscess resolved with antimicrobials and percutaneous transhepatic drainage, but regarding the endophthalmitis she was discharged from our hospital without recovery of her eyesight. Metastatic spread to the eye should be considered in all patients with liver abscesses who experience ocular signs and symptoms in order to establish a timely diagnosis of EE.

Spontaneous Bacterial Peritonitis in Cirrhotic Patients: A Shift in the Microbial Pattern? A Retrospective Analysis

<b><i>Introduction:</i></b> Over the last decade, a shift in the spontaneous bacterial peritonitis (SBP) microbial pattern toward an increasing incidence of gram-positive and multidrug-resistant (MDR) bacteria has been reported. Systematic surveillance of the local microbiological scenario and antibiotic resistance is crucial to SBP treatment success. The main objective of this study was to evaluate the microbiological profile and bacterial resistance of SBP pathogens in a Portuguese cohort to allow selection of the most appropriate empirical antibiotics. <b><i>Methods:</i></b> This is a single-center retrospective study including 63 adult cirrhotic patients with culture-positive SBP. Patients were identified using a hospital general diagnostic database and searching for all SBP events (neutrophil count in ascitic fluid ≥250/mm³) from January 1, 2012, to December 31, 2017. Patients were excluded if they had culture-negative SBP, secondary peritonitis, peritoneal dialysis, a liver transplant, or immunodeficiency. The site of SBP acquisition was classified as nosocomial if it was diagnosed 48 h or longer after hospitalization or as nonnosocomial if it was diagnosed within the first 48 h. MDR bacteria were those with an acquired resistance to at least 1 agent in 3 or more antimicrobial categories. All statistical analyses were carried out using IBM SPSS Statistics software version 22 (IBM, New York, USA). <b><i>Results:</i></b> The study cohort comprised 53 (84.1%) men. The mean age of the patients was 60.6 ± 11.2 years. Alcohol was the most common etiology (88.9%) and most patients had advanced liver cirrhosis (87.1%, Child C). Gram-negative bacteria were slightly more frequent than gram-positive bacteria (56.9 vs. 43.1%). <i>Escherichia coli</i> was the most common pathogen (33.8%). Nineteen (31.7%) bacteria were classified as MDR. Resistance to third-generation cephalosporins, quinolones, piperacillin-tazobactam, and carbapenems was found in 31.7, 35, 26.7, and 18.3% of the cases, respectively. The rates of gram-positive bacteria were similar between nosocomial and nonnosocomial episodes (45 vs. 42.2%; <i>p</i> = 0.835). MDR bacteria were more common in the nosocomial group (50 vs. 23.8%; <i>p</i> = 0.046). Resistance to third-generation cephalosporins (50 vs. 23.8%; <i>p</i> = 0.046), piperacillin-tazobactam (44.4 vs. 19.1%; <i>p</i> = 0.041), and carbapenems (33.3 vs. 11.9%; <i>p</i> = 0.049) occurred more frequently in nosocomial episodes. Resistance to first-line antibiotic occurred in 29.3% of the patients, being more common in the nosocomial group (44.4 vs. 22.5%; <i>p</i> = 0.089). <b><i>Conclusion:</i></b> Although gram-negative bacteria remain the most common causative microorganisms, our results emphasize the shift in SBP microbiological etiology, as almost half of the isolated microorganisms were gram positive. The emergence of bacteria resistant to traditionally recommended empirical antibiotics underlines the importance of basing this choice on local flora and antibiotic susceptibility data, allowing a more rational and successful use of antibiotics.

Role of Intestinal Ultrasound in the Evaluation of Postsurgical Recurrence in Crohn’s Disease: Correlation with Endoscopic Findings

<b><i>Introduction:</i></b> Endoscopy remains the exam of choice in the evaluation of activity in Crohn’s disease (CD) after surgery (ACD-AS). However, intestinal ultrasound (IUS) may represent a noninvasive alternative. The objective of this study is to determine the diagnostic accuracy of this modality compared to endoscopy. <b><i>Material and Methods:</i></b> This is a cross-sectional study, comprising a period of 14 months, carried out in patients with established CD and ileocecal resection due to the disease. IUS (HI-VISION Avius®, Tokyo, Japan) was performed with linear probe B-mode/Doppler prior to ileocolonoscopy. IUS and ileocolonoscopy were performed on the same day by 2 specialists in Gastroenterology dedicated to ultrasound and inflammatory bowel disease, in a double-blind mode. Collected demographic and clinical data (Harvey-Bradshaw Index [HBI]; remission ≤4), serological/fecal inflammatory parameters (leukocytes [4–10 × 10⁹ cells/L], C-reactive protein [≤0.5 mg/dL], and fecal calprotectin [&#x3c;50 mg/kg]), endoscopy (Rutgeerts score: remission &#x3c;i2), and ultrasound (intestinal wall thickening [≤3 mm] and digestive wall vascularization using the semiquantitative score of Limberg [absent = 0, sparse = 1, moderate = 2, and marked = 3]). <b><i>Results:</i></b> Thirty-nine patients (female: 64.1%, mean age: 43.5 ± 15.3 years) were included. The median post-surgery follow-up was 9 years (IQR 3–12). The Montreal classification was as follows: L1, 61.5% (<i>n</i> = 24); L3, 38.5% (<i>n</i> = 15); B1 and B2, 28.2% (<i>n</i> = 11); and B3, 43.6% (<i>n</i> = 17). Most patients were in clinical remission (87.2%; <i>n</i> = 34), with a mean HBI of 2.1 ± 2.2. Twenty-two patients (56.4%) had normal inflammatory markers. IUS (intestinal wall thickening &#x3e;3 mm and/or Limberg score &#x3e;1) was abnormal in 61.5% (<i>n</i> = 24) of the cases. Endoscopic remission (Rutgeerts score &#x3c;i2) in 53.8% (<i>n</i> = 21) of the cases. Compared to endoscopy, IUS (area under the receiver operating characteristic curve [AUROC] = 0.75, <i>p</i> = 0.007) showed a diagnostic accuracy superior to that of inflammatory parameters (AUROC = 0.66, <i>p</i> = 0.083) and clinical parameters (AUROC = 0.64, <i>p</i> = 0.139). IUS showed a moderate concordance with endoscopy (κ = 0.5, <i>p</i> = 0.001), which was higher than that with inflammatory parameters (ĸ = 0.33, <i>p</i> = 0.041) or clinical parameters (ĸ = 0.29, <i>p</i> = 0.01). <b><i>Conclusions:</i></b> Ultrasound evaluation of the digestive wall is a noninvasive technique that shows a good diagnostic accuracy and a moderate concordance with endoscopy, being superior to clinical and serological/fecal inflammatory parameters.

Post-match Recovery Practices in Professional Football: Design, Validity, and Reliability of a New Questionnaire

Introduction: Although several approaches have been proposed to mitigate post-match fatigue, few studies have been conducted in team sports to understand the types of recovery methods and the underlying reasons for the choices of medical and technical staff. This study aimed to develop a valid and reliable online questionnaire to assess the recovery practices implemented by football clubs within 72 h post-match.

Methods: Two research members developed the original questionnaire proposal, and two experts in sports science and sports medicine confirmed the content and face validities. Then, 20 football coaches (age: 39.4 ± 6.8 years) with a minimum of 5 years of experience in professional football (9.1 ± 4.9 years) and with an academic background participated in determining the ecological validity and reliability of the questionnaire. The acceptability and relevance of the questionnaire were determined using descriptive statistics.

Results: After confirming the content and face validities, one questionnaire section with two questions was excluded due to lack of relevance, seven open-ended questions were removed due to the adherence of small participants (i.e., 45.4%), and one section was divided into three to facilitate clearness in reading. The remaining sections were considered acceptable and relevant (>94.1%). About 91.8% of nominal and ordinal items derived from the questionnaire questions showed good to very good reliability outcomes (average k classification: 0.73 ± 0.13; min–max: 0.22–1.00, p < 0.05; average wk classification: 0.82 ± 0.15; min–max: 0.22–1.00, p < 0.05).

Conclusions: This study provided a novel, valid, reliable, and easy-to-use tool to examine the post-match recovery practices in professional football contexts.

The Role of Preprocedure Screening of SARS-CoV-2 Infection: A Tertiary Care Medical Center Analysis

PURPOSE

This study aimed to understand the prevalence of asymptomatic COVID-19 infection among patients undergoing endoscopic procedures at a tertiary care hospital. The results allow prediction of the magnitude of cases which this endoscopic service might witness in the next months and planning of future actions accordingly.

METHODS

This retrospective study was conducted in the gastroenterology department of a large urban tertiary care medical center from October 15, 2020, to November 15, 2020. In this institution, all patients proposed for endoscopic procedures under deep sedation must be submitted to reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) detection. These results were thoroughly reviewed.

RESULTS

In the 1-month period, a total of 833 different procedures were done in 833 patients admitted to the endoscopy unit. Of these, 167 (20%) were submitted to nasal swab for SARS-CoV-2. Only 1 (0.6%) was positive for this infection, and her procedure was postponed. This RT-PCR-positive patient was not symptomatic for CO-VID-19 infection at the time of preprocedure screening. She had no positive contacts for COVID-19 and had not traveled outside the country.

CONCLUSION

We found that the proportion of patients proposed for an endoscopic intervention who were asymptomatic carriers of SARS-CoV-2 was low. However, only one fifth of patients were tested and, considering the proportion of 0.6%, it is reasonable to consider that exposure of healthcare workers and other patients can occur. So, all prevention measures must be strictly followed. However, the cost-benefit of an universal testing policy must be proven.

Small bowel enteroscopy - A joint clinical guideline by the Spanish and Portuguese small-bowel study groups

The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small-bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication, and its diagnostic and therapeutic yield. A set of recommendations was issued accordingly.

Predictors for incomplete response to ursodeoxycholic acid in primary biliary cholangitis. Data from a national registry of liver disease

Background

The current standard of treatment in primary biliary cholangitis (PBC) is ursodeoxycholic acid (UDCA), although a considerable proportion of patients show incomplete response resulting in disease progression.

Objective

This study aimed to assess the prevalence of incomplete response to UDCA and determine associated patients' characteristics.

Methods

Patients with PBC as main diagnosis were included from a national multicentric patient registry—Liver.pt. Main endpoints included incomplete response to UDCA treatment according to Barcelona, Paris I and Paris II criteria, Globe and UK PBC scores and the association between baseline characteristics and incomplete response according to Paris II criteria.

Results

A total of 434 PBC patients were identified, with a mean age of 55 years and 89.2% females. Nearly half of patients were asymptomatic at diagnosis and 93.2% had positive anti‐mitochondrial antibodies. Almost all patients (95.6%) had been prescribed at least one drug for PBC treatment. At the last follow‐up visit, 93.3% were under treatment of which 99.8% received UDCA. Incomplete response to UDCA was observed in 30.7%, 35.3%, 53.7% and 36.4% of patients according to Barcelona, Paris I, Paris II criteria and Globe score, respectively. After adjusting for age and sex, and accordingly to Paris II criteria, the risk for incomplete biochemical response was 25% higher for patients with cirrhosis at diagnosis (odds ratio [OR] = 1.25; 95% confidence interval [95%CI]: 1.02–1.54; p = 0.033) and 35% (95%CI:1.06–1.72; p = 0.016) and 5% (OR = 1.05; 95%CI:1.01–1.10; p = 0.013) for those with elevated gamma‐glutamyl transferase (GGT) and alkaline phosphatase (ALP).

Conclusion

A considerable proportion of patients showed incomplete biochemical response to UDCA treatment according to Paris II criteria. Cirrhosis, elevated GGT and ALP at diagnosis were identified as associated risk factors for incomplete response. Early identification of patients at risk of incomplete response could improve treatment care and guide clinical decision to a more careful patient monitorization.

Summarise the established knowledge on this subject

Primary biliary cholangitis is a liver disease that can progress to end‐stage liver disease, with premature death or need for liver transplantation.

Treatment with ursodeoxycholic acid (UDCA) significantly increases liver transplant‐free survival. However, incomplete response to UDCA reduces this beneficial effect.

What are the significant and/or new findings of this study?

By evaluating prevalence and risk factors for UDCA incomplete response through a large multicentric national registry it was found that 53.7% of patients were incomplete responders, according to Paris II criteria, with cirrhosis, elevated gamma‐glutamyl transferase and alkaline phosphatase at diagnosis as the main risk factors.

These findings suggest that patients diagnosed at an advanced stage should be closely monitored and might benefit from novel therapies to improve outcomes if incomplete response is present.

Dietary supplements usage by elite female football players: an exploration of current practices

The present study aimed to investigate the prevalence of dietary supplements usage (types, reasons for usage, sources of information, purchase venues) among elite female football players, using a self-administered questionnaire. The study participants (n = 103) were recruited through team physicians during an official international tournament. Overall, 82% reported using dietary supplements at least once during the last 12 months. The most common dietary supplements were vitamin D (52%), omega-3 fatty acids (49%), and protein (45%). Primary reasons for dietary supplement use were to stay healthy (66%), to accelerate recovery (58%), and to increase energy/reduce fatigue (54%). Supplement advice came mainly from medical doctors (46%), dietitians/nutritionists (43%), and coaches/fitness coaches (41%). Most dietary supplements were acquired from supplement stores (30%), a sponsor (26%), or drugstores/pharmacies (22%). Elite female football players are frequent dietary supplement users. Further research needs to explore the frequency, dose, and timing of these supplements.

Persistent Peristomal Leakage from Percutaneous Endoscopic Gastrostomy Successfully Treated with Argon Plasma Coagulation

Introduction

Percutaneous endoscopic gastrostomy is a safe and effective technique and its use is widely spread. Peristomal leakage may occur within the first few days after gastrostomy tube placement and also in the mature gastrostomy tract. The initial treatment involves conservative measures. If the leakage does not resolve, different endoscopic interventions could be necessary with consequent impairing of enteral nutrition and, in some cases, the need of creating a new gastro-cutaneous fistula.

Case Report

We present 4 consecutive cases complicated with late peristomal leakage and medical treatment failure. These patients underwent upper digestive endoscopy, and circumferential fulguration of the mucosa surrounding the tube with pulsed argon plasma coagulation (APC) at 50 W and 1 L/min flow rate was performed. Additional long through-the-scope clips were applied in 2 cases, since the inner orifice remained enlarged, in order to obtain a better closure. Complete leakage and skin changes resolution occurred between 2 and 6 weeks after the procedure (mean 3.5 weeks). The overall mean follow-up was 19 months after the endoscopic procedure (maximum 30 months, minimum 10 months). There was no recurrence of leakage.

Conclusion

The use of APC alone or combined with long through-the-scope clips in large internal stoma orifice resolved persistent leakage from percutaneous endoscopic gastrostomy in all 4 presented cases without complications. In our case series, this technique appeared to be an effective, safe, and relatively low-cost alternative to the treatment of persistent peristomal leakage of the mature gastrostomy tract.

Are Soccer and Futsal Affected by the Relative Age Effect? The Portuguese Football Association Case

A better understanding of the relative age effect (RAE) in youth will increase the awareness of the need for reducing the bias of (de)selection. Thus, we investigated the RAE in youth female and male soccer and futsal players in Portugal, using nationwide data. Birthdates of 5,306 female and 126,285 male soccer players, and 2,437 female and 23,988 male futsal players (U7–U19), registered in Portugal during the season 2019–2020, and Portuguese National teams (from U15 to AA soccer teams and from U17 to AA futsal teams) were analyzed. Data were categorized into age groups and certification levels [no certification, basic football training center, football school, and training institution] of the respective clubs/academies. Birthdates were stratified from the start of the selection year using quartiles (Q) and semesters (S). Differences between the observed and expected birthdate distributions were analyzed using chi-square statistics, and RAEs were calculated using odds ratios (OR). In both soccer and futsal, female players, in the age category U9, RAEs were found (Q1 vs. Q4, OR: 1.49 and 1.84, respectively). In male soccer, differences in the birthdate distribution were observed in all age categories (U7–U19) with significant OR between all comparisons (Q and S). In contrast, an over-representation of young male futsal players (Q1 vs. Q4) was observed only in the age categories U7 and U9 (OR: 1.54 and 1.34, respectively). The stratification by certification level showed a significant RAE for all certification levels in male soccer players. In contrast, in male futsal players, the RAE was significant only in clubs and academies with the highest level. For National teams, the RAE was more pronounced in male soccer, particularly in the U16 and U17 (OR: 9.84 and 12.36, respectively). Data showed a RAE in female and male youth soccer and futsal, particularly in male, younger age categories, and in clubs and academies having a higher certification level, which could be accompanied by a loss of valuable elite players during the youth phase of their careers. Thus, adjustments in the systems and structure of talent identification are recommended to prevent RAE-related discrimination in youth soccer and futsal.

Lymphogranuloma Venereum-Associated Proctitis Mimicking a Malignant Rectal Neoplasia: Searching for Diagnosis

<b><i>Background:</i></b> <i>Chlamydia trachomatis</i>-lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) and an uncommon cause of proctitis. The diagnosis requires a high index of clinical suspicion, since the clinical, imaging, endoscopic, and histological findings can mimic multiple benign or malignant conditions like inflammatory bowel disease and rectal neoplasms. <b><i>Case Presentation:</i></b> We present the case of a 48-year-old Caucasian male with no significant previous medical history who was admitted due to the suspicion of a rectal neoplasia. He underwent an abdominopelvic computed tomography (CT) scan and pelvic magnetic resonance imaging (MRI) before admission due to complaints of anorectal pain, hematochezia, and constipation over the previous 2 weeks. The examination revealed a circumferential rectal wall thickening, infiltration of the perirectal fat and invasion of the mesorectal fascia, associated with perirectal fat lymphadenopathy. A radiological diagnosis of a rectal malignant neoplasia staged as T4N2MX was stated. Digital rectal examination identified a circumferential rectal tumor. Rectosigmoidoscopy showed an extensive and circumferential ulceration of the rectal mucosa, with elevated geographical borders, exudate, and aphthoid erosions at the proximal limit of the endoscopic mucosal ulceration. Biopsy specimens revealed acute ulcerative proctitis with lymphoplasmocytic inflammatory infiltrate but no evidence of dysplasia or malignancy. A STI screening was positive for HIV-1 (CD4+ 251/mm³; <i>N</i> = 700–1,100) and <i>C. trachomatis</i>, with an elevated IgA-specific antibody titer (52.000; <i>N</i> &#x3c; 5.0), suggesting LGV disease. The diagnosis was confirmed by the identification of <i>C. trachomatis</i> DNA on rectal swab. Other infectious causes of acute proctitis were excluded. When faced with these results, the patient ended up mentioning that he had unprotected anal sex with men. He started treatment with doxycycline 100 mg twice a day for 21 days, with a drastic improvement. Rectosigmoidoscopy was repeated and showed clear signs of progressive resolution of the ulcerative proctitis. <b><i>Discussion:</i></b> LGV-associated proctitis, often undervalued, is a reemerging disease which should always be considered a benign cause of rectal mass, in order to avoid delay in diagnosis and development of complications. Diagnosis becomes more challenging in patients with unknown HIV status. A detailed clinical history, including sexual behaviors, is a vital step to achieve the final diagnosis.

Monitoring Individual Sleep and Nocturnal Heart Rate Variability Indices: The Impact of Training and Match Schedule and Load in High-Level Female Soccer Players

PURPOSE

To describe individual sleep habits and nocturnal heart rate variability (HRV) responses, and to explore intra-individual associations of workload with sleep and nocturnal HRV indices in high-level female soccer players throughout a 2-week competitive period.

MATERIALS AND METHODS

The study followed a descriptive, observational design. Thirty-four high-level female soccer players (aged 20.6 ± 2.3 years) wore wrist actigraph units and heart rate (HR) monitors during night-sleep to record objective sleep and HRV data throughout 14 days [six evening-time training sessions (ET), six rest-days (RD), and two match-days (MD)]. During each ET and MD, exercise HR (HRexe), %HRpeak, training impulse (TRIMP), session rating of perceived exertion (s-RPE) and perceived ratings of wellbeing were monitored.

RESULTS

After ET, a higher number of players (17-22) slept less than 7 h/night, in contrast to the remaining days (i.e., MD and RD), but only 1-6 players had a sleep efficiency < 75%. The coefficient of variation (CV) for sleep duration and sleep efficiency ranged between 9-22% and 2-11%, respectively. A small negative within-subject correlation was found between TRIMP and sleep duration [r = -0.25 (-0.36; -0.12); P < 0.001] and sleep efficiency [r = -0.20 (-0.32; -0.08); P = 0.004]. A moderate and small negative within-subject correlation was found between s-RPE and sleep duration [r = -0.43 (-0.53; -0.32); P < 0.001] and sleep efficiency [r = -0.17 (-0.30; -0.05); P = 0.02]. Nocturnal HRV for the time-domain analyses ranged from 4.1 (3.9; 4.3) to 4.4 (4.1; 4.6) ln[ms], and for the frequency-domain analyses ranged from 6.3 (5.9; 6.7) to 7.5 (7.1; 7.9) ln[ms2]. CV for time-domain HRV ranged from 3 to 23%, and from 4 to 46% for the frequency-domain. Higher CV fluctuations in time- and frequency-domain HRV were particularly observed in four players.

CONCLUSION

Overall, this study highlights the individual variability of sleep and nocturnal HRV indices, indicating that sleep duration may be affected by training and match schedules and workloads. Training and matches workload were not associated with nocturnal HRV in high-level female soccer players.

Physical Activity Levels of Adult Virtual Football Players

Esports, including virtual football, are a worldwide phenomenon. Yet, little is known about the physical activity levels of individuals engaged in virtual football game play. Therefore, we aimed to perform a preliminary evaluation of the levels of physical activity, sedentarism, and habits of physical training of adults engaged with virtual football in Portugal. This was a cross-sectional investigation based on a structured online survey using the International Physical Activity Questionnaire (IPAQ) and a set of questions regarding habits of physical training. The participants (n = 433) reported spending a median of 5,625 MET-min⋅week⁻¹ being physically active. Still, the participants spent 320 min/day sitting, and 150 min/day practicing virtual football. According to the IPAQ scores, high physical activity levels were reported by 84.5% of the participants, and 87.1% were considered physically active considering the WHO guidelines on physical activity and sedentary behavior. Overall, 60.0% of the participants reported planning their own physical training. Maintaining or improving overall physical health was one of the main reasons for doing physical training (66.7%), with only 6.1% responding being active to improve virtual football performance. Overall, the results showed that virtual football players accomplished the standard recommendations for physical activity, with high levels of physical activity, and encompassing regular physical training focused mostly on health promotion, rather than improved virtual football performance.