DOCTORS CORNER with Dr JOHN KABUNGOLAST Sunday, I discussed the role sport can play in the prevention of malaria. This time around it is important to look at the problems which athletes with malaria encounter.Malaria is always a worrying condition in sport because of the many effects it has on the performance of an athlete. it is always a matter of concern when a team, and in this case a football team, is preparing for an important game and then it is reported that one of the team’s best players is struck with malaria.The issue becomes even more complicated when the malaria which someone has is not simple but complicated. I will try to explain a few things on the presentation of either simple or complicated malaria.I am very sure that a majority of Zambians have had malaria at some point and it won’t be a big hustle for me to go through how we can actually tell that someone has a bout of malaria. However it will be important to differentiate between simple and complicated malaria.these two forms of malaria will have a great impact on a player in terms of time taken for recovery and when the player will be allowed to get back and fully participate in a competitive match.Malaria affects all age groups with more serious and life-threatening forms occurring in children and pregnant women.In sport, both athletes and officials can be affected. Nowadays there is a lot of movement of players and match officials to different countries and this is the reason why everything must be done to have maximum protection of our athletes from malaria.FIFA has actually classified malaria to be amongst the BIG THREE medical conditions of public health interest. The other two conditions of this group are Tuberculosis (TB) and HIV/AIDS.The world soccer governing body has joined the many organisations in recognising that the three conditions are a threat to mankind and deserve to be given priority in terms of awareness and therefore reduce on the sufferings that come as a result of infections with these conditions.Malaria is the main parasitic infection affecting more than 500 million people and causing more than one million deaths each year world over. about 40 percent of the world’s population is at risk of getting malaria, mostly those living in the poorest countries.In football, due to the wide and rapid travel required by international match schedules, teams from malaria-free areas are exposed to infection.All sports persons travelling to malaria-endemic countries even for a short period may be at risk of becoming infected with malaria.In Zambia, malaria is still one of the leading causes of morbidity (sickness) and mortality (death) in our health institutions.Malaria has been around us for such a long time and so many resources and research have gone into ways of reducing transmission, finding drugs, which the malaria parasite is more susceptible to, and more importantly prompt and effective diagnosis of malaria.The most commonly asked questions regarding malaria are how long does it take for an individual to suffer the symptoms of malaria after being bitten by a mosquito? How can someone suspect that they have malaria?What is it that has to be done when malaria is suspected? What are the main treatment modalities involved? What are the effective preventive measures? How long should someone stay away from participating in sport once they suffer from a bout of malaria?for the transmission of malaria to occur, an infected female anopheles mosquito has to be involved. The bite from an infected female anopheles mosquito is a must! The time taken from the time one is bitten up to the time the symptoms of malaria appear is what is referred to as the incubation period.The minimum period between getting an infective bite and becoming ill with malaria is at least six days. Malaria symptoms can actually occur many months after being bitten by an infected mosquito.The specific parasite that commonly causes malaria and of great importance in our country is plasmodium falciparum. The other types of plasmodia which are found include plasmodium vivax, plasmodium ovale and plasmodium malariae.The main signs and symptoms of malaria are a headache, fever, flue-like symptoms including bouts of feeling cold and shivery, profuse sweating, joint and body pains, loss of appetite and general feeling of weakness (malaise).Malaria is a great pretender and can present in many ways including a bout of diarrhoea, vomiting, muscle pain or just a backache.these symptoms can occur at intervals and they basically form the simple type of malaria. However, other complications can occur, including mild to severe anaemia, because of the massive destruction of red blood cells by the malaria parasite.The anaemia in most cases is accompanied by dizziness, headaches and the heart beating faster than normal.The other complications can involve the kidneys, leading to renal failure, cerebral malaria accompanied by convulsions and mental confusion.In some cases malaria can result in a player or person going into a coma and if not properly treated this can result in death.The blood sugar levels are drastically reduced (Hypoglycaemia) by the malaria parasite and therefore affecting the energy levels of the individual.Sport, especially soccer, requires a lot of energy and malaria will deplete the energy stores and will not just allow the player to take part in training or a game. Malaria affects almost all systems of the body because of the said primary infection of red blood cells, which are vehicles to deliver oxygen to the many body tissues and organs.it is for this reason that a player or athlete suffering from malaria will not be able to participate in sport for some time.their participation in sport will depend on the improvement of their clinical picture after receiving appropriate treatment. there is no specific time frame with which return to normal physical activity is allowed, however careful monitoring and follow up of players with malaria are of great importance, especially if they are to participate at a very high level.at times recovery can take 10-14 days before an athlete returns to competition.Malaria is mainly diagnosed using a thin or thick blood smear on a glass slide and then competent laboratory personnel have to examine the slide.However, this type of examination or sending of a blood slide to the lab is not practical when the team is out where laboratory facilities are not easy to get.Nowadays the use of RDTs (Rapid Diagnostic Tests for malaria) has extremely made life easy. The tests mainly target the products from the malaria parasite in the blood stream.these tests are very easy to do and can be done by any person who has been oriented in skills of obtaining a drop of blood and the results are ready within a few minutes.Prevention of malaria has to be prioritised if sportsmen and women want to enjoy their sport.it must be emphasised that all camping facilities for sportspersons should have surroundings that are clean and not overgrown with grass.Overgrown grass and stagnant water are perfect breeding sites for mosquitoes.All sportspersons should make sure that they sleep under a treated mosquito net whether in camp or at their respective homes.The use of insect repellents either as applied directly to the skin or sprays has to be encouraged though this might prove to be costly in the long run.Sportspersons should be encouraged to wear long-sleeved clothing to cover the exposed areas and thus prevent the mosquito bites, especially at night when the malaria-causing mosquitoes are active.Another preventive measure is the use of drugs, especially when one is moving from a place where the incidence of malaria is lower than where they are visiting.This is known as chemoprophylaxis against malaria and this is done when an individual travels to a malaria zone (e.g. from Europe to Sub-Saharan Africa).The preventive measures have to target breeding sites for mosquitoes or areas where mosquitoes are likely to be found. In all the districts of Zambia, the Indoor Residue Spraying (IRS) is currently being done to help get rid of mosquitoes.The use of Rapid Diagnostic Tests kits by all teams’ must be encouraged because these are portable and easy to use.The recommended drug of choice for malaria as per our Zambian policy is the artemesinin-based combination therapy and the drug of choice is Coartem for treatment of all forms of simple malaria.many countries in our region have put this as the first line of choice for simple malaria for it has proved to be very effective and with no known serious side effects.The use of fansidar is only reserved for pregnant women in Zambia. The switch from the old chloroquin and fansidar has been due to the many malaria strains which do not respond to these drugs.My role now is to warn sportspersons to be wary of the fansidar they buy off the counter in chemists, BEWARE!!!You might take the fansidar with no response to your suspected malaria.The recommended anti-malaria for complicated malaria is QUININE.  The quinine can be given via the intravenous route or can be taken as an oral drug in tablet or capsule form.it is always important that an early diagnosis and treatment of malaria are instituted so that sportspersons can get back to their normal activities in the shortest time possible.Malaria can be such a huge drawback for an athlete and the entire team. Malaria can be prevented, so all sportspersons must make an Insecticide-Treated Net their number one training partner.Malaria will definitely affect an athlete in training or in competition and full recovery has to be allowed before resuming full activity.For questions and contributions write to: Dr Kabungo Joseph e-mail:

(Medical Xpress) — former Olympian Jarrod Shoemaker was in the middle of the swimming portion of a triathlon in Hamburg, Germany, when the swimmer in front of him accidentally kicked him in the face. Shoemaker finished the race, but could tell something was wrong with how his body was working. Three weeks later, he crashed hard from his bike onto wet pavement during a race in London, adding to his list of injuries.

“Upon returning home I knew that something was wrong besides me just feeling lethargic, apathetic and generally off,” says Shoemaker, a resident of Sudbury, Mass. “I wanted to make sure that there were no long-term problems, especially in a sport like triathlon, where perception and balance are key.

“My coach and I did some reading online about sports concussions and returning from them, and one of the names that we saw over and over was Dr. John Leddy. we did some research on Dr. Leddy and found that he was at the University at Buffalo. Coincidentally, we were headed to Buffalo for U.S. Nationals in two days. It was an amazing piece of fate for me.”

John Leddy, MD, internist, medical orthopedist and associate director of UB’s Sports Medicine Institute, met with Shoemaker at the UB institute’s Concussion Management Clinic to perform a series of tests to discover just how much damage had been done.

One such test involved Shoemaker choosing a target in the room, then shutting his eyes and moving his head, and then attempting to hit the target with a laser pointer while his eyes were still closed. This test measures how well a patient is able to tell where his or her head is facing, which is a sensation controlled by the neck.

“Jarrod could not run fast because his neck injury was aggravated by his posture and by the forces incurred during running,” Leddy says. “Upper neck injuries can produce the same symptoms as a concussion, which is a brain injury.”

Some of these symptoms include poor balance, poor sleep, personality change, nausea and headache, all of which are indicative of how the brain is affected by the injury.

“The brain is a unique organ,” adds Leddy. “You only have one, and you need it for almost everything else.”

After meeting with Shoemaker, discussing his symptoms and putting together the timeline of his injuries, Leddy concluded that Shoemaker’s concussion occurred when he was kicked in the face, and probably was made worse by his crash to the pavement. “Until this time, I had not even thought about these two events as being related,” Shoemaker says. “We came to the realization that the concussion and an upper cervical strain were causing me to have both physical and mental problems. I had never had a concussion before, but it was really interesting seeing how a concussion can really affect everything.”

According to Leddy, athletes who suffer repeated concussions, who do not recover properly, then continue to play with symptoms, are at risk for having permanent brain damage complicated by premature cognitive and emotional dysfunction that affects their lives and their families.

“This can lead to premature death,” Leddy explains. “There is no such thing as a minor concussion. all concussions are significant and must be treated appropriately by physicians familiar with concussion assessment and treatment. with such treatment, most athletes will recover, and be able to return to play safely.”

UB’s Concussion Management Clinic opened in 2007 and serves roughly 150 patients a year, including professional and amateur athletes and people injured at work, home or in car accidents.

When concussion is diagnosed, some patients, like Shoemaker, receive a standardized and scientifically validated exercise treadmill test to determine their degree of recovery from the concussion. Those with prolonged symptoms are prescribed an individualized exercise rehabilitation program based upon the results of the treadmill test.

Leddy and colleagues were the first to use the Balke treadmill protocol, a test usually used for cardiac stress testing, to help physicians determine whether an athlete is ready to return to play.

During the test, the incline of the treadmill is increased by a specific rate every minute. The athlete exercises until the point at which his or her concussion symptoms (headache, for example) become more severe.

“We feel that the best method of determining when athletes are physiologically ready to go back and play sports to maximum intensity is the treadmill test, because the exercise test replicates the physiology of what athletes have to do during sport,” Leddy says.

Based on the UB research, team physicians from around the country are beginning to change the way they manage athletes who have suffered a concussion.

“Dr. Leddy said that I could continue to train, but had to be very careful with how much running I did because of the pounding on my neck,” Shoemaker says.

“For me, taking the time out to finally figure out why my body was feeling so ‘off’ helped me make a big change in the last few races of my season,” he adds. “I raced in Buffalo two days after Dr. Leddy and I met, and I was careful while running, but could feel my body protecting my neck and head. I raced again two weeks later and my body was feeling a lot more like normal. I actually ended up winning the race and winning the U.S. Elite Series.”

Provided by University at Buffalo (news : web)

ScienceDaily (Feb. 7, 2011) — An international team of researchers has made new links between 29 regions of the genome and ulcerative colitis — a common form of inflammatory bowel disease (IBD). The new findings increase the total number of genome regions known to be associated with inflammatory bowel disease to 99.

The results point to several biological processes, including the way that our bodies maintain the lining of the intestinal wall, which are likely to play an important role in the development of ulcerative colitis.

The causes of inflammatory bowel disease are not fully understood, although it is thought that patients with inflammatory bowel disease have an overactive immune response against typical gut contents. Together, ulcerative colitis and Crohn’s disease — the two primary causes of inflammatory bowel disease — affect one in 250 people in Europe, North America and Australasia.

Unlike Crohn’s disease, which can impair any part of the human digestive tract, ulcerative colitis is restricted to the large bowel. up to 20 per cent of ulcerative colitis patients will require surgery to remove the entire large bowel.

"The outcomes and quality of life for patients with ulcerative colitis can be bleak," says Dr. John Rioux, from the Montreal Heart Institute and the Université de Montréal, senior author on the paper, and co-chair of the International IBD Genetics Consortium. "to understand the genetic causes of the disease, we carried out the largest study of the disease to date — taking a magnifying glass to over one million sites in the genomes of more than 26,000 people."

"Ultimately, we hope that unmasking the genetic processes that give rise to the disease will minimise the need for surgical outcomes, by opening the door for new therapies that can stop the disease in its tracks."

"With one in 160 Canadians living with either Crohn’s disease or ulcerative colitis, we have among the highest rates of IBD in the world," says Dr. Kevin Glasgow, Chief Executive Officer of the Crohn’s and Colitis Foundation of Canada. "Given the often limited treatment options and quality of life for patients with ulcerative colitis, the Canadian IBD community welcomes this research breakthrough and looks forward to its therapeutic application."

The team carried out a genome-wide scan to look for changes in the genetic code common to patients with ulcerative colitis. they did this by looking at genetic data from more than 32,000 apparently healthy people, and more than 16,000 people suffering from ulcerative colitis.

Using the technique, the team homed in on 29 new regions that are associated with the disease — bringing the total number for ulcerative colitis to 47 and the total for inflammatory bowel disease to 99.

Like signposts, these regions pointed the researchers towards several genes that might play an important role in ulcerative colitis.

"The genomic regions we have identified give us an insight into the biology underlying ulcerative colitis," says Dr. Carl Anderson, from the Wellcome Trust Sanger Institute and first author on the paper. "These important initial discoveries are the building blocks on which we can begin to derive better IBD treatments, though much further work is needed before these become a clinical reality. "

"to give us a better understanding of IBD biology, we compared the results of this ulcerative colitis study to those of a similar study we recently completed looking at Crohn’s disease, and the results were very informative."

The team found significant overlap between the genetic regions associated with each disease, with at least 19 of the total 47 ulcerative colitis regions also associated with Crohn’s disease.

The researchers show that many of the overlapping regions include genes involved in expanding and maintaining a group of T-cells involved in our immune response. The finding supports the idea that the way our immune system responds to the natural bacteria found in the gut could be an important part of the disease profile of inflammatory bowel disease.

The researchers suggest that the candidate genes — including several key members of the ‘IL23 pathway’ — could provide good targets for researchers developing therapeutic interventions against the disease.

As well as finding genes that point towards a shared biology — the researchers also found evidence of genetic events that might be unique to ulcerative colitis.

"for many patients, ulcerative colitis means a lifetime of bloody diarrhoea and stomach pains," says Dr. John Rioux. "The disease can be very severe in some patients resulting in life-threatening inflammation of the large bowel, and there is an increased risk of developing bowel cancer. This is a really unpleasant and intrusive illness that typically affects young adults, and for which we presently have no known cure. "

"we have some good medical therapies, but for many patients these are either not effective or poorly tolerated. we therefore have an urgent unmet therapeutic need and it is my great hope that we can translate our really exciting genetic findings into effective new therapies in the next five to ten years, " said Dr. John Rioux.

The new findings open the door for further research to explore the candidate genes identified and their possible role in the development of the ulcerative colitis and inflammatory bowel disease.

About inflammatory Bowel Disease (IBD)

Inflammatory bowel disease is a term used to describe conditions that are characterised by inflammation of the gastrointestinal tract. The term IBD is used predominantly to describe two diseases: Crohn’s disease and ulcerative colitis. in Crohn’s disease, the inflammation can affect any part of the digestive tract. in ulcerative colitis, the inflammation affects only the colon. Together, ulcerative colitis and Crohn’s disease affect one in 250 people in Europe, North America and Australasia. Inflammatory bowel disease should not be mistaken for irritable bowel syndrome — a separate disease which can present some similar symptoms.

Email or share this story:

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Montreal.

Journal Reference:

1. Anderson C A et al. Meta-analysis identifies 29 additional ulcerative colitis risk loci, increasing the number of confirmed associations to 47. Nature Genetics, February 6, 2011 DOI: 10.1038/ng.764

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Northwestern students beware: prolonged coughing could be a symptom of something more serious than the typical cold.

NU Health Service has been on alert for pertussis, or the whooping cough, since last month, after several cases were reported in the neighboring communities of Wilmette and Winnetka. Although NUHS has identified probable cases of pertussis on campus, there have been no confirmed cases.

Pertussis is a highly communicable bacterial disease characterized by violent coughing, often accompanied by a whooping sound. Early on, its symptoms mimic those of a common cold, so it’s difficult to diagnose, said Dr. John Alexander, acting executive director and medical director for NUHS. Symptoms often go away after 10 to 14 days, but a severe coughing fit that causes vomiting and difficulty breathing returns after that period, Alexander said.

Because of confirmed cases at middle schools in Wilmette and Winnetka, the Cook County Department of Public Health started offering free immunizations to all middle school students around Oct. 27, said Dianne Bader, public health nurse for the village of Wilmette.

“To date, there are 15 reported cases in Wilmette,” Bader said. “It’s still going around. we still have a few cases in some of the schools, but everyone is getting the booster shot for it, either through the free immunizations or through private physicians.”

A vaccine called Tdap is a combined protection against tetanus, diphtheria and pertussis given to most children, with boosters administered every few years.

In Evanston, there are no outbreaks of pertussis so far this year, said Margaret Mathias, communicable disease specialist for the city of Evanston. Mathias said an outbreak requires that two or more people from different households test positive for the disease.

Still, NUHS is taking extra precaution against probable cases because of the proximity of the confirmed cases, Alexander said. Students who exhibit the symptoms for more than two weeks are given antibiotics, he said.

“The difficulty with this disease is that you’re infectious for several weeks before we can make the diagnosis that it is, in fact, pertussis,” Alexander said. “I’ve instructed our doctors to be more aggressive in treating suspected pertussis, even if they don’t quite yet meet the probable case definition that the CDC (Centers for Disease Control and Prevention) provides.”

Divya Chhabra and five of her seven housemates had the symptoms of whooping cough. she said doctors told her the test to confirm pertussis was expensive, and while there was a free option, it was also painful. the test involved putting a tube up the nose and into the throat, she said.

“I decided against getting the test,” the Weinberg senior said. “They told me there’s nothing you can do once you have whooping cough but to just wait until it goes away.”

Alexander said prolonged coughing could also be indicative of something else, such as bronchitis or post-viral symptoms. Still, he said he encourages students with prolonged cold symptoms to come in, especially if their symptoms are not improving or are significantly getting worse.

“We’ve been telling people to get the Tdap booster, too,” he said. “It’s not a bad idea to boost their immunity to pertussis even if we haven’t had a diagnosed case.”