Injury

fitness

Liverpool manager Jurgen Klopp eager for good news as Naby Keita suffers injury

Jurgen Klopp has more injury worries
Jurgen Klopp has more injury worries

Liverpool manager Jurgen Klopp will be hoping for some good news on the fitness of midfielders Thiago Alcantara and Jordan Henderson in the next 24 hours after being struck down by yet more injury problems.

The defending Premier League champions underlined their enduring quality and will to win with a comfortable 3-0 victory over Leicester – setting a new club record of 64 unbeaten league matches at home – despite missing 10 members of his first-team squad.

But just as Klopp got Fabinho back from a three-week lay-off with a hamstring problem to play as an emergency centre-back he lost fellow midfielder Naby Keita to a similar injury.

And midfielder Xherdan Shaqiri did not even make the squad after it was discovered he had returned from international duty with yet another muscle problem.

With Wednesday’s Champions League visit of Atalanta offering the chance to secure qualification to the knockout phase with two matches still to play Klopp will hope either or both of Henderson, who came back from England duty with a thigh problem, and Thiago, having been sidelined by a knee problem since mid-October, can be available as he is still without Alex Oxlade-Chamberlain, who has not played after a knee injury in pre-season.

Without him his midfield options look fairly slim as, with James Milner filling in at right-back for the injured Trent Alexander-Arnold, 19-year-old academy graduate Leighton Clarkson made his first appearance in a match day squad against the Foxes after they learned of Shaqiri’s unavailability.

“Shaq had a muscle injury with the national team which he didn’t really realise,” said Klopp.

“He trained with us, we gave him a day off and then he came back and was involved in the session, but was not fully involved.

“After that he felt a little bit (of a problem). Then we did a scan and they found he has an injury from five or six days ago.

“Nobody knew about that, not even Shaq knew about it, but that’s how things sometimes are and so he was not able to be involved.

Mohamed Salah is likely to return to the squad after a negative Covid-19 test having tested positive on international duty with Egypt but in his absence summer signing Diogo Jota continued his hot streak.

A seventh goal in his last six club appearances saw him become the first Liverpool player to score in his first four home top-flight appearances.

“Yes, he’s a good player – that’s the reason why we signed him,” was Klopp’s assessment.

Leicester manager Brendan Rodgers has injury problems of his own, although not to the extent of his successor at Liverpool.

He had hoped to have left-back Timothy Castagne back for the trip to Anfield but the Belgium international suffered a minor set-back in his recovery from a thigh injury.

“He had a few good

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fitness

Christian Pulisic’s fitness ‘day to day,’ says USMNT coach as Chelsea star battles hamstring injury

Christian Pulisic’s fitness is “day to day,” according to U.S. Men’s National Team coach Gregg Berhalter.

The winger has only made five appearances for Chelsea this season after suffering a fresh injury setback shortly after his return from a long-term layoff.

Pulisic pulled up with a hamstring issue during the warmup before Chelsea’s 3-0 win away to Burnley at the end of October. He had previously been out for around two months after tearing his hamstring in the FA Cup final defeat to Arsenal, in which Pulisic scored the opening goal.

DeCOURCY: Berhalter showing unexpected gift for recruiting

The current international break sees the USMNT play its first fixtures since February, with friendly games against Wales and Panama.

Pulisic joined up with Berhalter’s squad for the games despite his lack of fitness, and the coach has praised his commitment to the cause.

“Christian is in camp and is listed as day to day,” Berhalter told Fox Sports. “It really says a lot about Christian that he wasn’t playing for Chelsea but he wanted to come into this camp and be around the team and his status is day to day.”

Former Chelsea left back Ashley Cole said he expects Pulisic to give manager Frank Lampard “a good dilemma” once he is back to full fitness.

Pulisic starred at the end of last season and, with Hakim Ziyech, Kai Havertz and Timo Werner finding their feet in the Premier League, things are looking up at Stamford Bridge.

Meanwhile, Berhalter was also pleased to welcome Juventus midfielder Weston McKennie back to the squad, though he won’t have Josh Sargent at his disposal for the upcoming games.

Sargent was not permitted to leave for international duty by his club Werder Bremen, citing Germany’s current coronavirus restrictions. That had led to some concern that McKennie, who recovered from Covid-19 after testing positive in October, might also struggle to link up with his international teammates.

“With Weston, we were able to get him out of Italy and the situation is changing by the hour,” Berhalter said. “Josh Sargent wasn’t able to join the team but Weston is able to come.”

The USMNT will be looking to hit form before its 2022 World Cup qualifying campaign begins in the new year.

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fitness

Shanghai’s Zeng faces fitness race after finger injury

HONG KONG (Reuters) – Veteran goalkeeper Zeng Cheng faces a race against time to be ready for Shanghai Shenhua’s opening fixture in the rescheduled 2020 Asian Champions League group phase next month after breaking the little finger on his right hand.

The 33-year-old, who joined Shenhua on loan from Guangzhou Evergrande ahead of the current season, is expected to be sidelined for at least three weeks after damaging his finger, according to a Shenhua club official.

That means Zeng, who won the Asian title with Guangzhou in 2013 and 2015, is a doubt for his club’s opening fixture of the competition in Doha against Australian side Perth Glory on Nov. 18.

Zeng is one of the most successful players in the history of Chinese football, having won the Chinese Super League title with Guangzhou on six occasions between 2012 and 2019. He has also represented China 42 times.

The group phase of the Asian Champions League featuring clubs from the east of the continent was due to be held from February until May but was postponed due to the coronavirus pandemic.

It is now being played in the Qatari capital from Nov. 18 until Dec. 13 with the final, against already-qualified Persepolis of Iran, also in Doha on Dec. 19.

Reporting by Michael Church, Editing by Clare Fallon

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health

Viral Co-Infections With C. Diff Add Insult to Injury

Gastrointestinal viruses often come along with community-acquired Clostridioides difficile infection (CA-CDI), CDC researchers said.

Adult and pediatric patients with CA-CDI showed 12% prevalence of viral GI pathogens, norovirus being the most common, reported Alice Y. Guh, MD, MPH, of the CDC in Atlanta, reporting in PLoS One.

Assessing 155 patients with stool-confirmed CA-CDI at five cross-country U.S. sites from December 2012 to February 2013, the investigators identified 18 CDI patients with such viruses: 10 norovirus, four adenovirus, three rotavirus, and one sapovirus.

Co-infected patients were more likely than non-co-infected to have nausea or vomiting – 56% versus 31% (P=0.04) – suggesting viral co-pathogens contributed to these symptoms in some.

Paralleling earlier research, no significant differences emerged between the two groups in previous healthcare, medication exposures, or CDI outcomes complications.

An earlier U.S. study of viral co-infections in pediatric patients reported a higher prevalence of 24% and an association with a greater CDI bacterial burden. Again, norovirus was the most common viral pathogen detected. Other countries have reported even higher viral co-infection rates, approaching 70% in some cases.

A 2016 study assessing for additional symptoms such as abdominal pain and gas found CDI patients co-infected with norovirus had more severe gastrointestinal symptoms.

The current study was undertaken by the CDC’s Emerging Infections Program (EIP), which conducts population- and laboratory-based CDI surveillance. The five participating EIP sites were in Georgia, Maryland, Minnesota, New York, and Oregon.

Although primarily healthcare-associated, CDI has been increasingly reported in the community among people with no traditional CDI risk factors. In previous studies, more than 35% of CA-CDI patients reported no recent antibiotic use, while more than 50% reported nausea or vomiting, neither of which is traditionally associated with CDI. These findings raised concerns that other pathogens may be involved.

They speculated that some CA-CDI cases testing positive for a viral pathogen may have been truly co-infected, with the viral pathogen causing nausea or vomiting and CDI causing diarrhea. Alternatively, some of the co-infected cases could have been merely colonized with C. difficile and actively infected solely with a viral pathogen; in many cases identified as co-infections, C. difficile could not be cultured.

“As the use of multiplex molecular panels increases, a greater frequency of co-pathogens might be identified among patients with CDI,” Guh and colleagues wrote, calling for a better understanding of the clinical significance of such findings in order to guide patient management and infection prevention.

Thaddeus Stappenbeck, MD, PhD, of the Cleveland Clinic’s Lerner Research Institute in Ohio, commented to MedPage Today that polymicrobial infection of the intestine is a well-established paradigm in clinical medicine. It affects a small but significant percentage of patients infected with one gut viral or bacterial pathogen who show co-infection with a pathogen from the other class, he said.

“The co-infection seems to create worse symptoms in a subset of these patients but not all,” he told MedPage Today.

“This report provides evidence that C. diff infection shows co-infection with common viral infections at a rate similar

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medicine

Knee injury may be treated by regrowing your cartilage

In 2019, however, he slipped and fell while frolicking with his young nephew in a natural waterfall during a Memorial Day outing at Georgia’s Kennesaw Mountain National Battlefield Park. “I didn’t think too much of it at the time,” says Oates, who lives in Raleigh, N.C., where he manages a moving-and-storage company. “My right knee hurt, but I ran through the pain. But my knee would swell, and it was impacting my stride.”

In January, he finally had an MRI, which showed he had torn his meniscus, a common sports injury to the cartilage that cushions the area between the shinbone and thighbone. But there was more. The scan also revealed an area under the kneecap where the cartilage had worn away, which often portends full-blown osteoarthritis — and possible knee replacement — years later. Unlike bone, which has the ability to heal, cartilage cannot restore itself once injured.

Until recently, Oates had few options, one of them to give up running entirely with the hope that his knee would not further deteriorate. He couldn’t live with that. “Running is my Zen time,” he says. “I couldn’t take a ‘you can’t run again.’ ”

Today, however, he says he hopes to benefit from a relatively new and innovative technique that regenerates cartilage from a sample of cells taken from his knee and grown in a lab, where they are embedded on a collagen membrane. The surgeon then implants the membrane back into the knee, where new cartilage tissue forms over time.

“It’s the first procedure that uses a patient’s own knee cartilage cells to try to regrow cartilage that has been lost or damaged,” says Seth Sherman, associate professor of orthopedic surgery at Stanford University Medical Center and chair of the Sports Medicine/Arthroscopy Committee for the American Academy of Orthopaedic Surgeons.

Sherman points out that the approach, approved by the Food and Drug Administration in 2016, has been in use for years in other countries with “robust evidence” to support its efficacy. “That’s why I like to use it,” Sherman says. “It’s a huge deal.”

It’s unclear how many of these cartilage-restoring operations have been performed in the United States since its introduction here, but experts say its use is rapidly growing.

“There are over a thousand of these procedures performed yearly in the United States,” says Joseph Barker, the Raleigh orthopedic surgeon who operated on Oates. “This new technology is certainly increasing in popularity as more surgeons become aware of it and are trained in performing the procedure. The number of cases has been steadily increasing by about 25 percent a year since 2017.”

The procedure is among the latest examples of regenerative medicine, a budding field that relies on the body’s natural properties to promote healing and restore function.

“Regenerative medicine and orthopedic surgery are starting to work together,” says John Ferrell, a D.C.-area sports medicine physician who specializes in regenerative treatments. “Even though its current application is still limited, I see it ushering in a new era

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health

Prehospital Plasma Boosts Survival in Traumatic Brain Injury

Prehospital plasma, administered soon after injury, appears to improve survival for patients with traumatic brain injury (TBI), results of a new analysis suggest.

Administration of prehospital plasma demonstrated a strong survival benefit and was associated with a 45% lower risk for mortality in TBI patients, Danielle S. Gruen, PhD, and colleagues write in their report, published online October 15 in JAMA Network Open.

The finding is from a post hoc secondary analysis of a prespecified subgroup from the Prehospital Air Medical Plasma (PAMPer) randomized clinical trial, published in 2018 in The New England Journal of Medicine.

PAMPer studied the safety and efficacy of prehospital administration of thawed plasma in injured patients at risk for hemorrhagic shock. It included 501 patients; 230 received prehospital plasma, and 271 received standard-care resuscitation that did not include prehospital plasma administration.

Results showed that mortality at 30 days, the trial’s primary endpoint, was significantly lower in the plasma group than in the standard-care group (23.2% vs 33.0%; P = .03).

The current analysis explored the association between prehospital plasma resuscitation and survival in a subgroup of 166 patients with TBI. Of these, 74 patients received prehospital plasma, and 92 received standard care.



Dr Jason Sperry

“If you give prehospital plasma to injured patients, there is a survival benefit, as PAMPer showed, and the current study demonstrates that the signal is strongest in patients who have traumatic brain injury,” senior author Jason L. Sperry, MD, MPH, professor of surgery and critical care, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, told Medscape Medical News.

“We think that giving plasma as soon as possible improves survival via several mechanisms,” he said. “These include volume expansion to restore perfusion, an alteration in the inflammatory response, a reduction in endothelial injury, and the prevention or mitigation of coagulopathy.”

The median age of the patients with TBI was 43 years (range, 25 – 60 years). Brain injury was shown on CT imaging. Most patients with TBI were men (n = 125, 75.3%), and all had blunt trauma injuries. The median Injury Severity Score was 29 (interquartile range [IQR], 22 – 38).

Patients with TBI were more severely injured than those without TBI, and the incidence of prehospital intubation was higher for those patients. In addition, they were more likely to receive in-hospital vasopressors, the length of stay in the intensive care unit was longer, they spent more days on mechanical ventilation, and 24-hour mortality rates (P = .001) and 30-day mortality rates (P = < .001) were higher.

Except for the plasma intervention, there were no significant differences in fluid administration during transport to the hospital. However, in-hospital transfusion requirements differed between the two groups. Patients with TBI who were treated with prehospital plasma received less crystalloid fluid, vasopressors, and packed red blood cells in the first 24 hours.

In addition, for patients with TBI who received prehospital plasma, international normalized ratios were lower (median, 1.20 [IQR, 1.10 – 1.40] vs 1.40 [IQR 1.20 – 1.80]).

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