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Use of tenofovir based anti-retroviral therapy (ART) in HIV patients is associated with low bone mineral density (BMD). Low BMD predisposes people living with HIV (PLWHIV) to fractures thereby increasing morbidity and mortality. Since the introduction of tenofovir based ARV regimens in 2011, information on the prevalence of low BMD in PLWHIV and receiving ART is still scarce in Malawi. This study aimed to determine the prevalence and associated factors of low BMD among adults living with HIV and receiving ART in Blantyre, Malawi. This was a cross sectional study involving 282 HIV-positive adults of whom 102 (36%) were males. The participants aged 18-45 years were recruited from three primary and one tertiary health care facilities. Patients with no other comorbidities or conditions associated with low BMD and on ART >12 months were included. Data on BMD (femoral neck and lumbar spine) were collected using Dual-Energy X-ray Absorptiometry (DEXA). The International Physical Activity Questionnaire (IPAQ) was used to assess the physical activity (PA) levels. Participants' body weight (kg) and height (m) were also measured. Descriptive statistics, Chi-Square test and multivariable logistic regression were used to analyse data. Mean age of participants was 37(± 6.4) years, mean duration on ART was 5(± 3.5) years and mean body mass index (BMI) was 23(± 4.5) kg/m2. Twenty percent (55) had reduced BMD. More males (28%) had reduced BMD than females (14%) (p = 0.04). There was a significant association between lumbar BMD and femoral neck BMD (r = 0.66,p<0.001). However, on average, lumbar BMD (g/cm2) was significantly lower than the femoral BMD (p < 0.001). Participants with low PA level (OR 1.23,p = 0.6) had higher odds of having reduced BMD compared to those with high PA level. Prevalence of reduced BMD is high among PLWHIV in Malawi especially male Malawian adults. Occurrence of low BMD is associated with low PA level. There is need for health care providers to routinely monitor BMD and PA levels of this population.

Background The acute and chronic adaptation of endurance athletes’ hearts shows that increased volume of endurance exercise might cause an acute reduction in cardiac function, causing a physiological cascade that leads to the release of cardiac biomarkers specific to cardiomyocyte stress. Heart rate variability (HRV) is a valuable tool used as a physiological measurement to evaluate the autonomic nervous system (ANS). It is frequently used to assess cardiac autonomic regulation, determining a patient’s risk for unfavorable events. This study set out to determine the changes in the ANS by participating in a 3-day mountain bike cycling race in amateur cyclists using HRV as an outcome measure. Methods Sixteen healthy participants (male and female) participating in a 3-day mountain bike cycling race underwent five-minute resting electrocardiography recordings in a supine position 2 days before the race (baseline testing). In addition, HRV measurements were recorded after each race day and 24 h post-race (recovery). Results Time-domain and frequency-domain measures showed significant changes from baseline HRV parameters after each race day (p ≤ 0.05). In addition, our data revealed that the mean heart rate and R–R variability intervals did not return to baseline values after 24 h of recovery. Thus, autonomic nervous system (ANS) alterations may be due to changes in cardiac sympatho-vagal balance. Conclusions The main strength of this study is using HRV as a measuring and screening tool to assess cardiac autonomic activity, whereby the state of the ANS before and after endurance races can be measured. Thus, physicians, athletes, and coaches can determine the stress of endurance races on the ANS and plan recovery strategies. The reasoning is that if the ANS is in a state of sub-optimal function, susceptible amateur athletes might be at risk for a cardiovascular event or maladaptation due to the endurance race.

Background: Progressive joint disorders (PJDs) are a leading cause of chronic pain and disability, requiring multidisciplinary management. Community pharmacists are well positioned to support patients through education, medication management and referrals, yet gaps in referral practices and interprofessional collaboration persist. Aim: To assess South African community pharmacists’ referral practices in managing PJDs and their knowledge of other healthcare providers’ roles, with the goal of identifying opportunities to enhance collaboration and inform the development of referral guidelines. Setting: Private community pharmacies across South Africa. Methods: A cross-sectional survey was conducted using a structured online questionnaire distributed nationally. Data on demographics, familiarity with PJDs, management practices, referral behaviours and barriers to collaboration were analysed using descriptive and inferential statistics. Results: Of 373 participants, 84.5% were familiar with PJDs, most commonly gout, osteoarthritis and rheumatoid arthritis. Over 60% did not use formal guidelines for PJD management. There was no significant association between guideline use and familiarity with other providers’ roles (p = 0.96). Referrals were predominantly to medical doctors with limited engagement with other health professionals. Barriers included a lack of referral protocols and limited knowledge of other providers’ roles. Most pharmacists expressed a willingness to improve care through better collaboration and education. Conclusion: Pharmacists play a pivotal role in PJD management and require better training, awareness and structured referral pathways to enhance multidisciplinary care and optimise patient outcomes. Contribution: This study highlights the need for evidence-based referral guidelines and interprofessional education in pharmacy curricula to strengthen pharmacists’ role in multidisciplinary PJD care.

Tears of the latissimus dorsi and/or teres major tendons are uncommon, with no definitive management. Surgical repair has been reported in high-level athletes, mostly in baseball players. Simultaneous tears of both latissimus dorsi and teres major tendons are rare, with little known of surgical intervention outcomes. We report on the first published case of surgical repair of both latissimus dorsi and teres major tendon tears from a water-skiing injury in a 45-year-old male with favorable outcomes.

Introduction Cirrhosis is the main cause of morbidity and mortality globally, accounting for approximately 1.2 million deaths annually. Impaired aerobic capacity, muscle wasting and reduced muscle strength are significant complications in patients with cirrhosis. Preoperative exercise intervention “prehabilitation” has been recognised as a potential approach to optimise muscle strength, aerobic capacity and body composition as well as quality of life in patients awaiting abdominal surgery. However, there is little evidence on the effects of preoperative exercise on older adults with cirrhosis and awaiting liver transplant. Thus, the primary objective of this systematic review and meta-analysis will be to assess the effects of exercise interventions in improving aerobic capacity, muscle strength and body composition of older adults with cirrhosis and awaiting liver transplant. Methods and analysis This systematic review and metaanalysis protocol was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review will include all peer-reviewed randomised controlled trials (RCTs), including cluster RCTs, controlled (non-controlled), complex clinical trials (CCTs) or cluster trials, cohort, observational studies published in English from inception until July 2024. The following electronic databases will be searched: MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO) and Scopus (Elsevier) and supplemented by a secondary screening of the reference lists of all included articles. Searches will involve studies with both male and female participants aged ≥ 18 years with cirrhosis and awaiting liver transplant. Primary outcomes will include muscle strength, and aerobic capacity. The secondary outcomes include body composition (e.g. body mass index, and thigh circumference). The Cochrane Collaboration Risk of Bias Tool will be used to evaluate quality of the studies and Review Manager (RevMan) V.5.3 (Copenhagen, Denmark: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Effect sizes will be expressed as a standardised mean difference, and their 95% confidence intervals will be calculated and presented as a forest plot. The standard χ 2 and I 2 tests will be used to test heterogeneity. Conclusion This systematic review and meta-analysis is anticipated to provide meaningful and contemporary evidence on the effects of preoperative exercise in older adults living with cirrhosis and awaiting liver transplant. In addition, the findings will help clinicians with developing safe and effective preoperative exercise regimens for these patients.

Background Anti-retroviral therapy (ART) is associated with low bone mineral density (BMD) among people living with HIV (PLWHIV). Although physical activity is recommended for improving bone health in patients with reduced BMD, data on effects of strength exercises on low BMD among PLWHIV is scarce. This study therefore aimed to determine the effects of a 12 weeks maximal strength training (MST) on BMD among PLWHIV in Blantyre, Malawi. Methods Twenty-six PLWHIV with reduced BMD were randomised into a training group (TG, n  = 15) and control group (CG, n  = 11). The TG underwent 12 weeks of MST consisting of 4 sets of 3 to 5 repetitions at 85–90% of one repetition maximum (1RM) 3 times per week. The CG was advised to maintain their usual lifestyle. Measurements of BMD using dual-energy X-ray absorptiometry, 1RM using a squat machine, heart rate using a heart rate monitor, weight, height and body mass index were obtained before and after the intervention in the TG and CG. Descriptive statistics and student’s t - tests were used to analyse data. Results The study was conducted for 12 weeks. Data of 24 participants [14 (TG) and 10 (CG)] were analysed. At base line, there were no significant differences in age ( p  = 0.34), height ( p  = 0.91), weight ( p  = 0.43) and body mass index ( p  = 0.34) between participants in the TG and the CG. After the intervention, there were significant improvements in lumbar BMD ( p  < 0.001) and resting heart rate ( p  = 0.03) in the TG compared to the CG. There were significant improvements in muscle strength (1 RM) in both the TG ( p  < 0.001) and the CG ( p  = 0.01). Conclusions MST improves lumbar BMD and strength in PLWHIV receiving ART in Blantyre, Malawi. MST with a shorter exercise duration of 12 weeks seem to have the potential in treating reduced BMD in PLWHIV. Trial registration PACTR201712002889203 . Registered with the Pan African Clinical Trial Registry on 22nd December, 2017 at www. pactr.org

The IOC recently published its framework on fairness, inclusion and non-discrimination based on gender identity and sex variations. This framework is drafted mainly from a human rights perspective, with less consideration for medical/scientific issues. The framework places the onus for gender eligibility and classification entirely on the International Federations (IFs), even though most will not have the capacity to implement the framework. The position of no presumption of advantage is contrary to the 2015 IOC consensus. Implementation of the 2021 framework will be a major challenge for IFs that have already recognised the inclusion of trans and women athletes with differences of sexual development (DSD) using a scientific/medical solution. The potential consequences for sports that need to prioritise fairness or safety could be one of two extremes (1) exclusion of all transgender or DSD athletes on the grounds of advantage or (2) self-identification that essentially equates to no eligibility rules. Exclusion of all transgender or DSD athletes is contrary to the Olympic charter and unlawful in many countries. While having no gender eligibility rules, sport loses its meaning and near-universal support. Athletes should not be under pressure to undergo medical procedures or treatment to meet eligibility criteria. However, if an athlete is fully informed and consents, then it is their free choice to undergo carefully considered or necessary interventions for gender classification for sport to compete fairly and safely in their chosen gender. Free choice is a fundamental human right, but so is the right to fair and safe competition.

Objective: The aim of this comparative study was to determine the gender differences in cardiac morphology and performance in adolescent black South African footballers. Methods: Anthropometry, electrocardiography and echocardiography data were measured in 167 (85 males and 82 females) adolescent black South African footballers (mean age: 14.8 ± 1.3 years). Vertical jump height was used as a performance measure of explosive lower-limb power. Results: The males had less body fat compared with the females (12.1 ± 3.6 vs 16.8 ± 4.1%, p < 0.05), while females had higher left ventricular end-diastolic diameters compared with males (48.7 ± 3.7 vs 40.7 ± 8.1, p < 0.05). Vertical jump height was higher in males (37.2 ± 10.3) compared with females (31.2 ± 8) and was inversely associated with body fat (β = –0.2, p < 0.05) and positively associated with lean mass (β = 0.5, p < 0.05). Conclusion: The findings showed that adolescent black South African male footballers had a performance advantage over females for explosive lower-limb power, which was explained by differences in body composition and not cardiac morphology.

In an effort to reduce transmission and number of infections of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) virus, governments and official bodies around the world have produced guidelines on the use of face masks and face coverings. While there is a growing body of recommendations for healthcare professionals and the wider population to use facial protection in “enclosed spaces” where minimal distancing from other individuals is not possible, there is a dearth of clear guidelines for individuals undertaking exercise and sporting activity. The present viewpoint aims to propose recommendations for face coverings while exercising during the COVID-19 pandemic that consider physical distancing, the environment, the density of active cases associated with the specific sports activity, and the practical use of face coverings in order to reduce potential viral transmission. Recommendations are provided on the basis of very limited available evidence in conjunction with the extensive collective clinical experience of the authors and acknowledging the need to consider the likelihood of the presence of the SARS-CoV-2 in the general population. We recommend that face coverings should be used in any environment considered to be of a high or moderate transmission risk, where tolerated and after individual risk assessment. In addition, as national caseloads fluctuate, individual sporting bodies should consider up to date guidance on the use of face coverings during sport and exercise, alongside other preventative measures.

Background: Progressive joint disorders (PJDs), including osteoarthritis, rheumatoid arthritis (RA) and are leading causes of disability worldwide. Early multidisciplinary intervention is critical; however, delayed non-pharmacological management, fragmented referral pathways and limited integration of pharmacists, despite their potential role in medication management and early ‘red flag’ identification, remain common. Aim: To identify which PJDs are managed by which healthcare providers, to inform pharmacist referral pathways and promote integrated care. Setting: Non-physician healthcare providers (HCPs) in South Africa, including physiotherapists, occupational therapists, chiropractors, podiatrists, osteopaths, biokineticists and other complementary therapy providers. Methods: A quantitative, cross-sectional survey was administered via REDCap® and distributed by professional bodies through email and professional association platform advertisements. Descriptive statistics and quantitative content analysis assessed condition management, referral practices and collaboration. Results: A total of 266 HCPs participated. Osteoarthritis (91.7%) and RA (84.6%) were the most managed conditions. High interprofessional collaboration was noted with physiotherapists (71.4%) and limited with pharmacists (23.3%). Most providers (76.3%) did not require referral letters. Referrals to and from other providers were common, but incoming referrals varied by profession. Internal consistency was acceptable (Cronbach’s α > 0.70). Conclusion: Progressive joint disorders were predominantly managed by chiropractors, physiotherapists and biokineticists. Referral pathways were inconsistent, and pharmacist integration remained limited. Contribution: This study presents the first national mapping of non-physician roles in PJD management in South Africa, providing critical insights for future development of pharmacist-inclusive referral guidelines.