4.6.3 Sport-Specific Protocols Sport-specific protocols governing medical intervention during competition are listed below. Local rules may vary, however, and the following should be used as a guide only: 1. Alpine Skiing There are no specific regulations. Skiing can be considered relatively high risk and a physician and emergency personnel should be scheduled to cover the races. The local ski patrol should also be on duty. 2. Athletes with a Disability A list of the medical problems of each athlete should be made available to those covering this venue. This information should be collected on the registration forms. 3. Badminton If a participant is injured during play, the Umpire will signal the referee who will request the medical personnel enter the court to assess the injured athlete. 4. Baseball Medical personnel must wait until the umpire interrupts the play in order to attend injuries on the field. Pitchers cannot wear white bandages or tape on their arms, wrists or fingers on the throwing hand ; . Bandages must be skin colour or a long sleeve shirt must cover the bandages. Pitchers also are forbidden to wear batting gloves underneath their catching gloves. 5. Basketball Medical and paramedical personnel cannot go onto the court until play has been stopped by the official's whistle. 6. Boxing Weigh-In In the morning of the competition day, and in conjunction with the official weigh-in, all competitors must undergo a medical inspection. In addition, all referees must also undergo a physical examination prior to the beginning of a bout. These medical inspections are the responsibility of the attending physician. The equipment required includes: opthalmoscope, otoscope, stethoscope, and blood pressure cuff. The athletes generally have a medical book which must be initialed by the medical officer prior to the fight. If they have been knocked out in the preceding 30 60 90 days depending upon the severity ; , they are not allowed to fight Boxing Commission of BC ; . Items to include in the pre-fight history include: History of recent headaches History of any recent visual disturbances Recent nausea History of ever being knocked out Recent illnesses and diovan.
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Shionoiri H, Kosaka T, Kita E, et al. Comparison of long-term therapeutic effect of an ACE inhibitor, temocapril, with that of a diuretic on microalbuminuria in non-diabetic essential hypertension. Hypertens Res. 2000; 23; 593-600. Stein JH, McBride PE. Hyperhomocysteinemia and atherosclerotic vascular disease: pathophysiology, screening, and treatment. Arch Intern Med. 1998; 158: 1301-1306. Thom DH, Grayston JT, Siscovick DS, et al. Association of prior infection with Chlamydia pneumoniae and angiographically demonstrated coronary artery disease. JAMA. 1992; 268: 68-72. Welch GN, Loscalzo J. Homocysteine and atherothrombosis. N Engl J Med. 1998; 338: 1042-1050. Cardio CRPTM Clinical Use: This test is used to determine the relative risk of cardiovascular disease CVD ; and to assess risk of recurrent cardiovascular event in patients with coronary heart disease CHD ; . Clinical Background: C-reactive protein CRP ; is a non-specific acutephase protein produced by the liver in response to tissue injury, infection, and inflammation. Measurement of serum levels, which rise as much as 1, 000-fold after an acute event, has traditionally been used to diagnose and monitor acute inflammatory states. However, mild CRP elevation within the normal, non-acute-phase range ; has recently emerged as a valuable marker of cardiovascular risk.1 Mildly elevated CRP eg, 10 mg L ; has been linked with risk for CVD, including first and recurrent coronary events1 and stroke; 2 vascular events after stroke; 3 myocardial infarction or angina in patients with peripheral vascular disease; 4 poor outcome in acute coronary syndromes1, 5 and congestive heart failure; 6 restenosis after coronary angioplasty; 7 sudden cardiac death; 8 hypertension; 9 dementia; 10 and type 2 diabetes mellitus.11 Prospective studies with highly sensitive assays such as Cardio CRP have consistently shown CRP to be a strong predictor of increased cardiovascular risk in both men and women.1 The predictive value of CRP is independent of other established risk factors, including LDL-cholesterol, and screening with both CRP and LDL may provide a better risk assessment than using either test alone.12 Additionally, evidence suggests patients with high CRP normal LDL are at greater risk than those with normal CRP high LDL.12 Many therapies aimed at reducing cardiovascular risk act through antiinflammatory pathways. Aspirin and statins both yield the greatest preventive effect in patients with the highest CRP levels.1, 13 Statin therapy reduces the risk of first acute coronary events14 and stroke15 associated with elevated CRP, and recent evidence suggests patients who have low CRP levels after statin therapy have better clinical outcomes regardless of the resultant LDL level.16 Statin therapy also appears to reduce the risk of major adverse cardiac events after stent implantation in patients with elevated CRP levels.17 Furthermore, evidence from multiple studies indicate that intensive statin therapy leads to an early reduction in cardiac events, sustained for over 2 years, in patients with acute coronary syndrome.18 Such reduction is likely related to diminished inflammation as evidenced by greater decreases in CRP levels observed after statin therapy than observed after placebo.19 Weight loss20 and regular physical activity, 21 both associated with reduced cardiovascular risk, appear to have anti-inflammatory effects as well reduced CRP, fibrinogen, and white blood cell levels ; . Individuals Suitable for Testing include those without a previous history of CHD, especially those with intermediate CHD risk 10-year risk 10% to 20% according to Framingham global risk scoring system1, 22 ; , and those with stable or acute coronary disease and diazepam.

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