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Clinical Director, Marian University College of Osteopathic Medicine

Repeated sprint test the ability to run fast and to perform repeated sprints can be easily tested by having the player sprint a given distance a number of times, separated by a period of recovery that leads to a decrease in performance. In relation to the latter aspect, it has been observed that performance in a 30-metre sprint could be maintained when subjects have a recovery period of 120 seconds between each sprint, but a marked decrease was found when the recovery time was 30 seconds or less. In a test measuring the ability to sprint and at the same time change direction, athletes perform seven sprints, each lasting about seven seconds, separated by 25-second rest Figure 2. Thus, it is suggested to perform 5 x 30 metres separated by a 30-second recovery period where players are walking back to the starting line. If the time is measured with a stopwatch, the test leader counts down "3-2-1-go", at which point the player starts the sprint. Cooper test One of the most widely used field tests is the Cooper test, where the player runs as far as possible within 12 minutes. It is simple to perform, but the type of exercise is very different from the typical activities in football. The main disadvantages are that it requires players to know how to perform the test tactically (pacing strategy) in order to obtain the best test result, and that a track of at least 200m is needed. Two markers are positioned at a distance of 20 metres and a third marker is placed 2. The speed is regularly increased, and the test is over when the player is no longer able to maintain the speed. Both tests can be used by anyone irrespective of their training status, since each of the tests has two levels. The Yo-Yo intermittent tests provide information on a high number of players within a relatively short time (30 players in 15 minutes), and both have higher validity regarding performance during competition than laboratory tests. The Yo-Yo tests have been shown to have a high reproducibility, sensitivity and validity for football. It should be emphasised that this type of comparison is complicated by the fact that in football, it is difficult to obtain a precise measure of physical performance. Thus, the test appears to be useful in evaluating the match-related physical capacity of a football player. Nevertheless, the results underline the accuracy of the tests to evaluate these aspects. During pre-season, this ability is commonly observed to improve by 25-40%, whilst during the season, the level is usually lower. However, it is not possible to generalise since major individual variations are found. Whereas all showed an improvement in pre-season, there were major differences in the response during the season: four players improved their test performance, but nine players showed a decrease in performance ranging from 40 to 440 metres. Non-exhaustive testing It is also possible to perform the Yo-Yo intermittent tests without exhausting the players. In this case, the test is stopped after a given time and the heart rate is measured to evaluate the development of the cardiovascular system. Such non-exhaustive tests can be used frequently and are especially useful for players in rehabilitation. To examine intermittent endurance, the Yo-Yo intermittent endurance test is recommended, and to evaluate the recovery capacity of a player, the Yo-Yo intermittent recovery test should be used. In addition, their reliability and validity are well known and strong correlations were found for instance between Yo-Yo test performance and the amount of high-intensity running during a football match. Submaximal testing using heart-rate measurements may be used for frequent testing. Epidemiological data on the incidence, mechanism, location and severity of injuries offers useful information and assistance for developing specific preventive strategies. In view of the fact that the greatest risk factor for injury is previous injury, especially if this has not been fully rehabilitated, it is crucial to conduct systematic medical assessments and carefully document previous injuries and current complaints. Finally, issues relating specially to certain target groups (such as referees, females and youth players) need to be considered.

In immunosuppressed children, prognosis depends to a great extent on that of the underlying illness. Miliary-Diagnosis is usually based on the classic "snowstorm" or "millet seed" appearance of lung fields on radiograph, although early in the course of disseminated tuberculosis the chest radiograph may show no or only subtle abnormalities. Other lesions may be present and produce osteomyelitis, arthritis, meningitis, tuberculomas of the brain, enteritis, or infection of the kidneys and liver. Meningitis-Symptoms include fever, vomiting, headache, lethargy, and irritability, with signs of meningeal irritation and increased intracranial pressure, cranial nerve palsies, convulsions, and coma. Lymphatic-The primary complex may be associated with a skin lesion drained by regional nodes or chronic cervical node enlargement or infection of the tonsils. False-negative results occur in malnourished patients, in those with overwhelming disease, and in 10% of children with isolated pulmonary disease. Temporary suppression of tuberculin reactivity may be seen with viral infections (eg, measles, influenza, varicella, and mumps), after live virus immunization, and during corticosteroid or other immunosuppressive drug therapy. For these reasons, a negative Mantoux test does not exclude the diagnosis of tuberculosis. When tuberculosis is suspected in a child, household members and adult contacts (eg, teachers and caregivers) also should be tested immediately. Multiple puncture tests (tine tests) should not be used because they are associated with false-negative and false-positive reactions, and because standards for interpretation of positive results do not exist. They are done on blood obtained by venipuncture and are further advantageous in requiring only a single visit; however, these tests are not yet sufficiently studied in children. Cultures of pooled early morning gastric aspirates from three successive days will yield M tuberculosis in about 40% of cases. Therapy should not be delayed in sus- Children 4 y without any risk factor 15 mm induration Standard intradermal Mantoux test, 5 test units. The direct detection of mycobacteria in body fluids or discharges is best done by staining specimens with auraminerhodamine and examining them with fluorescence microscopy; this method is superior to the Ziehl-Neelsen method. Imaging Chest radiograph should be obtained in all children with suspicion of tuberculosis at any site or with a positive skin test. Segmental consolidation with some volume loss and hilar adenopathy are common findings in children. Cavities and apical disease are unusual in children but are common in adolescents and adults. Differential Diagnosis Pulmonary tuberculosis must be differentiated from fungal, parasitic, mycoplasmal, and bacterial pneumonias; lung abscess; foreign body aspiration; lipoid pneumonia; sarcoidosis; and mediastinal cancer. Cervical lymphadenitis is most likely due to streptococcal or staphylococcal infections. Viral meningoencephalitis, head trauma (child abuse), lead poisoning, brain abscess, acute bacterial meningitis, brain tumor, and disseminated fungal infections must be excluded in tuberculous meningitis. The skin test in the patient or family contacts is frequently valuable in differentiating these conditions from tuberculosis. Specific Measures Most children with tuberculosis in the United States are hospitalized initially. If the infecting organism has not been isolated from the presumed contact for susceptibility testing, reasonable attempts should be made to obtain it from the child using morning gastric aspirates, sputum, bronchoscopy, thoracentesis, or biopsy when appropriate. Unfortunately, cultures are frequently negative in children, and the risk of these procedures must be weighed against the yield. Directly observed administration of all doses of antituberculosis therapy by a trained health care professional is essential to ensure compliance with therapy. In communities with resistance rates greater than 4%, initial therapy should usually include four drugs. Isoniazid-The hepatotoxicity from isoniazid seen in adults and some adolescents is rare in children.

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