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Sudden cardiac death (SCD) is the leading cause of death in athletes. Among which, cardiomyopathy is the most common in young asymptomatic sportsperson. The electrocardiogram (ECG) is used as a primary screening and diagnostic tool for detecting underlying conditions associated with SCD. However, providing medical clearance for an asymptomatic athlete without any positive personal or family history is especially challenging when the athlete demonstrates abnormal ECG, particularly repolarization patterns, highly suggestive of an inherited cardiomyopathy, or ion channelopathy. This paper presents two such cases of contrasting diagnostic conundrum which may help sports physicians and cardiologists working with athletes.

Background Judo has a relatively high injury risk and hence research on training injuries in judokas can identify the risk factors and help to develop specific prevention programs. Few studies have reported data on training injuries in judokas. Objective To present an epidemiological study of training injuries in elite Indian judokas. Design Prospective observational cohort study. Setting Elite Indian judokas training at National Institute of Sports, under centre of excellence scheme. Participants 45 judokas (22 male and 23 female) were followed up from June 2011 to May 2016. Assessment of Risk Factors Height, weight, age, BMI were recorded at the time of their admission. Training data were recorded as per training log. Injury data were collected using a validated assessment tool by Finch et al (2008). Competition injuries were excluded. Main Outcome Measurements Injury rate, average injury risk, re-injury risk, location, type and severity of injuries (time loss) were analyzed and compared. Results The injury rate was 0.75 (95% CI, 0.63–0.88) injuries per athlete year. The rate per 1000 exposures was 26.0 (95% CI, 6.0–46) in males and 43.1 (95% CI, 24–62) in females. Average risk or incidence proportion was 0.73 (0.82 in males and 0.65 in females). The observed re injury risk (average probability an injured athlete is at risk of repeated injury) was 0.79 of injured athletes. No significant difference was observed in terms of body parts injured between men and women (p>0.05). Injuries most frequently occurred in the lower limbs (40.7% in males and 43.2% in females) followed by upper limbs, trunk, head and neck. The most common injury type was a ligament sprain (37%). Grade 3 injuries were significantly more common in women than men (p Conclusions Indian male judokas have a high average risk of training injuries. Women are more prone to re injuries and severe injuries. Further studies are needed to address the impact of training- related risk factors for injury to implement effective preventive measures.

Background The European Society of Cardiology (ESC) released recommendations in 2010 for the interpretation of 12 lead electrocardiogram (ECG) in athletes. In 2013, the ‘Seattle Criteria’ was published with the aim to improve sensitivity of ECG screening. Objective To compare the sensitivity of these two criteria for Indian athletes. Design Cross sectional ECG data of the female athletes was collected during preparticipation screening. Any athletes with known cardiovascular disease was excluded from the study. Setting ECG was recorded during their entry in the national camp in 2014–15 at the National Institute of Sports. Written informed consent was obtained before the study. Patients (or Participants) The study population consisted of 63 elite female athletes (30 footballers and 33 from athletics) with mean age, height, weight, BMI of 22.71 (SD- 3.30) years, 157.38 (SD- 4.20) cm, 52.29 (SD- 3.87) kg, 21.77 (SD- 1.67) kg/m2 respectively along with mean training age of 9.79 (SD- 3.08) years. None of them was having any known cardiovascular disorder. Interventions (or Assessment of Risk Factors) The standard 12 lead ECG (RMS vesta 302i) was collected by a physician. Main Outcome Measurements All ECGs had been evaluated and compared as per ESC and Seattle criteria by single investigator. Results 12 (19%) [7(11.1%) with long QT syndrome and 5 (7.9%) with T wave inversion] and 3 (4.8%) [T wave inversion] athletes had abnormal ECG according to ESC and Seattle criteria respectively. Only one (1.5%) among them was detected cardiomyopathy by further investigations. The reduction was due to reclassification of 7 (11.1%) athletes with a redefined QTc interval, 2 (3.1%) with T wave inversion isolated to V1–2. Conclusions Using Seattle criteria for the athletes of Indian origin, the false positive ECG has been reduced from 17.5% to 3.3% but still the same athlete with cardiac abnormality can be identified.