The Athlete's Heart in Adolescent Africans An Electrocardiographic and Echocardiographic Study

ObjectivesThe goal of this study was to define electrocardiographic (ECG) and echocardiographic characteristics of adolescent African athletes.BackgroundRecent observations in African athletes reported large prevalence of left ventricular (LV) hypertrophy and ECG abnormalities. No data, so far, exist for adolescent Africans, which comprise a growing proportion of competitive/professional athletes.MethodsThe study included 154 soccer players participating at the 8th African Under-17 Championship of 2009, representing Algeria, Burkina Faso, Cameroon, Gambia, Guinea, Malawi, Nigeria, and Zimbabwe. For comparison, 62 Italian players with similar ages, sport achievements, and training schedules were included.ResultsAfrican athletes showed higher R5/S1-wave voltages than Caucasian athletes (48.6 ± 12.1 mm vs. 34.1 ± 8.9 mm; p < 0.01), larger prevalence of ECG LV hypertrophy (89% vs. 42%; p < 0.001), ST-segment elevation (91% vs. 56%; p < 0.001), and deeply inverted, or diffusely flat/biphasic, T waves (14% vs. 3% [p < 0.05] and 25% vs. 8% [p < 0.008], respectively). LV wall thicknesses were increased in Africans by 5% compared with Caucasians, and exceeded normal limits (≥13 mm) in 4 Africans but in no Caucasians. No athlete showed evidence of cardiomyopathies (i.e., hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy). On individual analysis, Algerians showed lower R/S-wave voltages compared with other African athletes. Increased wall thickness (≥13 mm) was observed only in sub-Saharian athletes (from Burkina Faso, Cameroon, and Niger).ConclusionsAfrican athletes displayed large proportion of ECG abnormalities, including a striking increase in R/S-wave voltage, ST-segment elevation, and deeply inverted or diffusely flat T waves by adolescence. LV remodeling in African athletes was characterized by a disproportionate wall thickening than in Caucasians but similar cavity size. Finally, distinctive peculiarities existed in African athletes according to the country (and ethnic) origin

Long-Term Clinical Consequences of Intense, Uninterrupted Endurance Training in Olympic Athletes

Objectives The aim of this study was to assess incidence of cardiac events and/or left ventricular (LV) dysfunction in athletes exposed to strenuous and uninterrupted training for extended periods of time. Background Whether highly intensive and uninterrupted athletic conditioning over a long period of time might be responsible for cardiac events and/or LV dysfunction is unresolved. Methods We assessed clinical profile and cardiac dimensions and function in 114 Olympic athletes (78% male; mean age 22 +/- 4 years), free of cardiovascular disease, participating in endurance disciplines, who experienced particularly intensive and uninterrupted training for 2 to 5 consecutive Olympic Games (total, 344 Olympic events), over a 4- to 17-year- period (mean 8.6 +/- 3 years). Results Over the extended period of training and competition, no cardiac events or new diagnoses of cardiomyopathies occurred in the 114 Olympic athletes. Global LV systolic function was unchanged (ejection fraction: 62 +/- 5% to 63 +/- 5%; p = NS), and wall motion abnormalities were absent. In addition, LV volumes (142 +/- 26 ml to 144 +/- 25 ml; p = 0.52) and LV mass index (109 +/- 21 g/m(2) to 110 +/- 22 g/m(2); p = 0.74) were unchanged, and LV filling patterns remained within normal limits, although left atrial dimension showed a mild increase (37.8 +/- 3.7 mm to 38.9 +/- 3.2 mm; p < 0.001). Conclusions In young Olympic athletes, extreme and uninterrupted endurance training over long periods of time (up to 17 years) was not associated with deterioration in LV function, significant changes in LV morphology, or occurrence of cardiovascular symptoms or events. (J Am Coll Cardiol 2010;55:1619-25) c 2010 by the American College of Cardiology Foundatio

Outcomes in Athletes with Marked ECG Repolarization Abnormalities

BACKGROUND: Young, trained athletes may have abnormal 12-lead electrocardiograms (ECGs) without evidence of structural cardiac disease. Whether such ECG patterns represent the initial expression of underlying cardiac disease with potential long-term adverse consequences remains unresolved. We assessed long-term clinical outcomes in athletes with ECGs characterized by marked repolarization abnormalities. METHODS: From a database of 12,550 trained athletes, we identified 81 with diffusely distributed and deeply inverted T waves ( or = 2 mm in at least three leads) who had no apparent cardiac disease and who had undergone serial clinical, ECG, and echocardiographic studies for a mean (+/-SD) of 9+/-7 years (range, 1 to 27). Comparisons were made with 229 matched control athletes with normal ECGs from the same database. RESULTS: Of the 81 athletes with abnormal ECGs, 5 (6%) ultimately proved to have cardiomyopathies, including one who died suddenly at the age of 24 years from clinically undetected arrhythmogenic right ventricular cardiomyopathy. Of the 80 surviving athletes, clinical and phenotypic features of hypertrophic cardiomyopathy developed in 3 after 12+/-5 years (at the ages of 27, 32, and 50 years), including 1 who had an aborted cardiac arrest. The fifth athlete demonstrated dilated cardiomyopathy after 9 years of follow-up. In contrast, none of the 229 athletes with normal ECGs had a cardiac event or received a diagnosis of cardiomyopathy 9+/-3 years after initial evaluation (P=0.001). CONCLUSIONS: Markedly abnormal ECGs in young and apparently healthy athletes may represent the initial expression of underlying cardiomyopathies that may not be evident until many years later and that may ultimately be associated with adverse outcomes. Athletes with such ECG patterns merit continued clinical surveillance

Myth and reality of the decline in semen quality: an example of the relativity of data interpretation.

Many hypotheses have been put forward to explain a suspected decline in semen quality. Up to now many sources of data were used but conflicting results are present in the literature. To study whether modifications of sperm parameters actually exist we used data from two groups of patients checked and two small groups of sperm bank donors selected at the beginning '80s and '90s. We tried to reduce bias to a minimum: all the semen analyses were carried out by the same biologist, using the same methods, groups were clinically evaluated by the same andrological team, the study groups were homogeneous for age, geographic-ethnic origin, residence, monthly-seasonal distribution and abstinence period. Comparing patients from the '80s and the '90s, sperm concentration and motility showed a significant reduction. Furthermore, the decrease in concentration and motility was mainly due to the higher age classes. In donors, no decline was observed. These results seem to indicate that sperm donors remain unaffected, while patients with lower levels of semen quality are experiencing a real decline. Unfortunately, many confounding variables, analyzed in detail in this review, still remain despite efforts at standardization

Statistical analysis in andrology

The authors began a statistical study on a file group of 9384 records of semen analyses and anamnestic data (P-1). From this file, they selected a group of 5191 patients having undergone analysis at least one time (P-2) and a file of 850 patients having undergone analysis at least three times (P-3). Finally a new group, derived from P-3, of 203 patients followed by their medical team was created (P-4). Two control groups-composed of 20 sperm-bank donors (DON) and 740 prevasectomy subjects (VAS)-were also created. Frequency distributions and cluster analyses were carried out. The multivariate statistical analysis allows a distinction to be made between fertile and infertile subjects regarding a patient's clinical condition. The most discriminating parameters appear to be sperm concentration and, above all, forward motility and sperm morphology

THE CHALLENGE OF HELICOBACTER PYLORI ERADICATION THERAPIES BASED ON ANTIBIOTIC SUSCEPTIBILITY TESTING IN A HIGHLY SELECTED GROUP OF PANGASTRITIS PATIENTS.

Introduction: Hp eradication continues to be a challenge in a small group of patients. Antibiotic susceptibility testing has been proposed in order to obtain definitive cure but results are controversial. Aim of the study: To verify outcomes of susceptibility testing and eradication therapies in pangastritis patients who underwent at least two previous eradication schedules. Patients and Methods: Thirty seven patients ( 30 women and 7 men, median age of 53 years) with pangastritis and who had already undergone more than two eradication attempts (median 3) were elected for susceptibility testing and eradication therapy. Eight biopsy samples ( 3 antrum, 3 corpus, 2 fundus ) were collected for Hp culture and susceptibility testing and 2 additional samples from each region for histology. Patients with positive cultures, received specific antibiotic therapy while pts with coccoid forms received empiric therapy.C13 Urea Breath test were performed after one month of wash-out period. Variables such as age, BMI, number of eradication therapies, pattern of gastritis distribution, Global Inflammation Score, Hp load, colloidal bismuth based therapies, susceptibility based or empirical therapy were matched with the result of eradication therapy. A descriptive statistical analysis was performed on observed data: frequency distributions were obtained and mean, median and standard deviation were computed on quantitative data. Two-way tables were then created including the variable 'therapeutic outcome' and each observed variable; relation between therapeutic outcome and other variables was assessed by chi square test. A two-tailed p<0.05 was considered statistically significant. Thereafter by logistic stepwise regression analysis the multiple relationship of therapeutic outcome with the other variables was assessed. Results: The culture and susceptibility testing were obtained in 64% of the pts (24/37). In 25%(6/24pts)eradication was successful. Empiric therapeutic schedules provided positive result in 53,8% pts (7/13). The overall eradication rate (negative C13 UBT) was 37%. Among the many variables examined only the presence of pangastritis and corpus predominant gastritis was associated to treatment failure in 80% of pts (12/15)(p<0.05). Conclusions: The probability of Hp eradication in pangastritis pts is very low and antibiotic susceptibility testing fails to improve the success rate of eradication

Statistical andrology: standard semen analysis and computer-assisted sperm motility analysis

Results are reported of a statistical evaluation of the variables obtained by standard microscopic semen analysis and by computer-assisted sperm motility analysis. Descriptive statistical analysis and cluster analysis were carried out on both sets of data. A contingency table was created to compare the classifications obtained by the two clustering procedures. A canonical correlation analysis was performed to evaluate the classification power of the variables obtained by the two semen analyses. The results show that the two techniques of semen analysis are complementary and not substitutive and that the correlated variables “percentage forward motility” and “sperm velocity” are the most discriminating. Read More: http://informahealthcare.com/doi/abs/10.3109/01485019308987742?journalCode=aa

A comparison of the Direct Immunobead Test and other tests for sperm antibodies detection

The authors report the results of a correlation study between the direct Immunobead Test (d-IBT) and other techniques for antisperm antibodies detection. The Gelatin Agglutination Test (GAT) and Tray Agglutination Test (TAT) were used to detect antibodies in blood serum and seminal plasma ("indirect methods"). The Direct IgG Mixed Antiglobulin Reaction Test (d-MAR test) was used to detect sperm antibodies bound to the sperm surface ("direct method"). A good concordance between the methods, measured by phi and K tests, was found and satisfactory mathematical models were established by regression analyses