Objectives We sought to explore the spectrum of cardiac abnormalities in student-athletes who returned to university campus in July 2020 with an uncomplicated Coronavirus disease 2019 (COVID-19). Background There is limited information regarding cardiovascular involvement in young individuals with mild or asymptomatic COVID-19. Methods Screening echocardiograms were performed in 54 consecutive student-athletes (mean age: 19 years, 85% males) who tested positive on reverse transcription–polymerase chain reaction nasal swab testing of the upper respiratory tract or IgG antibodies against SARS-CoV-2. A sequential cardiac magnetic resonance (CMR) imaging was performed in 48 (89%) subjects. Results A total of 16 (30%) athletes were asymptomatic while 36 (66%) and 2 (4%) reported mild and moderate COVID-19 related symptoms, respectively. For the 48 athletes completing both imaging studies, abnormal findings were identified in 27 (56.3%) individuals. This included 19 (39.5%) showing pericardial late enhancements with associated pericardial effusion. Of the individuals with pericardial enhancements, 6 (12.5%) had reduced global longitudinal strain (GLS) and/or an increased native T1. One patient showed myocardial enhancement and reduced left ventricular ejection fraction or reduced GLS with or without increased native T1 were also identified in additional 7 (14.6%) individuals. Native T2 were normal in all subjects and no specific imaging features of myocardial inflammation were identified. Hierarchical clustering of LV regional strain identified three unique myopericardial phenotypes that showed significant association with the CMR findings (P=0.03). Conclusion Over one in three previously healthy college-athletes recovering from COVID-19 infection showed imaging features of a resolving pericardial inflammation. Although subtle changes in myocardial structure and function were identified, no athlete showed specific imaging features to suggest an ongoing myocarditis. Further studies are needed to understand the clinical implications and long-term evolution of these abnormalities in uncomplicated COVID-19.

Context:Diabetes mellitus (DM) has become an epidemic in the United States and is associated with increased risk of multiple comorbidities, including painful musculoskeletal conditions. A common treatment for many of these painful musculoskeletal conditions is local soft tissue and intra-articular corticosteroid injection (CSI). These local injections have the potential to cause elevated blood glucose levels (BGLs) and cause complications in patients with DM. Therefore, it was the objective of this investigation to review the currently available evidence that directly addresses the effects of local CSIs used for painful musculoskeletal conditions on BGL in patients with DM.Evidence Acquisition:PubMed, Google Scholar, EMBASE, CINAHL, and Cochrane Review databases were searched with a combination of the terms corticosteroid, glucocorticoid, steroid, injection, musculoskeletal, and diabetes. Search limits included the English language. Bibliographic references from these articles were also examined to identify pertinent literature.Study Design:Clinical review.Level of Evidence:Level 3.Results:Ten studies that met the inclusion criteria were reviewed. All these studies showed significant but transient increases in postinjection BGL after a single local CSI in patients with DM. There were no adverse reactions or complications reported.Conclusion:Single, local soft tissue and intra-articular musculoskeletal CSIs are most likely safe in patients with well-controlled DM.

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Background Initial protocols for return to play cardiac testing in young competitive athletes following SARS‐CoV‐2 infection recommended cardiac troponin (cTn) to screen for cardiac involvement. This study aimed to define the diagnostic yield of cTn in athletes undergoing cardiovascular testing following SARS‐CoV‐2 infection. Methods and Results This prospective, observational cohort study from ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) included collegiate athletes who underwent cTn testing as a component of return to play protocols following SARS‐CoV‐2 infection. The cTn values were stratified as undetectable, detectable but within normal limits, and abnormal (>99% percentile). The presence of probable or definite SARS‐CoV‐2 myocardial involvement was compared between those with normal versus abnormal cTn levels. A total of 3184/3685 (86%) athletes in the ORCCA database met the inclusion criteria for this study (age 20±1 years, 32% female athletes, 28% Black race). The median time from SARS‐CoV‐2 diagnosis to cTn testing was 13 days (interquartile range, 11, 18 days). The cTn levels were undetectable in 2942 athletes (92%), detectable but within normal limits in 210 athletes (7%), and abnormal in 32 athletes (1%). Of the 32 athletes with abnormal cTn testing, 19/32 (59%) underwent cardiac magnetic resonance imaging, 30/32 (94%) underwent transthoracic echocardiography, and 1/32 (3%) did not have cardiac imaging. One athlete with abnormal troponin met the criteria for definite or probable SARS‐CoV‐2 myocardial involvement. In the total cohort, 21/3184 (0.7%) had SARS‐CoV‐2 myocardial involvement, among whom 20/21 (95%) had normal troponin testing. Conclusions Abnormal cTn during routine return to play cardiac screening among competitive athletes following SARS‐CoV‐2 infection appears to have limited diagnostic utility.

BackgroundEarly pregnancy complaints in emergency medicine are common. Emergency physicians (EP) increasingly employ ultrasound (US) in the evaluation of these complaints. As a result, it is likely that rare and important diagnoses will be encountered. We report a case of fetal anencephaly diagnosed by bedside emergency US in a patient presenting with first-trimester vaginal bleeding.Case ReportA 33-year-old patient at 10 weeks gestation presented with vaginal bleeding. After initial history and physical examination, a bedside US was performed. The EP noted the abnormal appearance of the fetal cranium and anencephaly was suspected. This finding was confirmed by a consultative high-resolution fetal US. Making the diagnosis at the point of care allowed earlier detection and more comprehensive maternal counseling about pregnancy options. This particular patient underwent elective abortion which was able to be performed at an earlier gestation, thus decreasing maternal risk. If this diagnosis would not have been recognized by the EP at the point of care, it may not have been diagnosed until the second trimester, and lower-risk maternal options would not have been available.