Background and aimThe efficacy of pre-COVID-19 and post-COVID-19 infection 12-lead ECGs for identifying athletes with myopericarditis has never been reported. We aimed to assess the prevalence and significance of de-novo ECG changes following COVID-19 infection.MethodsIn this multicentre observational study, between March 2020 and May 2022, we evaluated consecutive athletes with COVID-19 infection. Athletes exhibiting de-novo ECG changes underwent cardiovascular magnetic resonance (CMR) scans. One club mandated CMR scans for all players (n=30) following COVID-19 infection, despite the absence of cardiac symptoms or de-novo ECG changes.Results511 soccer players (median age 21 years, IQR 18–26 years) were included. 17 (3%) athletes demonstrated de-novo ECG changes, which included reduction in T-wave amplitude in the inferior and lateral leads (n=5), inferior leads (n=4) and lateral leads (n=4); inferior T-wave inversion (n=7); and ST-segment depression (n=2). 15 (88%) athletes with de-novo ECG changes revealed evidence of inflammatory cardiac sequelae. All 30 athletes who underwent a mandatory CMR scan had normal findings. Athletes revealing de-novo ECG changes had a higher prevalence of cardiac symptoms (71% vs 12%, p<0.0001) and longer median symptom duration (5 days, IQR 3–10) compared with athletes without de-novo ECG changes (2 days, IQR 1–3, p<0.001). Among athletes without cardiac symptoms, the additional yield of de-novo ECG changes to detect cardiac inflammation was 20%.Conclusions3% of athletes demonstrated de-novo ECG changes post COVID-19 infection, of which 88% were diagnosed with cardiac inflammation. Most affected athletes exhibited cardiac symptoms; however, de-novo ECG changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.

We present a case of multilevel lumbar transverse process fracture in a professional association football player, incurred after a fall from height during competitive play. Traditionally associated with high impact trauma in the general population, this injury is relatively rare in the context of professional football where it is more likely to be associated with lower impact trauma. We outline our experience of mechanism of injury, treatment options and recovery time serving as a guide for fellow clinicians when treating this condition in practice. In this particular case, the return to play time was 68 days.

Competing interests NL, CP, AH are consultants with Orreco who provide blood biomarker monitoring services to professional athletes. Patient consent for publication Not applicable.Ethics approval Not applicable.Provenance and peer review Not commissioned; externally peer reviewed.

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BackgroundSickle cell trait (SCT) is considered a benign heterozygous carrier state (both normal haemoglobin and abnormal HbS) compatible with elite level sport, whereas the autosomal recessive state of sickle cell disease is considered incompatible with strenuous exercise. Increased production of reactive oxygen species occurs in sickle cell disease, evident as increased pro-oxidants (FORT) and reduced anti-oxidants (FORD). This has been demonstrated using a novel point-of-care test (Giziet al.2011). No FORT/FORD data exist in athletes with SCT.Objective and ParticipantsIt was hypothesized that premiership football players with SCT (n=2) would show altered redox homeostasis compared to non-SCT players (n=19). These data were compared to previously published data on patients with sickle cell disease and controls.SettingEnglish Premiership Football Team.Design and Arisk factor assessmentA cross sectional comparison study design was adopted, and descriptive data are reported. Resting whole blood samples were collected at pre-season and mid-season and analysed immediately for FORT and FORD values. Mean values for non-SCT players were plotted against mean SCT player values (Figure 1).ResultsFigure 1FORD/FORT values for all players (grey diamonds), SCT players (black squares) and previous data for sickle cell disease (black triangle) and controls (black diamond).ConclusionsThe 2 SCT players in this case study exhibited elevated FORT values, compared to non-SCT players, although they were not extreme outliers, perhaps because athletes are exposed to other sources of pro-oxidants such as exercise. Further research is necessary with a larger cohort in order to further establish the relationship between redox homeostasis and SCT in athletes.ReferencesGiziet al.(2011) Assessment of oxidative stress in patients with sickle cell disease: The glutathione system and the oxidant–antioxidant status.Blood cells, Molecules and Diseases46, pp. 220–225.