Electrocardiographic findings in sports medicine: normal variants and the ones that should not be missed.

There are a few "red flag" findings in the history and physical examination of an athlete that may require obtaining an electrocardiogram (ECG) as part of a cardiac evaluation. In this article we discuss the normal variants seen in the ECG brought on by regular physical training and ECG abnormalities that are seen with a few of the structural and conduction abnormalities associated with an increased risk of sudden cardiac death. These conditions are all relatively uncommon and the ECG may reveal the first clue to the presence of a potentially significant underlying abnormality. After reading this article the sports medicine practitioner should be able to 1) confidently return to play those athletes with normal variants on their ECG, and 2) not miss the ECG abnormalities of an athlete who requires further evaluation for potentially significant abnormalities prior to participating in athletics.

An outbreak of malaria in US Army Rangers returning from Afghanistan.

CONTEXT: With numerous US military personnel currently deployed throughout the world, military and civilian health care professionals may encounter imported malaria from this population. OBJECTIVE: To identify malaria in US Army personnel deployed to a combat zone. DESIGN, SETTING, AND PATIENTS: Case series in the US Army health care system. A total of 38 cases of malaria were identified in a 725-man Ranger Task Force that deployed to eastern Afghanistan between June and September 2002. MAIN OUTCOME MEASURES: Identification of malaria cases and soldiers' self-report of compliance with antimalarial measures. RESULTS: A total of 38 patients were infected with Plasmodium vivax, yielding an attack rate of 52.4 cases per 1000 soldiers. Diagnosis was confirmed a median of 233 days (range, 1-339 days) after return from the malaria endemic region, with additional laboratory findings noting anemia and thrombocytopenia. One case was complicated with acute respiratory distress syndrome during the patient's primary attack and a spontaneous pneumothorax during relapse. This case accounted for 1 of 2 relapse cases in the study population. From an anonymous postdeployment survey of 72% (521/725) of the task force, the self-reported compliance rate was 52% for weekly chemoprophylaxis, 41% for terminal (postdeployment) chemoprophylaxis, 31% for both weekly and terminal chemoprophylaxis, 82% for treating uniforms with permethrin, and 29% for application of insect repellent. CONCLUSIONS: Delayed clinical presentation can occur with P vivax. Symptoms are often vague, but malaria should be included in the differential diagnosis for soldiers returning from an endemic region. Suboptimal compliance with preventive measures can result in a malaria outbreak.

Army Ranger casualty, attrition, and surgery rates for airborne operations in Afghanistan and Iraq.

INTRODUCTION: Although numerous articles have been published documenting parachute injuries, a search of the medical literature revealed none that detail casualty, attrition, and surgery rates for airborne operations conducted into actual combat. This study examines observed airborne casualty, attrition, and surgery rates in U.S. Army Rangers during combat operations in order to identify risk factors attributed to static-line parachute injuries and provide a comparison to estimated attrition rates. METHODS: Data were recorded on standardized manual casualty cards and tracking forms while treatment was provided during two missions into Afghanistan during Operation Enduring Freedom and two missions into Iraq during Operation Iraqi Freedom, and then consolidated onto an electronic database for further analysis. RESULTS: There were 4 airborne missions totaling 634 jumpers that resulted in 83 injuries sustained by 76 Rangers (12%). Of those, 27 Rangers (4%) were unable to continue the mission and were subsequently evacuated. There were 11 Rangers (2%) who required surgery following evacuation. The overall observed attrition rate differed from the estimated rate (p = 0.04). Although observed attrition rates did not differ from estimations in Afghanistan (p = 0.75), attrition rates in Iraq were greater than estimated rates (p = 0.02) and observed rates in Afghanistan (p = 0.05). DISCUSSION: Many factors impact casualty, attrition, and injury patterns. Terrain and equipment load were notable associations analyzed in this study. CONCLUSIONS: Medical, logistical, and operational personnel can optimize support for airborne forces through improved estimation of casualty, attrition, and surgical rates. Risk factors associated with military parachuting can potentially provide further accuracy in estimating attrition and are recommended for integration into current models.