A Drowned Diver – Four Expert Witness Opinions – Who is Right?

BACKGROUND: The paper describes the case of a drowned diver in the Adriatic Sea near Pula, Croatia. CASE PRESENTATION: The deceased diver had not been trained at any Health and Safety at Work programs nor had he been examined by the occupational medicine (OM) specialist. The pathologist in Pula concluded that this accident was caused by drowning and that diver’s blood was saturated with 38% carboxyhemoglobin (COHb). The second pathologist in Zagreb concluded that the diver drowned due to atherosclerosis sickness but that COHb was not present in his blood. The third expert witness from Forensics in Rijeka evaluated that the diver died due to increased exertion while diving, due to atherosclerosis and weakened heart. The fourth, the OM specialist expert witness from Rijeka, explained that the diver was a healthy athlete who died due to faulty diving equipment. CONCLUSION: Persons who work under the special working conditions should be examined at an Occupational medicine department as well as trained for work in a safe way. Periodical examinations and permanent training courses should be provided. That way the risk of fatal accidents would be reduced to a minimum.

The Female Athlete Triad/Relative Energy Deficiency in Sports (RED-S)

In a healthy athlete, the caloric intake is sufficient for sports energy needs and body physiological functions, allowing a balance between energy availability, bone metabolism, and menstrual cycle. On the other hand, an imbalance caused by low energy availability due to a restrictive diet, eating disorders or long periods of energy expenditure leads to multisystemic deregulation favoring the essential functions of the body. This phenomenon, described as the female athlete triad, occurs in a considerable percentage of high-performance athletes, with harmful consequences for their future. The present review was carried out based on a critical analysis of the most recent publications available and aims to provide a global perception of the topic relative energy deficit in sport (RED-S). The objective is to promote the acquisition of more consolidated knowledge on an undervalued theme, enabling the acquisition of preventive strategies, early diagnosis and/or appropriate treatment.

Trends in Body Mass Index among Children with Mild and Moderate Intellectual Disabilities

In recent years, worldwide obesity has increased both in the adult as well as childhood populations. Research shows that obesity nowadays is associated with still younger age. What is currently becoming the focal point of attention is the prevalence of obesity in people with intellectual disabilities whose physical and mental limitations affect, to a certain degree, their daily lives. Nevertheless, there is a lack of data for the childhood population with intellectual disabilities.This research seeks to compare trends in BMI indicators and eating habits among children with mild and moderate intellectual disabilities who live with their families as opposed to those who are provided for at Children’s home in region Zlín in the Czech Republic. The research method used was quantitative and comparative research approached deductively. BMI indicators were determined by means of InBody analyser. Eating habits data were collected through a questionnaire of our own design which is standardly used in the Special Olympics Healthy Athlete Project. The BMI trends were observed in twelve children from two primary schools. We have concluded that children with mild ID who are provided for at the children’s home do not tend to be obesity, rather they have a proclivity to overweight or normal BMI and children with moderate ID have a proclivity to normal BMI or underweight. As emerged from case histories, only children with moderate ID living with their own families tend to have obesity or normal BMI but children with mild ID living with their own families tend to have overweight or normal BMI. Obesity and overweight are connected only with boys.Children’s weight remained the same within the existing BMI ranges. Summer holidays in children with mild ID and moderate ID living in children’s home had no verifiable effect on the BMI indicators. Children living in their own families had a subsequent weight rise before summer holiday (June 2017, June 2018) and a weight loss after holiday (September 2017, September 2018). Summer holiday influences the BMI indicators in children with mild ID and moderate ID living in their families. The research further shows that children with mild ID and moderate ID being cared for in the institutional environment have a healthier diet than children with mild ID and moderate ID living with their families.The conclusions of the research may serve as a recommendation for parents to pay more attention to their children’s diet as well as their physical activity.

Effects of Overtraining Status on the Cortisol Awakening Response—Endocrine and Metabolic Responses on Overtraining Syndrome (EROS-CAR)

The cortisol awakening response (CAR) is a distinct component of the circadian cortisol profile and has promise as a biomarker for the monitoring of athlete readiness and training status. Although some studies have suggested the CAR may be affected by the development of overtraining syndrome (OTS), this has yet to be systematically investigated. Purpose: To compare the CAR and diurnal cortisol slope between athletes diagnosed with OTS, healthy athletes, and sedentary controls. Methods: This study was a secondary analysis of data from the Endocrine and Metabolic Responses on Overtraining study. Male participants were recruited to either OTS, healthy athlete, or sedentary control groups. The participants produced saliva samples immediately after waking (S1), 30 minutes after waking (S2), at 16:00 hours, and at 23:00 hours. Salivary cortisol concentration was determined by an electrochemiluminescence assay. Mixed-effects models were used to assess the conditional effect of group (sedentary controls, OTS, and healthy athletes) on the change in cortisol over time. Separate models were fit for the awakening samples (S1 and S2) and for the diurnal slope (linear change across S1, 16:00 h, and 23:00 h). Results: The models demonstrated significant time-by-group interaction for OTS for the 2 cortisol concentrations collected during the awakening period (β = −9.33, P < .001), but not for the diurnal cortisol slope (β = 0.02, P = .80). Conclusions: These results suggest the CAR may be associated with OTS and should be considered within a panel of biomarkers. Further research is necessary to determine whether alterations in the CAR may precede the diagnosis of OTS.

P4429Cardiac magnetic resonance characteristics of professional athletes and hypertrophic cardiomyopathy patients in the grey zone of hypertrophy

Differentiation between athlete's heart and hypertrophic cardiomyopathy (HCM) may cause difficulties especially in patients in the grey zone of hypertrophy. We aimed to determine conventional cardiac magnetic resonance (CMR) parameters such as left ventricular (LV) ejection fraction (EF), BSA-corrected end-diastolic (EDVi), end-systolic and stroke volume (SVi), mass (Mi), derived CMR parameters such as maximal end-diastolic wall thickness to LVEDVi ratio (EDWT/LVEDVi), LVM to LVEDV ratio (LVM/LVEDV), and CMR based strain values (global longitudinal (GLS), radial (GRS) and circumferential strain (GCS)) in male HCM patients and athletes. We consecutively enrolled male HCM patients with only slightly elevated EDWT (13–18 mm) and highly trained healthy athletes (n=30, 18.7±1.2 training hrs/week) with marked LV hypertrophy. HCM patient group was divided into sedentary (n=30, <7 training hrs/week) and athletic HCM group (n=10; >7 h/week, 12.7±7.3 h training hrs/week). Both sedentary and athletic HCM patients showed higher LVEF, lower LVEDVi and LVESVi and higher EDWT compared to the healthy athletes. LVMi of both healthy athletes and athletic HCM patients was significantly higher than in sedentary HCM patients, respectively (98.9±11.4; 94.5±7.8 vs 78.1±14.4 /m2). EDWT/LVEDVi ratio was higher in both sedentary and athletic HCM patients compared to healthy athletes, respectively (0.19±0.04; 0.17±0.04 vs 0.11±0.02). LVM/LVEDV also showed significant difference between HCM patients and healthy athletes. GLS and GRS showed no significant difference between the three groups, GCS was higher in athletic HCM compared to healthy athletes (−20.7±2.2 vs −17.8±2.3%). Figure 1. Feature tracking analysis of a healthy athlete and a patient with HCM. CMR characteristics of athletic and sedentary HCM may fundamentally alter. Our preliminary data suggest that besides conventional CMR parameters, derived parameters such as EDWT/LVEDVi and LVM/LVEDV ratios and deformation imaging may also help the differentiation between pathological and physiological hypertrophy. Acknowledgement/Funding National Research, Development and Innovation Office (NKFIH) of Hungary (K 120277). Project no. NVKP_16-1-2016-0017

Using Unilateral Strength, Power and Reactive Strength Tests to Detect the Magnitude and Direction of Asymmetry: A Test-Retest Design

The aims of the present study were to determine test-retest reliability for unilateral strength and power tests used to quantify asymmetry and determine the consistency of both the magnitude and direction of asymmetry between test sessions. Twenty-eight recreational trained sport athletes performed unilateral isometric squat, countermovement jump (CMJ) and drop jump (DJ) tests over two test sessions. Inter-limb asymmetry was calculated from both the best trial and as an average of three trials for each test. Test reliability was computed using the intraclass correlation coefficient (ICC), coefficient of variation (CV) and standard error of measurement (SEM). In addition, paired samples t-tests were used to determine systematic bias between test sessions and Kappa coefficients to report how consistently asymmetry favoured the same side. Within and between-session reliability ranged from moderate to excellent (ICC range = 0.70–0.96) and CV values ranged from 3.7–13.7% across tests. Significant differences in asymmetry between test sessions were seen for impulse during the isometric squat (p = 0.04; effect size = –0.60) but only when calculating from the best trial. When computing the direction of asymmetry across test sessions, levels of agreement were fair to substantial for the isometric squat (Kappa = 0.29–0.64), substantial for the CMJ (Kappa = 0.64–0.66) and fair to moderate for the DJ (Kappa = 0.36–0.56). These results show that when asymmetry is computed between test sessions, the group mean is generally devoid of systematic bias; however, the direction of asymmetry shows greater variability and is often inter-changeable. Thus, practitioners should consider both the direction and magnitude of asymmetry when monitoring inter-limb differences in healthy athlete populations.