Updated Blood Pressure Guidelines: Implications for Athletes.

PURPOSE OF REVIEW: To review the prevalence, short- and long-term impact of exercise on blood pressure, and the evaluation and treatment of hypertension in competitive athletes. RECENT FINDINGS: Due, in part, to inconsistencies in measurement and the definitions used, the true prevalence of hypertension is unknown as reports range from 0 to 83%. With recent changes in the blood pressure guidelines, the proportion of athletes that meet criteria for elevated blood pressure or stage 1 hypertension has increased dramatically with over one-third of collegiate and professional athletes meeting criteria for hypertension. Data consistently show that American-style football players, particularly linemen, display the highest rates of hypertension. These athletes typically have a larger body mass index, higher body fat percentage, and weight gain in serial follow-up. Many athletes with hypertension have traditional risk factors, and, to date, there is no evidence of a causal relationship between long-term sport participation and increased risk of developing hypertension. Many more athletes now meet criteria for hypertension, given the updated blood pressure guidelines. This should be taken as an opportunity for early intervention, as athletes are not immune to the development of cardiovascular risk factors and disease.

Player Tracking Technology and Data for Injury Prevention in the National Football League.

ABSTRACT: The recent partnership of NFL's Next Gen Stats with Amazon Web Services has created a buzz among media and fans, yet the full scope and utility of digital biosensors has yet to be determined. We review current uses of Global Positioning System technology and digital biosensors in the NFL and discuss the future role of this technology in injury prevention. A complete literature review was conducted, along with review of the NFL web site and news outlet articles, to obtain a comprehensive assessment of all prior and current uses of biosensor technology in the NFL. Limited data exist on successful injury prevention and return to play, and utilization of this emerging technology has mostly been for fan experience. While ethical and legal challenges exist, the integration of digital biosensor and GPS technology in the NFL has enormous potential and is an invaluable tool in the comprehensive assessment of player health.

Acute ST-Segment Elevation Myocardial Infarction as Initial Presentation of Atypical Hemolytic-Uremic Syndrome.

A young woman presented with an acute ST-segment elevation myocardial infarction. Her clinical course was complicated by cardiogenic shock and acute renal failure. Work-up revealed thrombocytopenia and hemolytic anemia. A diagnosis of atypical hemolytic-uremic syndrome was made on the basis of clinical and pathological findings. (Level of Difficulty: Intermediate.).

Air Should Not be There: A Case of Pneumomediastinum and Pneumopericardium in COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus identified after widespread pneumonia cases in Wuhan, China at the end of 2019. This virus has been deemed a global pandemic and there remain many unknowns regarding the pathogenesis, management, treatment, and outcomes. This case report highlights a rare condition that possibly developed from the novel virus.  A 68-year-old Hispanic male with hypertension and gastroesophageal reflux disease, presented with two weeks history of fevers, chills, cough, and progressive shortness of breath. He was found to be positive for the novel SARS-CoV-2 upon admission. He rapidly developed severe acute respiratory distress syndrome (ARDS) secondary to his coronavirus disease 2019 (COVID-19) pneumonia requiring intubation and full ventilator support associated with acute anuric renal failure requiring emergent hemodialysis catheter placement and continuous renal replacement therapy (CRRT). Two weeks after being on mechanical ventilation and CRRT, he developed episodes of hypotension and tachycardia. A chest radiograph and computed tomography (CT) scan diagnosed pneumopericardium. In the case presented, the patient's CT of his thorax demonstrated bilateral ground-glass opacities and bilateral reticulations consistent with intraparenchymal injuries, most likely from his ARDS secondary to his initial SARS-CoV-2 infection. To date, there remains an unknown association between COVID-19 and causation of pneumomediastinum and pneumopericardium. There continues to be reports of clinically significant findings of pneumomediastinum and pneumopericardium in COVID-19 patients. It is known that COVID-19 causes dysregulated inflammation leading to diffuse alveolar damage and rupture, as well as myocarditis which may be the precipitant to the development of pneumomediastinum and pneumopericardium. This case highlights the findings of pneumopericardium and pneumomediastinum in the novel SARS-CoV-2 virus. Given the multiple reported cases with similar time frames to the development of spontaneous pneumomediastinum in COVID-19 patients, an association between COVID-19 and spontaneous pneumomediastinum should be further studied.