4. DİSCUSSİON

When the distribution of the participants was examined according to their sports branch, football was the most preferred branch with 16.6%, followed by volleyball and swimming. When the data were compared in terms of dependent variable, there was a statistically significant difference in terms of cardiac rate, HDL, LDL, calcium, ALT, diastolic blood pressure, and the number of training times per week, there was no significant difference in other variables. When the categorical variables were compared according to the main outcome measures of the participants, a statistically significant difference was found in terms of ventricular hypertrophy, T wave, and deviation in cardiac axis.
Sudden athlete deaths, injuries during sports and variability in athlete performances have led to the discussion of the examination of athletes. The athletes underwent an evaluation including potential personal health history, family history, history of drug use, physical examination and possible diagnostic tests to identify potential risks for heart disease, musculoskeletal disease, neurological diseases, respiratory disease, bleeding disorders and psychiatric disorders, they kept.
The athletes underwent an evaluation including potential personal health history, family history, history of drug use, physical examination and possible diagnostic tests to identify potential risks for heart disease, musculoskeletal disease, neurological diseases, respiratory disease, bleeding disorders and psychiatric disorders. they kept.
Blood tests and ECG can be used to assess the structure and function of the heart and the health status of the organs. Abnormal findings detected in history, physical examination, blood tests or ECG may lead to further diagnostic tests and evaluations.18 In our study, pathology was detected in the light of these findings in 13.8% of the participants (25 people) and referred to internal medicine, cardiology and pediatric hematology departments for further diagnostic tests and evaluations. However, it was concluded that the pathologies identified as a result of the analyzes did not prevent the participants from doing sports.
An important issue that limits physical examinations before participation in sports is the potential to cause unnecessary tests.19 False positive findings in tests may cause unnecessary anxiety in the patient and may lead to further tests. In order to ensure that unnecessary testing and treatment are minimized, it is important for the physician to evaluate each athlete according to his condition.20
The fact that there are many interested in football among the participants may be due to the interest in football in our country as well as the fact that it requires more team players compared to other branches. The fact that the number of those who were interested in swimming was relatively high among those who participated in the study suggested that health awareness might be higher among those who preferred this branch.
The use of doping is known to increase hemoglobin levels.21 In our study, hemoglobin level was found to be significantly higher in the group with pathology. This increased the suspicion that the higher pathological findings may be due to doping in the group with high number of training sessions per week. In addition, it was evaluated that both the intensity of training and the desire to use doping may be higher in individuals with high ambition to win.
An important reason for pre-accession screening in athletes is the effort to prevent sudden deaths. The main cardiac causes of sudden death in athletes are; hypertrophic cardiomyopathy, cardiac conduction problems, coronary artery anomalies, cardiac arrest due to severe blows to the chest and upper respiratory tract infection may be considered as carditis.22 Hypertrophic cardiomyopathy (36%), coronary anomalies (19%) and cardiac mass increase (10%) were found in the top three in a study that investigated sudden deaths in 158 competing athletes in the United States between 1985 and 1995.23
Both the American Heart Association (AHA) and the European Cardiology Association (ESC) panel recommendations agreed that young competing athletes should be screened for cardiac exposure.24,25However, there are differences in screening methods. While AHA recommends a complete medical history and family history with physical examination, ESC recommends the routine use of a 12-lead ECG in the initial screening.26
Hypertrophic cardiomyopathy or right ventricular cardiomyopathy shows various ECG changes, including straight or deeply inverted T waves and deep Q waves (including a dramatic increase in R or S wave voltage) indicating the presence of structural cardiovascular disease. In a study conducted with 1005 individuals from 38 different sports branches comparing ECG with echocardiography, 40% of the participants had abnormal ECG findings and 5% had structural heart problems.27
In our study, ECG findings were interpreted pathologically in 4 people (2.2%); one person had delta wave, two had right bundle branch block (one with axial deviation), and one had short QTc. It appears that the pathological ECGs interpreted as belonging to men. This may be due to the fact that most of the participants (81.8%) are men. On the other hand, it has been considered that male gender is a risk factor in itself for sudden cardiac death.22 However, it was understood that these findings did not predict the important pathologies that would prevent the individuals from continuing their sports life.
There are different applications for screening methods. The main reason for this difference is the variability in cost approach. According to a study conducted in the USA in 2012, the cost of more than $ 10 million is saved in every case where sudden death is prevented by ECG.28 In the same study, it is strangely argued that ECG is a financial burden on the US economy and may hinder the implementation of some methods that can be used to prevent cardiac death. In addition, according to another study led by Italian researchers, a screening program in which ECG will not be used will be both more expensive and insufficient to identify heart disease.29 It is thought that this difference in opinion on cost effectiveness depends on different structuring of health systems. In this regard, the health system in terms of cost-effectiveness of screening with ECG in Turkey closer to European Union countries that have been evaluated would be more useful.
The existence of family medicine practice in our country can be used as a great advantage in this respect. From birth to death, it will be very easy for a family physician to monitor and record at least one ECG record for participation in sports to a person with records. In addition, 12-lead ECG is not widely used and interpretable in our country. It is considered that it would be beneficial to take measures to eliminate the lack of education in this regard.
It will be necessary to interpret this research with some limitations. First, the age range of athletes is distributed over a wide range. The possibility of such a wide range of influences should be kept in mind. On the other hand, muscle building protein contents, anabolic steroids that athletes may use are not considered. In addition, the lack of examination and laboratory data of athletes before starting sports can be considered a limitation.

5. CONCLUSİON

The presence of conditions that may pose a risk to the health of athletes in people who are engaged in active sports suggests that some findings have been missed in the examinations for entry to sports. This research shows that health screening is important for the health of the athlete, although a health report is obtained to start sports in the current practice, some pathologies can be omitted, on the other hand, only anamnesis and physical examination may not be sufficient to determine the health problems and basic laboratory tests should be performed. Based on this research, a national guide for sports entry examinations and screening of athletes should be developed with larger sample and multi-center studies.