Emergency department usage and medical care needs of adolescent participants in a high-intensity wrestling cAMP.

BACKGROUND: Thousands of children and adolescents attend high-intensity athletic camps each year; the rate and type of injuries sustained are unknown. HYPOTHESIS: Participants in a high-intensity athletic camp would have significant, identifiable health care needs associated with injuries and illnesses. STUDY DESIGN: Retrospective, observational study. METHODS: Acute medical care for camp participants was primarily provided in an academic medical center emergency department (ED). All participants treated in the ED or by a volunteer camp physician were included in the study. Medical and camp records for camp participants were reviewed and described. RESULTS: In sum, 263 participants attended the high-intensity wrestling camp in 2009. Seventy-eight (30%) were treated in the ED; median age was 15.8 years. Sixteen were seen more than once, totaling 96 visits. Thirty-four percent of visits included x-ray and 25% laboratory studies. Forty-four percent were skin complaints. One patient had methicillin-resistant Staphylococcus aureus infection; none had positive viral skin cultures. Musculoskeletal or facial trauma occurred in 37%, with 5 fractures. Injury rate was 1.9 per 1000 athlete exposures. Overall, 47% of campers sought medical care during camp; 11 (4.2%) left camp early because of illness or injury. Few wrestlers received follow-up care. CONCLUSIONS: Illnesses and injuries requiring medical attention were common in this high-intensity sports camp. While many ED patients could have been treated in a clinic, 50% required ED medical resources for diagnosis or care.

Valacyclovir pharmacokinetics and exploratory pharmacodynamics in young adults with Epstein-Barr virus infectious mononucleosis.

Primary Epstein-Barr virus (EBV) infection often results in infectious mononucleosis and is associated with serious sequelae. No treatment is approved for EBV infection, and an antiviral intervention would be significant. The objectives of this study are to characterize the pharmacokinetics and explore the pharmacodynamics of acyclovir in plasma and oral washings of 8 subjects receiving 7 days of valacyclovir 1500 mg twice daily for EBV infectious mononucleosis. Virologic and clinical responses are assessed over 12 days. Acyclovir is measured by liquid chromatography/ultraviolet detection. EBV DNA is quantitated by TaqMan polymerase chain reaction. NONMEM VI and linear regression are used for data analysis. Acyclovir profiles in plasma and oral washings are consistent with a 1-compartment model. Final model estimates of clearance, volume of distribution, and fraction of acyclovir in oral wash supernatant are 49.9 L/h, 74.1 L, and 1.14%, respectively. The quantity of EBV DNA in oral washings and blood, and the severity of illness, measured by a graded scale, decrease during treatment. After treatment, viral rebound occurs in oral washings but not in blood, and the severity of illness continues to decline. Acyclovir pharmacokinetic parameters do not correlate with response metrics. These results support further studies of valacyclovir for EBV infectious mononucleosis.

The epidemiology and clinical analysis of several outbreaks of herpes gladiatorum.

UNLABELLED: PURPOSE The purpose of this analysis was to determine whether present National Federation of State High School Associations (NFHS) guidelines adequately prevent and control outbreaks of primary herpes gladiatorum (HG) in high-school wrestlers. METHODS: Using telephone interviews, direct physical examinations, and review of medical charts, data were collected on HG outbreaks among participating teams in the 1999 Minnesota State High School League (MSHSL) wrestling season and on HG outbreaks for 3 yr at a 28-d summer wrestling camp. RESULTS: The outbreak during the 1999 MSHSL wrestling season involved 61 wrestlers and three coaches on 19 teams over 42 d, with a 32.7% probability of transmission to sparring partners. Typical length of time from exposure to outbreak varied from 4 to 11 d with an average of 6.80 +/- 1.70 d. Analysis of data from three outbreaks at a 28-d wrestling camp showed that most outbreaks (96%) occurred on the ventral surface of the body, with 71.9% on the head, face, and neck, areas in direct contact when wrestlers are engaged in the lock-up position. Analysis of data from the 2001 camp outbreak showed that the locations of the lesions reflected the handedness of the wrestler. CONCLUSION: The NFHS guidelines are inadequate to prevent and control outbreaks of HG. The focus of preventive efforts needs to change from mat cleanliness to more rapid detection of outbreaks by requiring culture results and appropriate therapy for all suspected bacterial and herpes lesions before allowing return to contact. To minimize and control spread of HG, treatment and isolation should be implemented based not only on vesicle formation but also on systemic signs and symptoms.