Neutral metallated and meso-substituted porphyrins as antimicrobial agents against gram-positive pathogens.

Staphylococcus aureus is a bacterial pathogen that causes severe infections among humans. The increasing emergence of antibiotic resistance necessitates the development of new strategies to combat the spread of disease. One approach is photodynamic inactivation using porphyrin photosensitizers, which generate superoxide and other radicals in the presence of light, causing cell death via the oxidation of proteins and lipids. In this study, we analyzed a novel library of meso-substituted and metallated porphyrins for activity against multidrug-resistant S. aureus. From a library of 251 compounds, 51 showed antimicrobial activity, in three discrete classes of activity: those that functioned only in light, those that had toxicity only in darkness, and those that displayed activity regardless of illumination. We further demonstrated the broad-spectrum activity of these compounds against a variety of pathogens, including Bacillus anthracis, Enterococcus faecalis, and Escherichia coli. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) analyses of lead compounds (XPZ-263 and XPZ-271) revealed strong activity and killing towards methicillin-resistant S. aureus (MRSA) strains. An analysis of mutation frequencies revealed low incidences of resistance to lead compounds by E. coli and MRSA. Finally, an exploration of the underlying mechanism of action suggests that these compounds do not depend solely upon light-induced radical generation for toxicity, highlighting their potential for clinical applications.

Should a history section be included on the National Youth Sports Program preparticipation physical examination?

The National Youth Sports Program (NYSP) is an annual event sponsored by the National Collegiate Athletic Association that provides structured sports and enrichment programs to youth of low socioeconomic status. As part of the program, youths undergo a free medical examination that uses a physical examination checklist but does not include a section on medical history. To determine what additional information a medical history would provide, a history form was used in conjunction with the regular preparticipation examination for participants in the 1996 NYSP at the North Carolina Agricultural and Technical State University. The history form provided information such as family history of sudden death, personal history of asthma or bone injury, and whether participants took medications or used corrective lenses. Seventy-nine percent of the completed history forms documented a positive response to at least one question. Of these, only 5% had physical findings on examination. Conversely, 15% of participants had physical findings that were not reported on the history form. Because much of what is discovered by a medical history often is not found on physical examination and because history information can be used to prevent the occurrence of an accident or illness, this study suggests that the use of such a form is beneficial in providing a more comprehensive screening.

Lisfranc injury of the foot: a commonly missed diagnosis.

Lisfranc joint injuries are rare, complex and often misdiagnosed. Typical signs and symptoms include pain, swelling and the inability to bear weight. Clinically, these injuries vary from mild sprains to fracture-dislocations. On physical examination, swelling is found primarily over the midfoot region. Pain is elicited with palpation along the tarsometatarsal articulations, and force applied to this area may elicit medial or lateral pain. Radiographs showing diastasis of the normal architecture confirm the presence of a severe sprain and possible dislocation. Negative standard and weight-bearing radiographs do not rule out a mild (grade I) or moderate (grade II) sprain. Reevaluation may be necessary if pain and swelling continue for 10 days after the injury. Proper treatment of a mild to moderate Lisfranc injury improves the chance of successful healing and reduces the likelihood of complications. Patients with fractures and fracture-dislocations should be referred for surgical management.

The association between flexibility and running economy in sub-elite male distance runners.

The purpose of this study was to examine the association between nine measures of limb and trunk flexibility and running economy. Within a week prior to running economy assessment, and after 10 min of jogging at 3.13 m.s-1, 19 well-trained male sub-elite distance runners underwent two complete sets of lower limb and trunk flexibility assessments. Runners then completed two 10-min running economy assessment sessions on consecutive days at 4.13 m.s-1 following two 30-min sessions of treadmill accommodation at 4.13 m.s-1. Intraclass correlation coefficients indicated that the repeated flexibility measurements were highly reliable (X R = 0.92 +/- 0.09), as were the two running economy appraisals (R = 0.99). Correlational analyses revealed that dorsiflexion (r = 0.65) and standing hip rotation (r = 0.53) were significantly (P < or = 0.05) associated with the mean aerobic demand of running, such that runners who were less flexible on these measures were more economical. Although speculative, these results suggest that inflexibility in certain areas of the musculoskeletal system may enhance running economy in sub-elite male runners by increasing storage and return of elastic energy and minimizing the need for muscle-stabilizing activity.

Clearing athletes for participation in sports. The North Carolina Medical Society Sports Medicine Committee's recommended examination.

The North Carolina Medical Society's Medicine Committee has reviewed current U.S. literature on preparticipation examinations and adopted a documentation form that fits the specific needs of our state. In spite of a recently published comprehensive monograph on preparticipation physical evaluation, no national consensus exists about whether comprehensive preparticipation exams or brief, focused examinations are better. With this in mind, we limited medical history questions to those determined by previous studies to identify specific problems. Also included are evaluations of blood pressure, musculoskeletal, and cardiovascular systems since studies have shown significant yield from these. The same studies find little benefit from the remainder of a comprehensive physical assessment. The recommended evaluation represents a minimal standard and addresses the core areas likely to prevent athletes from participating safely in sports. No recommended exam could cover all issues that affect school-age athletes--health prevention, adolescent development, general medical care, and psychological stresses--but physicians can use the recording form as a starting point and incorporate a more extensive evaluation into the assessment of athletes found to be at increased risk. Consistent use of this examination should promote better detection of sport-specific risks related to cardiovascular disorders, asthma, musculoskeletal problems, concussions, heat-related problems, and general medical problems. The Sports Medicine Committee wants to promote physical activity. Before disqualifying athletes physicians should remember that the disqualification rate in published studies averages only 1%. When questions about the need for disqualification arise, consultation may be advisable.(ABSTRACT TRUNCATED AT 250 WORDS)

Leiomyosarcoma of the femoral vein in a marathon runner.

Leiomyosarcoma of the femoral vein is a rare tumor. Physicians involved in the care of athletic patients must not be cavalier in evaluating overuse injuries and should endeavor to make a specific diagnosis. If atypical findings, such as generalized extremity swelling, are present, the physician must consider systemic illness including malignancy in apparently healthy, physically active individuals.

Rehabilitation exercises for common sports injuries.

Residual weakness after joint injury is a risk factor for recurrent injury. A rehabilitation program helps patients recover strength and helps prevent further injuries. Orthopedic injuries account for 10 percent of visits to family physicians, yet many primary care physicians do not routinely prescribe rehabilitation exercises for injured patients. Illustrations of exercises for the hip, knee, ankle and shoulder are included as a reference for family physicians to use when prescribing rehabilitation exercises.

A prospective study of type A behavior and running injuries.

A prospective study was developed to examine whether personality factors predispose runners to injury. Forty runners who completed a type A behavior screening were followed for 1 year during which they documented their training mileage, injuries, and time lost from training because of injury. Runners with high scores on the type A behavior screening questionnaire experienced significantly more injuries, especially multiple injuries. Although not significant, high scorers lost nearly twice as much training time because of injury. No significant relationship was found between mileage and injury. The data suggest that a type A behavior score warrants consideration as a predictive risk factor when screening for potential running injuries.

Focusing the preparticipation sports examination.

Athletic preparticipation evaluations are among the most common routine health screening tools, yet no standardized approach to these evaluations has been adopted. This paper presents a focused preparticipation examination form developed by the authors with the assistance of the North Carolina Academy of Family Physicians' Task Force on Sports Medicine. After reviewing the major studies of preparticipation examinations, 11 basic questions that identify specific risks for sports participation were selected. Three specific components form the core of the physical examination: blood pressure measurement, a comprehensive orthopedic examination, and cardiovascular auscultation. Other portions of the physical examination may be included because of sport-specific risks or problems identified in the history, but are not routine. The rationale for this form and guidelines for the physician to make recommendations for sports participation and timing of reevaluation are discussed.

Myocardial infarction and denial.

Denial, a natural defense mechanism, can be either an appropriate or an inappropriate response to anginal pain. Myocardial infarction sufferers often delay several hours before seeking medical attention, and most deaths from infarction occur before hospitalization. These two facts indicate that denial may contribute to mortality from coronary artery disease. To encourage "stoical" patients to seek medical care, nonthreatening educational approaches to cardiac disease and concentrated efforts to reduce anxiety toward hospitals are needed. Family physicians knowledgeable about the effects of denial can screen cardiac-prone patients for inappropriate denial and alter diagnostic approaches in an attempt to lessen the role denial plays in cardiac deaths.

Head Injuries in Soccer.

In brief: Although soccer is considered a safe sport, fatal head injuries have occurred on rare occasion. Mechanisms of injury include heading the ball improperly and making head-to-head contact; injury may also occur when a forcefully kicked ball strikes a player's head. Goalkeepers most commonly sustain collision injuries when the head strikes the goalpost, the playing field, or another player's elbow, foot, or head. The author reviews the medical literature on soccer injuries and contends that rule changes and other measures may be more appropriate than the use of helmets to prevent head injuries.