Military medicine
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This report examines the etiology of hemiballistic movements that began 24 hours after a 63-year-old male with vascular risk factors received tissue plasminogen activator (tPa) and thrombolysis in cerebral ischemia 3 (TICI3) thrombectomy for a left middle cerebral artery (MCA) ischemic stroke. The clinical course was reviewed from an admission at a large academic institution where assessments included physical exams, head and neck computed tomography angiography (CTA), and head magnetic resonance imaging (MRI) without contrast. The patient's initial physical exam was consistent with a left MCA syndrome and included a National Institute of Health Stroke Scale (NIHSS) of 20. ⋯ No prior cases of hemiballism have been reported as a likely complication of treatment with tPa and thrombectomy. The globus pallidus is the suspected origin of the ballistic movements either from a decreased insular signal or embolic event during treatment. As stroke interventions improve, the susceptibility of certain tissues to brief ischemic events during treatment must be assessed.
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Gender distribution in academic ob-gyn leadership positions has previously been examined in the civilian sector, but not in military medicine. ⋯ In contrast to civilian academic leadership positions, Department Chairs were most likely to be uro-gynecologists. Similar to civilian programs, women remain underrepresented as chairs, Assistant Chairs, Fellowship Directors, and Division Directors and similarly represented as Residency Program Directors. Despite a smaller pool of women available to fill academic leadership positions in military ob-gyn departments, the proportion of women in leadership roles reaches parity with the civilian sector. This suggests that a greater proportion of women rise to leadership positions in military academic ob-gyn departments than in the civilian sector.
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We present a rare case of cashew-induced oxalate nephropathy in a 69 year old veteran male with history of type 2 diabetes mellitus, nephrolithiasis, and undiagnosed chronic kidney disease (CKD). Oxalate nephropathy is a rare cause of acute renal failure with poor prognosis. The various causes of oxalate nephropathy are categorized as primary or secondary hyperoxaluria. ⋯ Diet-induced oxalate nephropathy is often identified after unexplained acute kidney injury in patients with underlying CKD. Definitive diagnosis requires renal biopsy as laboratory tests are non-specific. A simple dietary history in CKD patients during routine primary care visit may lead to early diagnosis and lead to prevention of acute renal failure and progression of renal disease.
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Editorial Comment
Army Urban Augmentation Medical Task Forces for COVID-19: Part 2-Initial Utilization.
This article describes the utilization of a new ad hoc medical formation, named Urban Augmentation Medical Task Force for the Department of Defense response to the coronavirus disease 2019 pandemic in the Continental United States during the spring of 2020. Military medical personnel from these units were used to staff a variety of different mission assignments. We review the benefits and limitation of this type of formation and recommend future force allocation models.
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Adequate energy supply is a prerequisite for optimal performances and recovery. The aims of the present study were to estimate energy balance and energy availability during a selection course for Belgian paratroopers. ⋯ Energy intake is not optimal as indicated by the negative energy balance and the low energy availability, which means that the participants to this selection course had to perform in suboptimal conditions.