Military medicine
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Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the U. S. military and accounts for more healthcare visits than the next two most common STIs combined. Human papillomavirus is preventable with a safe, effective, prophylactic vaccine that has been available since 2006, yet vaccination rates remain low. ⋯ With more than half of the 1.3 million service members in the catch-up vaccination age range of less than 26 years of age, we are poised to have a profound impact through mandatory active duty service member vaccination. Although multiple strategies for improving vaccination rates have been proposed, mandatory vaccination would be in line with current joint service policy that requires all ACIP-recommended vaccines. It is time to update the joint service guidelines and add HPV vaccine to the list of mandatory vaccines.
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Special Weapons and Tactics (SWAT) personnel who practice breaching with blast exposure are at risk for blast-related head trauma. We aimed to investigate the impact of low-level blast exposure on underlying white matter (WM) microstructure based on diffusion tensor imaging (DTI) and neurite orientation and density imaging (NODDI) in SWAT personnel before and after breacher training. Diffusion tensor imaging is an advanced MRI technique sensitive to underlying WM alterations. NODDI is a novel MRI technique emerged recently that acquires diffusion weighted data from multiple shells modeling for different compartments in the microstructural environment in the brain. We also aimed to evaluate the effect of a jugular vein compression collar device in mitigating the alteration of the diffusion properties in the WM as well as its role as a moderator on the association between the diffusion property changes and the blast exposure. ⋯ Our data provided initial evidence of the impact of blast exposure on WM diffusion alteration based on both DTI and NODDI. The mitigating effect of WM diffusivity changes and the moderating effect of collar wearing suggest that the device may serve as a promising solution to protect WM against blast exposure.
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Frostbite, or the freezing of the tissues by exposure to conditions below the freezing point of water, is an unsettling and potentially dangerous condition that one can develop while living and working in cold environments below 0°C without proper protections. Civilians and military personnel operating in prolonged field conditions in temperatures below freezing rely on advanced fabrics and multiple layers to maintain body heat around the extremities to prevent frostbite. Here, we detail the situation and findings of frostbite in 2 American service members who were exposed to temperatures of approximately -19.5°C for 5 hours while hiking on frozen sea ice. ⋯ The personnel presented with the classic signs and symptoms of second-degree frostbite with blistering and tingling but went on to have no lasting serious sequelae. We find these cases important as it documents the inadequacy of the footgear utilized, despite being operated in weather conditions within the range of the manufacturer's safety recommendations. Sea ice and other very cold, conducting surfaces may require other gear considerations when operating in this unique terrain type.
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Military physicians trained in military Graduate Medical Education programs are uniquely prepared to lead in austere and chaotic environments based on formal and informal curricula taught in military treatment facilities. The coronavirus disease-2019 pandemic highlighted this reality when military-trained physician leaders were challenged to lead change directly from the front.
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Case Reports
Accelerated Progression of Disseminated Coccidioidomycosis Following SARS-CoV-2 Infection: A Case Report.
We describe a patient with subclinical coccidioidomycosis who experienced rapid disease dissemination shortly after SARS-CoV-2 infection, suggesting host immune response dysregulation to coccidioidomycosis by SARS-CoV-2. We hypothesize that disrupted cell-mediated signaling may result after SARS-CoV-2 infection leading to functional exhaustion and CD8+ T-cell senescence with impairment in host cellular response to Coccidioides infection.