Military medicine
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Comparative Study
Optimizing Fetal Aneuploidy Screening in an Austere Military Clinical Environment: A Prenatal Cost Comparison.
Austere clinical settings, including remote military installations, face unique challenges in screening pregnant women for aneuploidy. The objective of this study was to compare the direct and indirect prenatal costs of traditional 2-part serum-based screening to cell-free DNA (cfDNA) for detection of trisomies 18 and 21 for a military treatment facility with limited in-house perinatal resources. ⋯ Cell-free DNA as an initial screening strategy offers enhanced detection rates for trisomies 18 and 21 but remains more costly than traditional screening when incorporating direct and indirect expenses. In a low volume setting with limited resources, the added cost may be justified given the implications of unrecognized aneuploidy.
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Increases in C-reactive protein (CRP) are used to track the inflammatory process of COVID-19 and are associated with disease state progression. Decreases in heart rate variability (HRV) correlate with worsening of disease states. This observational study tracks changes in HRV relative to changes in CRP in COVID-19 patients. ⋯ Substantial decreases in HRV preceded elevations in CRP in the ensuing 72 hours with a 90.9% positive predictive value. Early detection of increasing inflammation may prove vital in mitigating the deleterious effects of an abnormal inflammatory response, particularly in COVID-19 patients. This capability could have a major impact in triage and care of moderate to severe COVID-19 patients in major medical centers as well as field hospitals. This study demonstrates the potential value of short-segment, intermittent HRV analysis in COVID-19 patients.
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Per Joint Trauma System guidelines, military anesthesiologists are expected to be ready to lead an Acute Pain Service with regional anesthesia in combat casualty care. However, regional anesthesia practice volume has not been assessed in the military. The objective of this study was to assess regional anesthesia utilization among current residents and graduates of U.S. military anesthesiology residency programs. ⋯ These findings highlight the need for creative solutions to increase regional anesthesia training in military anesthesiology programs and continued ability to implement skills, such that all military anesthesiologists have adequate practice for deployed responsibilities.
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We present the experience of our U.S. Navy Role 2's deployment to the U.S. Central Command area of responsibility in support of Operation Inherent Resolve and serving a multinational, joint-service military base. We detail our efforts to establish a low-titer O (LTO) walking blood bank (WBB) in an effort to prepare for potential combat casualties. ⋯ A WBB based on LTO blood is possible in theater. In order to maximize donor pools, it is imperative that units deploying to forward areas complete titer and transfusion transmissible disease testing before arrival in theater.
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The novel human coronavirus of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has quickly swept throughout the entire world. As the ongoing pandemic has spread, recent studies have described children presenting with a multisystem inflammatory disorder sharing the features of Kawasaki disease (KD) and toxic shock syndrome, now named Multisystem Inflammatory Syndrome in Children (MIS-C). ⋯ Herein, we describe the presentation, clinical characteristics, and management of an 11-year-old boy with prolonged fever, strikingly elevated inflammatory markers, and profound, early coronary artery aneurysm consistent with a hyperinflammatory, multisystem disease temporally associated with coronavirus disease 2019. We highlight our multidisciplinary team's management with intravenous immunoglobulin, methylprednisolone, and an interleukin-1 receptor antagonist, anakinra, as a strategy to manage this multisystem, hyperinflammatory disease process.