Military medicine
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Gestational diabetes mellitus (GDM) affects approximately 1-14% of all pregnancies in the United States and has significant maternal and neonatal consequences. Developing GDM can increase a patient's risk of developing overt diabetes in the future which may impact a soldier's readiness. The purpose of this study is to compare the incidence of GDM in active duty females compared with civilian dependents. ⋯ This study highlights active duty females have similar rates of GDM as dependents. Gestational diabetes mellitus is known to affect short- and long-term maternal and neonatal outcomes and can impact a soldier's readiness. Further research is required to determine the long-term impact of GDM in active duty females and best practices to decrease rates of GDM in the military population.
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Outbreaks of gastrointestinal disease among military service personnel can have severe impact on operational effectivity and force readiness. Thus, early outbreak detection is critical to minimize spread. This pilot study aimed to explore field-based molecular screening of sewage as a supplemental tool in early outbreak warning before disease is diagnosed in personnel seeking medical care. ⋯ Molecular screening of sewage allows rapid detection of multiple gastrointestinal pathogens in biological waste from military camps. However, background levels of pathogens challenges interpretation of qualitative analyses in outbreak situations. As such, quantitative measures, as well as high-resolution sequence-based methods, which allows strain identification and broader target spectrum, should be further explored in future studies.
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Case Reports
Andexanet Alfa Use for Small Bowel Obstruction Patient With History of Sugiura Procedure.
This case report is about a 51-year-old active duty male with JAK2 mutation and medical history significant for prehepatic portal hypertension from portal vein thrombus on lifelong anticoagulation with rivaroxaban, an oral factor Xa inhibitor, presenting with closed-loop small bowel obstruction requiring emergent laparotomy. We present this surgical case as it required emergent reversal of the oral factor Xa inhibitor with andexanet alfa.
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The lifetime prevalence for development of Posttraumatic Stress Disorder (PTSD) among military combat veterans has been estimated to be as high as 17%, or more than double the national average. The stellate ganglion block (SGB) has been proposed as a PTSD treatment modality that may potentially affect positive change in the attitude of a service member (SM) toward mental health treatment, lead to improved clinical outcomes, promote the likelihood of a return to a productive job performance, and decrease the economic burden of PTSD treatment on the Department of Defense. ⋯ The most significant benefit of the SGB appears to be its ability to act as a gateway to treatment and to facilitate active participation and compliance by the SM during its "window" of efficacy. Additional research, including RCTs are required to continue to evaluate its efficacy relative to symptom-specific effectiveness, effectiveness of sequential procedures, and effectiveness when combined with other nonpharmaceutical treatment modalities. Moreover, the application of an accepted medical procedure as a mental health (MH) therapy with marked reduction in stigma, encourages pursuit of additional such treatment methods that reduce stigma and promote active SM participation in PTSD management.
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To evaluate whether a daily full-dose aspirin regimen after anterior cruciate ligament (ACL) reconstruction reduces the risk of postoperative symptomatic deep-venous thrombosis (DVT). ⋯ No statistically significant difference was observed in postoperative symptomatic DVT after ACL reconstruction in those who received full-dose aspirin chemoprophylaxis versus those with no chemoprophylaxis. Additionally, there was a significantly increased risk of postoperative symptomatic DVT with tobacco use.