Military medicine
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Mediastinal masses can be challenging to the surgical team and anesthetic considerations vary according to the location, pathology, surgical approach, and patient comorbidities. We report the case of a 21 cm symptomatic intrathoracic teratoma in a postpartum patient with a history of poliomyelitis. Significant challenges were presented for anesthetic induction, potential extracorporeal membrane oxygenation, and the use of neuraxial pain techniques and neuromuscular blockade. This case report demonstrates techniques to safely manage a patient with a large symptomatic mediastinal mass and potential neuromuscular disease.
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Review Case Reports
Moral Injury Among Nigerian Soldiers Following Combat: Case Reports and a Review of the Literature.
Moral injury is a phenomenon in which unpleasant psychological consequences such as guilt and shame follow exposure to activities that transgress one's deeply held moral beliefs and expectations. Combat engagement places service members at a heightened risk on account of exposure to potentially morally injurious experiences (PMIEs). It remains a more recent construct in comparison with posttraumatic stress disorder (PTSD) despite several studies. ⋯ We report three cases of personnel of the Nigerian Army referred to our clinic after combat in northeastern Nigeria and following exposure to PMIE, the circumstances of exposure to morally injurious situations and subsequent reactions. Our study brought up several findings including the effect of exposure to multiple potentially injurious events, apparent frequent co-occurrence of moral injury with PTSD, and the complicating unpleasant mental health outcomes. Being a report of cases, this implies that generalizations might not be warranted but serve as possible questions for future research.
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Since its detection in the early 1980s, HIV and AIDS have claimed 32.7 million lives. The HIV epidemic continues to plague the world with its most devastating effects felt in Eastern and Southern Africa. The exposure, vulnerability, and impact of HIV have been prominent among military personnel due to environmental, demographic, and socioeconomic characteristics. Policies have been developed to mitigate its exposure, vulnerability, and impact on the military. However, there are disparities across these policies, especially on recruitment, enlistment, and deployment. These contentions inspired this evaluation, which was designed to provide vital information and insights for militaries developing new HIV policies, for example, the Ghana Armed Forces (GAF). ⋯ First, the contents of the military policies are not very diverse since most militaries do not enlist or deploy PLHIV except few countries including SA. Implementation and interpretation is however inconsistent. Some militaries continue to exclude PLHIV despite the existence of policies that permit their inclusion. Second, discrepancies exist among the military policies, national legislations, and international policies. The UN policy is not coherent and empowers the military to exclude PLHIV. Also, potential costs to be incurred, in the form of compensation and repatriation, seem to be a major factor in the decision to deploy HIV-positive service members. Harmonization of military HIV policies to ensure uniform standards, interpretation, and implementation and the coherence of the UN policy are essential to guide countries developing new policies, for example, GAF.
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Although there is increasing awareness of brachial plexopathy secondary to rucksack use, isolated mononeuropathies have been less well described. Three cases of mononeuropathy secondary to rucksack use in military personnel are presented, including injuries to the long thoracic and spinal accessory nerves. We also review several different factors in the proper construction, components, and fitting of the rucksack that should be considered in order to prevent rucksack palsy and provide a concise suggestion for rucksack use and education.
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Understanding how soldiers die after separation from military service, particularly those who die shortly after separating from service, may help to identify opportunities to ease transitions to civilian life. ⋯ The time period immediately following separation from the Army presents a unique challenge for many soldiers. Developing more effective pre-separation prevention programs that target specific risks requires knowing the causes of death for natural deaths, suicides, and accidents. Over half of all deaths occurring shortly after separation from service are preventable. Continued surveillance of specific causes of preventable deaths following separation can improve pre-separation prevention programs and transitions to post-service care.