Military medicine
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In order to decrease adverse donor reactions during blood donation, volunteers are screened to safely donate according to the U.S. Food and Drug Administration standards. Volunteers must be normocardic, with a pulse between 50 and 100 beats per minute. Bradycardic volunteers with a pulse lower than 50 beats per minute who otherwise meet requirements may donate with physician approval. Blood donors in military settings tend to be younger and more physically fit than the average donor population, resulting in a higher percentage of bradycardic donors. The relationship between bradycardia and adverse donor reactions has not been well studied. Herein, we aim to compare post-donation adverse reactions and the ability to complete donation between normocardic and bradycardic donors. ⋯ Donors with bradycardia are as safe to donate as normocardic donors. In the absence of comorbidities, blood donor centers should ensure their policies consider donation for volunteers with bradycardia.
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A 45-year-old otherwise healthy active duty male was admitted to the medical intensive care unit for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) encephalopathy associated with hyperpyrexia. Magnetic resonance imaging findings demonstrated cytotoxic lesions primarily at the midline of the splenium of corpus callosum (CLOCC). Similar cases involving hyperpyrexia in the setting of SARS-CoV2 infection have demonstrated exceedingly high-mortality outcomes. ⋯ Magnetic resonance imaging findings in this case show diffusion restriction of the corpus callosum without evidence of any Central Nervous System (CNS) vessel abnormality. Given that hyperpyrexia has a clear association with increased mortality and morbidity in the SARS-CoV2 infected population, the decision to initiate steroids and remdesivir regardless of respiratory status was made for the concern for severe SARS-CoV2 infection as demonstrated by the CLOCC. Additional cases will be needed to assess their potential use as a radiological marker of disease burden.
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The purpose of this qualitative study is to describe the clinical course of two patients who presented with new-onset seizures within hours of vaping and to survey neurologists' screening for vaping in such patients. A 30-subject single-institution survey found that 19 out of 30 neurology providers have not been subjectively qualifying vaping as a potential seizure-provoking factor since the 2019 emergence of literature on this topic. Inquiring about vaping during a new-onset seizure assessment could lead to earlier recognition of a seizure-provoking factor. Further investigations into the epileptogenicity of vaping are needed and the utility of AntiEpileptic Drug (AED) initiation for these patients is currently unknown.
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Chronic exertional compartment syndrome (CECS) can be a debilitating condition observed in athletes, including military service members. Surgical fascial release, first described in 1956, has long been a standard treatment despite symptom recurrence in up to 45% of surgically treated military service members. A 2013 case series introduced intracompartmental Botulinum Toxin-A (BoNT-A) injections as a nonsurgical CECS treatment option, demonstrating efficacy for 15 of 16 patients. ⋯ Military service member treated with ultrasound-guided BoNT-A for bilateral lower leg CECS. This patient achieved pain-free activities for 36 months with one treatment. This case, coupled with additional literature, supports consideration of BoNT-A as a potential long-term, nonsurgical alternative for CECS.
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The differential diagnosis of vesiculobullous lesions can be intimidating to the primary care provider. While some entities such as bullous impetigo may easily be diagnosed clinically if the patient's demographics as well as the lesion morphology and distribution present classically, atypical presentations may require additional laboratory studies for confirmation. We describe a case of bullous impetigo with characteristics that clinically mimicked two rare immunobullous dermatoses. Although extensive diagnostic testing was performed, we recommend an approach for primary care providers to initiate empiric treatment while maintaining awareness of less common immunobullous entities.