Military medicine
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Historical Article
Failure to Plan: The Disease That Cost an American Empire.
In 1802, the deadliest recorded epidemic of yellow fever struck a French expeditionary force, permanently destroying Napoleon Bonaparte's ambition to re-conquer Haiti and secure a North American empire. Toussaint L'Ouverture, Haitian revolutionary, effectively used his medical experience to spread this disease among French troops.
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Our goal was to develop a successful research collaboration program, Military Ob/Gyn HeadHunters, to connect military medical students with residents, fellows, and staff physicians across the Military Health System (MHS) to foster research collaboration and mentorship. ⋯ Our novel research collaboration program successfully connected military medical students with active researchers in the MHS. Leaders in medical education can consider adopting this framework to improve trainee participation in research.
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Randomized Controlled Trial
Inhaled Sargramostim (Recombinant Human Granulocyte-Macrophage Colony-Stimulating Factor) for COVID-19-Associated Acute Hypoxemia: Results of the Phase 2, Randomized, Open-Label Trial (iLeukPulm).
Granulocyte-macrophage colony-stimulating factor (GM-CSF), a protein produced in the lung, is essential for pulmonary host defense and alveolar integrity. Prior studies suggest potential benefits in several pulmonary conditions, including acute respiratory distress syndrome and viral infections. This trial evaluated the effect of the addition of inhaled sargramostim (yeast-derived, glycosylated recombinant human GM-CSF) to standard of care (SOC) on oxygenation and clinical outcomes in patients with COVID-19-associated acute hypoxemia. ⋯ The addition of inhaled sargramostim to SOC improved P(A-a)O2, a measure of oxygenation, by day 6 in hospitalized patients with COVID-19-associated acute hypoxemia and was well tolerated. Inhaled sargramostim is delivered directly to the lung, minimizing systemic effects, and is simple to administer making it a feasible treatment option in patients in settings where other therapy routes may be difficult. Although proportionally lower rates of intubation and mortality were observed in sargramostim-treated patients, this study was insufficiently powered to demonstrate significant changes in these outcomes. However, the significant improvement in gas exchange with sargramostim shows this inhalational treatment enhances pulmonary efficiency in this severe respiratory illness. These data provide strong support for further evaluation of sargramostim in high-risk patients with COVID-19.