Military medicine
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It is important to understand the behavioral and occupational health needs of military police personnel, a high-risk and understudied population. ⋯ It is important to provide tailored resources and programming to employees in high-stress settings to help prevent or manage behavioral and occupational health conditions and reduce the stigma surrounding the utilization of such resources and programs.
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Case Reports
Case Report: Vision-Threatening Fungal Keratitis in a Service Member Stationed at Guantanamo Bay.
Fungal keratitis is a major cause of corneal blindness worldwide. Compared to other types of infectious keratitis, fungal keratitis has a relatively poor prognosis because of various factors such as delayed patient presentation and diagnosis. ⋯ Here, we report a case of a 20-year-old active duty contact lens-wearing military service member stationed at Guantanamo Bay who developed a severe vision-threatening fungal keratitis in her left eye. Enhancing health and safety precautions in at-risk settings, maintaining vigilance, and leveraging new imaging modalities will be important to ensure early recognition and treatment.
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Loaded ruck marching is a common training and operational task for many members of the military. It is known to cause fatigue, affect soldier readiness, and can lead to traumatic and overuse injuries. Quantifying the gait changes that occur over the course of a loaded ruck march may provide a better understanding of injury mechanisms and potentially allow for development of individualized injury-prevention training programs. This study examined the change in soldiers' gait patterns over the course of a loaded ruck march in order to examine the correlation between fatigue and kinematic parameters. Fatigue is a subjective term that may encompass factors such as energy expenditure, muscle exhaustion, and cognitive engagement. Since it can be difficult to quantify, the current study makes the broad assumption that fatigue increases in some (potentially nonlinear) fashion during a loaded ruck march. ⋯ Although they do not describe a direct relationship to injury, these results can inform enhanced approaches to quantify and predict soldier fatigue and more reliably prevent future injury.
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Veterans using the Veterans Administration Health Care System (VAHCS) for obstetrical care experience disparate pregnancy-related risks and health outcomes when compared to their pregnant counterparts. This study examined the prevalence of risk factors associated with pregnancy-related comorbidities among U.S. Veterans receiving obstetrical care using VAHCS benefits in Birmingham, Alabama. ⋯ The findings highlight the need for further examination of social factors that may be driving disparities among pregnant Veterans, who may benefit from supplemental services to address modifiable comorbidities. Additionally, the implementation of a centralized database to track pregnancy-related outcomes for Veterans would allow these comorbidities to be more closely monitored and addressed. Heightened awareness of a patient's Veteran status and associated increased risks can alert providers to screen for depression and anxiety more frequently and to familiarize themselves with additional services the VAHCS may offer to patients. These steps could improve referrals to counseling and/or targeted exercise interventions.
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Clinicians may confuse an impaired sensitivity to thyroid hormone with hyperthyroidism and offer an inappropriate treatment. We report a diagnosis of resistance to thyroid hormone (RTH) caused by a rare mutation in the thyroid hormone receptor beta gene in a patient previously presumed to have Graves' disease. We have found only one published case of a novel point mutation, c.749T>C (p. ⋯ Thyroid ablation should generally be avoided. Clinicians must be cautious whenever they encounter concurrent elevation of TSH, FT4, and FT3. This RTH-beta patient has a rare I250T mutant of the thyroid hormone receptor beta gene, the second reported case in the literature.