Articles: function.
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We report the case of a 37-year-old man presenting with pain out of proportion to the exam with hydrofluoric acid burns to his upper extremities after he spilled a wheel-stripping compound on his forearms while working at his powder coating business. His burns initially appeared mild and superficial, but over the course of several days, these evolved from simple erythema to significant partial thickness tissue destruction and ulceration. He required substantial topical, intradermal, and intravenous therapies to control the unseen burning process during his index visit to the emergency department. ⋯ Following nonoperative management, he had an uneventful recovery with full function retained in the affected extremities. Hydrofluoric acid burns require prompt treatment with calcium to neutralize the burning process, despite a potentially benign initial appearance. The emergency clinician should use an aggressive diagnostic and therapeutic approach to patients presenting with pain out of proportion to their exam, as this finding is associated with various serious underlying pathology.
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Randomized Controlled Trial
Electromyostimulation With Blood Flow Restriction for Patellofemoral Pain Syndrome in Active Duty Military Personnel: A Randomized Controlled Trial.
The high prevalence of patellofemoral pain in military service members results in strength loss, pain, and functional limitations during required physical performance tasks. Knee pain is often the limiting factor during high-intensity exercise for strengthening and functional improvement, thus limiting certain therapies. Blood flow restriction (BFR) improves muscle strength when combined with resistance or aerobic exercise and may serve as a possible alternative to high-intensity training during recovery. In our previous work, we showed that Neuromuscular electrical stimulation (NMES) improves pain, strength, and function in patellofemoral pain syndrome (PFPS), which led us to ask whether the addition of BFR to NMES would result in further improvements. This randomized controlled trial compared knee and hip muscle strength, pain, and physical performance of service members with PFPS who received BFR-NMES (80% limb occlusion pressure [LOP]) or BFR-NMES set at 20 mmHg (active control/sham) over 9 weeks. ⋯ NMES strength training offers moderate improvements in strength, pain, and performance; however, BFR did not provide an additive effect to NMES plus exercise. Improvements were positively related to the number of BFR-NMES treatments and NMES usage.
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PTSD is common among veteran combatants. PTSD is characterized by brain changes, for which available treatments have shown limited effect. In a short-term study, we showed that hyperbaric oxygen therapy (HBOT) induced neuroplasticity and improved clinical symptoms of veterans with treatment-resistant PTSD. Here, we evaluated the long-term clinical symptoms of the participants of that study. ⋯ The beneficial clinical effects of HBOT are persistent and were not attenuated at long-term follow-up of about 2 years after completion of HBOT. Additional long-term effects of the treatment were observed in social function and in decreased medication use.
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Alcohol use disorder (AUD) and PTSD have high rates of co-occurrence in U.S. Military Veterans resulting in incrementally worse functional outcomes relative to having either one of these disorders alone. Cognitive dysfunction can impede one's ability to benefit from standard behavioral AUD and PTSD treatments. Cigarette smoking is also highly prevalent among U.S. Military Veterans, and cognitive dysfunction is associated with chronic cigarette use among individuals with AUD and PTSD independently. However, much less is known about to what extent cigarette smoking further impairs cognitive functioning in individuals with both co-occurring AUD and PTSD. ⋯ Overall, results provide evidence for the compounding impact of alcohol use, traumatic stress, and cigarette smoking on cognitive functioning. Impaired cognitive performance on a global level as well as on individual domains of cognitive inhibition and auditory-verbal learning were evident. Cognitive dysfunction may impede a Veteran's ability to benefit from therapeutic treatment, and these cognitive domains may represent potential targets for cognitive training efforts. Further, study results support smoking cessation initiatives and smoke-free policies enacted at Veterans Affairs healthcare facilities and medical centers.
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Neuromusculoskeletal injuries (NMSKI) are very common in the military, which contribute to short- and long-term disability. ⋯ Body region, sex, age, rank, and branch were the salient factors for NMSKI. The significant protective effect during the pandemic was likely a function of reduced physical exposure and limited access to nonurgent care. Geographically accessible specialized care, aligned with communities with the greatest risk, is needed for timely NMSKI prevention, assessment, and treatment.