Military medicine
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Pharmacogenomics (PGx) plays a fundamental role in personalized medicine, providing an evidence-based treatment approach centered on the relationship between genomic variations and their effect on drug metabolism. Cytochrome P450 (CYP450) enzymes are responsible for the metabolism of most clinically prescribed drugs and a major source of variability in drug pharmacokinetics and pharmacodynamics. To assess the prevalence of PGx testing within the Military Health System (MHS), testing of specific CYP450 enzymes was evaluated. ⋯ Testing was found to be provider driven, suggesting a lack of a standardized approach to PGx and its application in patient care within the MHS. We initially recommend targeted education and revising testing labels to be more uniform and informative. Long-term recommendations include establishing pharmacy-driven protocols and point-of-care PGx testing to optimize patient outcomes.
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Concussion has become the signature injury facing the U.S. military. However, little is understood about the relationship between military fitness and concussion recovery. The current study examined the recoveries of cadets at a U.S. Service Academy to determine whether preinjury physical fitness improved recovery and whether recovery was associated with post-injury physical fitness measures. ⋯ Preconcussion physical fitness levels do not appear to impact concussion recovery time among a highly physically fit cohort. Possible methods to reduce the effect of symptom duration on strength-related physical fitness should be investigated along with evaluating reductions in strength as a possible mechanism for postconcussion injury risk.
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Pharmacogenomics is a pillar of personalized medicine that has the potential to deliver optimized treatment in many medical settings. Military medicine in the deployed setting is unique and therefore warrants separate assessment pertaining to its potential capabilities and impact. Pharmacogenomics for United States Active Duty Service Members medical care in the deployed setting has not, to our knowledge, been previously reviewed. ⋯ Drugs and pharmacogenomics liabilities were tabulated. Eight specific drugs or classes are expounded upon given the belief of the authors of their potential for impacting future treatment on the battlefield in the setting of prolonged field care. This review outlines several genes with liabilities in the prolonged field care setting and areas that may produce improved care with further study.
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Autonomic nervous system dysregulation is commonly observed in Gulf War illness (GWI). Using a new sample, we sought to replicate and extend findings from a previous study that found autonomic symptoms predicted physical functioning in Veterans with GWI. ⋯ Treatments that address autonomic dysregulation should be prioritized for research and clinical recommendations for Veterans with GWI who experience chronic pain.
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Developments in genetics, pharmacology, biomarker identification, imaging, and interventional biotechnology are enabling medicine to become increasingly more precise in "personalized" approaches to assessing and treating individual patients. Here we describe current scientific and technological developments in precision medicine and elucidate the dual-use risks of employing these tools and capabilities to exert disruptive influence upon human health, economics, social structure, military capabilities, and global dimensions of power. We advocate continued enterprise toward more completely addressing nuances in the ethical systems and approaches that can-and should-be implemented (and communicated) to more effectively inform policy to guide and govern the biosecurity and use of current and emerging bioscience and technology on the rapidly shifting global stage.