Military medicine
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Electronic cigarettes continue to rise in popularity as a reportedly safe alternative to standard cigarette smoking. Their use has become common in our society and specifically in our young active duty population. ⋯ However, there is another potential risk associated with vaping: the relative ease at which vaping devices can be modified has allowed a growing community of users to invent novel ways of delivering higher concentrations of nicotine. Here, we describe two cases of active duty patients who presented to an emergency department with clinical nicotine toxicity after using a heavily modified e-cigarette.
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Many active duty service members and their health care providers feel that the current body mass index (BMI) standard for diagnosing obesity, BMI ≥30 kg/m2, may unfairly overclassify as obese those with higher muscle mass. Unfortunately, a closer look at the data available for service members repeatedly demonstrates the exact opposite: we are actually underestimating the rates of obesity in service members using current BMI cutoffs when compared with body fat mass as measured by either dual-energy X-ray absorptiometry or bioelectrical impedance analysis as the gold standard. Using a lower BMI threshold and refining positive results via history, exam, labs, and/or more specific measurements of body composition would more accurately estimate body fat percentage in active duty service members while remaining convenient and scalable. Given the current obesity epidemic in our nation, this suggests the critical need for new approaches to screening, as well as treatment, of overweight and obesity in our military to improve service readiness.
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Amidst a constrained supply of novel therapeutics for the outpatient treatment of mild-to-moderate COVID-19, clinicians face new challenges, especially among those practicing at overseas military treatment facilities. Although prescribers may be unfamiliar with these medications, appropriate use necessitates detailed query of patient symptomatology and familiarization with each drug's side effect profile. Risk stratification also requires careful consideration to patient-specific comorbidities and immunization status for determining whom to treat and how. In recognition of these complexities, a stepwise guide is provided here to aid clinicians in their management of outpatients with mild-to-moderate COVID-19.
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Leptospirosis and rickettsial diseases are global zoonotic diseases. In severe infection cases, mortality can range from 10% to 30%. Currently most epidemiological data available are based on outbreak investigations and hospital-based studies from endemic countries. The U.S. soldiers at military bases in these countries are highly vulnerable due to the fact that most of them are immunologically naïve to these pathogens. No risk assessment of leptospirosis and rickettsial diseases among U.S. military personnel in Honduras is currently available. This study was aimed at determining the prevalence of leptospirosis and rickettsial diseases in U.S. military personnel deployed to Honduras using serological assays. ⋯ Our results suggest a leptospirosis seroconversion rate of 7.3%, which is higher than the 0.9% and 3.9% seroconversion in Korea and Japan, respectively. The higher rate of seroconversion indicates potential risk of Leptospira exposure. Additional testing of water samples in the pools and pits around the training sites to locate the infected areas is important to eliminate or reduce future exposure to Leptospira during trainings. The rates of seroconversion for ST, MT, spotted fever Rickettsia, and QF were 4.3%, 1.9%, 3.9%, and 2.7%, respectively, indicating the potential exposure to a variety of rickettsial-related pathogens. Testing of vectors for rickettsial pathogens in the areas could inform effective vector control countermeasures to prevent exposure. Proper precaution and protective measures are needed to better protect military personnel deployed to Honduras.