Military medicine
-
Whipple's Disease (WD) is a rare disease caused by the infection of Tropheryma whipplei. It can lead to immunosuppression and a multitude of effects on different organ systems, resulting in a constellation of seemingly unrelated findings. Although treatment may appear straightforward, T. whipplei can be difficult to eradicate. ⋯ There have been previously reported cases of patients with WD with concomitant esophageal candidiasis, and this association implies a likely state of relative immunosuppression associated with WD, which is thought to be the result of impaired T helper cell 1 activity. This impairment likely contributes to the high rate of relapse. Having a low threshold for repeat evaluation is advisable for recurrent symptoms, but long-term surveillance strategies are not clearly defined.
-
Pediatric osteomyelitis is a rare diagnosis associated with devastating consequences when treatment is delayed. We report a case of hematogenous osteomyelitis in a 5-week-old male presenting to the emergency department (ED) with a flaccid right upper extremity. In the ED, the patient was evaluated with comprehensive infectious and trauma workups. ⋯ Empiric broad spectrum antibiotics were initiated, and the infant was admitted to the pediatric service. At 48 hours following presentation, cultures resulted positive for Staphylococcus aureus and MRI imaging revealed osteomyelitis of the proximal right humeral metadiaphysis. Given the subtle presentation of early hematogenous osteomyelitis, emergency providers should maintain a high index of suspicion for infection as the underlying cause in infants presenting with a flaccid extremity.
-
Health facility planning is a key global health engagement capability that assesses the health needs of a population and identifies the combination of services, equipment, facilities, and infrastructure necessary to support them. Collaboration with local health care and building professionals is essential to achieving local buy-in and sustainable solutions.
-
This was an in vivo animal study designed to investigate the interaction between dexamethasone (Dex) and microRNA-204 (miR-204) in a mouse alkali burn-induced corneal neovascularization (CNV) model. The function of miR-204 was then investigated in human mammary epithelial cells (HMECs) in vitro. ⋯ The role of Dex in attenuating CNV may be partly attributed to miR-204. MiR-204 may be a potential therapeutic target in alkali burn-induced CNV.
-
Vitamin toxicity represents an increasingly frequent clinical diagnosis and can be difficult to initially recognize given the plethora of over-the-counter supplements available. The young, active, and heavily male population of the military is especially susceptible to such supplementation pitfalls. Here we present the case of acute renal failure with hypercalcemia that was found to be secondary to unrecognized high-dose over-the-counter vitamin supplementation and subsequent vitamin D hypervitaminosis initiated by the patient in the hope of boosting testosterone production. This clinical scenario demonstrates the dangers of easily accessible, often seemingly benign supplements and the need for greater education and awareness of supplementation use.