Military medicine
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This report summarizes an outbreak of measles among five unvaccinated children living in a U. S. military community in Wiesbaden, Germany, in March to April of 2004. The index case was a 3-year-old whose parents' refusal to have their child vaccinated with measles-containing vaccine had been documented many times. ⋯ Record review revealed that only 71% of 19- to 35-month olds in the community had been vaccinated with measles-containing vaccine before the outbreak, creating a "pocket of susceptibility." Children of travelers, expatriates, and military service members are at increased risk from vaccine-preventable diseases. Vaccine refusal is increasingly common, resulting in pockets of susceptibility to vaccine-preventable diseases, and increasing the risk of outbreaks. Missed opportunities and other delays in vaccination can also contribute to these pockets of susceptibility.
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Case Reports
A case of malignant hyperthermia in a child encountered during a humanitarian assistance mission to the Philippines.
Potentially fatal operating room events have become largely preventable with advances in anesthesia and surgical technique. Nonetheless, some lethal emergencies remain unpredictable and can occur whenever general anesthesia is given. We describe a case of malignant hyperthermia encountered and treated during surgical operations concurrent with an overseas humanitarian assistance mission. This case highlights the clinical diversity of malignant hyperthemia as well as the importance of preparation for any potential adverse event wherever trigger agents may be used from the mundane to exotic locales.
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The objective of this study was to explore correlates of the use of firearms to commit suicide. ⋯ Gun ownership rates, legislation, and levels of community cohesiveness are significantly associated with the likelihood of psychiatric patients committing suicide with a gun.
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Brugada syndrome describes a subgroup of patients at risk for polymorphic ventricular tachycardia, ventricular fibrillation, and sudden cardiac death and is likely underdiagnosed among aviators. ⋯ Symptomatic patients displaying type 1 Brugada ECG (spontaneous or after sodium channel blockade) should receive an implantable cardioverter defibrillator and must be permanently disqualified. The Aeromedical Consultation Service should review all cases of Brugada syndrome and render a return to fly for asymptomatic nondiagnostic Brugada types.
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Increasing rates of coccidioidomycosis among the general population are being described. Given the large number of military personnel stationed and training in endemic areas, data regarding infection trends among military members would be informative. ⋯ Coccidioidomycosis incidence rates have significantly increased during the last 5 years among military beneficiaries. Active duty members were more likely to develop coccidioidomycosis than dependents or retirees, perhaps related to the number and intensity of exposures in this group.