Military medicine
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Pulse oximetry oxygen saturation (SpO2) does not distinguish carboxyhemoglobin (COHb) from oxyhemoglobin (O2Hb), giving a false impression of the apparent degree of oxyhemoglobin saturation in smokers who have elevated levels of COHb. We questioned whether accounting for smoking exposure history could improve description of pulse oximetry by correcting for COHb levels. We evaluated smoking history and %SpO2 as predictors of %O2Hb and %COHb by CO-oximetry of arterial blood in 18 actively smoking and 18 age-matched nonsmoking patients in a clinical pilot study. ⋯ This difference correlated with %COHb (rp = 0.789; p < 0.001) and the smoking exposure score (SES, rp = 0.621; p < 0.001), a six-point index we developed based on whether patients were active smokers, refrained from smoking prior to testing, or were exposed to passive smoking in the home or workplace. The following formula summarizes the correction: %O2Hb = 0.882[%SpO2] - 0.968[SES] + 9.245 (rp = 0.841; SES = 2.478; p < 0.001). This pilot study suggests that smoking exposure history correlates with COHb levels and that correction for smoking exposure improves the accuracy of pulse oximetry.
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To document the ongoing trauma experience of U.S. Army surgeons during peacetime clinical practice. ⋯ Our data support perceptions concerning lack of an ongoing trauma experience for military surgeons and reinforces the need for collaborative education and training in busy civilian trauma centers. A regional approach is suggested as a viable solution.
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Tunga penetrans is a burrowing flea that is prevalent in Central and South America, the Caribbean, tropical Africa, India, and Pakistan, and rarely is imported to the United States. Tungiasis results from the cutaneous infestation of humans by the gravid female flea, T. penetrans. We report a case of tungiasis in a female who had been on a missionary expedition along the Brazilian Amazon River. The clinical presentation, life cycle, differential diagnosis, military and historical aspects, and treatment are discussed.
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The prevalence and incidence of HIV-1 infection in the U. S. military has been higher in minorities than in whites. In order to understand the reason for this disproportionate impact of the epidemic, military HIV research efforts were reviewed for race/ethnic-specific differences in a conference held in July 1993. ⋯ This report summarizes the presentations made at that conference. Few race/ethnic-related differences were identified in this setting of early diagnosis of HIV-1 infection and equal access to a quality health care system. More information of this type will be needed to allow the targeting of interventions for maximal effect in decreasing the risk of HIV infection.