Articles: disease.
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Case Reports
A Case Series of Ocular Syphilis Cases at Military Treatment Facility From 2020 to 2021.
Syphilis is a sexually transmitted infection, caused by the spirochete Treponema pallidum, that can lead to multi-organ involvement. In 2020, over 138,000 cases were reported in the United States equating to a case report of 40.8 per 100,000 people. Ocular syphilis is a rare manifestation and is defined as the clinical presentation of ocular disease in a person with laboratory-confirmed syphilis infection of any stage, with estimated incidence of 0.6-2% of all cases. ⋯ This highlights the need for providers to have a high level of clinical suspicion and awareness of ocular manifestations of syphilis, especially in high risk populations. We present a case series of five patients diagnosed with ocular syphilis at a military treatment facility. Each patient had different presenting symptoms as well as different ocular manifestations.
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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.
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The National Guard (NG) served as a critical component of the USA's response to the Coronavirus Disease 2019 (COVID-19) pandemic, while concurrently managing their personal responses to the pandemic. Determining whether the activation of NG service members in response to the COVID-19 pandemic was associated with a greater psychological strain can identify NG's needs for mental health support. ⋯ COVID-19 activation did not increase the risk of mental health difficulties among NGU service members. However, low levels of unit cohesion were associated with the risk of PTSD, anxiety and depression, and anger, and low levels of leadership were associated with the risk of PTSD and anger. The results suggest a resilient psychological response to COVID-19 activation and the potential for strengthening all NG service members through enhancing unit cohesion and leadership support. Future research on specific activation exposures, including the type of work tasks in which service members are engaged, particularly those associated with high-stress work conditions, is needed to help better understand their activation experience and how it may influence post-activation responses.
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Clinicians may confuse an impaired sensitivity to thyroid hormone with hyperthyroidism and offer an inappropriate treatment. We report a diagnosis of resistance to thyroid hormone (RTH) caused by a rare mutation in the thyroid hormone receptor beta gene in a patient previously presumed to have Graves' disease. We have found only one published case of a novel point mutation, c.749T>C (p. ⋯ Thyroid ablation should generally be avoided. Clinicians must be cautious whenever they encounter concurrent elevation of TSH, FT4, and FT3. This RTH-beta patient has a rare I250T mutant of the thyroid hormone receptor beta gene, the second reported case in the literature.
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Military service members (SMs) demonstrate high rates of patellofemoral chondral defects (PFCDs) that are difficult to diagnosis and, if untreated, result in a cascade of events eventually leading to osteoarthritis. Running is an essential occupational task for SMs; however, there is little evidence regarding techniques to maintain running ability in individuals with cartilage defects. The purpose of this case series was to assess the clinical application of foot strike run retraining in patients with PFCDs. ⋯ Biomechanical analysis showed that both patients demonstrated a 63% to 70% reduction in average and peak vertical ground reaction force loading rates post-treatment. Modification of foot strike pattern from rear to non-rearfoot strike during running for individuals with PFCD can reduce the magnitude of impact loading, which potentially limits disease progression. These findings suggest that foot strike run retraining may be a feasible strategy to reduce pain and improve function in SMs with PFCD who are required to run for occupational responsibilities.