Facial Nerve Paresis: Case Report of Blunt Facial Nerve Injury.

Facial nerve paresis is an uncommon but concerning condition in the pediatric population. The function and anatomy of the facial nerve is complex, and injuries to this structure may be associated with devastating physiological and psychological implications for the affected child and family. The purpose of this paper was to report a case involving a six-year-old Caucasian female who suffered a blunt traumatic injury to the orofacial region resulting in partial paralysis of the seventh cranial nerve.

Sandfly fever in Afghanistan-a sometimes overlooked disease of military importance: a case series and review of the literature.

Sandfly fever, sometimes known as pappataci fever or Phlebotomus fever, is a vector transmitted viral illness with a history of affecting naïve military formations that travel through or fight in areas in which the infection is endemic. We present a series of 4 hospitalized cases of sandfly fever (2 presumptive, 2 laboratory confirmed) that were admitted to a Role 3 hospital in Afghanistan for evaluation and treatment following medical evacuation from a forward area for marked fevers and malaise. Laboratory evaluation of these cases was significant for leukopenia and thrombocytopenia, consistent with historical descriptions of sandfly fever.

The Epidemiology and Natural History of Anterior Shoulder Instability.

Purpose Of Review: The purpose of this review is to outline the natural history and best clinical practices for nonoperative management of anterior shoulder instability.

Recent Findings: Recent studies continue to demonstrate a role for nonoperative treatment in the successful long-term management of anterior glenohumeral instability. The success of different positions of shoulder immobilization is reviewed as well.

The implementation of prolonged exposure: Design of a multisite study evaluating the usefulness of workshop with and without consultation.

This randomized trial examines the dissemination and implementation of prolonged exposure (PE) therapy for posttraumatic stress symptoms in U.S. Army medical treatment facilities.

Arthroscopic treatment of posterior shoulder instability in patients with and without glenoid dysplasia: a comparative outcomes analysis.

Background: The purpose of this study was to evaluate the influence of glenoid dysplasia on outcomes after isolated arthroscopic posterior labral repair in a young military population.

Methods: Thirty-seven male patients who underwent arthroscopic posterior labral repair for symptomatic posterior shoulder instability were evaluated at a mean duration of 3.1 years.

Severe Systemic Lead Toxicity Resulting From Extra-Articular Retained Shrapnel Presenting as Jaundice and Hepatitis: A Case Report and Review of the Literature.

Introduction: Despite greater than 60,000 nonfatal firearm injuries per year in the United States, retained shrapnel is a relatively rare cause of systemic lead toxicity with less than 100 cases reported in the medical literature since 1867. While intra-articular retained shrapnel as a cause of lead toxicity is well-described, extra-articular fragments are less well known to cause symptomatic disease.

Case Report: A 31-year-old man initially presented with abdominal pain, constipation, jaundice, and elevated liver transaminases approximately 3 weeks after suffering a left lower extremity injury during athletic activity.

The effect of chiropractic treatment on the reaction and response times of special operation forces military personnel: study protocol for a randomized controlled trial.

Background: Chiropractic care is commonly used to treat musculoskeletal conditions and has been endorsed by clinical practice guidelines as being evidence-based and cost-effective for the treatment of patients with low back pain. Gaps in the literature exist regarding the physiological outcomes of chiropractic treatment. Previous pilot work has indicated the possibility of improvements in response time following the application of chiropractic treatment.

Dismounted Blast Injuries in Patients Treated at a Role 3 Military Hospital in Afghanistan: Patterns of Injury and Mortality.

Background: The purposes of this study are to define the pattern of injuries sustained by dismounted troops exposed to improvised explosive devices blasts treated at a Role 3 combat support hospital and to assess injury patterns and mortality associated with the mechanism. Our hypothesis was that mortality is associated with pelvic fracture, massive transfusion, high Injury Severity Score (ISS), multiple limb amputations, and transfer from a Role 2 facility.

Study Design: Retrospective study of 457 patients.

Effects of Deployment on Musculoskeletal and Physiological Characteristics and Balance.

Despite many nonbattle injuries reported during deployment, few studies have been conducted to evaluate the effects of deployment on musculoskeletal and physiological characteristics and balance. A total of 35 active duty U.S.

Occult Pneumomediastinum in the Deployed Setting: Evaluation and Management.

Pneumomediastinum can occur after both blunt and penetrating trauma. The greatest concern involving this finding in a trauma patient is an aerodigestive tract injury. Prompt evaluation, identification, and management of these injuries are extremely important.

Sonographic Findings in Subcoracoid Impingement Syndrome: A Case Report and Literature Review.

Unlabelled: Subcoracoid impingement syndrome is a rare and underrecognized cause of anterior shoulder pain. Currently, subcoracoid impingement syndrome is understood to involve impingement of anatomic structures such as the subcoracoid bursa and subscapularis tendon within the coracohumeral space, and there are no reports of sonographic findings in subcoracoid impingement syndrome other than the impingement of thickened subscapularis bursa. Here we report a case of subcoracoid impingement syndrome, including a novel sonographic finding, arthroscopic findings, and a proposed pathophysiology.

Arthroscopic Anatomic Coracoclavicular Ligament Repair Using a 6-Strand Polyester Suture Tape and Cortical Button Construct.

Acromioclavicular separations are common injuries. Low-grade separations are typically managed with nonoperative treatment. However, surgical treatment is recommended for high-grade separations, as well as for chronic low-grade separations that remain symptomatic.

Normal Weight Status in Military Service Members Was Associated With Intuitive Eating Characteristic.

The purpose of this study was to determine the relationship between individual weight status and intuitive eating or motivation for eating characteristics. Participants were predominantly white (57%), Army (91%), enlisted (72%), males (71%), with a mean age of 30 ± 9 years and mean body mass index (BMI) of 27.0 ± 4.

Carpal Tunnel Syndrome in an Adolescent With Obesity.

Purpose: Carpal tunnel syndrome (CTS) is typically found in adults and may be associated with a variety of metabolic conditions including obesity. Obesity is a growing problem among today's youth, and adult diseases often associated with obesity are now being found in a younger population. This case study describes a young adolescent girl with obesity and CTS.

Intravenous Ondansetron and the QT Interval in Adult Emergency Department Patients: An Observational Study.

Objectives: Ondansetron is known to cause QT interval prolongation, but this effect and clinical significance has not been prospectively studied in adult emergency department (ED) patients. The primary objective was to determine the mean maximal corrected QT interval (QTc) prolongation after intravenous (IV) administration of 4 mg of ondansetron. The secondary objective was to report any serious adverse cardiac electrical events.

Osteomyelitis is Commonly Associated With Septic Arthritis of the Shoulder in Children.

Purpose: To describe the clinical presentation, management, and outcomes of surgically treated septic arthritis of the shoulder in a pediatric population.

Methods: A retrospective chart review over 5 years of children with operatively managed septic arthritis of the shoulder was completed. Demographics, clinical presentation, symptoms duration, antibiotic regimen and duration, number of surgical procedures, and evaluation of laboratory value improvements were collected.

Sickle Cell Trait Complicated by Acute Rhabdomyolysis in Military Personnel: A Case Report.

Sickle cell trait, a trait known to be protective against falciparum malaria, is prevalent in the African American community. Unlike true sickle cell disease, sickle cell trait is currently not a disqualifying condition for military service. In the case below, we describe an occurrence, from Logar Provence, Afghanistan (2,072 m above mean sea level), of exertional acute rhabdomyolysis in an American service member known to be a sickle cell trait carrier.

Pharmacologic prevention of human immunodeficiency virus in women: practical approaches for the obstetrician and gynecologist.

Importance: Obstetricians and gynecologists (Ob-Gyns) play a crucial role in efforts to detect and prevent human immunodeficiency virus (HIV) infection in women. Multiple strategies can be implemented into general practice as part of a comprehensive primary women's health care agenda. Educational and behavioral strategies to reduce HIV acquisition in women can now be supplemented with pharmacologic measures.

Impact of an Enduring War on Two Military Psychiatry Residency Programs.

Four active duty military psychiatrists at different points in their careers were asked to reflect on the impact that the wars in Iraq and Afghanistan had on their respective training in military psychiatry residency programs. The result is an inside look from four unique perspectives on how military psychiatry residency training adapted over time to prepare their graduates to practice psychiatry in a wartime setting as many graduates went to the front lines of war shortly after graduation. This article will provide an understanding of the challenges faced by these residency programs striving to meet the behavioral health needs created by war while balancing this with ongoing ACGME requirements, how those challenges were met, and the impact it had on residents.

Home exercise program compliance of service members in the deployed environment: an observational cohort study.

Background: Home exercise programs (HEP) are an integral part of any physical therapy treatment plan, but are especially important in theater. The primary aim of this study was to determine if the number of exercises prescribed in a HEP was associated with compliance rate of Service Members (SM) in theater with a secondary aim of determining variables associated with compliance and noncompliance.

Materials/methods: Subjects were 155 deployed SM undergoing physical therapy in Iraq and Afghanistan.

A woman with dyspnea and hemoptysis.

A 55-year-old female presented to the emergency department at a small community hospital with cough, fever, dyspnea and blood-streaked sputum. A chest radiograph was ordered. She was diagnosed with pneumonia and discharged home with antibiotics.

Final report of the phase I/II clinical trial of the E75 (nelipepimut-S) vaccine with booster inoculations to prevent disease recurrence in high-risk breast cancer patients.

Background: E75 (nelipepimut-S) is a human leukocyte antigen (HLA)-A2/A3-restricted immunogenic peptide derived from the HER2 protein. We have conducted phase I/II clinical trials vaccinating breast cancer patients with nelipepimut-S and granulocyte-macrophage colony-stimulating factor (GM-CSF) in the adjuvant setting to prevent disease recurrence. All patients have completed 60 months follow-up, and here, we report the final analyses.

Prevalence and predictors of nonalcoholic steatohepatitis in obese patients undergoing bariatric surgery: a Department of Defense experience.

Nonalcoholic steatohepatitis (NASH) is a silent liver disease that can lead to inflammation and subsequent scaring. If left untreated, cirrhosis may ensue. Morbidly obese patients are at an increased risk of NASH.