Military Medicine最新文献

Introduction: This study aimed to examine the prevalence of cold injuries and review the cold injury monitoring system in the South Korean military.

Materials and methods: This study conducted a retrospective and cross-sectional analysis using data from the Defense Medical Statistic Information System (DMSIS) on cold injuries among military personnel from 2018 to 2023. It incorporated findings from the Korean Armed Forces Medical Command's cold injury surveillance system and analyzed cases from the Armed Forces Capital Hospital, covering all branches of the military by status and rank.

Results: An analysis of cold injury in the South Korean military over the past 5 years revealed varying numbers of cases treated, from 799 in 2018-2019 to 467 in 2022-2023. According to the surveillance system in 2023-2024, the Army experienced the majority of these cases, with 94.5% of the total. The incidence per 1,000 personnel was the highest in the Army at 0.98 compared to the Air Force and Navy/Marine Corps. Rank-based analysis indicated the most affected were private first-class soldiers. Frostbite was the most frequent condition, alongside chilblains, hypothermia, and immersion injuries, with no marked difference in the type of illness across branches.

Conclusions: The study underscores the need for focused prevention and treatment, particularly in the Army. By analyzing data from a newly implemented surveillance system, it revealed a higher incidence of frostbite and chilblains among lower ranks. The findings highlight the importance of targeted educational measures and enhanced response strategies to protect personnel against cold injuries.

Introduction: Operating room fires can have devastating consequences and as such must be prevented. There exists a paucity of literature requiring further elucidation regarding manufacturer recommendations of a predefined waiting period prior to patient draping after using alcohol-based surgical antiseptics, in order to reduce the risk of operating room fires.

Methods: This was further investigated by exposing two common alcohol-based surgical antiseptics to electrosurgery and open flames at various power settings and time intervals in an ex vivo porcine model. The simulated surgical site was prepped following manufacturer recommendations and exposed to monopolar electrosurgery at low and high power, using both PURE CUT and COAGULATION modes, and open flame, at 15-s increments after application.

Results: While using PURE CUT mode at both low and high power, no ignition was observed on hairless surgical sites prepped with ChloraPrep® at any time point. However, use of COAGULATION mode at both low and high powers resulted in ignition consistently out to 1-min post-application. Additionally, if the prepped area subjectively appeared wet, especially with pooling of the antiseptic, both COAGULATION mode and open flame caused ignition. Dry time was found to be about 59 s for both prep solutions. It was also observed that the amount of pressure directly correlated with the amount of prep dispersed and increased dry times.

Conclusion: In conclusion, our data suggest an average dry time of less than 1-min, with ignition only observed when the antiseptic was visibly wet. Ignition did not occur on hairless skin with electrocautery on CUT mode using ChloraPrep at any time point. Additionally, ignition on hair-bearing skin was not observed past 3 min, with current manufacturer recommendations stating 1 h wait time for hair-bearing skin. Arbitrarily waiting a specific predetermined dry time until patient draping, as recommended by the manufacturers, may be unnecessary and lead to hours' worth of time wasted each year. Ongoing research will further investigate the utility of drying the antiseptic after application and its affect on not only preventing ignition but also antimicrobial efficacy.

Introduction: The U.S. Army Aeromedical Research Laboratory (USAARL), a partner in the Joint Trauma Analysis for the Prevention of Injury in Combat (JTAPIC) partnership, conducted a series of retrospective reviews to investigate injuries sustained by occupants of U.S. Army rotary-wing aircraft involved in combat damage incidents. The reviews were conducted to provide occupant survivability information to the Aviation Survivability Development and Tactics team, an agency within the U.S. Army Aviation Center of Excellence. For these reviews, combat damage incidents that produced casualties were separated into direct events (i.e., events in which an enemy weapon system directly injured occupants) and indirect events (i.e., incidents in which occupants were injured as a result of a crash caused by the enemy weapon system). The previous USAARL reviews provided an overview of injuries sustained during direct and indirect events. The objective of this review was to conduct a detailed analysis of injuries occurring during direct events.

Materials and methods: A descriptive retrospective review was conducted on injuries sustained by occupants of U.S. Army rotary-wing aircraft involved in combat damage incidents between 2003 and 2014. All Black Hawk, Apache, and Chinook combat aviation damage incidents for the study period were reviewed. Personnel casualty information from the Defense Casualty Information Processing System (DCIPS) was linked to combat damage incident information by matching the aircraft platform, incident date, and circumstantial information found in incident narratives. Injury information for personnel identified in DCIPS as being wounded in action was obtained from the JTAPIC partnership; injury data for personnel killed in action were retrieved from the Armed Forces Medical Examiner System. All injuries were coded using the Abbreviated Injury Scale (AIS). Descriptive statistics were used to describe the frequency and distribution of injuries to personnel involved in direct events.

Results: Overall, the extremities were the most commonly injured body regions, with lower extremities suffering more injuries than upper extremities. Penetrating injuries were identified as the primary injury mechanism for all body regions. Injuries to each AIS body region were predominantly of minor (AIS 1) and moderate (AIS 2) severity.

Conclusions: Although injury severities were generally low (AIS 1 or AIS 2), the results of this effort indicate which body regions may benefit from additional protection during rotary-wing operations in hostile environments. The influence of occupant position within the aircraft and the use and effectiveness of personal protective equipment could not be effectively analyzed due to a lack of information.

Introduction: In prolonged care scenarios, where medical evacuations are significantly delayed, the treatment and transport of casualties with extremity musculoskeletal injuries will drain combat units' human resources. Developing enhanced splinting techniques to restore casualty mobility and function can alleviate this drain. To guide this development, a panel of tactical combat and wilderness medicine experts was assembled to determine which extremity musculoskeletal injuries had the greatest impact on unit capabilities, and the materials available for splinting these injuries.

Information gathering: Unstructured consultations with panel members yielded preliminary lists of injuries and materials. These lists were consolidated and redistributed to panel members for final evaluation where they ranked the injuries based on frequency and human resource cost and assessed the accessibility of materials. Responses for the final evaluation were statistically analyzed using Wilcoxon rank-sum tests and Placket Luce models.

Lessons learned: Aggregated responses indicated that panel members thought that knee and ankle ligamentous injuries and radial head fractures were the most frequently occurring injuries, although closed distal femoral fractures, below knee amputations, and open tibia fractures would require the most demand for injury care. Assessing the combined impact of frequency and human resource cost indicated that knee and ankle ligamentous injuries and closed tibia fractures had the greatest impact on unit readiness. Responses also indicated that a variety of materials would be available for applying or improvising splints.

Conclusion: Although the combined impact of knee and ankle ligamentous injuries were ranked the highest, limitations in relative rankings and the existence of effective low-cost treatments for these injuries suggest that greater gains in unit effectiveness would come from focusing on developing solutions for fractures with higher human resource cost, such as leg and arm fractures. This information can be used to develop enhanced splints that can preserve unit readiness in the field.

Introduction: A rise in tinea cruris among Thai Naval Cadets has been observed. Clotrimazole powder has been shown to be effective as an adjunct treatment for tinea cruris; however, its efficacy as a monotherapy is limited.

Objectives: The aim is to determine the efficacy of 1% clotrimazole cream versus 1% clotrimazole powder in treating tinea cruris.

Material and methods: A randomized trial was conducted at the Thai Naval Rating School, Chonburi, Thailand. Naval rating cadets with suspected tinea cruris were randomly assigned to one of two groups: 1% clotrimazole cream or 1% clotrimazole powder, and they were instructed to apply the related medication to the affected lesion twice daily for 4 weeks. Clinical and symptomatic evaluations were carried out at 4 and 8 weeks.

Results: All 17 and 14 participants who received 1% clotrimazole cream and powder, respectively, were included. After 4 weeks, the clinical cure rates were 76.5% in the cream group and 85.7% in the powder group (P = .664). All participants were clinically cured within 8 weeks. The self-evaluation of itch severity using a visual analog scale (VAS) revealed no significant difference between the two groups (P = .343). The dermatology quality of life index decreased as clinical improvement was achieved in both the clotrimazole cream and powder groups (6.0 vs. 7.5 score reductions, respectively; P = .765). The score for sweat reduction was higher in the 1% clotrimazole powder group compared to the cream group (5.0 vs. 4.0, respectively; P = .006).

Conclusion: Monotherapy with 1% clotrimazole powder showed comparable efficacy to 1% clotrimazole cream. Furthermore, the powder treatment reduced sweat more effectively compared to the cream.

Introduction: The neurobehavioral significance of white matter hyperintensities (WMHs) seen on magnetic resonance imaging after traumatic brain injury (TBI) remains unclear, especially in Veterans and Service Members with a history of mild TBI (mTBI). In this study, we investigate the relation between WMH, mTBI, age, and cognitive performance in a large multisite cohort from the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium.

Materials and methods: The neuroimaging and neurobehavioral assessments for 1,011 combat-exposed, post-9/11 Veterans and Service Members (age range 22-69 years), including those with a history of at least 1 mTBI (n = 813; median postinjury interval of 8 years) or negative mTBI history (n = 198), were examined.

Results: White matter hyperintensities were present in both mTBI and comparison groups at similar rates (39% and 37%, respectively). There was an age-by-diagnostic group interaction, such that older Veterans and Service Members with a history of mTBI demonstrated a significant increase in the number of WMHs present compared to those without a history of mTBI. Additional associations between an increase in the number of WMHs and service-connected disability, insulin-like growth factor-1 levels, and worse performance on tests of episodic memory and executive functioning-processing speed were found.

Conclusions: Subtle but important clinical relationships are identified when larger samples of mTBI participants are used to examine the relationship between history of head injury and radiological findings. Future studies should use follow-up magnetic resonance imaging and longitudinal neurobehavioral assessments to evaluate the long-term implications of WMHs following mTBI.