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Gazmuri R.J.,Franklin University | Gazmuri R.J.,Capt James vell Federal Health Care Center | Kaufman C.L.,ZOLL Medical Corporation | Baetiong A.,Franklin University | Radhakrishnan J.,Franklin University
PLoS ONE | Year: 2016

Background: Several characteristics of the ventricular fibrillation (VF) waveform have been found predictive of successful defibrillation and hypothesized to reflect the myocardial energy state. In an open-chest swine model of VF, we modeled "average CPR" using extracorporeal circulation (ECC) and assessed the time course of coronary blood flow, myocardial metabolism, and myocardial structure in relation to the amplitude spectral area (AMSA) of the VF waveform without artifacts related to chest compression. Methods: VF was induced and left untreated for 8 minutes in 16 swine. ECC was then started adjusting its flow to maintain a coronary perfusion pressure of 10 mmHg for 10 minutes. AMSA was calculated in the frequency domain and analyzed continuously with a 2.1 s timeframe and a Tukey window that moved ahead every 0.5 s. Results: AMSA progressively declined during untreated VF. With ECC, AMSA increased from 7.0 ± 1.9 mV·Hz (at minute 8) to 12.8 ± 3.3 mV·Hz (at minute 14) (p < 0.05) without subsequent increase and showing a modest correlation with coronary blood flow of borderline statistical significance (r = 0.489, p = 0.0547). Myocardial energy measurements showed marked reduction in phosphocreatine and moderate reduction in ATP with increases in ADP, AMP, and adenosine along with myocardial lactate, all indicative of ischemia. Yet, ischemia did not resolve during ECC despite a coronary blood flow of ∼ 30% of baseline. Conclusion: AMSA increased upon return of coronary blood flow during ECC. However, the maximal level was reached after ∼ 6 minutes without further change. The significance of the findings for determining the optimal timing for delivering an electrical shock during resuscitation from VF remains to be further explored. © This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.


PubMed | Naval Medical Center and Capt James vell Federal Health Care Center
Type: Journal Article | Journal: Military medicine | Year: 2016

Schistosomiasis is a known risk after exposure to freshwater in tropical parts of the world. In March 2014, 28 off-duty U.S. service members went on a water adventure in the Nile River in Jinja, Uganda. In April 2014, 10 of the 28 service members returned for a second water adventure. Twelve weeks after freshwater exposure, schistosomiasis enzyme-linked immunosorbent assay testing was performed. Twenty-five percent had elevated Schistosomiasis mansoni immunoglobulin G (7 positive of 28 exposed); all had negative pre-exposure serology. The serology-positive service members were treated with oral praziquantel 60 mg/kg in divided doses. Our report is the first schistosomiasis report among U.S. service members deployed to Africa since World War II. The absence of reports among U.S. service members and several reports among deployed foreign military units and tourists in sub-Saharan Africa suggest a lack of postexposure testing. We recommend schistosomiasis testing of prior and future U.S. military units deployed to sub-Saharan Africa with fresh water exposure. Unit commanders and medical personnel should discourage unnecessary fresh water contact in sub-Saharan Africa.

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