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Gunepin M.,British Petroleum | Derache F.,Military Hospital Sainte Anne | Ausset I.,Military Hospital Begin | Berlizot P.,University of Paris Descartes | Simecek J.,Naval Medical Research Unit San Antonio
Military Medicine

Objectives: The objectives of this study were as follows: (1) to quantify the dental emergency (DE) rate observed in French soldiers serving in Afghanistan and (2) to determine the percentage of DEs that could have been prevented had predeployment treatment been provided. Methods: All DEs presenting at the French medical-surgical hospital in Kabul, Afghanistan, were documented during the period of December 12, 2009 to February 6, 2010. Dental Officers documented (1) the etiology of each DE and (2) whether the DE could have been prevented with predeployment treatment. Results: An estimated rate of 293 DE per 1,000 personnel per year was observed, 78% of the 210 DEs were considered preventable, and 65% of patients required medical evacuation from their units. Conclusion: Previous studies have observed high DE rates for French Army personnel. The intensity, danger, and geography of the mission in Afghanistan exacerbate the negative operational impact of dental pathologies. Source

Colthirst P.M.,Institute of Surgical Research | Berg R.G.,Institute of Surgical Research | DeNicolo P.,Institute of Surgical Research | Simecek J.W.,Naval Medical Research Unit San Antonio
Military Medicine

The documentation of dental emergency (DE) rates in past global conflicts has been well established; however, little is known about wartime DE costs on the battlefield. Using DEs as an example for decreased combat effectiveness, this article analyzes the cost of treating DEs in theater, both in terms of fixed and variable costs, and also highlighted the difficulties that military units experience when faced with degradation of combat manpower because of DEs. The study found that Dental-Disease and Non-Battle Injury cost the U.S. Army a total of $21.4M between July 1, 2009 and June 30, 2010, and $21.9M between July 1, 2010 and June 30, 2011. The results also revealed that approximately 32% of DE required follow-up treatment over the 2-year period, which increased the costs associated with a DE over time. Understanding the etiology and cost of DE cases, military dental practitioners will be better equipped to provide oral health instructions and preventive measures before worldwide deploymen © Association of Military Surgeons of the U.S. All rights reserved. Source

Rall J.M.,General Dynamics Corporation | Songer A.G.,Naval Diving and Salvage Training Center | Cestero R.F.,Naval Medical Research Unit San Antonio | Ross J.D.,Science and Technology Office WilfordHallAmbulatory SurgicalCenter
Journal of Trauma and Acute Care Surgery

BACKGROUND: Uncontrolled hemorrhage is the leading cause of preventable death on the battlefield. The development, testing, and application of novel hemostatic dressings may lead to a reduction of prehospital mortality through enhanced point-of-injury hemostatic control. This study aimed to determine the efficacy of currently available hemostatic dressings as compared with the current Committee for Tactical Combat Casualty Care Guidelines standard of treatment for hemorrhage control (QuikClot Combat Gauze [QCG]). METHODS: The femoral artery of anesthetized Yorkshire pigs was isolated and punctured. Free bleeding was allowed to proceed for 45 seconds before packing of QCG, QuikClot Combat Gauze XL (QCX), Celox Trauma Gauze (CTG), Celox Gauze (CEL), or HemCon ChitoGauze (HCG), into the wound. After 3 minutes of applied, direct pressure, fluid resuscitation was administered to elevate and maintain a mean arterial pressure of 60 mm Hg or greater during the 150-minute observation time. Animal survival, hemostasis, and blood loss were measured as primary end points. Hemodynamic and physiologic parameters, along with markers of coagulation, were recorded and analyzed. RESULTS: Sixty percent of QCG-treated animals (controls) survived through the 150-minute observation period. QCX, CEL, and HCG were observed to have higher rates of survival in comparison to QCG (70%, 90%, and 70% respectively), although these results were not found to be of statistical significance in pairwise comparison to QCG. Immediate hemostasis was achieved in 30% of QCG applications, 80% of QCX, 70% of CEL, 60% of HCG, and 30% of CTG-treated animals. Posttreatment blood loss varied from an average of 64 mL/kg with CTG to 29 mL/kg with CEL, but no significant difference among groups was observed. CONCLUSION: These results suggest that the novel hemostatic devices perform at least as well as the current Committee on Tactical Combat Casualty Care standard for point-of-injury hemorrhage control. Despite their different compositions and sizes, the lack of clear superiority of any agent suggests that contemporary hemostatic dressing technology has potentially reached a plateau for efficacy. Copyright © 2013 Lippincott Williams & Wilkins. Source

Schultz S.,Naval Medical Research Unit San Antonio | Desilva M.,Naval Medical Research Unit San Antonio | Gu T.T.,University of Texas Health Science Center at San Antonio | Qiang M.,University of Texas Health Science Center at San Antonio | Whang K.,University of Texas Health Science Center at San Antonio
Basic and Clinical Pharmacology and Toxicology

Acetaminophen has been used as an analgesic for more than a hundred years, but its mechanism of action has remained elusive. Recently, it has been shown that acetaminophen produces analgesia by the activation of the brain endocannabinoid receptor CB1 through its para-aminophenol (p-aminophenol) metabolite. The objective of this study was to determine whether p-aminophenol could be toxic for in vitro developing mouse cortical neurons as a first step in establishing a link between acetaminophen use and neuronal apoptosis. We exposed developing mouse cortical neurons to various concentrations of drugs for 24hr in vitro. Acetaminophen itself was not toxic to developing mouse cortical neurons at therapeutic concentrations of 10-250μg/ml. However, concentrations of p-aminophenol from 1 to 100μg/ml produced significant (p<0.05) loss of mouse cortical neuron viability at 24hr compared to the controls. The naturally occurring endocannabinoid anandamide also caused similar 24-hr loss of cell viability in developing mouse cortical neurons at concentrations from 1 to 100μg/ml, which indicates the mechanism of cell death could be through the cannabinoid receptors. The results of our experiments have shown a detrimental effect of the acetaminophen metabolite p-aminophenol on in vitro developing cortical neuron viability which could act through CB1 receptors of the endocannabinoid system. These results could be especially important in recommending an analgesic for children or individuals with traumatic brain injury who have developing cortical neurons. © 2011. Source

Bienek D.R.,Naval Medical Research Unit San Antonio | Bienek D.R.,University of Texas at San Antonio | Perez N.M.,Naval Medical Research Unit San Antonio
Military Medicine

The usability of a rapid point-of-care ABO-Rh blood typing kit was determined by comparing the performance of individuals with extensive medical training/experience to those with a lesser extent. Subjects were asked to use the blood typing kit with their own blood. These outcomes were compared to that listed in the subject's medical record, stamped on their dog tag, and the result interpreted by a laboratorian. For all participants, there was ~80% consistency between the result interpreted by the subject and that stated in their medical record. The participant's level of formal education (P ≤ 0.05) affected the accuracy of the blood typing kit. When comparing the subject's outcome to that stated in their medical record, the performance of individuals in the Medical Corps was approximately 10% and 25% higher (P < 0.05) than that observed with Hospital Corpsman or Medical Service Corps members, respectively. To remove bias that can occur when interpreting the blood type of oneself, the subjects also interpreted the result from cards prepared by the investigator. Taken together, a discrepancy between the potential diagnostic accuracy of the kit and that observed with potential end users was identified. © Association of Military Surgeons of the U.S. All rights reserved. Source

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