BackgroundMusculoskeletal conditions often affect patients’ mobility and ability to participate in health behaviors such as exercise, potentially affecting their systemic health. The purpose of this ...research is to determine how frequently cardiac-related comorbidities present in a veteran population with musculoskeletal service-connected disability and how this affects musculoskeletal health care utilization. MethodologyA retrospective cohort of Iraq and Afghanistan Veterans who received a Veterans Affairs (VA) disability determination for service-connected musculoskeletal disability were categorized according to the diagnosis of cardiac comorbidity including diabetes mellitus, hyperlipidemia, hypertension, and obesity, and atherosclerosis disease documented by ICD-9 codes in the VA administrative data. Among veterans with musculoskeletal service-connected disability, logistic regression was modeled to determine if musculoskeletal clinic utilization was associated with also having a cardiac comorbid condition. ResultsVeterans with musculoskeletal disability had a comorbid cardiac disorder 43% of the time. Post-traumatic arthritis was the only musculoskeletal condition positively associated with comorbid cardiac conditions. Veterans with comorbid cardiac diagnoses had 26-37% higher odds of receiving care by physical and occupational therapy, physical medicine, and orthopaedic surgery clinics compared to veterans without comorbid cardiac disease.ConclusionsVeterans in this cohort with musculoskeletal service-connected disability, plus cardiac conditions had greater clinic use for musculoskeletal and rehabilitation services compared to those without cardiac conditions. These results have implications for the rehabilitation and other health service needs of a new generation of veterans.
Drug therapy for leishmaniasis remains a major challenge as currently available drugs have limited efficacy, induce serious side-effects and are not accessible to everyone. Thus, the discovery of ...affordable drugs is urgently needed. Chalcones present a great potential as bioactive agents due to simple structure and functionalization capacity. The antileishmanial activity of different natural and synthetic chalcones have been reported. Here we report the synthesis of twenty-five novel prenylated chalcones that displayed antiparasitic activity in
Leishmania mexicana.
All the chalcones were evaluated at 5 µg/mL and eleven compounds exhibited a metabolic inhibition close to or exceeding 50%. Compounds
49
,
30
and
55
were the three most active with IC
50
values < 10 μM. These chalcones also showed the highest selectivity index (SI) values. Interestingly
49
and
55
possessing a substituent at a
meta
position in the
B
ring suggests that the substitution pattern influences antileishmanial activity. Additionally, a tridimensional model of fumarate reductase of
L. mexicana
was obtained by homology modeling. Docking studies suggest that prenylated chalcones could modulate fumarate reductase activity by binding with good affinity to two binding sites that are critical for the target. In conclusion, the novel prenylated chalcones could be considered as promising antileishmanial agents.
Graphical abstract
Health agencies call for the immediate mobilization of existing interventions in response to numerous child and family mental health concerns that have arisen as result of the COVID-19 pandemic. ...Answering this call, this pilot study describes the rapid, full-scale change from a primarily clinic-based Parent–Child Interaction Therapy (PCIT) model to a virtual service model (i.e., I-PCIT) in an academic and community-based program in Miami, Florida. First, we describe the virtual service training model our program developed and its implementation with 17 therapists (
M
Age
= 32.35, 88.2% female, 47.1% Hispanic) to enable our clinic to shift from providing virtual services to a small portion of the families served (29.1%) to all of the families served. Second, we examine the effect of I-PCIT on child and caregiver outcomes during the 2-month stay-at-home period between March 16, 2020, and May 16, 2020, in 86 families (
M
ChildAge
= 4.75, 71% Hispanic). Due to the rapid nature of the current study, all active participants were transferred to virtual services, and therefore there was no comparison or control group, and outcomes represent the most recently available scores and not treatment completion. Results reveal that I-PCIT reduced child externalizing and internalizing problems and caregiver stress, and increased parenting skills and child compliance with medium to large effects even in the midst of the COVID-19 pandemic. Finally, the study examined components of our virtual service training model associated with the greatest improvements in child and caregiver outcomes. Preliminary findings revealed that locally and collaboratively developed strategies (e.g., online communities of practice, training videos and guides) had the strongest association with child and caregiver outcomes. Implications for virtual service delivery, implementation, and practice in the midst of the COVID-19 pandemic are discussed.
Military guidelines endorse early fasciotomy after revascularization of lower extremity injuries to prevent compartment syndrome, but the real-world impact is unknown. We assessed the association ...between fasciotomy and amputation and limb complications among lower extremitys with vascular injury.
A retrospectively collected lower extremity injury database was queried for limbs undergoing attempted salvage with vascular procedure (2004-2012). Limbs were categorized as having undergone fasciotomy or not. Injury and treatment characteristics were collected, as were intervention timing data when available. The primary outcome measure was amputation. Multivariate models examined the impact of fasciotomy on limb outcomes.
Inclusion criteria were met by 515 limbs, 335 (65%) with fasciotomy (median 7.7 h postinjury). Of 212 limbs, 174 (84%) with timing data had fasciotomy within 30 min of initial surgery. Compartment syndrome and suspicion of elevated pressure was documented in 127 limbs (25%; 122 had fasciotomy). Tourniquet and shunt use, fracture, multiple arterial and combined arteriovenous injuries, popliteal involvement, and graft reconstruction were more common in fasciotomy limbs. Isolated venous injury and vascular ligation were more common in nonfasciotomy limbs. Fasciotomy timing was not associated with amputation. Controlling for limb injury severity, fasciotomy was not associated with amputation but was associated with limb infection, motor dysfunction, and contracture. Sixty-three percent of fasciotomies were open for >7 d, and 43% had multiple closure procedures. Fasciotomy revision (17%) was not associated with increased amputation or complications.
Fasciotomy after military lower extremity vascular injury is predominantly performed early, frequently without documented compartment pressure elevation. Early fasciotomy is generally performed in severely injured limbs with a subsequent high rate of limb complications.
Background
Civilian trauma literature suggests sexual dimorphism in outcomes after trauma. Because women represent an increasing demographic among veterans, the question remains if war trauma ...outcomes, like civilian trauma outcomes, differ between genders.
Questions/purposes
(1) Do women service members develop different conditions resulting in long-term disability compared with men service members after injuries sustained during deployment? (2) Do women service members have more or less severe disability after deployment injury compared with men service members? (3) Are men or women more likely to return to duty after combat injury?
Methods
The Department of Defense Trauma Registry was queried for women injured during deployment from 2001 to 2011. The subjects were then queried in the Physical Evaluation Board database to determine each subject’s return-to-duty status and what disabling conditions and disability percentages were assigned to those who did not return to duty. Frequency of disabling conditions, disability percentages, and return-to-duty rates for 368 women were compared with a previously published cohort of 450 men service members, 378 of whom had orthopaedic injuries.
Results
Women who were unable to return to duty had a higher frequency of arthritic conditions (58% 48 of 83 of women versus 35% 133 of 378 of men, p = 0.002; relative risk RR, 1.64; 95% confidence interval CI, 1.307–2.067) and lower frequencies of general chronic pain (1% one of 83 of women versus 19% 59 of 378 of men, p < 0.001; RR, 0.08; 95% CI, 0.011–0.549) and neurogenic pain disorders (1% one of 83 of women versus 7% 27 of 378 of men, p = 0.0410; RR, 0.169; 95% CI, 0.023–1.224). Women had more severely rated posttraumatic stress disorder (PTSD) compared with men (38% ± 23% versus 19% ± 17%). Forty-eight percent (64 of 133) of battle-injured women were unable to return to active duty, resulting in a lower return-to-duty rate compared with men (34% 450 of 1333; p = 0.003).
Conclusions
After deployment-related injury, women have higher rates of arthritis, lower rates of pain disorders, and more severely rated PTSD compared with men. Women are unable to return to duty more often than men injured in combat. These results suggest some difference between men’s and women’s outcomes after deployment injury, important information for military and Veterans Administration providers seeking to minimize postdeployment disability.
Level of Evidence
Level III, prognostic study.
Abstract Background context The severity and prognosis of combat-related injuries to the spine and spine injuries sustained unrelated to direct combat have not been previously compared. Differences ...may have implications on tactics, treatment strategies, and directions for future research. Purpose Compare the severity and prognosis of battle and nonbattle injuries to the spine. Study design Retrospective study. Patient sample American military personnel who were injured in a combat zone and whose medical data were abstracted in the Joint Theater Trauma Registry (JTTR). Methods The JTTR was queried using International Statistical Classification of Diseases, Ninth Revision codes to identify all individuals who sustained battle and nonbattle injuries to the neck, back, spinal column, or spinal cord in Operation Iraqi Freedom or Operation Enduring Freedom from October 2001 to December 2009. Medical records of all identified servicemembers were individually reviewed. Demographic information, including sex, age, military rank, date of injury, and final disposition, was obtained for all patients. Spinal injuries were categorized according to anatomic location, associated neurologic involvement, precipitating mechanism of injury (MOI), and concomitant wounds. These data points were compared for the groups battle spine injuries (BSIs) and nonbattle spine injuries (NBSIs). Results Five hundred two servicemembers sustained a total of 1,834 battle injuries to the spinal column, including 1,687 fractures (92%), compared with 92 servicemembers sustaining 267 nonbattle spinal column injuries, with 241 (90%) fractures. Ninety-one BSI servicemembers (18% of patients) sustained spinal cord injuries (SCIs) with 41 (45%) complete SCIs, compared with 13 (14% of patients) nonbattle SCIs with six (46.2%) complete injuries (p=.92). The reported MOI for 335 BSI servicemembers (66.7%) was an explosion compared with one NBSI explosive injury. Eighty-four patients (17%) sustained gunshot wounds (GSWs) in battle compared with five (5.2%) nonbattle GSWs. Fifteen patients (3.0%) sustained a battle-related fall compared with 29 (30%) nonbattle-related falls. Battle spine injury servicemembers underwent significantly higher rates of surgical interventions (p<.0001), were injured by high-energy injury mechanisms at a significantly greater rate (p<.0001), and demonstrated a trend toward lower neurologic recovery rates after SCI (p=.16). Conclusions Battle spine injury and NBSI are separate entities that may ultimately have disparate long-term prognoses. Nonbattle spine injury patients, although having similar MOIs compared with civilian spinal trauma, maintain a different patient demographic. Further research must be directed at accurately quantifying the long-term disabilities of all spine injuries sustained in a combat theater, whether they are the result of battle or not.
Military literature has demonstrated the utility and safety of tourniquets in preventing mortality for some time, paving the way for increased use of tourniquets in civilian settings, including ...perioperatively to provide a bloodless surgical field. However, tourniquet use is not without risk and the subsequent effects of tissue ischemia can impede downstream rehabilitative efforts to regenerate and salvage nerve, muscle, tissue and bone in the limb. Limb ischemia studies in both the mouse and pig models have indicated not only that there is residual flow past the tourniquet by means of microcirculation, but also that recovery from tissue ischemia is dependent upon this microcirculation. Here we expand upon these previous studies using portable Near-Infrared Imaging to quantify residual plasma flow distal to the tourniquet in mice, pigs, and humans and leverage this flow to show that plasma can be supersaturated with oxygen to reduce intracellular hypoxia and promote tissue salvage following tourniquet placement. Our findings provide a mechanism of delivery for the application of oxygen, tissue preservation solutions, and anti-microbial agents prior to tourniquet release to improve postoperative recovery. In the current environment of increased tourniquet use, techniques which promote distal tissue preservation and limb salvage rates are crucial.
Abstract Introduction: Annual scientific meetings are intended in part to provide initial dissemination of research findings directly to meeting participants. However, the eventual publication of ...research findings is important for dissemination to the broader medical and scientific communities. The Limb Lengthening and Reconstruction Society: ASAMI–North America (LLRS) annual meetings showcase important research and case studies in the field of limb reconstruction pertinent to an international community of surgeons. The purpose of this analysis is to determine the publication rates of abstracts from recent LLRS annual meetings. Materials and Methods: Annual meeting programs from six LLRS annual meetings from 2014 to 2021 were cataloged. Listed abstract titles and authors were then queried in PubMed, Google Scholar, and the Journal of Limb Lengthen and Reconstruction to determine if a corresponding work was published journal up to December 2022 and time to publication. Results: During all studied annual meetings, 249 abstracts were presented. By December 2022, 60% (161/269) were published. The longest time to publication was 6 years following the presented annual meeting, whereas the meantime to publication was 21 months. The top publishing journals were the Journal of Pediatric Orthopaedics , the Journal of Limb Lengthening and Reconstruction , and Strategies in Trauma and Limb Reconstruction . Discussion: The LLRS annual meeting abstracts lead to a corresponding publication at rates revealing other orthopedic subspecialty societies. However, there are opportunities to improve these rates by continuing to promote the LLRS partnering journals including the Journal of Limb Lengthening and Reconstruction .
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