No abstract

Assessment of acute mild traumatic brain injury (mTBI) symptoms after a combat blast could aid diagnosis and guide follow-up care. Our objective was to document acute mTBI symptoms following a combat blast and to examine associations between acute symptoms and mental health and service discharge outcomes. A retrospective cohort study was conducted with 1656 service personnel who experienced a combat blast-related mTBI in Iraq. Acute mTBI symptoms were ascertained from point-of-injury medical records. The associations between acute symptoms and posttraumatic stress disorder (PTSD), postconcussion syndrome (PCS), and type of service discharge were examined. Disability discharge occurred in 11% of patients, while 36% had a non-disability discharge and 52% had no recorded discharge. A PTSD and PCS diagnosis was made in 19% and 15% of the sample, respectively. The most common acute mTBI symptoms were headache (62.8%), loss of consciousness (LOC) (34.5%), and tinnitus (33.2%). LOC was predictive of PTSD (odds ratio [OR] 1.54; 95% confidence interval [CI] 1.18, 2.00) and PCS (OR 2.08; 95% CI 1.56, 2.77), while altered mental status (OR 1.53; 95% CI 1.07, 2.17) and previous blast history (OR 1.83; 95% CI 1.15, 2.90) also were predictive of PCS. While no acute mTBI symptoms were associated with discharge outcomes, injury severity was associated with disability discharge. LOC after blast-related mTBI was associated with PTSD and PCS, and injury severity was predictive of disability discharge. The assessment of cognitive status immediately after a blast could assist in diagnosing mTBI and indicate a need for follow-up care.

Intravenous (iv) administration of gamma-melanocyte-stimulating hormone (gamma-MSH) produces central sympathetically mediated pressor and cardioaccelerator effects and increases the activity of hypothalamic vasopressinergic neurons. The autonomic actions are similar to infusion of vasopressin (Vp) into the hindbrain of 4th ventricle (Ven). To ascertain whether activation of the central Vp system is the proximate cause of the pressor effects of gamma-MSH, we investigated the effects of gamma-MSH in rats pre- and postblockade of central nervous system Vp receptors and in rats with a hereditary lack of vasopressin (Brattleboro strain). Central Vp receptor blockade significantly reduced (80%) the pressor effects of iv gamma-MSH. As a control, iv administration of the antagonist, while effective in blocking the pressor effect of iv Vp, had no effect on the gamma-MSH pressor response. When compared with their genetic controls (Long-Evans strain), Brattleboro rats also had greater than 80% reduction in their pressor response to iv gamma-MSH. The results indicate that circulating gamma-MSH activates the central Vp system to produce its sympathoexcitatory pressor effects.

Purpose: The aims of the present study were: (a) to identify the incidence of osteoarthritis (OA) after a traumatic knee injury; (b) identify the risk of post-traumatic osteoarthritis (PTOA) based on the type of injury; and (c) identify the time from injury to OA diagnosis.Patients and methods: The Expeditionary Medical Encounter Database, containing healthcare utilization for all deployment injuries sustained by military service members, was queried for traumatic knee injuries between 2001 and 2016. Subsequent diagnosis of knee OA was identified, defined as PTOA. Time to knee PTOA diagnosis was determined and logistic regression was used to obtain odds ratios (ORs) (95% confidence interval [CI]) between knee injury type and development of PTOA.Results: A total of 345 (9.57%) of the 3,605 subjects were diagnosed with PTOA.The median time to diagnosis was 4.10 years. Four primary diagnoses remained significantly associated with PTOA after adjusting for age and injury severity score: fracture (adjusted OR [aOR] = 1.36; 95% CI 1.02, 1.82), sprain (aOR = 1.59; 95% CI 1.23, 2.06), dislocation (aOR = 3.70; 95% CI 2.09, 6.55) and derangement (aOR = 2.38; 95% CI 1.33, 4.28). Subjects were significantly less likely to develop PTOA after a softtissue injury (aOR = 0.44; 95% CI 0.41, 0.75). Conclusions:A substantial number of individuals with a traumatic knee injury developed early PTOA (9.6%). Certain knee injuries have a greater association with PTOA. Future studies should implement longer surveillance periods and identify other healthcare variables associated with the risk of developing PTOA, to include appropriate and timely interventions.

Although historically restricted from combat roles, women suffer from combat-related injuries, especially in recent conflicts where asymmetrical warfare erases distinctions between forward and rear operating areas. U.S. servicewomen who sustained combat-related injury in Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF) between January 2003 and May 2014 were identified from the Expeditionary Medical Encounter Database. Injuries were characterized using Abbreviated Injury Scale and International Classification of Diseases, 9th Revision codes. Of the 844 combat-related injury episodes in women, 51% (n = 433) were OIF injuries and 49% (n = 411) were OEF injuries. Blast events were responsible for 90% of injuries. The average Injury Severity Score was 3, with no statistical difference in means between OIF and OEF. Of significance were increased head injuries in OEF compared with OIF (80% vs. 48%; p < 0.001). Although the majority of combat-related injuries suffered by women were mild, some women suffered life-threatening injuries, and nearly 65% of the injury episodes resulted in more than one injury. More research is needed as the roles of women in the military continue to expand. Future studies will investigate quality of life outcomes and gender differences in combat-related injuries.