Army helicopter casualty evacuations in Belize in 1995 and 1996

Since the withdrawal of Royal Air Force Puma helicopters from Belize in 1994, the role of casualty evacuation (CASEVAC) of British military personnel, Belizean and foreign nationals throughout the country, has passed to 25 Flight Army Air Corps, currently equipped with Gazelle helicopters. Details of causalty evacuations during 1995 and 1996 have been collated and analysed in order to provided information on casualty types, and the locations from which casualties have been evacuated, during this 2 year period. The data so obtained might be used to ensure the future provision of an appropriately equipped CASEVAC helicopter, or to highlight common causes of significant morbidity in Britian troops deployed to Belize.(AU)

Randomised trial of single-dose ciprofloxacin for travellers' diarrhoea

Diarrhoea is the most common illness affecting travellers to developing countries. Our study was designed to compare the efficacy of a single 500 mg dose of ciprofloxacin with placebo for treatment of acute diarrhoea in travellers. British troops who were within their first 8 weeks of deployment in Belize and who presented within 24h of the onset of diarrhoea, were randomised to receive either ciprofloxacin 500 mg or placebo. Every subject recorded the number and consistency of stools and presence of any other associated symptoms for 72 h or until recovery. Of 88 subjects enrolled, 83 were evaluable, of whom 45 received ciprofloxacin and 38 placebo. Groups did not differ with regard to duration or severity of diarrhoea at randomisation. Mean (SE) duration of diarrhoea, as assessed by time to the last liquid and last unformed stool, was reduced from 50.4 (4.5) h and 53.5 (4.4) h, respectively, in the placebo group to 20.9 (3.4) h and 24.8 (3.8) h in those receiving ciprofloxacin (p<0.0001). Mean number of liquid stools was reduced from 11.4 (1.2) in the placebo group to 5.0 (0.7) in the ciprofloxacin-treated group (p<0.0001). The cumulative percentages of subjects with no unformed stool after 24 h, 48 h, and 72 h were, respectively, 64 percent, 82 percent, and 93 percent in the ciprofloxacin group and 11 percent, 42 percent, and 79 percent in the placebo group (p<0.0001, p<0.001, and not significant, respectively). A single 500 mg dose of ciprofloxacin was an effective empirical treatment for reducing the duration and severity of diarrhoea in travellers. The regimen should maximise compliance and reduce the cost and duration of therapy (AU)

A clinico-pathological study of cutaneous leishmaniasis in British troops from Belize

Thirty-four cases of cutaneous leishmaniasis contracted by British soldiers in Belize were studied. Pre- and post-treatment biopsies were taken from all patients. The range of histological appearances is described and the value of histological examination (including Giemsa staining and immunohistochemistry), cytological preparations and microbiological culture in diagnosis and clinical management assessed. Histology and culture were found to be complementary techniques in reaching a positive diagnosis, whilst cytological preparations were of no additional value. Histological examination of post-treatment biopsies merely confirmed the clinical impression of healing or non-healing whilst culture identified viable organisms in apparently healed lesions, which were subsequently re-treated (AU)

Cutaneous leishmaniasis in British troops from Belize

The medical records of 306 British soldiers in whom a clinical diagnosis of cutaneous leishmaniasis had been made following a tour of duty in Belize were analysed. Parasitological confirmation of the diagnosis was established in 187 cases; leishmania were cultured in 117 cases and leishman-Donovan bodies were identified in 78 cases and Leishmania mexicana mexicana in a further 29 cases. Leishmania braziliensis was indentified in 78 cases and Leishmania mexicana mexicana in a further 29 cases. Seventy-one per cent of patients had a single lesion which, in most cases, occurred on the exposed extremities. The mean diameter of the ulcers was 14.4 mm. Treatment with sodium stobogluconate was effective. Two regimens were used, consisting of either 600-800 mg daily given initially for 10 days, or 600 mg b.d. given initially for 14 days. Of those allocated to the lower dose regimen 48.5 percent were cured after the initial 10-day course, and ultimately the ulcers of 93 percent of patients healed following more prolonged treatment at this dose. Of those allocated to the higher dose regiment 63.9 percent were cured after the initial 14-day course and ultimately the ulcers of all patients healed after more prolonged treatement at this dose. A transient leucopenia and a rise in liver enzymes were noted during treatment, and these changes were dose-dependent. No cases of mucocutaneous leishmaniasis were encountered (AU)

Prostitution and the military: planning AIDS intervention in Belize

First world militaries based in "third world" countries offer an appropriate context for developing AIDS intervention models that are keyed to large-scale population movements and regional differences in HIV infection. In this work, the ethnographic concept of "social interface" replaces the epidemiological concept of "risk group" to allow for a more dynamic analysis of the particular forms of interactions between groups that may be linked to the sexual transmission of HIV. The social interface between military and sex workers in Belize displays two distinct forms of organization: (1) "recognized prostitution" in health-regulated brothels, and (2) "quasi-prostitution" in non-health regulated public sites such as bars and hotels. These two forms are also distinguished by the ethnicity, national origin, and professional identify of sex workers. Based on survey-form participant-observation in Belize and cross-cultural data on condoms use, the social identify of sex workers emerges as a factor crucial to understanding how public health information is incorporated by heterosexuals who put themselves at risk for HIV in different social contexts. The scope of analysis shifts between the personal and transnational; discussion of the possibilties for inter-governmental negotiations regarding AIDS policy issues is included.(AU)

An outbreak of hookworm infection associated with military operations in Grenada

During 1983, a multinational military intervention took place on Grenada. After deployment, troops from several U.S. Army units noted signs and symptoms consistent with soil-transmitted helminthic infection. Of 684 soldiers screened five to seven weeks post-development, over 20 percent reported abdominal pain and/or diarrhea during or after the action. Eosinophilia of at least 10 percent was observed in 119 (22.5 percent) of 529 soldiers evaluated further; eosinophilia of 5-9 percent was documented in another 126 (23.8 percent) of the 529 soldiers. Stool examinations confirmed hookworm infection in 35 soldiers. One case of strongyloidiasis was also documented. Infection was attributed to ground exposure near homes with compromised sanitation. Units that joined the operation after the initial assault phase were at low risk of hookworm infection. (AU)

Points in the examination of recruits

The plan of examination of army recruits is outlined. Details of common defects which disqualify the recruit are given. (AU)