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2.
J R Army Med Corps ; 164(2): 92-95, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-28855343

RESUMEN

INTRODUCTION: Airborne operations enable large numbers of military forces to deploy on the ground in the shortest possible time. This however must be balanced by an increased risk of injury. The aim of this paper is to review the current UK military drop zone medical estimate process, which may help to predict the risk of potential injury and assist in planning appropriate levels of medical support. METHOD: In spring 2015, a British Airborne Battlegroup (UKBG) deployed on a 7-week overseas interoperability training exercise in the USA with their American counterparts (USBG). This culminated in a 7-day Combined Joint Operations Access Exercise, which began with an airborne Joint Forcible Entry (JFE) of approximately 2100 paratroopers.The predicted number of jump-related injuries was estimated using Parachute Order Number 8 (PO No 8). Such injuries were defined as injuries occurring from the time the paratrooper exited the aircraft until they released their parachute harness on the ground. RESULTS: Overall, a total of 53 (2.5%) casualties occurred in the JFE phase of the exercise, lower than the predicted number of 168 (8%) using the PO No 8 tool. There was a higher incidence of back (30% actual vs 20% estimated) and head injuries (21% actual vs 5% estimated) than predicted with PO No 8. CONCLUSION: The current method for predicting the incidence of medical injuries after a parachute drop using the PO No 8 tool is potentially not accurate enough for current requirements. Further research into injury rate, influencing factors and injury type are urgently required in order to provide an evidence base to ensure optimal medical logistical and clinical planning for airborne training and operations in the future.


Asunto(s)
Aviación , Medicina Militar/métodos , Personal Militar/estadística & datos numéricos , Heridas y Lesiones/epidemiología , Traumatismos de la Espalda/epidemiología , Traumatismos Craneocerebrales/epidemiología , Humanos , Incidencia , Medicina Militar/organización & administración , Reino Unido/epidemiología , Estados Unidos/epidemiología , Heridas y Lesiones/clasificación
4.
Shock ; 40(1): 15-20, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23649100

RESUMEN

Trauma transfusion strategies, which incorporate balanced red-cell concentrate (RCC)-to-fresh frozen plasma (FFP) ratios, may be associated with improved survival in massively transfused patients. However, the use of this approach in nonmassively transfused patients has led to concern regarding an increase in acute respiratory distress syndrome (ARDS). The aim of this study was to assess the incidence of ARDS in transfused UK military casualties. All UK military casualties receiving an RCC transfusion within a 16-month period were identified from the UK Trauma Registry, and chest radiographs retrieved. If bilateral infiltrates were present, case notes were retrieved to calculate the PaO2/FIO2 ratio in accordance with the American-European Consensus Conference criteria. Patients were divided into massively transfused (≥ 10 U/24 h) and nonmassively transfused (<10 U/24 h) receiving a high ratio (≥ 0.75) or low (<0.75) RCC:FFP ratio. The primary outcome was the development of ARDS within 7 days of transfusion. Primary blast lung injury was excluded. Of 145 patients identified, 144 had records available for analysis with a median injury severity score of 21. The majority were injured by explosion (76%), and the remainder by gunshot (24%). There were 60 nonmassively transfused patients with 18 in the low and 42 in the high RCC:FFP ratio groups. Of the remaining 80 massively transfused patients, 11 were in the low and 73 were in the high-ratio groups. There was no difference in the incidence of ARDS between low- and high-ratio groups in either nonmassively transfused (22.2% vs. 9.5%; P = 0.232) or massively transfused (18.2% vs. 23.3%; P = 1.000) casualties. There was no statistically significant increase in the incidence of ARDS in UK casualties treated with high, compared with low, ratios of plasma to RCC.


Asunto(s)
Transfusión Sanguínea/métodos , Eritrocitos/fisiología , Plasma/fisiología , Síndrome de Dificultad Respiratoria/mortalidad , Síndrome de Dificultad Respiratoria/terapia , Transfusión de Componentes Sanguíneos , Humanos , Puntaje de Gravedad del Traumatismo , Personal Militar/estadística & datos numéricos , Estudios Retrospectivos , Reino Unido
5.
J Clin Endocrinol Metab ; 88(1): 55-9, 2003 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-12519830

RESUMEN

A male type-2 diabetic, treated with the peroxisome proliferator-activated receptor (PPAR) agonist, Pioglitazone, experienced exacerbation of his thyroid eye disease (TED), which had been stable and inactive for more then 2 yr. Expansion of the orbital fat developed, and we have investigated the effects of PPAR gamma agonists, including Pioglitazone and, subsequently, an antagonist on the adipogenesis of preadipocytes from TED orbits and Graves' neck fats. The percentage of differentiating cells, assessed by oil red O staining, morphological changes, and PPAR gamma transcript levels, was determined for preadipocytes in hormone/agonist-induced models of adipogenesis, supplemented or not with PPAR gamma agonists or antagonist. The PPAR gamma agonists resulted in a 2- to 13-fold increase, and a PPAR gamma antagonist produced a 2- to 7-fold reduction in adipogenesis in vitro. Effects were dose dependent and maximal at 1 or 10 micro M. We suggest that care should be exercised when selecting patients for treatment with PPAR gamma agonists and that such agonists may be contraindicated in individuals with a previous history of autoimmune thyroid or eye diseases. Our work also suggests that PPAR gamma antagonists could provide a novel therapy for TED patients in the active stage of disease.


Asunto(s)
Enfermedad de Graves/tratamiento farmacológico , Enfermedad de Graves/metabolismo , Hipoglucemiantes , Receptores Citoplasmáticos y Nucleares/agonistas , Receptores Citoplasmáticos y Nucleares/metabolismo , Tiazoles , Tiazolidinedionas , Factores de Transcripción/agonistas , Factores de Transcripción/metabolismo , Adipocitos/metabolismo , Adipocitos/patología , Tejido Adiposo/efectos de los fármacos , Tejido Adiposo/patología , Anilidas/farmacología , Diferenciación Celular/efectos de los fármacos , Células Cultivadas , Contraindicaciones , Enfermedad de Graves/diagnóstico , Enfermedad de Graves/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pioglitazona , ARN Mensajero/metabolismo , Células Madre/metabolismo , Células Madre/patología
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