Rates of Preeclampsia and Post-preeclamptic Cardiovascular Disease Among US Military Servicewomen: A Retrospective Case-cohort Study.

INTRODUCTION: Preeclampsia (PE), a hypertensive-inflammatory disorder of pregnancy, poses acute risks of seizures, stroke, and heart attack during pregnancy and up to 6 weeks post-delivery. Recent data suggest that residual increased risks for cardiovascular disease (CVD) linger for much longer, possibly decades, after PE pregnancies. In civilian studies, PE and the major vascular events resulting from it disproportionately affect women from minority groups, especially African American women. The Military Health System (MHS) provides equal access to care for all active-duty servicewomen (ADSW), thus theoretically mitigating disparities. Racial/ethnic breakdown for PE and post PE CVD has not been studied in the MHS. MATERIALS AND METHODS: We identified healthy pregnancies in the MHS electronic health records of ADSW in the years 2009/2010 and those with a PE diagnosis. Patients with preexisting conditions of PE or CVD based on a look-back period of two calendar years were excluded. Cases were matched to controls based on age at pregnancy within 5 years and race/ethnicity. Cohort was assessed for diagnosed CVDs, race, age, and service during 2011-2017. Time to first CVD event was assessed with Cox proportional hazards model, results reported as relative risks (95% CI). All variables were summarized using mean (SD) for normally distributed continuous variables; non-normal continuous variables were characterized by median [IQR] and categorical variables were summarized by counts and frequencies. All statistical testings were two-sided with a significance level of 5% and were completed using SAS-EG version 9.2 or R version 3.5.2. RESULTS: From an analysis of 106,808 inpatient ADSW records, PE incidence by race is 11.8% for White, 12% for African American, 11.4% for Asian/Pacific Islander, 11.2% for Native American, 9.5% for Other, and 7.6% for unknown (not documented) race. Thus, in the US Military, African American women have comparable (0.2% higher) PE rate than White women in contrast with civilian studies that often report much higher incidence in the African American population. Using Asians as referent group, PE increases the risk of CVD. White women have a hazard ratio (HR) of 1.47 95%CI (1.15-1.88), African Americans a HR of 1.51 95% CI (1.18-1.93), and Other a HR of 1.39 95% CI (1.01-1.91). CONCLUSION: In this study, we report overall higher incidence of PE in military women than what is published for civilian women in all races and across all services. Importantly, we do not find significantly higher numbers of PE and post-PE CVD for African American, compared to White women in the military. Our study is not designed to address differences between military and civilian PE epidemiology, but these results deserve further exploration. This study shines light on a health risk unique to women, which we found to be more prevalent in the US Military than published civilian population. Further study to determine the details of long-term morbidity, disability, and death attributable to PE (CVD, stroke, and kidney diseases) are needed to design optimal medical management protocols, ensure readiness for duty, and protect our Women Warfighters.

Prehospital medical documentation in the Joint Theater Trauma Registry: a retrospective study.

BACKGROUND: Prehospital care of combat casualties is a critical phase of emergency medical practice on the battlefield. The Joint Theater Trauma Registry (JTTR) was developed to standardize a system of data collection for combat casualty care; however, the degree of population and granularity of prehospital data were unknown. METHODS: This is a retrospective comparative study of all US military personnel who sustained battle injuries in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). The JTTR was queried for all US military battle casualties from OIF and OEF entered between January 2002 and July 2009 containing any data entered into the prefacility fields. Data were separated based on origination, OIF, or OEF. A comparative analysis was performed. RESULTS: During the period studied, 13,080 (66%) entries into the JTTR were recorded in the category of "Battle Injury" and met study inclusion criteria; 3,187 (24%) battle injury entries contained prehospital data (n = 3,187). The percentage of casualty records containing prehospital data were 18.6% for OEF and 25.4% for OIF (p < 0.01). CONCLUSION: Both poor population of data points and poor granularity of prehospital data entered into the JTTR were observed. It appears that the volume and quality of reporting of role-I data were better for OIF than OEF for this study period. Further investigations into the obstacles to free flow of role-I casualty clinical data, and the means to mitigate this situation, are warranted.

"March fractures" on a female military recruit.

Stress fractures are caused by repetitive low-impact activities. It is important to have a high index of suspicion in diagnosing and treating stress fractures early for remodeling to occur. This is a case report of a 19-year-old female military recruit with stress fractures of the right foot. The patient had an extended non-weight-bearing treatment that eventually had a successful outcome after allowing the fracture to heal by starting the patient on weight-bearing activities and a "walk-to-run" program. Treatment points in managing stress fractures including female-specific issues are also discussed.

Installation Management Command's COVID-19 Pandemic Efforts Rely on Multiple Collaborative Partnerships.

The Installation Management Command (IMCOM) delivers quality base support from the strategic support area, enabling readiness for a globally responsive Army. IMCOM has more than 75 installations, covering more than 13 million acres, in 17 time zones, 12 countries and 58 services. In early March 2020, the COVID-19 pandemic required IMCOM to shift focus in ensuring health protection measures were implemented early and quickly, which relied on medical expertise. The IMCOM Surgeon and the Deputy Surgeon serve as the command's key advisors for all matters related to health care and medical readiness. During the COVID-19 pandemic, the IMCOM Surgeon and the Deputy Surgeon were critical in the consolidation of various information from multiple organizations. They promoted the integration of force health protection principles during COVID-19 operations. All of the military members at IMCOM headquarters (HQ) were considered mission essential while other personnel were identified on a phasing structure in the early stages of the pandemic, which meant civilian personnel were instructed to telework.

Magnetic resonance diagnosis of tarsal tunnel syndrome due to flexor digitorum accessorius longus and peroneocalcaneus internus muscles.

Anomalous muscles of the ankle are common. Although they are often asymptomatic, they can sometimes cause tarsal tunnel syndrome. We report a case of tarsal tunnel syndrome due to flexor digitorum accessorius longus and peroneocalcaneus internus muscles diagnosed on magnetic resonance imaging. Recognition of the most common accessory muscles of the ankle on magnetic resonance imaging and tarsal tunnel syndrome are also reviewed.