Case report of electronic cigarettes possibly associated with eosinophilic pneumonitis in a previously healthy active-duty sailor.

BACKGROUND: Electronic cigarettes (e-cigarettes) are a technology that has been touted as a safe and effective alternative to traditional cigarettes. There is, however, a paucity of literature showing the adverse outcomes of e-cigarettes and a correlation with acute eosinophilic pneumonia (AEP). OBJECTIVE: To present a possible association between e-cigarettes and AEP. CASE REPORT: A 20-year-old previously healthy man was found to develop AEP after smoking an e-cigarette. He was treated with antibiotics and steroids and his symptoms improved. CONCLUSION: Though an alternative to traditional cigarettes, e-cigarettes can have unpredictable and potentially serious adverse effects. More research needs to be conducted to determine their safety. If seeing a patient in the ED with pulmonary symptoms after use of e-cigarettes, AEP should be considered in the differential.

Revolutionizing Combat Casualty Care: The Power of Digital Twins in Optimizing Casualty Care Through Passive Data Collection.

The potential impact of large-scale combat operations and multidomain operations against peer adversaries poses significant challenges to the Military Health System including large volumes of critically ill and injured casualties, prolonged care times in austere care contexts, limited movement, contested logistics, and denied communications. These challenges contribute to the probability of higher casualty mortality and risk that casualty care hinders commanders' forward momentum or opportunities for overmatch on the battlefield. Novel technical solutions and associated concepts of operation that fundamentally change the delivery of casualty care are necessary to achieve desired medical outcomes that include maximizing Warfighter battle-readiness, minimizing return-to-duty time, optimizing medical evacuation that clears casualties from the battlefield while minimizing casualty morbidity and mortality, and minimizing resource consumption across the care continuum. These novel solutions promise to "automate" certain aspects of casualty care at the level of the individual caregiver and the system level, to unburden our limited number of providers to do more and make better (data-driven) decisions. In this commentary, we describe concepts of casualty digital twins-virtual representations of a casualty's physical journey through the roles of care-and how they, combined with passive data collection about casualty status, caregiver actions, and real-time resource use, can lead to human-machine teaming and increasing automation of casualty care across the care continuum while maintaining or improving outcomes. Our path to combat casualty care automation starts with mapping and modeling the context of casualty care in realistic environments through passive data collection of large amounts of unstructured data to inform machine learning models. These context-aware models will be matched with patient physiology models to create casualty digital twins that better predict casualty needs and resources required and ultimately inform and accelerate decision-making across the continuum of care. We will draw from the experience of the automotive industry as an exemplar for achieving automation in health care and inculcate automation as a mechanism for optimizing the casualty care survival chain.

In vitro biotransformation, in vivo efficacy and pharmacokinetics of antimalarial chalcones.

4'-n-Butoxy-2,4-dimethoxy-chalcone (MBC) has been described as protecting mice from an otherwise lethal infection with Plasmodium yoelii when dosed orally at 50 mg/kg/dose, daily for 5 days. In contrast, we found that oral dosing of MBC at 640 mg/kg/dose, daily for 5 days, failed to extend the survivability of P. berghei-infected mice. The timing of compound administration and metabolic activation likely contribute to the outcome of efficacy testing in vivo. Microsomal digest of MBC yielded 4'-n-butoxy-4-hydroxy-2-methoxy-chalcone and 4'-(1-hydroxy-n-butoxy)-2,4-dimethoxy-chalcone. We propose that the latter will hydrolyze in vivo to 4'-hydroxy-2,4-dimethoxy-chalcone, which has greater efficacy than MBC in our P. berghei-infected mouse model and was detected in plasma following oral dosing of mice with MBC. Pharmacokinetic parameters suggest that poor absorption, distribution, metabolism and excretion properties contribute to the limited in vivo efficacy observed for MBC and its analogs.

Evaluating the Relationship Between Fitbit Sleep Data and Self-Reported Mood, Sleep, and Environmental Contextual Factors in Healthy Adults: Pilot Observational Cohort Study.

BACKGROUND: Mental health disorders can disrupt a person's sleep, resulting in lower quality of life. Early identification and referral to mental health services are critical for active duty service members returning from forward-deployed missions. Although technologies like wearable computing devices have the potential to help address this problem, research on the role of technologies like Fitbit in mental health services is in its infancy. OBJECTIVE: If Fitbit proves to be an appropriate clinical tool in a military setting, it could provide potential cost savings, improve clinician access to patient data, and create real-time treatment options for the greater active duty service member population. The purpose of this study was to determine if the Fitbit device can be used to identify indicators of mental health disorders by measuring the relationship between Fitbit sleep data, self-reported mood, and environmental contextual factors that may disrupt sleep. METHODS: This observational cohort study was conducted at the Madigan Army Medical Center. The study included 17 healthy adults who wore a Fitbit Flex for 2 weeks and completed a daily self-reported mood and sleep log. Daily Fitbit data were obtained for each participant. Contextual factors were collected with interim and postintervention surveys. This study had 3 specific aims: (1) Determine the correlation between daily Fitbit sleep data and daily self-reported sleep, (2) Determine the correlation between number of waking events and self-reported mood, and (3) Explore the qualitative relationships between Fitbit waking events and self-reported contextual factors for sleep. RESULTS: There was no significant difference in the scores for the pre-intevention Pittsburg Sleep Quality Index (PSQI; mean 5.88 points, SD 3.71 points) and postintervention PSQI (mean 5.33 points, SD 2.83 points). The Wilcoxon signed-ranks test showed that the difference between the pre-intervention PSQI and postintervention PSQI survey data was not statistically significant (Z=0.751, P=.05). The Spearman correlation between Fitbit sleep time and self-reported sleep time was moderate (r=0.643, P=.005). The Spearman correlation between number of waking events and self-reported mood was weak (r=0.354, P=.163). Top contextual factors disrupting sleep were "pain," "noises," and "worries." A subanalysis of participants reporting "worries" found evidence of potential stress resilience and outliers in waking events. CONCLUSIONS: Findings contribute valuable evidence on the strength of the Fitbit Flex device as a proxy that is consistent with self-reported sleep data. Mood data alone do not predict number of waking events. Mood and Fitbit data combined with further screening tools may be able to identify markers of underlying mental health disease.

Spontaneous Lung Herniation Through the Chest Wall.

A 71-yr-old male with a medical history significant for chronic obstructive pulmonary disease presented to emergency department for worsening cough, right-sided pleuritic chest pain, and dyspnea. This was the patient's third visit to the emergency department in 4 d. The patient was initially treated for chronic obstructive pulmonary disease exacerbation and subsequently evaluated for congestive heart failure. He was ultimately diagnosed with a spontaneous herniation of the lung parenchyma through the chest wall. The patient was transferred to an outside host nation facility for definitive treatment and repair of the chest wall defect. Refractory cough and dyspnea failing to respond to typical treatments should warrant an expanded differential to include the rare etiology of atraumatic spontaneous lung herniation.

Wernicke's Encephalopathy in a Patient Without Chronic Alcohol Abuse.

Wernicke's encephalopathy (WE) is traditionally seen in the emergency department in patients with chronic alcohol abuse. WE can result in significant morbidity and mortality if untreated, making early diagnosis and intervention paramount. We discuss a case of WE in a 63-year-old female with no history of chronic alcohol abuse, who presented with bilateral opthalmoplegia that resolved after intravenous thiamine administration. This case report highlights the varied clinical settings other than chronic alcohol abuse in which the diagnosis of WE should be considered.

A Case of Superior Mesenteric Artery Syndrome in a Healthy Active Duty Marine.

Superior mesenteric artery (SMA) syndrome is an uncommon disorder that can lead to small bowel obstructions or perforations. Typical populations include young females with anorexia. However, there have been a few reports of healthy males with acute vomiting reported to have SMA syndrome. Our case report highlights an active duty Marine who developed SMA syndrome and the importance of recognizing this disease given the severity in delay of diagnosis in population of young healthy active duty members.

Acute, proximal aortic dissection with negative D-Dimer assay and normal portable chest radiograph: a case report.

Acute aortic dissection is one of the most devastating and time-sensitive diagnosis to consider in young adults with chest pain. Military medicine is represented by a larger proportion of 18- to 50-year-old individuals than is seen in the general medical population. Although uncommon in frequency, younger patients are more likely to suffer from proximal, aortic dissections. Chest radiographs and D-Dimer assays are used frequently as risk stratification tools, but have significant limitations in these more proximal dissections. Because of the frequency and lethality of nonspecific presentations, there exists a need for a sensitive screening tool. This case report presents a 43-year-old male with a concerning history and physical examination for aortic dissection, but a normal portable chest radiograph and a normal D-Dimer assay. It highlights the importance of clinical acumen in developing and maintaining a high clinical index of suspicion based on a Bayesian pretest probability model.

In vitro and in vivo efficacy and in vitro metabolism of 1-phenyl-3-aryl-2-propen-1-ones against Plasmodium falciparum.

Investigation of a series of 1-phenyl-3-aryl-2-propen-1-ones resulted in the identification of nine inhibitors with submicromolar efficacy against at least one Plasmodium falciparum strain in vitro. These inhibitors were inactive when given orally in a Plasmodium berghei infected mouse model. Significant compound degradation occurred upon their exposure to a liver microsome preparation, suggesting metabolic instability may be responsible for the lack of activity in vivo.