Case Report: Scarring Alopecia After Scalp Avulsion.

Scalp avulsion is a rare trauma in the developed world but is a common injury in countries with poorly established infrastructure and safety regulations. This case reports the long-term sequelae of this injury, observed while conducting a humanitarian mission, and discusses immediate actions for management in an acute setting. We aim to increase awareness about this injury, its risk factors, and treatment options to better prepare clinicians in the developed world to provide care for this condition in the austere environment, which may include not only chronic pain, functional, and aesthetic concerns, but also a psychological impact that persists years after the initial injury.

Utility of Point of Care Ultrasound in Humanitarian Assistance Missions.

INTRODUCTION: Point of care ultrasound (POCUS) is increasingly used in primary care in the USA and has been shown to provide significant benefit to care in deployed military settings and during disaster relief efforts. It is less studied as a tool during humanitarian assistance missions. We sought to determine the utility of POCUS in a humanitarian assistance setting during the February 2019 joint U.S.-Brazilian hospital assistance mission aboard the Hospitalar Assistance Ship Carlos Chagas along the Madeira River in the Brazilian Amazon. MATERIALS AND METHODS: Point of care ultrasound was offered as a diagnostic modality to primary care physicians during the course of a month-long mission. A handheld IVIZ ultrasound machine was loaned for use during this mission by Sonosite. A P21v phased array (5-1 MHz) or an L38v linear (10-5 MHz) transducer was used for scanning. Requests for POCUS examinations, their findings, and changes in patient management were recorded. RESULTS: Point of care ultrasound examinations were requested and performed in 24 of 814 (3%) outpatient primary care visits. Ten of these studies (42% of POCUS examinations, 1.2% of all patient visits) directed patient management decisions, in each case preventing unnecessary referral. CONCLUSIONS: In this austere setting, POCUS proved to be an inexpensive, effective tool at preventing unnecessary referrals. Future medical humanitarian assistance missions may likewise find POCUS to be a primary care force-multiplier.

Health Characteristics of the Madeira Riverine Population.

INTRODUCTION: The Amazon River Basin is the largest and the most complex fluvial system in the world. The Brazilian government provides dental and medical care to the riverine populations in this region in part through medical assistance missions, conducted by four hospital ships. The Brazilian Navy invited U.S. Navy medical personnel to join the February 2019 mission aboard Navio de Assistência Hospitalar (NAsH) Carlos Chagas to provide care along the Madeira River. MATERIALS AND METHODS: In the course of providing primary care services, demographic, health, and dental data of the Madeira Riverine population were collected. Descriptive statistics were used to generate average health and dental data. Chi-square tests were used to compare population prevalence data. Linear regression was used to evaluate dental caries per patient with proximity to nearest large population center and village population. This project was approved by Naval Medical Center Portsmouth Institutional Review Board. RESULTS: The Madeira Riverine population has similar dental health to Brazilians living in urban centers. Their prevalence of hypertension and diabetes compared favorably with the U.S. averages (17.7% vs. 34.3% [P < 0.001] and 3% vs. 9.4% [P < 0.001], respectively). Based on the most prevalent ICD-10 code diagnoses, future missions can expect high volumes of patients with intestinal parasites, hypertension, common skin infections, women's health concerns, and musculoskeletal complaints. CONCLUSIONS: This study adds to the limited health data currently available on Brazilian Riverine populations. It demonstrates the effectiveness of the Hospital Assistance missions in providing dental care and documents some unique aspects of Riverine health that warrant further study.

Impact of a new practice guideline on antibiotic use with pediatric tonsillectomy.

IMPORTANCE: More than 500,000 children undergo tonsillectomy each year in the United States. Although prior studies suggest that most patients received perioperative antibiotics, practice varies across centers. In 2011, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published a practice guideline recommending against perioperative antibiotic use for pediatric tonsillectomy. The impact of this recommendation has not been thoroughly examined. OBJECTIVE: To determine the impact of the AAO-HNS guideline on the use of perioperative antibiotics and patient outcomes for pediatric tonsillectomy. DESIGN, SETTING, AND PARTICIPANTS: This was a quasi-experimental study including 9265 children who underwent routine tonsillectomy from January 2009 through August 2012 within a large pediatric health care network containing hospital-based and ambulatory surgical facilities. Data were collected from a shared electronic health record and validated through manual medical record review. We used an interrupted time series analysis with segmented logistic regression and a nonequivalent dependent variable (tympanoplasty) to assess acute changes and differences in trends over time relative to guideline publication. INTERVENTIONS: Publication of the AAO-HNS clinical practice guideline. MAIN OUTCOMES AND MEASURES: The primary outcome was antibiotic administration on the day of surgery. Secondary outcomes included otolaryngology clinic encounters, emergency department encounters, hospital admissions, and surgical procedures for bleeding in the 30 days following tonsillectomy. RESULTS: Of 9265 tonsillectomies during the study period, 5359 met inclusion criteria. Immediately after guideline publication, perioperative antibiotic use dropped by 86.5% (P < .001) and was sustained throughout the postintervention period. Rates of otolaryngology clinic encounters, emergency department encounters, and hospital admissions did not change significantly over time. There was a small but statistically significant increase in surgical procedures for bleeding following the intervention from 1.35% (95% CI, 0.57%-2.14%) to 3.48% (95% CI, 1.85%-5.10%). CONCLUSIONS AND RELEVANCE: AAO-HNS guideline publication decreased perioperative antibiotic use for pediatric tonsillectomy across a large pediatric health care network. Although there were no changes in otolaryngology clinic visits, emergency department visits, or admissions, we found a small but significant increase in surgery for bleeding following guideline publication. Additional studies are necessary to verify this unexpected association.