The Impact of Aeroallergens on Military Readiness: A Case Report.

Seasonal aeroallergens commonly cause allergic conjunctivitis, rhinorrhea, sinusitis, and cough in sensitized individuals. These clinical symptoms are the result of IgE-mediated type I hypersensitivity reactions, which trigger the degranulaton of mast cells and basophils. In contrast, aeroallergens are not common precipitants of urticarial dermatitis, which is driven by a cell-mediated type IV hypersensitivity reaction. In this case report, we describe an Active Duty Air Force member stationed in San Antonio, TX, who presented to the dermatology clinic with a three year history of recalcitrant urticarial dermatitis found to be directly related to exposure to the pollen from the Juniperus ashei tree, also referred to as Mountain Cedar. While laboratory findings confirmed a high level of circulating IgE antibody to Mountain Cedar, the patient had no upper respiratory symptoms consistent with a typical allergic reaction. Further, his skin disease rapidly cleared within 24 hours of leaving southern Texas. Because of the recalcitrant nature of his condition upon returning home, he was considered unfit for further military service. This case not only highlights the growing link between IgE and chronic skin disease, but also the impact aeroallergens can have on the medical readiness and world-wide deployability of Airmen, Sailors, Soldiers, and Marines.

Solid-State Examination of Conformationally Diverse Sulfonamide Receptors Based on Bis(2-anilinoethynyl)pyridine, -Bipyridine, and -Thiophene.

Utilizing an induced-fit model and taking advantage of rotatable acetylenic C(sp)-C(sp2) bonds, we disclose the synthesis and solid-state structures of a series of conformationally diverse bis-sulfonamide arylethynyl receptors using either pyridine, 2,2'-bipyridine, or thiophene as the core aryl group. Whereas the bipyridine and thiophene structures do not appear to bind guests in the solid state, the pyridine receptors form 2 + 2 dimers with water molecules, two halides, or one of each, depending on the protonation state of the pyridine nitrogen atom. Isolation of a related bis-sulfonimide derivative demonstrates the importance of the sulfonamide N-H hydrogen bonds in dimer formation. The pyridine receptors form monomeric structures with larger guests such as BF4- or HSO4-, where the sulfonamide arms rotate to the side opposite the pyridine N atom.

Pneumonia Outbreak Caused by Chlamydophila pneumoniae among US Air Force Academy Cadets, Colorado, USA.

During October 2013-May 2014, there were 102 cases of pneumonia diagnosed in US Air Force Academy cadets. A total of 73% of tested nasal washes contained Chlamydophila pneumoniae. This agent can be considered to be present on campus settings during outbreaks with numerous, seemingly disconnected cases of relatively mild pneumonia.

Exercise-induced cardiac arrest in a sickle cell trait-positive Air Force recruit: a case report.

In October 2011, a sickle cell trait (SCT)-positive Air Force recruit collapsed and died immediately following his physical fitness test. The cause of death was reported to be a cardiac dysrhythmia secondary to an acute sickling crisis. Although it is well known that SCT-positive individuals have a significant risk of exercise-related death (ERD), this case is notable in that none of the commonly cited risk factors were present, including exertional heat injury, dehydration, training at altitude, and rhabdomyolysis. Our findings challenge the commonly held assertion exertional heat illness is the fundamental underlying etiology in these cases, and that the current Department of Defense's policy on SCT screening is ineffective at mitigating the risk of ERD in SCT-positive recruits. Furthermore, we argue that without a clearer understanding of the precise risk factors for ERD in this population, screening programs may actually shift excessive health risks onto those without SCT.

Bilateral lower extremity inflammatory lymphedema in Air Force basic trainees: clinical and epidemiologic study of a new disease entity.

IMPORTANCE: This observational study characterizes a new clinical condition identified in 55 military trainees. OBJECTIVE: To determine the incidence and underlying cause of bilateral lower extremity inflammatory lymphedema in Air Force basic trainees. DESIGN, SETTING, AND PARTICIPANTS: An observational study was conducted at Lackland Air Force Base in San Antonio, Texas. Participants included 14 243 Air Force basic trainees who entered training between September 2011 and January 2012 and the 55 trainees (0.4%) who developed bilateral lower extremity inflammatory lymphedema that occurred during the 8½-week basic training course. Two modifiable risk factors were evaluated: vaccine reaction and newly issued military footwear (combat boots and boot socks). INTERVENTIONS: During November 2011, all new trainees wore only white socks and running shoes rather than the issued military footwear. During December 2011 and January 2012, the scheduled administration of tetanus/diphtheria/acellular pertussis and meningococcal vaccines, respectively, was delayed by 1 week for all new trainees. A full medical record review was conducted for every confirmed case of bilateral lower extremity inflammatory lymphedema. MAIN OUTCOMES AND MEASURES: Identification of incident cases, symptom onset, antimicrobial treatment, immunization reaction, laboratory studies, specialty referral, and biopsy. RESULTS: Fifty-four of the 55 incident cases (98%) of bilateral lower extremity inflammatory lymphedema occurred during the first 120 hours of training. Alterations in the timing of the military footwear used and selected vaccine administration had no effect on the incidence of new cases. Two participants (4%) experienced symptom onset before receipt of the vaccines. Oral antimicrobial medications were not found to speed symptom resolution compared with conservative treatment measures (P = .34). One incident case was diagnosed as leukocytoclastic vasculitis by tissue examination. CONCLUSIONS AND RELEVANCE: Multiple training-related risk factors were ruled out as sources of bilateral lower extremity inflammatory lymphedema. Cases are likely secondary to prolonged standing with resultant gravity-dependent venous congestion and inflammatory vasculitis. The potential roles of undiagnosed venous reflux disease and the military physical training environment in these cases remain to be elucidated.