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1.
J Spec Oper Med ; 21(1): 25-29, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33721302

RESUMO

BACKGROUND: The Air Force Special Warfare Medical Officer Course was created to address the lack of operationally focused, job-specific clinical training for medical officers (MOs). This course addresses the gap in knowledge, skill, and application of operational medicine, as well as the behavioral health, human performance, education, and medical oversight of Operators. METHODS: The course was designed around the senior author's decade of experience piecing together training for his own role as a pararescue flight surgeon and informed by 5 years of flight surgeon courses, lessons learned from case studies of ill-prepared deployed physicians, and input from prehospital medicine subject matter experts. RESULTS: Air Force pararescue and special tactics flight surgeons, physician assistants, and an independent duty medical technician (IDMT) attended. The course consisted of 10 full weekdays of didactics and skills sessions covering theory and application of operational medicine, human performance optimization, behavioral health for Operators, adult education theory, principles of prehospital clinical oversight, and other expeditionary concepts. The course culminated with combat casualty care scenario-based exercises, in which the providers performed operational medicine in full kit with weapons and simulation rounds. DISCUSSION: For many logistical and practical reasons, civilian medical experience, traditional military medical training, existing special operations medical courses, and "merit badge" card classes are not adequate preparation for this specialized role. Focused, job-specific training should be provided to Special Operations Forces Medical Officers (SOFMO) and, ultimately, to any MO deploying in support of medics or combatants. The goal is to maximize the success of military medical operations while reducing the morbidity and mortality of combat and training casualties. CONCLUSION: This operationally focused MO course can serve as a model for the future training of SOFMO and has stimulated discussion for consideration of a joint approach to prehospital medical training.


Assuntos
Medicina Militar , Militares , Pessoal de Saúde , Humanos , Guerra
2.
J Spec Oper Med ; 21(1): 127-133, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33721322

RESUMO

The Tactical Combat Casualty Care (TCCC) project initiated by Naval Special Warfare and continued by the US Special Operations Command has developed a new set of combat trauma care guidelines that seek to combine good medical care with good small-unit tactics. The principles of care recommended in TCCC have gained increasing acceptance throughout the Department of Defense in the four years since their publication and increasing numbers of combat medical personnel and military physicians have been trained in this concept. Since casualty scenarios in small-unit operations typically present tactical as well as medical problems, however, it has become apparent that a customized version of this course suitable for small-unit mission commanders is a necessary addition to the program. This paper describes the development of a course in Tactical Medicine for SEAL Mission Commanders and its transition into use in the Naval Special Warfare community.


Assuntos
Serviços Médicos de Emergência , Medicina , Medicina Militar , Militares , Humanos , Guerra
3.
Nature ; 590(7846): 389, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33594284
4.
Am J Phys Anthropol ; 174(1): 3-19, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32935864

RESUMO

OBJECTIVES: Warfare is assumed to be one of the defining cultural characteristics of steppe nomads in Eastern Eurasia. For the first-centuries CE, a period of political turmoil in Northern China and Southern Siberia, relatively few data are, however, available about the degree and variability of violence in these communities. Here, we provide new data on violence among steppe nomads during the first-centuries CE by analyzing the type, anatomical distribution, and demographic distribution of perimortem trauma at Tunnug1 (Tuva, Southern Siberia-second to fourth c. CE). MATERIALS AND METHODS: Perimortem traumas were assessed on 87 individuals representing both sexes and different age classes. The timing of the lesions was assessed based on morphological criteria, including the absence and presence of bone reactive processes and the relative plasticity of the bone at the moment of impact. The distribution by age, sex, and anatomical location of trauma was analyzed by means of logistic models, Fisher's exact tests, and 3D visualizations. RESULTS: A total of 130 perimortem traumas, including chop marks, slice marks, penetrating lesions, and blunt traumas were identified on 22 individuals. Chop marks were mostly at the level of the skull and vertebrae and were likely caused by bladed weapons. Slice marks were found on the cervical vertebrae and cranium and may be the result of throat slitting and scalping by means of smaller bladed implements. Traumas were more frequent in males, and their presence is not correlated with age. DISCUSSION: This study adds new data to the few available regarding violence among steppe nomadic cultures and provides new insights about the effects of political instability on the life of the people inhabiting Eastern Eurasia during the early centuries CE.


Assuntos
Grupo com Ancestrais do Continente Asiático/história , Violência/história , Ferimentos Penetrantes/história , Adolescente , Adulto , Antropologia Física , Osso e Ossos/lesões , Osso e Ossos/patologia , Sepultamento/história , Criança , Pré-Escolar , Decapitação/história , Feminino , História Antiga , Humanos , Lactente , Recém-Nascido , Masculino , Sibéria , Migrantes , Guerra/história , Adulto Jovem
5.
Rev. crim ; 62(3): 159-173, sep.-dic. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1144427

RESUMO

Resumen La seguridad y la reconciliación son dos factores determinantes para la construcción de la paz. Este artículo presenta los resultados de una investigación que tiene como objetivo comprender las ideas y creencias sobre la reconciliación desde el sector de seguridad en el contexto del posacuerdo en Colombia. Se utilizó una metodología cualitativa con un diseño fenomenológico, para analizar los testimonios de 15 policías adscritos a la Unidad Policial para la Edificación de la Paz, quienes fueron responsables de la seguridad de los excombatientes de las FARC-EP en las zonas veredales donde iniciaron su reincorporación a la vida civil después de la firma del acuerdo de paz con el Gobierno colombiano. Entre los resultados se destacan tres categorías conceptuales que emergieron de las narrativas de los participantes: condiciones necesarias para la interacción con el antiguo adversario, factores que facilitan la reconciliación desde el sector de seguridad y emociones involucradas en la reconciliación. Finalmente, se presentan algunas reflexiones para comprender la reconciliación desde el sector de seguridad en un escenario de posacuerdo.


Abstract Security and reconciliation are two determining factors for peacebuilding. This article presents the results of research whose objective is to understand the ideas and beliefs regarding reconciliation from the security sector in the post-agreement context in Colombia. A qualitative methodology was used with a phenomenological design to analyze the testimonies of 15 police officers assigned to the Police Unit for Peacebuilding. They were responsible for the security of former FARC-EP combatants in the rural areas where they began their reinsertion into civilian life after signing the peace agreement with the Colombian government. Three conceptual categories stood out among the results, which emerged from the participants' narratives: the necessary conditions to interact with the former adversary, factors that facilitated reconciliation from the security sector, and the emotions involved in reconciliation. Finally, some reflections are presented to understand reconciliation from the security sector in a post-agreement setting.


Resumo Segurança e reconciliação são dois fatores determinantes para a construção da paz. Este artigo apresenta os resultados de uma investigação que visa compreender as ideias e crenças sobre a reconciliação do setor de segurança no contexto do pós-acordo na Colômbia. Foi utilizada uma metodologia qualitativa de desenho fenomenològico para analisar os depoimentos de 15 policiais vinculados à Unidade Policial para a Construção da Paz, responsáveis pela segurança dos ex-combatentes das FARC-EP nas áreas rurais onde iniciaram sua reincorporação à vida civil após a assinatura do acordo de paz com o Governo colombiano. Dentre os resultados, destacam-se três categorias conceituais que emergiram das narrativas dos participantes: condições necessárias para interação com o antigo adversário, fatores que facilitam a reconciliação do setor de segurança e emoções envolvidas na reconciliação. Por fim, são apresentadas algumas reflexões para entender a reconciliação do setor de segurança em um cenário pós-acordo.


Assuntos
Humanos , Ciências Sociais , Segurança , Guerra , Estudos de Avaliação como Assunto
7.
Nature ; 586(7827): 7-8, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32999488
8.
Psychiatr Danub ; 32(Suppl 3): 320-336, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33030447

RESUMO

The war in Bosnia and Herzegovina (1992-1995) was an extremely hard traumatic event with different losses, separations of people, injuries, hard physical and psychical suffering of everyone. Children were especially in difficult conditions. One of the most remarkable things about children, as anyone who works with them soon finds out, is their resilience. While children are vulnerable to psychic damage and, if the damage is deep enough, to delays in emotional and even physical growth, they also have an astonishing capacity to bounce back. This is one of the most rewarding things about treating traumatized children. For many children, it takes very little, perhaps only some words of understanding, to help them tap into their own ability to heal. Taking care of child war psycho-trauma was a difficult task for me, as the war-time head of Department of psychiatry, without enough knowledge in child psycho-trauma and as person with a high responsibility, to organize together with other psychological caretakers of children, especially refugee children. This presentation will be some kind of my remembrance of period of 20-25 years ago when we, I think did good work of what we could and what we knew.


Assuntos
Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Guerra/psicologia , Adolescente , Adulto , Idoso , Bósnia e Herzegóvina , Criança , Família/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Refugiados/psicologia , Resiliência Psicológica , Transtornos de Estresse Pós-Traumáticos/reabilitação , Adulto Jovem
9.
Psychiatr Danub ; 32(Suppl 3): 360-363, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33030453

RESUMO

The establishment of the United Nations after World War II raised hopes of a new era of peace. This was over-optimistic. Between 1945 and 1992, there were 149 major wars, killing more than 23 million people. Recent developments in warfare have significantly heightened the dangers for children. During the last decade child war victims have included: 2 million killed; 4-5 million disabled; 12 million left homeless; more than 1 million orphaned or separated from their parents; some 10 million psychologically traumatized. Researches indicate that children do develop PTSD after experiencing very stressful, life-threatening events such as happen in war. Wars of 21st century are often guerrilla-type civil wars in which women and children are not only the main victims, but are deliberately targeted. Thousands are displaced both internally and across borders. Wars at the end of nineties of 20th century in the region of ex Yugoslavian countries brought all the cruelty of war vivid again on European ground. Population were exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. During the War in Bosnia and Herzegovina 1992-1995 there were about 100 000 people killed (20% woman and 3.5% children) and about 18 000 children were orphaned because of war. Children are not capable to regulate their emotions and hyper-arousal on their own. It depends of the way how their parents (caretaker) regulate her/his own emotions. During the war weak child's ego is paralyzed with intensive stimuli and floating anxiety, it does not manage to make constructive solution for traumatic experiences in such a short time. Mothers with small children are especially vulnerable group during the war time: they are supposed to take care about children and feel happiness, what is almost impossible Severe war experiences could cause depressive symptoms in mothers, what reduce their emotional disposability and could lead in different form of the child's neglecting. PTSD symptoms were lasting longer in children if their mothers have had functioning problems. Traumatization of mothers is connected with different behavior problems in their children. Wars are continuing all over the world and there is a continuity of researches about their consequences on children. Any programs that intend to mitigate the psychological effects of such trauma need to adopt a public health approach aimed at reaching many thousands.


Assuntos
Transtornos de Estresse Pós-Traumáticos/epidemiologia , Guerra/psicologia , Guerra/estatística & dados numéricos , Bósnia e Herzegóvina/epidemiologia , Criança , Humanos , Mães/psicologia , Comportamento Problema , Transtornos de Estresse Pós-Traumáticos/psicologia , Violência/psicologia , Violência/estatística & dados numéricos , Lesões Relacionadas à Guerra/epidemiologia , Lesões Relacionadas à Guerra/psicologia
10.
Leg Med (Tokyo) ; 47: 101766, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32919340

RESUMO

This study analyses variable levels of body fragmentation among secondary mass grave sites with similar formation process history. The study is based on data from 10 commingled secondary mass grave sites and two primary sites related to the war in Bosnia in 1995. The aim was to investigate differences in level of body fragmentation between mass graves of similar origin and taphonomy. In order to quantify the degree of fragmentation (and level of commingling) within a grave, we introduced a fragmentation index (FI). FI represents the ratio between the number of complete bodies and number of body parts from the same context. Results show high discrepancies in body fragmentations between different sites. FI for secondary sites of similar formation history varied from 0.01 to 0.59 (max = 1), while two primary sites have values 0.92 and 0.90 respectively. Variable levels of fragmentation among similar secondary sites suggest a possibility of different peri mortem circumstances of buried, so we tested whether the "body fragmentation index" could assist in elucidating the manner of death. Unusually high levels of body fragmentation (FI value below 0.1) in some secondary sites may indicate that body disarticulation was most likely caused peri-mortem by explosives, land mines, mortars or tank fire, all suggesting a combat situation.


Assuntos
Restos Mortais/patologia , Sepultamento , Exumação , Antropologia Forense/métodos , Balística Forense/métodos , Ciências Forenses/métodos , Guerra , Bósnia e Herzegóvina , Humanos
11.
Am J Disaster Med ; 15(1): 49-69, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804386

RESUMO

OBJECTIVE: Conflict is often destructive to existing services and exacerbates population health inequities and the vulner-abilities of existing healthcare. We undertook a scoping review of the literature concerning delivery of primary healthcare (PHC) in post-conflict settings. DESIGN: We undertook a scoping review of the peer-reviewed and gray literature to identify articles related to the development and delivery of PHC in post-conflict settings. We searched PubMed/Medline, Cochrane Library, Em-base/Ovid, CAB abstracts, POPLINE, and WHO.int. between January 1990 through the December end of 2017, for arti-cles in the English language. Two researchers independently assessed each article and applied inclusion criteria: refer-ring to post-conflict settings and a range of terms related to PHC or health system development. Search terms were selected by careful review of the World Health Organization's analytical framework for developing a strategy on univer-sal coverage and analysis according to the availability, accessibility, affordability, and acceptability of healthcare and further themes involving demand-side or user-side concerns. RESULTS: Findings were captured to reflect a range of conflict-affected settings and varied priorities and approaches to PHC reconstruction. Integrated immediate and longer-term strategies, involving needs-assessments, effective ad-ministration, development of institutions, and cost-efficient investment in human resources, infrastructure, and capacity building are needed to deliver expanded and equitable services, responsive to population health needs, critical to the delivery of equitable PHC. CONCLUSIONS: Scoping review of the literature may be formative in the generation of evidence-base to inform delivery of universal PHC, when applied according to context specificity of conflict-affected setting.


Assuntos
Assistência à Saúde/organização & administração , Segurança do Paciente , Atenção Primária à Saúde/organização & administração , Guerra , Humanos
12.
PLoS One ; 15(8): e0237029, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764793

RESUMO

Paleomagnetic analysis of archaeological materials is crucial for understanding the behavior of the geomagnetic field in the past. As it is often difficult to accurately date the acquisition of magnetic information recorded in archaeological materials, large age uncertainties and discrepancies are common in archaeomagnetic datasets, limiting the ability to use these data for geomagnetic modeling and archaeomagnetic dating. Here we present an accurately dated reconstruction of the intensity and direction of the field in Jerusalem in August, 586 BCE, the date of the city's destruction by fire by the Babylonian army, which marks the end of the Iron Age in the Levant. We analyzed 54 floor segments, of unprecedented construction quality, unearthed within a large monumental structure that had served as an elite or public building and collapsed during the conflagration. From the reconstructed paleomagnetic directions, we conclude that the tilted floor segments had originally been part of the floor of the second story of the building and cooled after they had collapsed. This firmly connects the time of the magnetic acquisition to the date of the destruction. The relatively high field intensity, corresponding to virtual axial dipole moment (VADM) of 148.9 ± 3.9 ZAm2, accompanied by a geocentric axial dipole (GAD) inclination and a positive declination of 8.3°, suggests instability of the field during the 6th century BCE and redefines the duration of the Levantine Iron Age Anomaly. The narrow dating of the geomagnetic reconstruction enabled us to constrain the age of other Iron Age finds and resolve a long archaeological and historical discussion regarding the role and dating of royal Judean stamped jar handles. This demonstrates how archaeomagnetic data derived from historically-dated destructions can serve as an anchor for archaeomagnetic dating and its particular potency for periods in which radiocarbon is not adequate for high resolution dating.


Assuntos
Arqueologia/métodos , Planeta Terra , Campos Magnéticos , Materiais de Construção/análise , Materiais de Construção/história , Fogo/história , Pisos e Cobertura de Pisos/história , História Antiga , Humanos , Israel , Colapso Estrutural/história , Fatores de Tempo , Guerra/história
14.
BMC Public Health ; 20(1): 1076, 2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641028

RESUMO

BACKGROUND: Posttraumatic stress disorder (PTSD) and hearing loss are hallmark public health issues related to military service in Iraq and Afghanistan. Although both are significant individual contributors to disability among veterans, their co-occurrence has not been specifically explored. METHODS: A total of 1179 male U.S. military personnel who sustained an injury between 2004 and 2012 during operations in Iraq or Afghanistan were identified from clinical records. Pre- and postinjury audiometric data were used to define new-onset hearing loss, which was categorized as unilateral or bilateral. Diagnosed PTSD was abstracted from electronic medical records. Logistic regression analysis examined the relationship between hearing loss and PTSD, while adjusting for age, year of injury, occupation, injury severity, injury mechanism, and presence of concussion. RESULTS: The majority of the study sample were aged 18-25 years (79.9%) and sustained mild-moderate injuries (94.6%). New-onset hearing loss was present in 14.4% of casualties (10.3% unilateral, 4.1% bilateral). Rates of diagnosed PTSD were 9.1, 13.9, and 29.2% for those with no hearing loss, unilateral hearing loss, and bilateral hearing loss, respectively. After adjusting for covariates, those with bilateral hearing loss had nearly three-times higher odds of PTSD (odds ratio = 2.92; 95% CI, 1.47-5.81) compared to those with no hearing loss. Unilateral hearing loss was not associated with PTSD. CONCLUSIONS: Both PTSD and hearing loss are frequent consequences of modern warfare that adversely affect the overall health of the military. Bilateral, but not unilateral, hearing loss was associated with a greater burden of PTSD. This has implications for warfighter rehabilitation and should encourage collaboration between audiology and mental health professionals.


Assuntos
Perda Auditiva/epidemiologia , Militares/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adolescente , Adulto , Campanha Afegã de 2001- , Fatores Etários , Concussão Encefálica/epidemiologia , Humanos , Guerra do Iraque 2003-2011 , Masculino , Estudos Retrospectivos , Índices de Gravidade do Trauma , Estados Unidos/epidemiologia , Guerra , Adulto Jovem
15.
J Surg Res ; 255: 297-303, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32585467

RESUMO

BACKGROUND: Prospective predictors of trauma-related outcomes have been validated to guide management in low-resource settings. The primary objective of this study was to determine the optimal prospective prediction method for mortality within combat and humanitarian trauma. MATERIALS AND METHODS: Retrospective review of the Department of Defense Trauma Registry from 2008 to 2016 was performed for adult patients. Areas under receiver operating characteristic curves (AUROCs) were calculated to assess the predictability of shock index (SI), reverse SI × Glasgow Coma Scale (rSIG), SI × Glasgow Coma Scale (SIG), Revised Trauma Score, and Trauma and Injury Severity Score (TRISS) on mortality at point of injury, arrival in emergency department (ED), and the difference in vital signs between those time points. RESULTS: A total of 22,218 patients were included. Overall, 97.1% were male, median age range 25-29 y, Injury Severity Score 9.4 ± 0.07, with predominantly penetrating injuries (58.1%), and mortality of 3.4%. ED vitals yielded higher predictability of mortality for all tests based on higher AUROCs. TRISS and rSIG demonstrated the highest AUROCs (0.955 and 0.923, respectively). The optimal cutoff value for rSIG was 14.1 (sensitivity 89% and specificity 87%). rSIG values <14.1 were significantly associated with mortality (P < 0.01; odds ratio = 5.901). CONCLUSIONS: Initial ED vital signs represented a better predictor of early mortality compared with point of injury vital signs for all predictive tools assessed. TRISS and rSIG proved to be most predictive of mortality. However, of the prospective tools assessed, rSIG may be optimal scoring tool because of its ease of calculation and its increased ability to predict mortality.


Assuntos
Índices de Gravidade do Trauma , Guerra/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adulto , Feminino , Humanos , Masculino , Oriente Médio/epidemiologia , Militares , Socorro em Desastres , Estudos Retrospectivos
16.
J Craniofac Surg ; 31(5): 1434-1437, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32502104

RESUMO

As the most prominent portion of the human body, the face embraces a multifaceted responsibility for functionality and survival while contributing to identity and self-image. Inopportunely, due to its distinctive anatomical location, the face as a unit is highly suspectable to trauma, particularly in warfare. As a result, facial injury creates a physical and psychological trauma that needs to be addressed immediately. In the following article, a detailed literature review was conducted to examine the interplay between facial injuries throughout multiple wars in Iraq and their management. The authors found a significant increase in facial injuries due to shell fragments corresponding with modern advances in warfare targeting mass casualties. The capacity to manage the magnitude and level of trauma observed in Iraq requires a substantial amount of resources and a systematic approach that unfortunately is unattainable in a country that is still struggling to rebuild after decades of oppression and war. Due to the circumstances, surgeons have to rely on training and experience to provide the best care for their patients and it is imperative that we continue to train our surgeons to rely on their skills and experience to ensure a high level of care with limited resources and lack of technology.


Assuntos
Traumatismos Craniocerebrais/terapia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Iraque , Guerra do Iraque 2003-2011 , Masculino , Pessoa de Meia-Idade , Guerra , Adulto Jovem
17.
PLoS One ; 15(5): e0232063, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365107

RESUMO

BACKGROUND: During the Kosovo War (1998-99) approximately 31,000 rounds with Depleted Uranium (DU) were fired on 85 targets in Kosovo. The number of haematological malignancies (HM) increased after the war and the concern was the use of DU during the war. The aim of this study was to analyse the incidence rates of HM in Kosovo throughout a 20-year that includes pre- and post- war period (1995-2015); and to examine if there is any association between the use of DU rounds and incidence rates of HM in different regions of Kosovo. METHODS: In this retrospective register-based study, 1,798 new patients diagnosed with leukaemia, Hodgkin lymphoma, non-Hodgkin lymphoma and Multiple myeloma were analysed over a 20 year period. Incidence rates were calculated focusing on specific time periods, regions and age-groups. In addition, the correlation between the use of DU in different regions and their incidence of HM was analysed. RESULTS: The average annual crude rate of all HM in Kosovo was 5.02 cases per 100,000 persons. Incidence rates of HM in first post-war period (2000-2003) increased by 0.37 cases/100,000 persons (9.51%) compared to the pre-war period (1995-1998) whereas in the last post-war period (2012-2015), incidence of HM increased by 3.19/100,000 persons (82%). Gjakova and Peja, the first and third most exposed regions to DU ordnance ranked first and second in difference in HM. Prishtina, Gjilan and Ferizaj, regions with the least number of rounds/km2, were characterized by a decline of incidence rates. CONCLUSIONS: After the war, the increase in incidence rate of HM was higher in two regions with most DU rounds/km2 expended Despite these findings, this study warrants further investigation and does not lead us to a conclusive finding on the existence of a causal relationship between the use of DU during the war and the rise in incidence of HM in Kosovo.


Assuntos
Neoplasias Hematológicas/epidemiologia , Urânio , Guerra , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Neoplasias Hematológicas/história , História do Século XX , História do Século XXI , Humanos , Incidência , Lactente , Recém-Nascido , Kosovo/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Guerra/história , Adulto Jovem
19.
Neurology ; 94(23): e2412-e2423, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32461282

RESUMO

OBJECTIVE: To measure exosomal and plasma levels of candidate blood biomarkers in veterans with history of mild traumatic brain injury (mTBI) and test their relationship with chronic symptoms. METHODS: Exosomal and plasma levels of neurofilament light (NfL) chain, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and vascular endothelial growth factor (VEGF) were measured using an ultrasensitive assay in a cohort of 195 veterans, enrolled in the Chronic Effects of Neurotrauma Consortium Longitudinal Study. We examined relationships between candidate biomarkers and symptoms of postconcussive syndrome (PCS), posttraumatic stress disorder (PTSD), and depression. Biomarker levels were compared among those with no traumatic brain injury (TBI) (controls), 1-2 mTBIs, and repetitive (3 or more) mTBIs. RESULTS: Elevated exosomal and plasma levels of NfL were associated with repetitive mTBIs and with chronic PCS, PTSD, and depression symptoms. Plasma TNF-α levels correlated with PCS and PTSD symptoms. The total number of mTBIs correlated with exosomal and plasma NfL levels and plasma IL-6. Increased number of years since the most recent TBI correlated with higher exosomal NfL and lower plasma IL-6 levels, while increased number of years since first TBI correlated with higher levels of exosomal and plasma NfL, as well as plasma TNF-α and VEGF. CONCLUSION: Repetitive mTBIs are associated with elevated exosomal and plasma levels of NfL, even years following these injuries, with the greatest elevations in those with chronic PCS, PTSD, and depression symptoms. Our results suggest a possible neuroinflammatory and axonal disruptive basis for symptoms that persist years after mTBI, especially repetitive.


Assuntos
Concussão Encefálica/sangue , Exossomos/química , Proteínas de Neurofilamentos/sangue , Saúde dos Veteranos , Veteranos , Adulto , Biomarcadores , Traumatismos por Explosões/sangue , Traumatismos por Explosões/complicações , Concussão Encefálica/complicações , Estudos Transversais , Depressão/sangue , Depressão/etiologia , Feminino , Seguimentos , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Concussão/sangue , Síndrome Pós-Concussão/etiologia , Prognóstico , Degeneração Retrógrada , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/sangue , Transtornos de Estresse Pós-Traumáticos/etiologia , Fator de Necrose Tumoral alfa/análise , Fator A de Crescimento do Endotélio Vascular/sangue , Guerra
20.
J Craniofac Surg ; 31(5): 1179-1181, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32472887

RESUMO

The industrialization of modern warfare dating back to WWI led to an increase in combat-related injuries with unprecedented levels of severity. The necessity of addressing the clinical challenges that ensued led to the emergence of modern reconstructive surgery and subsequently a robust healthcare initiative for veterans in the form of the Department of Veterans Affairs. In the following article, a literature review was conducted to examine the interplay between combat injuries, veterans' care, and reconstructive surgery. We found that the relationship between military trauma and reconstructive surgery has led to an increase in survival rates and advances in mass casualty response while allowing the survivors to maintain a high quality of life. The relationship between the Veterans Affairs hospitals and plastic surgery has only strengthened over time as these hospitals play a major role in training the next generation of plastic surgeons throughout the nation. It is imperative to maintain this cooperative relationship to ensure a high level of care for our veterans and a comprehensive training experience for plastic surgery residents.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Assistência à Saúde , Humanos , Militares , Qualidade de Vida , Sobreviventes , Estados Unidos , Lesões Relacionadas à Guerra , Guerra
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