Unique Presentation of Septic Cavernous Sinus Thrombosis and Pulmonary Embolism in the Setting of Reusable Face Covering.

Identified in December 2019, SARS-CoV-2 quickly spread worldwide with a resultant increase in global morbidity, mortality, and economic disruption on a scale not seen since the 1918 Spanish flu. Health officials recommended universal masking to further reduce human-to-human spread of SARS-CoV-2. The state of Hawaii and the Department of Defense (DOD) adopted strict mask policies early in the pandemic and is shown to be effective at reducing transmission. We report a case of Staphylococcus aureus bacteremia in an immunocompetent 21-year-old man attributed to local skin irritation with resultant infection in the setting of continuous reuse of a mask that resulted in bilateral cavernous venous thrombosis and septic pulmonary embolism.

Ranger O Low Titer (ROLO): Whole Blood Transfusion for Forward Deployed Units.

First-time use of Ranger O Low Titer (ROLO) blood and implementation of a forward-walking blood bank using predetermined donors proved essential in the survival of a 33-year-old active duty soldier following a complex blast injury during combat operations. The patient sustained significant bone, soft tissue, and vascular damage and continued to deteriorate despite resuscitation with cold-stored whole blood (WB). Only after utilizing the ROLO battle drill and transfusing with fresh WB was the patient able to be stabilized and evacuated. In this case report, we discuss how ROLO walking blood bank takes the next step in aiding resuscitation, providing smaller, forward-deployed units with blood resupply without the administrative burden of storage, particularly in resource-scarce environments. We provide an overview of WB and contrast its use to that of component therapy. In conjunction with the Golden Hour, ROLO can be incorporated as the standard damage control resuscitation to reduce the risks of noncompressible hemorrhage. By taking precautionary steps in the pre-deployment setting, ROLO offers an invaluable alternative to conventional resuscitation.

A Bariatric Curveball: A Rare Case of Recurrent Lactobezoars after Roux-en-Y Gastric Bypass Surgery.

Bariatric surgery is a major risk factor for bezoar formation secondary to decreased gastric motility, gastric acidity, and pyloric function.1 This case is about a 49-year-old female veteran, 3 weeks status-post Roux-en-Y gastric bypass surgery, who presented with acute abdominal pain and oral intolerance. After being diagnosed with a bezoar and esophagogastroduodenoscopic removal, the patient had immediate relief of symptoms. Unfortunately, over the course of 4 months, this patient experienced three recurrent episodes of bezoar formation (with a possible fourth episode that could not be confirmed secondary to resolution of symptoms after administration of oral contrast load). Based on her dietary history and gross appearance of the bezoar, the patient was determined to have developed recurrent lactobezoars. Lactobezoars are composed of milk and mucous proteins and are commonly found in neonates with immature gastrointestinal tracts.7 This unusual complication demonstrates how current dietary recommendations encouraging dairy consumption to meet daily protein requirements may have increased this patient's risk for lactobezoar formation. This case illustrates the importance of balancing the risks and benefits of macronutrient requirements after bariatric surgery with postsurgical bezoar complications.

Career Satisfaction of Military Medical Officers.

INTRODUCTION: Having a mentor is associated with higher job satisfaction among U.S. physicians. The objective of this study was to assess satisfaction among military medical officers and to assess if mentorship and job satisfaction are associated with intention to continue military service. MATERIALS AND METHODS: This is a cross-sectional study using voluntary, anonymous data from 2018 Uniformed Services Academy of Family Physicians Annual Meeting registered attendees who completed an online Omnibus Survey. Outcome measures: satisfaction with work hours and workload; voice in organizational decision-making; amount of teaching, research, and other administrative tasks; being and having a mentor; and likelihood of remaining in the military beyond current service obligation. Statistical analysis: descriptive statistics, chi-square, and logistic regression. RESULTS: There was a 66% response rate (310/568) among registered attendees. Respondents reported being satisfied with work hours-workload (53.3%), voice in organizational decision-making (47.4%), and amount of teaching-research-other administrative tasks (55.7%). About 64.6% of respondents reported being a mentor, and 80.7% reported having a mentor. About 53.4% reported being likely/very likely to continue military service beyond their current service obligation. Adjustment for demographic and occupational factors, with significance defined as P ≤ 0.05, revealed that higher percent time in clinical care was negatively associated with satisfaction with voice in organizational decision-making; being a mentor and working in an academic practice setting were positively associated with satisfaction in amount of time with teaching, research, and administrative tasks; and having a mentor was the only factor associated with being likely/very likely to continue military service beyond current service obligation (odd ratio 3.9, 95% confidence interval 1.2-12.1). CONCLUSIONS: Having a mentor was the only factor associated with intention to remain in the military among 2018 Uniformed Services Academy of Family Physicians Omnibus Survey respondents. These results support enhancing mentorship among military medical officers.