Infectious disease in athletes.

While orthopedic injuries most commonly are associated with sports, infectious diseases cause significant morbidity in athletes. Exercise improves immunity at moderate intensity but impairs immune function at extremes of duration and intensity. Respiratory infections are the most common, but skin, blood borne, sexually transmitted, and even cardiac infections occur. Infectious disease outbreaks are a constant concern. Treatment of such infections resembles those used in the general population. Return to play issues and prevention of infection are especially important in athletes.

Hearing threshold comparisons between 2001-02 NHANES and 2003-05 Fort Bliss U.S. Army Service components.

This study compares population mean hearing threshold levels in decibels (dB) at 4 kHz among the 2001-02 National Health and Nutrition Examination Survey (NHANES) (n=1872) and the 2003-05 Fort Bliss Army Active Duty (AD) (n=9096), National Guard (NG) (n=3842), and Reserve Components (RC) (n=2025) and by gender. Comparisons between male populations show that mean hearing thresholds are not significantly different (p<0.05) between U.S. Army Active Duty males and NHANES males, which differ from a 1984 U.S. Army Active Duty/1971-74 NHANES study showing significantly higher hearing thresholds for the Army Active Duty population. In addition, this study shows that Active Duty males have significantly lower hearing thresholds than National Guard males at ages <40 years old. Female groups generally have significantly lower hearing thresholds than male groups at all ages, but there are not significant differences between female military and civilian populations.

Modeling hospital response to mild and severe influenza pandemic scenarios under normal and expanded capacities.

William Beaumont Army Medical Center conducted quantitative modeling with FluSurge 2.0 (Centers for Disease Control and Prevention) to determine hospital capabilities in responding to patient arrival surges of the Fort Bliss population in mild 1968-type and severe 1918-type influenza pandemics. Model predictions showed that William Beaumont Army Medical Center could adequately care for all intensive care unit (ICU) and non-ICU patients during a mild pandemic, particularly if hospital capacity was expanded using the emergency management plan, excess surge plan, or activation of a contagious disease outbreak facility. For a severe influenza pandemic, model predictions showed that hospital beds, ventilators, and other resources would be exceeded within 2 or 3 weeks. Even at maximal hospital expansion, for a 12-week severe pandemic with a 35% attack rate there would be peak demand for 214% of available non-ICU beds, 785% of ICU beds, and 392% of ventilators. Health care planners and decision-makers should prepare for resource challenges when developing plans for the next influenza pandemic.

Preventive medicine in Task Force 1st Armored Division during Operation Iraqi Freedom.

Task Force 1st Armored Division (TF1AD) deployed to Baghdad and South Central Iraq from April 2003 through July 2004. TF1AD preventive medicine had responsibility for ensuring divisional force health protection, including soldier health, disease and nonbattle injury mitigation, health promotion, and civil affairs operations. Heat injury, diarrheal disease, skin and respiratory disease, and eye and musculoskeletal injury rates were high. Command emphasis and preventive medicine action resulted in better living conditions and personal sanitation. To counter the threat, the TF1AD preventive medicine/ division surgeon team used a "spiraling out" approach that focused attention first on hand-washing, potable water, vector control, waste disposal, and food sanitation and later on noise, asbestos, environmental contamination, and radiation. In April 2004, TF1AD shifted focus to the Multinational Division Central-South region of Iraq and many similar problems occurred as in May 2003, although they were less severe, in part because of the lessons learned in Baghdad.

Comparison of nondeployable hearing profiles by Army component (Active Duty, National Guard, and Reserve) and by gender.

The Hearing Conservation Service at Fort Bliss conducted baseline-hearing assessments from January 2003 to March 2005 on 14,974 soldiers in the Active Duty (AD), National Guard (NG), and Reserve Component (RC). The percentages of soldiers with >H-2 (i.e., nondeployable) hearing profiles based on Army component and gender are as follows: AD male = 2.21%; AD female = 0.65%; NG male = 5.05%; NG female = 1.64%; RC male = 5.02%; and RC female = 0.54%. Female soldiers in all three components and AD male soldiers are not significantly different (p < 0.05) from each other and have a significantly lower percentage of >H-2 hearing profiles than NG and RC male soldiers after adjusting for age. With the Army engaged in worldwide missions, these results should prove useful to commanders and medical officers for assessing deployment capabilities and for hearing conservation interventions.

The effect of glucosamine-chondroitin supplementation on glycosylated hemoglobin levels in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial.

BACKGROUND: With increasing use of glucosamine-containing supplements for the treatment of osteoarthritis, there is increasing concern in the medical community about possible toxic effects. The present study was undertaken to determine whether glucosamine supplementation altered hemoglobin A1c concentrations in patients with well-controlled diabetes mellitus. OBJECTIVE: To evaluate possible effects of glucosamine supplementation on glycemic control in a selected population of patients with type 2 diabetes mellitus. DESIGN: Placebo-controlled, double-blinded, randomized clinical trial. SETTING: Outpatient, diabetes monitoring clinic. PATIENTS: Patients were typically elderly patients, evenly divided between men and women. Most of the patients were being treated with 1 or 2 drugs for glycemic control. INTERVENTION: In daily doses for 90 days, patients received either placebo or a combination of 1500 mg of glucosamine hydrochloride with 1200 mg of chondroitin sulfate (Cosamin DS; Nutramax Laboratories Inc, Edgewood, Md). Main Outcome Measure Hemoglobin A1c levels before and after 90 days of therapy. RESULTS: There were 4 withdrawals from the glucosamine-treated group. Three were related to comorbidities (myocardial infarction, congestive heart failure, and atrial fibrillation) and 1 to a possible adverse reaction (excessive flatus). No other patient reported any adverse effects of glucosamine therapy, and no patient had any change in their diabetes management. Mean hemoglobin A1c concentrations were not significantly different between groups prior to glucosamine therapy. Posttreatment hemoglobin A1c concentrations were not significantly different between groups, nor were there any significant differences within groups before and after treatment. CONCLUSION: This study demonstrates that oral glucosamine supplementation does not result in clinically significant alterations in glucose metabolism in patients with type 2 diabetes mellitus.

Laser eye injuries in military occupations.

INTRODUCTION: Lasers (light amplification by stimulated emission of radiation) play an important role in our world and their use is increasing. They are powerful tools for good, but can also cause tragedy, especially in an aviation environment. Information about injuries associated with lasers is limited. This study highlights several laser eye injuries in the U.S. military and discusses issues pertaining to them. METHODS: We gathered data from the U.S. Army Safety Center, the U.S. Army Center for Health Promotion and Preventive Medicine, and the Walter Reed Army Institute of Research. This paper describes ten representative cases of laser eye injury that occurred in the U.S. military between 1984 and 2000. RESULTS: Patients suffered retinal damage, though no corneal injury occurred. Most were caused by accidental exposure to a Q-switched, Neodynium:YAG (Nd:YAG) laser at 1064 nm wavelength. The incidents occurred both on and off duty, indoors and outdoors, and from close and long ranges. None of the victims were wearing eye protection. Inadequate training and poor equipment design were major factors in at least six of the nine unintentional cases. The tenth occurred during military operations in the Persian Gulf. All of the victims needed several months medical care and follow up. Two received medical discharges as a result of their injuries. DISCUSSION: As illustrated by these cases, human and societal costs from unintentional laser eye injuries can be reduced by improving operator training, safety procedure compliance, and equipment design. In addition, intentional laser eye injuries are a growing concern and further research is needed to design appropriate protection, treatment and countermeasures.

Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis.

OBJECTIVE: The use of colchicine to prevent acute gout flares during initiation of allopurinol therapy is widely practiced despite lack of proven benefit. We investigated if colchicine administration during initiation of allopurinol for chronic gouty arthritis reduces the frequency and/or severity of acute gout flares. METHODS: Patients starting allopurinol for crystal-proven chronic gouty arthritis were randomized to receive colchicine 0.6 mg po bid or placebo in a randomized, prospective, double blind, placebo controlled trial. Subjects were followed for evidence of acute gout flares and remained on study drug for 3 months beyond attaining a serum urate concentration < 6.5 mg/dl. Treatment arms were analyzed regarding frequency of flares, likelihood of any flare or multiple flares, severity of flares on the visual analog scale (VAS), and length of flares in days. RESULTS: Forty-three subjects were studied. Subjects treated with colchicine experienced fewer total flares (0.52 vs 2.91, p = 0.008), fewer flares from 0 to 3 months (0.57 vs 1.91, p = 0.022), fewer flares 3-6 months (0 vs 1.05, p = 0.033), less severe flares as reported on VAS (3.64 vs 5.08, p = 0.018), and fewer recurrent gout flares (p = 0.001). Colchicine was well tolerated. CONCLUSION: Colchicine prophylaxis during initiation of allopurinol for chronic gouty arthritis reduces the frequency and severity of acute flares, and reduces the likelihood of recurrent flares. Treating patients with colchicine during initiation of allopurinol therapy for 6 months is supported by our data.