From Didactics to Disasters: Unveiling CBRNe and Counter-Terrorism Medicine Training in US Medical Schools.

INTRODUCTION: The threat of chemical, biological, radiologic, nuclear, and explosive (CBRNe) terrorist attacks has increased over time. The need for rapid and effective responses to such attacks is paramount. Effective medical counter-measures to CBRNe events are critical and training for such may effectively occur early in physician training. While some medical specialties are more involved than others, counter-terrorism medicine (CTM) spans all medical specialties. METHODS: All United States allopathic medical schools were examined via online curriculums and queries for academic content related to CBRNe and terrorist medical counter-measures. RESULTS: Analysis of 153 United States allopathic medical schools demonstrated that 15 (9.8%) medical schools offered educational content related to CBRNe and terrorist counter-measures. This is in contrast to legislation following the September 11, 2001 attacks that called for high priority for such education. CONCLUSION: Effective CBRNe medical counter-measures are currently in place; however, there is room for improvement in education that may begin during medical school. While certain medical specialties such as emergency medicine, primary care, and dermatology may have specific niches in such events, physicians of all medical specialties have something to offer, and even a basic education in medical school can help best prepare the nation for future attacks.

Low-Cost Model for Battlefield Wound and Hemorrhage Training.

INTRODUCTION: Exsanguination is the leading cause of preventable death on the battlefield and in austere environments. Multiple courses have been developed to save lives by stopping hemorrhage. Training for this requires simulation models; however, many models are expensive, preventing the further expansion of this life-saving training. We present a low-cost model for hemorrhage training and realistic moulage based on simple medical supplies and grocery store meats. MATERIALS AND METHODS: Wound packing training was completed by use of a block of pork shoulder roast with an incision simulating a wound and IV tubing connected to a syringe with fake blood. Hemostasis was obtained with proper wound packing by the student, causing the bleeding to be tamponaded. Wound moulage utilized remaining supplies of pork roast being attached to patient actors or mannequins and adorned with fake blood creating wounds with the appearance and feel of real tissues. RESULTS: Tactical Combat Casualty Care (TCCC) training was completed at a small military medical facility with a start-up cost of less than $70 and a single course as cheap as $15. These methods have been utilized to establish other TCCC training centers while keeping costs low. CONCLUSIONS: We present low-cost models for simulating massive hemorrhage for wound packing with pork roast and realistic moulage. These methods can be utilized for other hemorrhage training courses such as TCCC, Advanced Wilderness Life Support, and Stop the Bleed.

Reconstruction of Large Transmural Nasal Defects With a Nasolabial Turnover Interpolation Flap.

BACKGROUND: Reconstruction of large nasal surgical defects often warrant the use of mucosal flaps to repair the inner lining. This often presents a challenge for surgical reconstruction. OBJECTIVE: To describe a unique reconstructive option for the repair of large surgical wounds that necessitate mucosal nasal lining. MATERIALS AND METHODS: This study is a retrospective review of 10 patients who underwent surgical reconstruction of large nasal and/or heminasal surgical defects following Mohs micrographic surgery. A nasolabial turnover interpolation flap was used to repair missing nasal mucosal lining, coupled with a cutaneous flap which typically involved a paramedian forehead flap. The duration of follow-up was 8 months. An aesthetic and functional surgical outcomes measure was used to assess the final repair. RESULTS: Favorable aesthetic outcomes were obtained in all patients and without need of revision surgery by the use of a nasolabial turnover interpolation flap. CONCLUSION: The nasolabial turnover interpolation flap offers a reliable and effective method of repair for large transmural nasal surgical wounds. We typically paired this nasal lining flap with a paramedian forehead flap with reliable and aesthetic outcomes. This technique is straightforward, reproducible, and with both good aesthetic and functional outcomes.

Clinical Features of Scleritis Across the Asia-Pacific Region.

Purpose: To examine the spectrum of scleritis in four tertiary institutions across the Asia-Pacific. Methods: Clinical records from 354 patients were reviewed from centers in Australia, Singapore, and India, excluding those with insufficient data (n = 24). Results: Indian patients presented younger (41.5 ± 13.4 years) than Australians (50.8 ± 17.5) and Singaporeans (48.6 ± 15.9), with fewer women (49% vs 62%/57%). Diffuse disease was universally most common. Autoimmune and infectious disease proportions were similar in Australia (31%/10.3%) and Singapore (27.5%/8.3%) but reversed in India (8.3%/30%). Necrotizing scleritis was most frequently associated with infection (27.3%). Presumed ocular tuberculosis accounted for 75% of infectious cases in India. Posterior scleritis had the highest complication rate (82.4%) and immunosuppressants used per patient (0.98 ± 0.31 95% CI). Conclusions: Clinical presentations of scleritis vary across the Asia-Pacific, particularly in endemic regions for tuberculosis such as India, where it affects younger men with a predominance of nodular and infectious disease.

Laboratory evolution of artificially expanded DNA gives redesignable aptamers that target the toxic form of anthrax protective antigen.

Reported here is a laboratory in vitro evolution (LIVE) experiment based on an artificially expanded genetic information system (AEGIS). This experiment delivers the first example of an AEGIS aptamer that binds to an isolated protein target, the first whose structural contact with its target has been outlined and the first to inhibit biologically important activities of its target, the protective antigen from Bacillus anthracis We show how rational design based on secondary structure predictions can also direct the use of AEGIS to improve the stability and binding of the aptamer to its target. The final aptamer has a dissociation constant of ∼35 nM. These results illustrate the value of AEGIS-LIVE for those seeking to obtain receptors and ligands without the complexities of medicinal chemistry, and also challenge the biophysical community to develop new tools to analyze the spectroscopic signatures of new DNA folds that will emerge in synthetic genetic systems replacing standard DNA and RNA as platforms for LIVE.

Bioterrorism and disaster preparedness among medical specialties.

OBJECTIVE: A core priority of all medical specialties includes information for members regarding inherent priorities and principles. The authors sought to investigate the priority and contribution of various medical specialties to the fields of bioterrorism, terrorism, disaster preparedness, and emergency preparedness. DESIGN: A mixed study design (quantitative and qualitative) was used to identify pertinent characteristics of various medical specialties. A scored survey analysis of resources available from the representative organizations and/or societies of the primary medical specialties and select subspecialties was examined and scored based on availability, ease of accessibility, updated status, and content. A MEDLINE search completed through PubMed using the medical subject headings bioterrorism, terrorism, disaster preparedness, and emergency preparedness coupled with specific medical specialties was conducted to assess the involvement and contribution of each to the medical literature. MAIN OUTCOME MEASURES: The primary study outcome was to evaluate the priority of and existing resources available to members for bioterrorism/terrorism and disaster/emergency preparedness among various medical specialties as reflected by their representative organizations and scientific publication. RESULTS: The search of individual medical specialties and of the medical literature (2000-2010) revealed that these topics (via keywords bioterrorism, terrorism, disaster preparedness, and emergency preparedness) are indeed a priority topic for the majority of medical specialties. A number of specialties with expectant priority in these topics were confirmed. All seven primary care specialties demonstrated a core priority of these topics and offered resources. The MEDLINE (PubMed) search yielded 7,228 articles published from 2000 to 2010. CONCLUSION: Bioterrorism/terrorism and disaster/ emergency preparedness are priority topics of most medical specialties. This core priority is demonstrated by both the medical specialty resources in addition to the contribution of scientific articles from these medical specialties. This reflects the diverse medical care that is necessary for terrorist threats and the collaborative efforts that will help to make the medical response to these threats more cohesive.

Perineural involvement of squamous cell carcinoma presenting with formication.

Perineural involvement of a cutaneous neoplasm marks an aggressive feature. Tumors with perineural involvement share an increased propensity for local invasion via perineural spread. Formication may be an indicator of perineural involvement by cutaneous neoplasms. We present a case of an 82-year-old man with perineural involvement of a squamous cell carcinoma (SCC) identified by clinical symptoms of formication. Successful resolution of these symptoms was achieved with radiation therapy.