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1.
Mil Med ; 188(1-2): 25-29, 2023 01 04.
Article in English | MEDLINE | ID: mdl-36208154

ABSTRACT

Military medicine has a long history of humanitarian efforts globally, including responses to natural disasters and as planned medical civil action projects. However, ending two decades of war in Afghanistan, Walter Reed National Military Medical Center (WRNMMC) was tasked to receive up to 63 injured patients with less than 96-hour notice on August 27, 2021. As part of Operation Allies Refuge and transition to Operation Allies Welcome, this article highlights the complicated cross-organizational and multidisciplinary response at WRNMMC where ultimately 277 Afghan patients and nonmedical attendants received medical care and other requirements for resettlement. Lessons learned from coordinating the complex short suspense medical, cultural, and logistic efforts are noted as considerations and practical recommendations for future missions.


Subject(s)
Military Medicine , Military Personnel , Humans , United States , Hospitals, Military , Afghanistan
2.
Mil Med ; 188(9-10): e3256-e3260, 2023 08 29.
Article in English | MEDLINE | ID: mdl-36399369

ABSTRACT

Newly diagnosed malignancy during pregnancy is rare affecting approximately 1 in 1,000 pregnancies. Breast followed by hematologic malignancies are most common. Hodgkin's lymphoma (HL) is a lymphoid neoplasm which can present with lymphadenopathy or mediastinal mass and represents 6% of all malignancies diagnosed during pregnancy. Treatment involves a combination of chemotherapy with or without adjuvant radiation which poses significant challenges when diagnosed antepartum. We highlight a 28-year-old primigravida at 26 weeks gestation who presented to the emergency department in Japan with cough, dyspnea, and sore throat for 3-5 days. Initial chest radiography demonstrated a large perihilar mass with mediastinal shift. Follow-up CT chest revealed an anterior mediastinal mass measuring 8 cm × 19 cm × 16 cm with features concerning for aggressive lymphoma. The patient was subsequently transferred to a stateside tertiary care center for expedited workup. She underwent two core needle biopsies, both of which were non-diagnostic. Cardiothoracic surgery performed a cervical mediastinoscopy with excision of the enlarged right supraclavicular lymph node. Pathologic analysis revealed classical HL, nodular sclerosis subtype. Treatment was initiated with adriamycin, bleomycin, vinblastine, and dacarbazine with two cycles planned antepartum followed by additional cycles postpartum. The patient had an uncomplicated vaginal delivery at 38 weeks gestation. Diagnosis of HL in pregnancy is rare, and expedited diagnosis can be challenging as multiple diagnostic and treatment modalities may impact pregnancy. Management in pregnancy requires a multidisciplinary approach, and decisions regarding treatment and delivery timing should be weighed against risk to the fetus.


Subject(s)
Hodgkin Disease , Pregnancy , Female , Humans , Adult , Hodgkin Disease/diagnosis , Hodgkin Disease/complications , Hodgkin Disease/drug therapy , Pregnancy Trimester, Second , Bleomycin/therapeutic use , Doxorubicin/therapeutic use , Vinblastine/therapeutic use
3.
Clin Obstet Gynecol ; 62(3): 572-579, 2019 09.
Article in English | MEDLINE | ID: mdl-31169555

ABSTRACT

There is no single framework for a successful obstetric patient safety program. However, there are ample resources for the important components needed to create a patient safety program. All labor and delivery units should formulate their own quality and safety program that is individualized to the patients and staff that they serve. Here we will lay out the infrastructure as has been supported by the literature and reinforced in our experience.


Subject(s)
Delivery, Obstetric/standards , Patient Safety/standards , Program Development/methods , Quality Improvement , Female , Humans , Pregnancy
4.
Arch Gynecol Obstet ; 292(3): 549-58, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25731150

ABSTRACT

OBJECTIVE: This study aimed to determine the relationship between spousal deployment and postpartum depression diagnosis among U.S. military wives, accounting for the timing of deployment with respect to pregnancy and delivery. METHODS: A retrospective cohort study was conducted to evaluate the association between spousal deployment and postpartum depression among pregnant wives of active-duty service members. Electronic medical records for 161,454 births occurring between 2004 and 2009 were used to define postpartum depression. Three non-mutually exclusive exposure variables were created to categorize deployments as occurring before, during, or after the infant's delivery. A multivariable logistic regression model mutually adjusted for these exposure variables was fitted, producing an odds ratio for each of the three timing categories. RESULTS: A modest significant association was detected only in those whose husbands deployed in pregnancy and returned after delivery (i.e., deployed during delivery) [odds ratio (OR) 1.10, 95 % confidence interval (CI) 1.04-1.15]. An interactive effect between preexisting depression or anxiety and deployment during delivery was also detected in the data (OR 1.13, 95 % CI 1.07-1.20 for those without a preexisting diagnosis; OR 0.87, 95 % CI 0.80-0.95 for those with a preexisting diagnosis). CONCLUSION: Health care providers should continue to be aware of spousal deployment as a military-unique stressor in this population and rigorously screen for potential symptoms of postpartum depression, especially among those whose husbands are absent at delivery.


Subject(s)
Delivery, Obstetric/psychology , Depression, Postpartum/etiology , Military Personnel , Spouses/psychology , Adult , Anxiety/epidemiology , Anxiety Disorders/epidemiology , California/epidemiology , Cohort Studies , Depression, Postpartum/epidemiology , Depressive Disorder/epidemiology , Female , Humans , Infant , Logistic Models , Male , Odds Ratio , Pregnancy , Prevalence , Retrospective Studies , Risk Factors
5.
Obstet Gynecol ; 122(2 Pt 2): 500-502, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23884275

ABSTRACT

BACKGROUND: Brodifacoum, a superwarfarin, is a common household agent used for rodenticides. We present a case of maternal brodifacoum ingestion that resulted in neonatal death. CASE: A 19-year-old primigravid woman presented at 32 weeks of gestation with spontaneous mucosal bleeding. Her fetus showed evidence of acidosis on external fetal monitoring. Laboratory values were consistent with maternal coagulopathy. After correction of the coagulopathy, the patient was taken for urgent cesarean delivery. The neonate showed evidence of fetal coagulopathy and died at 4 days of life. CONCLUSION: Brodifacoum is a dangerous household chemical that, if ingested, can result in significant morbidity and mortality for both mother and neonate. Increased awareness of the serious and potentially lethal effects of brodifacoum is important.


Subject(s)
4-Hydroxycoumarins/poisoning , Anticoagulants/poisoning , Blood Coagulation Disorders/chemically induced , Infant, Newborn, Diseases/chemically induced , Prenatal Exposure Delayed Effects , Adult , Fatal Outcome , Female , Humans , Infant, Newborn , Maternal-Fetal Exchange , Pregnancy , Rodenticides/poisoning , Young Adult
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