Acute Acoustic Trauma among Soldiers during an Intense Combat.

BACKGROUND: During military actions, soldiers are constantly exposed to various forms of potentially harmful noises. Acute acoustic trauma (AAT) results from an impact, unexpected intense noise ≥140 dB, which generates a high-energy sound wave that can damage the auditory system. PURPOSE: We sought to characterize AAT injuries among military personnel during operation "Protective Edge," to analyze the effectiveness of hearing protection devices (HPDs), and to evaluate the benefit of steroid treatment in early-diagnosed AAT injury. RESEARCH DESIGN: We retrospectively identified affected individuals who presented to military medical facilities with solitary or combined AAT injuries within 4 mo following an intense military operation, which was characterized with an abrupt, intensive noise exposure (July-December 2014). STUDY SAMPLE: A total of 186 participants who were referred during and shortly after a military operation with suspected AAT injury. INTERVENTIONS: HPDs, oral steroids. DATA COLLECTION AND ANALYSIS: Data extracted from charts and audiograms included demographics, AAT severity, worn HPDs, first and last audiograms and treatment (if given). The Student's independent samples t test was used to compare continuous variables. All tests were considered significant if p values were ≤0.05. RESULTS: A total of 186 participants presented with hearing complaints attributed to AAT: 122, 39, and 25 were in duty service, career personnel, and reservists, with a mean age of 21.1, 29.2, and 30.4 yr, respectively. Of them, 92 (49%) participants had confirmed hearing loss in at least one ear. Hearing impairment was significantly more common in unprotected participants, when compared with protected participants: 62% (74/119) versus 45% (30/67), p < 0.05. Tinnitus was more common in unprotected participants when compared with protected participants (75% versus 49%, p = 0.04), whereas vertigo was an uncommon symptom (5% versus 2.5%, respectively, p > 0.05). In the 21 participants who received steroid treatment for early-diagnosed AAT, bone-conduction hearing thresholds significantly improved in the posttreatment audiograms, when compared with untreated participants (p < 0.01, for 1-4 kHz). CONCLUSIONS: AAT is a common military injury, and should be diagnosed early to minimize associated morbidity. HPDs were proven to be effective in preventing and minimizing AAT hearing sequelae. Steroid treatment was effective in AAT injury, if initiated within 7 days after noise exposure.

Near real-time space-time cluster analysis for detection of enteric disease outbreaks in a community setting.

OBJECTIVES: To enhance timely surveillance of bacterial enteric pathogens, space-time cluster analysis was introduced in Israel in May 2013. METHODS: Stool isolation data of Salmonella, Shigella, and Campylobacter from patients of a large Health Maintenance Organization were analyzed weekly by ArcGIS and SaTScan, and cluster results were sent promptly to local departments of health (LDOHs). RESULTS: During eighteen months, we identified 52 Shigella sonnei clusters, two Salmonella clusters, and no Campylobacter clusters. S. sonnei clusters lasted from one to 33 days and included three to 30 individuals. Thirty-one (60%) of the S. sonnei clusters were known to LDOHs prior to cluster analysis. Clusters not previously known by the LDOHs prompted epidemiologic investigations. In 31 of the 37 (84%) confirmed clusters, educational institutes (nursery schools, kindergartens, and a primary school) were involved. CONCLUSIONS: Cluster analysis demonstrated capability to complement enteric disease surveillance. Scaling up the system can further enhance timely detection and control of outbreaks.

Different effects of long-term exposures to SO2 and NO2 air pollutants on asthma severity in young adults.

Numerous studies demonstrated that exposure to ambient air pollutants contributes to severity and frequency of asthma exacerbations. However, whether common air pollutants, such as nitrogen dioxide (NO2) and sulfur dioxide (SO2), exert differential effects on asthma occurrence and severity is unclear. The aim of this investigation was to determine whether exposure to NO2 and/or SO2 may initiate different long-term effects on prevalence and severity of asthma in young adults. Medical records of 137,040 males, 17 years old, who underwent standard premilitary service health examinations during 1999-2008 were examined. Air-pollution data for NO2 and SO2 were linked to the place of residence of each subject. The influence of specific air pollutants on asthma prevalence and severity was evaluated using bivariate logistic regression, controlling for individuals' sociodemographic attributes. For both ambient air pollutants, there was a significant dose-response effect on severity of asthma at ambient concentrations below the current National Ambient Air Quality Standards. However, in residential areas with high levels of SO2 (13.3-592.7µg/m(3)) and high levels of NO2 (27.2-43.2µg/m(3)) the risk of asthma occurrence was significantly higher than that in residential areas with high levels of NO2 (27.2-43.2 µg/m(3)) and intermediate levels (6.7-13.3 µg/m(3)) of SO2 pollution. The effects of exposure to SO2 and NO2 air pollutants on the respiratory airways system appear to differ, with possible implications regarding medical management, even in cases of exposure to mixtures of these pollutants.

Case report: a brain abscess in a disaster zone- beyond the call of duty.

We present a case of a child with a suspected brain abscess treated by a military field hospital in post-typhoon Philippines. We review our intervention and decision process both at the field hospital and following his transfer to a referral center. These interventions were critical for his successful outcome.

Pediatric otolaryngology in a field hospital in the Philippines.

BACKGROUND: Major natural disasters adversely affect local medical services and resources. We sought to characterize pediatric patients presenting with otolaryngology-head and neck surgery (OTO-HNS)-related diseases/injuries to a field hospital over 11 days of operation, which was deployed to assist the healthcare facilities in Bogo, the Philippines, in the aftermath of typhoon Haiyan (Yolanda). METHODS: We reviewed charts of pediatric patients aged 0-18 years visiting our field hospital, who presented with OTO-HNS-related diseases/injuries. We also describe the structure of the field hospital, equipment, facilities and capabilities of our service, discuss medical and ethical concerns, and propose several recommendations for future similar missions. RESULTS: Of the 863 pediatric visits, 91 (11%) presented with OTO-HNS-related diseases/injuries, 3 of them were of recurring patients. Of the 88 included individual patients, 47 (53%) were boys, with an average age of 6.9±4.9 years. Ear-related diseases, mostly acute otitis media (AOM), and neck-related diseases were the most common pathologies (49% and 16% of the patients, respectively). Antibiotic therapy was administered to 36 (41%) patients, mostly to children with AOM. Despite limited resources, we were able to perform surgical interventions on 8 (9%) patients, which included laceration suturing, abscess drainage and neck surgery. CONCLUSIONS: Otolaryngologists have an important role in the treatment of children affected in a disaster area, at a time of an increased demand for healthcare. Unlike 'acute phase' missions, where traumatic injuries are the focus for treatment, 'subacute' phase missions provide more routine medical and surgical care.